What patient education should be provided to a female patient with a blunt‑force injury to the right calf and knee while awaiting imaging results?

Patient Education for Blunt Calf and Knee Injury Awaiting Imaging

While awaiting imaging results, educate the patient on immediate injury management, warning signs requiring urgent re-evaluation, and activity modifications to prevent complications and optimize healing.

Immediate Injury Management

Rest and Weight-Bearing Guidance

• Avoid bearing full weight on the injured leg until imaging results are reviewed and cleared by the physician 1, 2
• Use crutches or other assistive devices if provided to minimize stress on the injured structures 3
• The ability to bear weight is a positive prognostic sign, but inability to take four consecutive weight-bearing steps was a criterion for obtaining imaging and suggests potential significant injury 1, 4

Ice, Elevation, and Compression

• Apply ice to the injured area for 15-20 minutes every 2-3 hours during the first 48-72 hours to reduce swelling and pain 5
• Elevate the leg above heart level whenever possible to minimize swelling 5
• If an elastic bandage or compression wrap was applied, ensure it is snug but not cutting off circulation 6

Pain Management

• Take prescribed or recommended pain medications as directed; multimodal analgesia (combining different types of pain relievers) is more effective than opioids alone 5
• Over-the-counter options such as acetaminophen or ibuprofen may be recommended unless contraindicated 5
• Pain should be assessed regularly, and if it worsens despite medication, notify your healthcare provider immediately 5

Critical Warning Signs Requiring Immediate Return to Emergency Department

Vascular Compromise

• Sudden onset of severe pain, numbness, tingling, or coldness in the foot or toes indicates possible vascular injury and requires immediate evaluation 1, 2
• Loss of pulse in the foot or pale/blue discoloration of the toes are emergencies 2
• Knee dislocations carry approximately 30% risk of vascular injury and require urgent assessment 2

Compartment Syndrome

• Progressive, severe pain that is out of proportion to the injury and not relieved by elevation or pain medication may indicate compartment syndrome 7
• Tightness, firmness, or extreme tenderness in the calf muscle requires urgent re-evaluation 7
• Numbness or inability to move the toes are late signs of compartment syndrome 7

Infection Risk (If Skin Broken)

• If there is any break in the skin over the injury site, watch for increasing redness, warmth, drainage, or fever, which may indicate infection 7
• Open fractures require aggressive early treatment within 6 hours to prevent major complications 7

Joint Effusion and Instability

• Rapidly increasing swelling in the knee joint, especially if accompanied by fever, requires urgent aspiration to rule out septic arthritis 2, 4
• A sensation that the knee is "giving way" or unstable suggests ligamentous injury and warrants specialist evaluation 2

Activity Modifications and Precautions

Movement Restrictions

• Do not attempt to "walk it off" or test the injury by bearing full weight before medical clearance 1, 4
• Avoid twisting, pivoting, or sudden movements of the knee until evaluated 1
• If you heard or felt a "pop" at the time of injury, this suggests possible ligamentous or meniscal tear and requires careful evaluation 2, 8

Range of Motion

• Gently move the ankle and toes periodically to maintain circulation, but do not force knee flexion or extension if painful 4, 5
• Inability to flex the knee to 90 degrees was a criterion for obtaining imaging and suggests significant injury 1, 4

Splint or Brace Care

• If a splint or immobilizer was applied, keep it in place and dry 3
• Check skin under the splint edges for pressure sores or irritation 3
• Effective splints should be complete, compact, and comfortable; if the splint causes increased pain or numbness, return for adjustment 3

Follow-Up and Next Steps

Imaging Results Timeline

• Radiographs are the initial standard imaging for acute knee trauma to exclude fractures requiring immediate intervention 1, 2
• If radiographs are negative but you have persistent pain, mechanical symptoms (locking, catching), or inability to bear weight after 5-7 days, MRI without contrast may be recommended to evaluate for meniscal or ligamentous injuries 2, 8

Re-Assessment Schedule

• Return for clinical re-examination 2-5 days after injury if initial exam was limited by swelling and pain 4
• Excessive swelling can limit examination accuracy for up to 48 hours, and re-evaluation is important if partial tears are suspected 4

Expected Recovery Milestones

• Most blunt musculoskeletal injuries show improvement in pain and swelling within 48-72 hours with appropriate rest and ice 6, 5
• If symptoms worsen or fail to improve after 5-7 days of conservative management, further evaluation with MRI or specialist referral is indicated 2

Common Pitfalls to Avoid

• Do not assume that the ability to walk rules out all significant injuries; soft tissue injuries such as meniscal tears or ligament sprains may still be present despite negative radiographs 2
• Do not apply heat to the injury in the first 48-72 hours, as this can increase swelling 5
• Do not remove or adjust any splint or immobilizer without medical guidance 3
• Do not ignore red-flag symptoms such as gross deformity, palpable gap in tendon, fever with joint swelling, or progressive numbness 2, 4