Are there any open wounds (open fractures range from <1 cm to near amputation) or any sites where skin is tenting/threatened?

Are there any associated injuries?

Is IV access in place? Immediately initiate antibiotics if there is any concern for open fracture.

Does the patient have pain out of proportion or paresthesia? Should raise concern for compartment syndrome.

Ensure the leg is stabilized, elevated, and iced immediately.

X-rays of the tibia, knee, and ankle.

Open fractures: should be irrigated in ED and receive antibiotics (will require formal irrigation and debridement in OR)

Compartment syndrome: requires emergent fasciotomies

AP and lateral views of the tibia are necessary for evaluation.

CT is appropriate if there is concern for intra-articular extension.