Assessment of severe lower limb trauma with the aid of on-site photography.

To cite: Gouk C, Mohanakrishnan N, Keen EJ. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2015-210155 DESCRIPTION A 44-year-old man was brought to the hospital by ambulance with a severely deformed right femur following a motorbike accident. The initial deformity was reduced on-site, but the ambulance crew provided a pre-reduction photograph (figure 1). The patient was travelling at 100 kmph when he collided with a wall. Evaluation on-site, and primary and secondary surveys, revealed that the patient was stable (as per Advanced Trauma Life Support (ATLS) protocol) and his injured limb was neurovascularly intact. Owing to the severity of his initial deformity, a CT angiogram was performed. Examination and imaging revealed a compound, comminuted right femoral fracture involving the distal third of the femoral shaft and femoral condyles with associated fracture of the patella (figures 2 and 3). However, there was no evidence of arterial injury. No other injuries were identified. Emergency open reduction and internal fixation was performed using headless compression screws and a lateral locking plate (figure 4). Postoperatively, the patient was placed in a range of motion brace Figure 1 On-site photograph of the injured lower limb.