A patient presents with a gross anterior dislocation of the tibia with absent pedal pulses. What is the most appropriate management?

In cases of gross anterior dislocation of the tibia accompanied by absent pedal pulses, the most appropriate management is immediate reduction in the emergency department. This situation suggests a high risk of vascular compromise due to the dislocation potentially compressing or disrupting the blood supply to the lower extremity.

Immediate reduction is critical as it can restore blood flow to the affected limb and reduce the risk of limb ischemia, which can lead to irreversible damage if not addressed promptly. The time-sensitive nature of this condition necessitates an urgent attempt to relieve any pressure on the arteries, hence the emphasis on emergency department reduction.

Following reduction, the patient's vascular status should be reassessed, and further management can be determined based on the outcome. While consultation with an orthopedic surgeon is essential for ongoing care of such an injury, the initial focus must be on restoring circulation to prevent complications.

After significant reduction and stabilization, if vascular abnormalities persist or there are signs of significant injury, then arteriography or surgical exploration may be indicated. However, the priority remains immediate reduction in the emergency setting.