From the Research
I strongly recommend managing this 35-year-old male prison inmate with multiple fractures of the left fifth toe using a walking boot, pain medication, and an orthopedic consultation, prioritizing non-steroidal anti-inflammatory drugs (NSAIDs) for pain control as they reduce post-trauma pain and the need for opioids with a minimal risk of non-union 1. For pain management, prescribe acetaminophen 650 mg every 6 hours and ibuprofen 600 mg every 8 hours with food for 7-10 days, as NSAIDs have been conditionally recommended for patients with traumatic fractures due to their benefits in reducing pain and opioid use 1. Some key considerations for the patient's treatment plan include:
- The walking boot should be worn at all times when ambulatory for 4-6 weeks to provide proper immobilization and support to the fractured toe.
- The patient should be instructed to elevate the foot when sitting or lying down to reduce swelling.
- Ice can be applied for 15-20 minutes every 2-3 hours during the first 48-72 hours to help manage pain and inflammation. The orthopedic consultation is crucial to determine if surgical intervention is needed, as multiple fractures may require more specialized care than simple toe fractures. The patient should be scheduled for follow-up in 7-10 days to assess healing progress and adjust the treatment plan as needed, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.