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Home / Station 9: Severe leg pain after tibial fracture

NAC OSCE preparation

Station 9: Severe leg pain after tibial fracture

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Severe leg pain after tibial fracture

11 minutes

Discipline: Surgery & Perioperative Care
Station type: Focused assessment + emergency management
Setting: Emergency department

Your task

Take a brief history and describe examination. State diagnosis and immediate management.

Information available at entry

HR 110/minBP 146/88 mm HgRR 22/minSpO₂ 98%T 36.9°C

Coach prompt: Recognize acute compartment syndrome and escalate without delay.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 9 of 30

Standardized-patient profile

NameMr. Noah Williams

Age32

Pronounshe/him

RolePatient

Demeanour: In severe distress despite analgesia.

Opening statement: “The pain is unbearable even though I was given pain medicine.”

History and standardized-patient responses

Injury/progression

Candidate explores	Standardized-patient response
Mechanism	Closed tibial fracture after motorcycle collision six hours ago.
Pain	Rapidly worsening, deep pressure, 10/10 and out of proportion.
Analgesia	Minimal relief.
Neurologic	New tingling in first web space and ankle weakness.

Other

Candidate explores	Standardized-patient response
Splint	Feels increasingly tight.
Bleeding risk	No anticoagulant or disorder.

Physical findings

Tense swollen anterior compartment.
Severe pain with passive toe extension.
Reduced first-web-space sensation.
Pedal pulse and capillary refill remain present.

Examiner prompts

Diagnosis?

Acute compartment syndrome.

Do pulses exclude it?

No; pulses may remain until late.

Immediate care?

Remove constriction, limb at heart level, analgesia and immediate orthopedics/fasciotomy; do not delay for imaging. Pressure measurement only if uncertain and without delay.

Differential diagnosis

Compartment syndrome
Fracture pain
Acute arterial injury
DVT
Nerve injury
Necrotizing infection

Investigations

Clinical diagnosis
Compartment pressure only if uncertain
CBC, electrolytes, renal function and CK for systemic injury
Fracture imaging must not delay treatment

Management

Release external compression
Urgent fasciotomy
Analgesia and correct positioning
Monitor rhabdomyolysis/renal complications
Definitive fracture care afterward

Communication behaviours

Explain time-critical pressure threat
Do not reassure because pulses are present
Consent without delaying emergency care

Critical safety actions

Call orthopedics immediately
Do not wait for all six P's or loss of pulse
Do not elevate far above heart

Model closing summary

This patient has acute compartment syndrome after tibial fracture, shown by escalating pain out of proportion, pain with passive stretch, a tense compartment and new sensory/motor symptoms. A palpable pulse does not exclude it. I would remove constrictive dressings, keep the limb at heart level, give analgesia and call orthopedics immediately for urgent fasciotomy without delaying for imaging.

Common pitfalls

Doppler first
Reassuring from normal capillary refill
Tighter cast
Repeated analgesia while delaying referral

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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