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Lower Limb Trauma

Overview

Lower limb trauma includes injuries from the hip to the toes. Fractures and dislocations can affect walking, joint surfaces, alignment, skin, muscle, tendon, nerves and circulation. Some injuries require urgent realignment, wound cleaning and removal of damaged tissue, or surgical fixation, while stable injuries can be treated without surgery. Decisions balance reliable healing, preservation of joints and soft tissues, medical risk and the person’s mobility needs.

Injuries assessed

  • Hip and proximal femur fractures.
  • Femoral shaft, knee and tibial fractures.
  • Patella, tendon and ligament trauma around the knee.
  • Ankle fractures, ‘high ankle’ ligament injuries and dislocations.
  • Lisfranc, metatarsal, calcaneal, talar and toe injuries.
  • Open fractures, crush injuries, wounds and complications after previous treatment.

Initial priorities

Major trauma requires assessment of life-threatening injuries before the limb. For the injured limb, urgent concerns include an open fracture, dislocation, threatened skin, loss of circulation, progressive nerve deficit and compartment syndrome.

Severe pain out of proportion to the injury, pain when the toes are gently moved, a tense swollen limb or new numbness can indicate acute compartment syndrome. This is an emergency. Do not wait for the limb to lose its pulse.

Assessment and imaging

Assessment includes the injury mechanism, ability to bear weight, skin condition, swelling, alignment, joint stability, tendon function, sensation and circulation. Health, bone quality, smoking, diabetes, anticoagulation and pre-injury mobility influence treatment.

X-rays are the usual first test. CT is commonly used for complex joint or foot fractures and surgical planning. MRI or ultrasound is used selectively for occult fracture, cartilage, ligament or tendon injury.

Non-surgical treatment

Stable fractures with acceptable alignment may be managed in a brace, cast or Moonboot, sometimes after realignment without an incision. Weight-bearing may be allowed, restricted or prohibited depending on the injury. Repeat examination and imaging confirm that alignment, circulation and skin remain satisfactory.

Blood-clot prevention, pressure care and maintenance of strength in unaffected joints are considered during periods of reduced mobility. Missing follow-up can allow loss of reduction or delayed recognition of a complication.

When may surgery be considered?

Indications include an open injury, unstable or unacceptable displacement, a joint surface that is no longer aligned, threatened skin, loss of blood flow or nerve function, failure of treatment without an incision, and injuries with a poor chance of useful healing without fixation.

Operations may involve wound cleaning and removal of damaged tissue, realignment and fixation with screws, plates, nails, wires or an external frame; ligament or tendon repair; bone grafting; emergency release of compartment pressure; fusion; or joint replacement for selected fractures. Severe soft-tissue swelling can require temporary stabilisation and delayed definitive surgery.

Recovery and rehabilitation

Recovery depends on bone healing, joint damage, soft tissues and the time spent with restricted weight-bearing. Swelling, stiffness, weakness and altered gait may continue after X-rays show union. Physiotherapy focuses on safe mobility, movement, strength, balance and return to work or recreation.

Driving is not safe while immobilisation, weakness, pain or medicine prevents reliable emergency braking and vehicle control. Follow advice from your treating team, licensing authority and insurer. Return to work varies greatly between seated duties and heavy or uneven-ground work.

Possible complications

  • Infection, wound breakdown or deep bone infection.
  • Blood clots, pulmonary embolism and loss of strength or fitness during recovery.
  • Nerve or blood vessel injury, compartment syndrome or chronic pain.
  • Delayed or failed bone healing, healing in the wrong position, or fixation failure.
  • Stiffness, instability, tendon dysfunction or post-traumatic arthritis.
  • Limb-length or alignment change and need for further surgery.
  • In severe injuries, loss of limb or life despite treatment.

Seek urgent care

  • An open wound over a suspected fracture, exposed bone or a visibly deformed limb. Do not push exposed bone back into the wound.
  • A cold, pale or blue foot; absent pulse; or rapidly worsening numbness.
  • Severe escalating pain, tense swelling or pain with passive movement of toes.
  • New calf swelling, chest pain, shortness of breath or fainting.
  • Fever, wound drainage or increasing redness after injury or surgery.

Frequently asked questions

Does every ankle or foot fracture need surgery?

No. Stability, alignment, joint involvement, skin and the ability to maintain reduction determine treatment.

Operating through severely swollen or blistered skin can increase wound complications. Temporary support or fixation may be used while soft tissues recover.

Some fractures or repairs can displace or fail before sufficient healing. The restriction is specific to the injury and fixation.

Yes. Damage to a joint surface, instability or malalignment can lead to post-traumatic arthritis even after appropriate treatment.

Severe escalating pain, tense swelling, pain with passive stretch and new sensory or motor change require emergency assessment.

General information

This page provides general information only. It cannot diagnose your condition or replace advice from a clinician who has assessed you. Your treatment and recovery plan may differ from the examples described here. Follow the instructions from your treating team. In an emergency, call 000 or attend the nearest emergency department.

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