Fractures of the tibia and fibula.docx

Introduction Is a common injury. Many times, it is open because of its subcutaneous position. Mechanism of injury Twisting force → spiral # at different levels. Angulation force → transverse or oblique # at the same level. Direct injury may crush or split the overlying skin leading to compound fr...

Introduction Is a common injury. Many times, it is open because of its subcutaneous position. Mechanism of injury Twisting force → spiral # at different levels. Angulation force → transverse or oblique # at the same level. Direct injury may crush or split the overlying skin leading to compound fractures and these fractures are classified by Gustilo. Management Aims of treatment Limit soft tissue damage & preserve the skin. Prevent compartment syndrome (especially with proximal fractures). Reduce & hold the fracture. Start early weight bearing. Early joint movement. Conservative This consists of Full-length cast (from upper thigh to metatarsal necks) & elevation for 2 weeks. Then checking x -ray & change the cast as swelling decreases. With starting partial weight bearing (PWB) for 8 – 12 weeks. If skin viability is doubtful→ 2 weeks skeletal traction, then casting. Indications for conservative treatment are: Undisplaced & slightly displaced fractures. displaced fractures that can be reduced (& remain stable) by manipulation. Operative Indications for operative treatment are: Failure of closed reduction. Displaced high energy # that are comminuted & unstable. Types of fixations: Internal: Closed intramedullary nailing with locking screws (for closed diaphyseal fractures). Plate fixation (for metaphyseal fractures). External fixation (for open fractures & closed comminuted fractures). Complications Early Vascular injury: proximal 1/3 # may injure the popliteal artery→ this requires vascular repair. Compartment syndrome (proximal fractures) → requires fasciotomy → & then external fixation. The incidence of tissue breakdown and/or infection ranges from 1% for Gustilo type I to 30% for type IIIC. Late Malunion: 1.5 cm shortening & 7 angulation are acceptable, if more or malrotation→ this will require tibial osteotomy. Delayed union & nonunion: Especially in high energy #, infection or bone loss → and this treated by stable fixation & bone graft. Joint stiffness of ankle: This may last 12 months.