Synopsis
Separate articular plateau injury from shaft injury, identify open fracture, arterial damage and evolving compartment syndrome early, obtain pattern-defining imaging, and coordinate soft-tissue-safe fixation, rehabilitation and surveillance.
- Begin with trauma ABCDE and haemorrhage control; inspect from thigh to toes and examine skin, wounds, compartments, pulses, capillary refill and tibial and fibular nerve function before and after every manipulation.
- For an open fracture, photograph once if policy permits, cover with saline-soaked gauze and an occlusive layer, give intravenous antibiotics as soon as possible and ideally within one hour, realign and splint, and avoid repeated wound inspection or emergency-department irrigation.
- Do not rule out compartment syndrome because pulses are present. Escalating pain, pain on passive stretch, tense swelling and evolving sensory or motor change require immediate senior review and repeated documented examination.
Key red flags
An open wound, gross contamination, exposed bone, threatened skin, major deformity or uncontrolled bleeding needs immediate cover, antibiotics, alignment, splintage and orthopaedic trauma escalation.
Investigation priorities
Define plateau or shaft pattern, alignment and joint extension.
Management branches
A tibial injury is open, grossly deformed, ischaemic or associated with possible compartment syndrome.
- Complete trauma ABCDE, control external haemorrhage and expose the entire injured limb while preventing hypothermia.
- Cover open wounds, give intravenous network prophylaxis immediately, verify tetanus requirements, align and splint without repeated wound handling.
CT confirms a tibial-plateau fracture after urgent limb threats have been controlled.
Key medicines
Intravenous open-fracture prophylaxisGive the major-trauma network's specified intravenous agent and weight-based dose as soon as possible and ideally within 1 hour of injury; record agent, dose and administration time, then continue only for the protocol-defined contamination and operative course.
Tranexamic acid in major trauma with active or suspected bleedingFor an adult within 3 hours of injury, give 1 g intravenously over 10 minutes followed by 1 g intravenously over 8 hours when the major-trauma haemorrhage protocol indicates treatment.