Long bone fracture following fall at fun run

Patient Information

Dispatch: A 28YO female has come to the FAP after tripping on a kerb during the City to Surf Fun Run. She is sitting on the ground holding her lower left leg and unable to weight bear. (Sarah Tran)
Patient: Sarah Tran — 28yr (65kg)
Incident History: Pt was running approximately 8km into the course when she caught her foot on a raised kerb, fell forward and landed heavily. She heard and felt a 'crack' in her lower left leg and has been unable to stand since. Bystanders assisted her to the FAP.
Emergency Contact: Daniel Tran (Husband) — 0412 388 047

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil swelling or stridor.
Breathing: Adequate. Slightly elevated respiratory rate consistent with pain and anxiety. Nil audible wheeze or crackles.
Circulation: Radial pulse strong and regular. Skin pale and slightly diaphoretic around face. No active external haemorrhage visible. Obvious deformity and swelling to mid-left tibia with intact skin.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place, and person. Distressed due to pain.
Exposure: Deformity and swelling to mid-shaft left tibia. Skin intact — no open fracture. Left running shoe and sock in place. No other injuries identified.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	20	104	122/78	<2s	15	4 4 ++	–	–	8
10 mins	99% (RA)	Nil	16	92	118/76	<2s	15	4 4 ++	–	–	5

History Taking

Treatment Response

Diagnosis

This patient is suffering from a suspected mid-shaft left tibial fracture with distal neurovascular compromise (tingling to left foot).

Facilitator Triggers — if trainees miss a critical step

! (If distal neurovascular observations — capillary refill, colour, warmth, movement, sensation to toes — are NOT assessed before splinting, the patient reports that the tingling in her foot has become numbness and her toes look pale. Prompt the trainee: 'What do you notice about her foot?')
! (If splinting is applied without padding of hollows and bony prominences, the patient reports increased discomfort at the ankle. Prompt the trainee: 'She says it feels very tight at her ankle — what might you check?')
! (If distal neurovascular observations are NOT repeated after splinting, inform the trainee: 'Your assessor asks — have you reassessed circulation, movement, and sensation distal to the splint?')
! (If the left shoe and sock are not removed or the limb is not exposed prior to assessment, prompt: 'You have not fully exposed the injury — what else might you be missing?')
! (If jewellery — there is an ankle bracelet on the left ankle — is not removed before splinting and oedema increases, the patient winces and points to her ankle. Prompt: 'She is pointing to something on her ankle — what do you notice?')

Treatment Objectives

1 Don appropriate PPE including gloves.
2 Perform Primary Survey — confirm airway patent, breathing adequate, no life-threatening haemorrhage.
3 Control any haemorrhage — confirm skin is intact; apply direct pressure if open wound identified.
4 Expose the injured limb — carefully remove left running shoe and sock; note and remove ankle bracelet before oedema occurs.
5 Assess distal neurovascular observations BEFORE splinting — capillary refill time, skin colour, warmth, movement (ask patient to wiggle toes), and sensation (ask patient to describe feeling in toes) to left foot.
6 Document baseline neurovascular findings — CRT <2s, tingling present to left toes, movement intact.
7 Perform Secondary/CNS Survey — assess for any other injuries from the fall including wrists and hands.
8 Pad natural hollows, deformities, and bony prominences (ankle, knee) with appropriate padding prior to splint application.
9 Apply soft splint or rigid splint immobilising the joint above (knee) and below (ankle) the injury site using broad bandages — maintain limb in position of comfort.
10 Reassess distal neurovascular observations AFTER splinting — CRT, colour, warmth, movement, and sensation to toes. Loosen bandages if compromise is found.
11 Reassess and document pain score post-splinting — target improvement from 8/10.
12 Apply cold pack to injury site wrapped in a towel or bluey — do not apply directly to skin.
13 Elevate the injured limb where tolerated to reduce swelling.
14 Apply pulse oximetry and monitor vital signs including heart rate and respiratory rate.
15 Reassure patient continuously throughout — explain each step before performing it.
16 Record full observations every 10 minutes.
17 Arrange transport to hospital via ambulance — document pain score and mechanism for ambulance handover.
18 Document all findings including neurovascular assessment before and after splinting on patient care record.
19 Scenario ends on arrival of ambulance and IMISTAMBO handover.
20 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Limb Trauma · Haemorrhage · Primary Survey · Secondary & CNS Survey · Pain Assessment · Fractures & Dislocations — Splinting

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