EM Forum Case #111 "I Just Tripped and Fell"
by Charlene Babcock Irvin, MD, FACEP
A morbidly obese 60 y/o male presents after a trip and fall. He was complaining of knee pain. He did not strike his head, no LOC, no other injuries. He was walking in the parking lot, slipped on some ice and fell forward. His lower leg hit the cement parking bumper, and he fell forward into the grass beyond.
PMH: Diabetes, HTN
PE: Remarkable only for his obesity, and examination of the leg.
Pulses are present, mild pain is noted on palpation of the knee. No swelling or effusion is appreciated.
Here is the x-ray: http://www.learningradiology.com/caseofweek/caseoftheweekpix2008-2/cow330-1arr.jpg
Questions:
1. How often will this spontaneously reduce?
2. If pulses are absent, should you reduce it or call vascular surgery?
3. How do you calculate the ankle/ brachial index, and what number is abnormal?
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