Authors: Stephen Edward McCabe, Frances Claire Verey / Editor: Jason M Kendall / Reviewer: Tadgh Moriarty / Codes: RP4, SLO3, SLO4, SLO5, TC2, TP10, TP7 / Published: 22/11/2020
A 13-year-old boy was brought into the ED by ambulance after falling off his BMX bike. He fell onto the tip of one handlebar whilst doing tricks, and had to remove it from deep in his right groin area. At the scene, he was able to weight bear on the affected limb. In transit he had a brief period of hypotension (BP 88/61).
On examination in resus, he was haemodynamically stable. His primary survey revealed a deep right groin laceration on exposure. This was approximately 10cm in length (see picture below). This was not bleeding heavily. Examination revealed an inability to extend his big toe, with concomitant decreased sensation.
With remarkable insight for a 13 year old boy he also mentioned that the wound may have been a lot less deep had he had his trousers pulled up and not low slung as is the fashion!
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Question 1 of 3
1. Question
Which one of the following regarding his initial assessment and management is most appropriate?
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Question 2 of 3
2. Question
On further examination he was found to have an absent pedal pulse on the injured side, and was unable to dorsiflex his big toe. He continued to deny pain elsewhere, and the thigh distal to the wound was soft and non tender. What is the likely diagnosis in this patient?
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Question 3 of 3
3. Question
In view of your suspected diagnosis from the previous question, which one of the following is the best investigation to further assess this patient?
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9 responses
Interesting case
Good one
Interesting case.
Thanks for a small but useful course.
Important case of full neurovascular examination of lower limb
thanks for the nice case
Good case
Many thanks.
Interesting case.