Limb Pain and Redness

🗒️ Question

A 45 year old man presents to A&E with severe pain and swelling in his left tibia following a recent open fracture. He has had high-grade fever and chills over the last two days.

On examination, there is localised erythema, swelling and tenderness over the affected area. The wound site is draining purulent material and there is limited range of motion in the nearby joint.

Investigations

• White cell count: 14 × 10⁹/L (4–11)

• CRP: 120 mg/L (<5)

• ESR: 90 mm/h (0–22)

• X-ray: periosteal reaction and lytic lesions in the affected tibia

What is the most appropriate immediate action?

(A) Administer broad-spectrum intravenous antibiotics

(B) Perform surgical debridement

(C) Initiate oral antibiotics

(D) Request an MRI of the affected area

(E) Take a wound swab for culture and sensitivity