A common sporting injury, especially in disciplines that require stop start sprints or rapid changes of direction
Category: MSK
Lisfranc Injuries
A Lisfranc injury describes an injury of the foot between the metatarsal and tarsal spaces. Around 20-40% of lisfranc injuries are initially missed, so a high degree of clinical suspicion is required.
Thomas Spint – how to apply
Invented by a Welshman ‘Hugh Owen Thomas’, the introduction of this simple device in World War 1 went on to reduce the mortality of #femurs from 80% to 16%.
The Kit
- Measuring Tape
- Thomas splint – Adult or Paediatric (depending on size)
- Hoop – Sizing guide can be found here
- Slings
- Hoop Pad
- Skin Traction – Adult or Paediatric
- Padding rolls x 2
- Bandages (wide) x 2
- Tape
- Scissors
- Tongue Depressors x 2
Measuring
Measure the Inside Leg (unbroken leg) and add 30cm/12inch (to give room for the traction)
Adjusting Splint
Adjust length to the above measurement. ensuring the Hoop is at an angle with the lateral (outside leg) higher than the medial (inside leg).
Set up
- Apply the hoop Pad (to reduce pressure and secure to tight)
- Apply the 4 slings (lowest should be 40cm from base)
- Apply padding along slings
- Creat a small padding for behind the knee
Application
- Ensure Adequate analgesia (this hurts) – typically Opiates and entonox
- Femoral nerve block may be helpful (however, this is variable due to the innovation of the femur and reduces the more distal the fracture)
- Check Genitals not trapped – by the hoop
- Apply skin traction & and bandage from ankle to thigh
- Secure the tight Clip – remembering to put the padding under the clip and velcro round
The Knot
1. take the strings and pass one over and one under the sides of the frame.
2. secure tightly with a Reef Knot
3. pass strings down (one over and one under) around the base, bringing them back over the Reef Knot and back around the base. This makes a pulley system.
4. Tension the pulley system and tie-off using a bow
5. Pass the tongue depressors (2 tongue depressors tapped together), twist the tongue depressors to achieve the required tension, and lock off against the side.
Bandage & Elevate
- Bandage the leg to the sling using the bandage – to keep secure
- Place a pillow or blankets under the splint to elevate the heel – To prevent pressure sores
Eye Clinic Referral Criteria
What should you send to Eye Clinic and how soon?
Morton’s Neuroma
Morton’s Neuroma is a painful condition resulting from the fibrous thickening of the plantar interdigital nerve of the foot.
Often described as feeling like there is a pebble in the shoe, this is is a chronic condition not associated with acute trauma. It is gradual in onset but may present as acutely painful.
Paronychia
- Infection in the skin fold (or paronychium) to lateral edge of the nail (of the finger or toe, but most commonly finger).
- Leads to a pus filled abscess.
- Can result in cellulitis of the digit, and any other complications usually seen with this.
- Is often very painful.
- Common in nail biting.
Tick Bites
Though less common locally than in some areas, tick bites pre and post removal do offer some concern to patients.
Lower Limb ED Physio Referrals
Lower limb (LL) and especially knee injuries are a very common presentation within the ED, but in the acute phase can be difficult to give a definitive diagnosis and an appropriate treatment / referral plan.
Upper Limb ED Physio Referrals
Upper limb (UL) and especially shoulder injuries are a fairly common presentation within the ED, but in the acute phase can be difficult to give a definitive diagnosis and an appropriate treatment / referral plan.
