Are there any open wounds (possible open fracture) or any sites where skin is tenting/threatened?

Are there any associated injuries?

Does the patient have IV access in place? Initiate antibiotics if there is concern for open fracture.

Does the patient have pain out of proportion or paresthesia, or is there any other concern for compartment syndrome?

Has the patient been made NPO if sedation for reduction is needed?

Ensure leg is stabilized, elevated, and iced immediately.

X-rays of the knee, tibia, ankle, and foot (if concerned about associated injury).

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

Compartment syndrome requires immediate ice and elevation, as well as preparation for emergent fasciotomy.

Irreducible fractures may require operative intervention (periosteum, tendons, or other soft tissue structures may be interposed).

AP, lateral, and oblique views of the ankle and distal tibia are necessary for evaluation.

AP and lateral views of the knee and full length tibia are required to rule out Maisonneuve-type fracture or associated injury.