Office treatment of lower extremity injuries. A view of feasibility, limitations and hazards.

The injuries to the lower extremities seen in a surgical office may be classified as contusions, lacerations, sprains, lesions of tendons and their sheaths, involvement of bursae, chronic muscle fatigue, infections and deformities of the nails, leg ulcers, and fractures of the ankle, foot and toes. The treatment of these conditions in an office will vary under different circumstances, but one should be guided by certain fundamental rules. Contusions are best treated by the application of elastic compression bandages. Extensive lacerations should be explored under local anesthesia with the tourniquet in place, injured tissue excised, and the wound sutured. Ankle sprains should be strapped. Immediate hospitalization must be considered in all moderate to severe initial sprains to the knee. Lesions of bursae usually respond to the injection of hydrocortisone preparations. The same treatment is used in chronic muscle fatigue, plus immobilization of the part. Chronic recurrent infection and deformities of the nails are treated by removal of the nail under local anesthesia. Fractures of the ankle, the foot and toes may be reduced under local anesthesia and a cast applied. If further swelling is feared, the patient should be put in hospital immediately.