Immediate life-saving interventions
›Limb-threatening scenarios
›If open fracture suspected, cover with sterile dressing, initiate antibiotics, tetanus pathway, urgent orthopedics
›If neurovascular compromise, urgent reduction or alignment correction if deformity, immediate specialist involvement
›If compartment syndrome concern, emergent orthopedics, fasciotomy pathway activation
Immobilization and Splinting
›Lower extremity splint options
›Posterior short leg splint
›Foot in neutral position
›Toe box clearance
›Posterior short leg plus stirrup
›Additional inversion-eversion control
›High swelling expectation
›Immobilization principles
›Swelling phase avoidance of circumferential cast
›Two-finger tightness check at wrap
›Padding over malleoli and heel
›Post-splint checks
›Pain trend after immobilization
›Toe cap refill
›Dorsalis pedis pulse
›Sensation over dorsal foot
›Reduction usually not required
›Nondisplaced Jones fracture typical
›If significant angulation or displacement, urgent orthopedics for reduction plan
›Analgesia and anesthesia support
›Oral analgesia first-line when stable
›Acetaminophen PO
›1000 mg every 6 to 8 hours as needed
›Maximum 3000 mg per day in most adults
›Ibuprofen PO
›400 mg every 6 hours as needed
›Maximum 2400 mg per day
›If inadequate control, short course opioid
›Hydromorphone PO
›1 mg every 4 to 6 hours as needed
›Avoid with oversedation risk
›Regional anesthesia option if reduction required
›Sural nerve block consideration
›Local anesthetic per institutional protocol
›Post-block neurovascular documentation
›Sedation pathway if reduction required and pain uncontrolled
›ACEP Level B procedural sedation monitoring standards
›Continuous pulse oximetry
›Capnography when available
›Resuscitation equipment readiness
Open fracture medications and timing
›Antibiotics timing
›As soon as feasible after recognition
›First dose within 60 minutes target when possible
›Antibiotic selection for low-grade open fracture pattern
›Cefazolin IV
›2 g once
›3 g once if body mass high per local protocol
›If severe beta-lactam allergy
›Clindamycin IV
›900 mg once
›Tetanus prophylaxis
›Vaccination status review
›Tdap booster if not up to date
›Tetanus immune globulin for unknown or incomplete immunization with dirty wound
DVT prophylaxis when relevant
›Routine pharmacologic prophylaxis usually not indicated for isolated foot fracture
›Low VTE risk in most ambulatory patients
›Mobilization with non-weight-bearing aids encouraged
›High-risk features prompting individualized plan
›Prior VTE history
›Active malignancy
›Prolonged immobilization with minimal mobility
›Estrogen therapy
›Shared decision-making and local protocol alignment