This document provides guidelines for emergency room treatment of lower extremity injuries such as puncture wounds and fractures. It outlines how to classify and treat puncture wounds based on depth and contamination risk. All puncture wounds should be explored, treated with antibiotics, and deeper wounds should undergo irrigation and debridement. For fractures, the document stages injuries based on location and provides treatment guidelines, emphasizing the need for splinting, casting, and keeping the area non-weight bearing to prevent complications. Missed or improperly treated fractures can result in poor healing, infection, or need for later surgical fixation.