Dr. E. T. Wyman Jr.: This 44-year-old woman was injured 20 minutes before admission. She said she had been struck by an automobile and had not been unconscious.
There was marked lateral displacement of the right foot at the ankle. The right tibia protruded through a 4-cm. transverse skin laceration located approximately 3 cm. above the tip of the medial malleolus. Articular cartilage of the distal tibia was visible. The medial malleolus had been sheared off just below the level of the joint. There was a small amount of dirt present in the wound. The dorsalis pedis pulse was present and bounding. No defect of sensory or motor nerve function was demonstrated. There were no other injuries, and her general condition was good.
After initial evaluation in the emergency ward, an intravenous infusion was started, and blood specimens were sent for cross-matching. After appropriate skin testing had been done, 3,000