Management Plan: When treating Ramon, we must be sure to treat the patient as a whole as well as his fractured tibia and femur. The general management of the patient involves the control of pain, the management of associated injuries and prophlyactic empirical antibiotics. Since no other body systems seem to be damaged, we feel relatively safe in pursuing surgical reduction and stabilization of the fractures. We would refer to an orthopedic surgeon who would utilize bone plates, wires, pins, and screws to fix the bones back into normal anatomic position. The major goal of this surgery is to all and encourage the union of the fracture and to restore optimum function to the injured limbs. Post-surgical care would require check-ups in 4-6 weeks to assess bone healing and stability of the fixation technique. These fractures will most likely take 2-3 months to heal completely. RamonŐs exercise should be limited and cage rest might be indicated for the initial part of therapy. However, he should be encouraged to walk and use the limbs to encourage and accelerate healing. Once the limbs are stabilized, physical therapy will be indicated to further improve muscle strength. Non-weight bearing exercise such as swimming (provided all surgical fixations and sutures have been removed) would be ideal. Aside from physical repair of the fractures, we must be certain to include pain relief. These fractures are severe and the bones and surrounding soft tissue structures have been greatly traumatized. Analgesics should be administered and Ramon should probably have a fentynal patch post surgery. Anti-inflammatories would also assist in decreasing pain and improving healing. Special care and attention should be paid to bone fracture repair complications. Skin care is extremely important in fracture management because the epithelial structures may have been damaged by underlying fracture fragments, fracture blisters, and necrosis. Furthermore, vascular and nervous structures may have been destroyed at the time of truama or during surgical repair. There may also be problems with malunion, delayed union, and non-union if the fixation technique was incorrect or became unstable. Other comlications may include osteomyelitis or bone sequestrum formation.