Oh, Deer! Accident Leaves Man in Pain

A 50-year-old man is brought to your facility by EMS personnel for evaluation after a motor vehicle crash. He was an unrestrained driver who swerved suddenly to avoid hitting a deer that jumped in front of him. He lost control of his vehicle, which rolled over several times and eventually landed in a ditch. His airbag deployed. The patient’s primary complaint is neck and right leg pain. His medical history is essentially unremarkable. He is awake, alert, and oriented, with stable vital signs. Primary survey shows a large laceration of his right leg over the tibia, with extensive soft-tissue injury and loss through the muscle. He has good range of motion in his knee, with no evident pain or swelling. His ankle and foot also show no injury and appear to be neurovascularly intact. You obtain a radiograph of the right tibia. What is your impression?