Osler Round 3 - 32/M with lower limb swelling after a road traffic accident

The clinical case

A 32-year-old male, K.L, is brought to the emergency department after being involved in a road traffic accident. He was on a boda boda when he collided with a car at a high speed. The accident occurred about 5 days prior to presentation, but the patient's friends first sought care from a nearby clinic, where he received first aid and the subsequent treatment. On arrival, the patient is conscious, talking in short sentences but appears pale and weak. His vitals are: blood pressure 87/62 mmHg, pulse 120 beats per minute, respiratory rate 24 breaths per minute, oxygen saturation 92% on room air, and temperature 38°C. The examination reveals a deformed left leg with an open wound that was being dressed from the clinic, and he is unable to move the leg due to pain. The initial investigations show a hemoglobin level of 7.3 g/dL, and a blood glucose level of 8.3 mmol/L. The attending doctor is unable to do the x-ray as there was no electricity at the moment. His family reports that he has been having some little bleeding oozing from the wound, which was not worrying as he was being dressed daily. However, the leg is markedly swollen from the knee downwards. The patient's past medical history is significant for sickle cell disease, for which he has been receiving folate supplements.