$tibia and fibula fracture$

$tibia and fibula fracture$

#Tibia and fibula fracture update
#Tibia and fibula fracture skin

Proximal third and distal third fractures (with or without simple articular fracture involvement) can be treated with open reduction and internal fixation (ORIF) with plates and screws or IMN. The vast majority of extra-articular fractures are treated with intramedullary nails (IMN). For example, small to medium traumatic anterior medial wounds can be accessed through an anterolateral approach.

$tibia and fibula fracture$

Traumatic wounds are extended proximally and distally to expose the entire zone of injury and facilitate adequate debridement.Ĭonsider soft-tissue friendly counter incisions for debridement in select locations. Types IIIB and IIIC typically undergo staged management with an external fixator prior to definitive fixation depending on the amount of contamination and severity of soft-tissue injury. Types I, II, and IIIA can generally be treated definitively immediately following debridement assuming there is not gross contamination present. Open fractures should undergo urgent surgical debridement: Medically moribund patients are also candidates for cast treatment.

$tibia and fibula fracture$

Rarely fractures treated nonoperatively should meet the following criteria:Ĭlosed, isolated, simple, nondisplaced, or minimally displaced tibial shaft fractures in patients willing to comply with non–weight bearing.Īble to tolerate multiple cast changes and frequent X-ray follow-ups. Operative management has the following advantages: improved alignment, earlier ankle and knee range of motion, immediate weight bearing, and improved functional outcomes. However, most displaced tibia fractures are currently treated surgically. Historical data suggest that many tibia fractures can be treated nonoperatively with reduction and casting.

#Tibia and fibula fracture update

Any gross contamination should be removed, but formal debridement should be reserved for the operating room.Īppropriate antibiotics (typically a first-generation cephalosporin) and tetanus update are administered. Open wounds should have sterile dressings applied. Reduction in the emergency department and placement into a padded long leg splint as soon as possible. Open fractures are typically classified according to the Gustilo–Anderson classification (for further reference, please see Chapter 2, Open Fractures). Type C-complex fractures with increasing comminution from C1 to C3. Type B-wedge fractures increasing in complexity from B1 to B3. Type A-simple patterns, progressing from spiral (A1) to transverse (A3). The AO/OTA classification is useful to describe tibia shaft fractures. Fibula fractures at the same level as the tibia fracture tend to be higher energy than at distant (either proximal or distal) sites. Suspected open fractures, high-energy mechanisms (segmental, comminuted) with severe soft-tissue injury can be identified on X-rays.įibula fractures seen on X-ray can also give clues to the energy of the fracture mechanism. Plain radiographs can help identify many specific details about the fracture. The axial views are most helpful to plan potential fixation of the posterior malleolus fragment (▶ Fig. If this is suspected and not seen on X-ray, a CT scan should be obtained. (c) Lateral X-ray after placement of clamps, reducing the fracture.ĭistal third fractures-high rate of associated posterior malleolus fracture. (b) CT scan axial cut at tibial plafond showing associated posterior malleolar fracture that can guide trajectory of clamp and screw. 41.1 Distal third tibia shaft fracture with (a) lateral X-ray revealing associated posterior malleolar fracture ( arrow). X-rays of knee and ankle are also recommended because articular extension at both the knee and at the ankle is common (▶ Fig. Disproportionate pain or pain with passive flexion/extension should alert the surgeon to the high probability of compartment syndrome (see section “ III, Complications” in this chapter).Īdequate quality orthogonal X-ray views of the tibia. Patients are at risk for compartment syndrome and should be re-examined frequently with corresponding documentation. Repeat (and document) neurovascular examination after reduction and splinting.

#Tibia and fibula fracture skin

Skin integrity must be evaluated to look for open fractures.ĭetailed initial neurovascular and compartment examination should be documented. Preoperative Evaluation and AssessmentĬommonly associated with high-energy mechanism.įull orthopaedic workup including careful examination for associated fractures.

$tibia and fibula fracture$