fractures of tibia and fibula l.
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Fractures of tibia and fibula . Tibial shaft fracture. Most common long bone fractures Isolated tibial fracture – 23 % Both tibia and fibular fractures – 77 % 77 % of tibial fractures are closed 23 % are open fractures . Features of tibial fractures . Most common of all long bone fractures

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Presentation Transcript
tibial shaft fracture
Tibial shaft fracture
  • Most common long bone fractures
  • Isolated tibial fracture – 23 %
  • Both tibia and fibular fractures – 77 %
  • 77 % of tibial fractures are closed
  • 23 % are open fractures
features of tibial fractures
Features of tibial fractures
  • Most common of all long bone fractures
  • Subcutaneous and hence incidence of open fracture is high
  • Distal one third has a deficient blood supply and a fracture in this area is known for delayed union and nonunion
  • Bounded above and below by hinge joints
  • Respond well to conservative treatment
  • Only 5 % need operative treatment
mechanism of injury
Mechanism of injury
  • RTA – 37 %
  • Sports – 25 %
  • Assaults – 5 %
  • Falls – rest
  • Direct voilence due to RTA (common ) , fall , assault , etc. Open fractures are common
  • Indirect voilence due to falls , twisting force due to sports injuries .
classification ellis
Grades of severity

1 minor

2 moderate

3 major

Features

Undisplaced

Not angulated

Minor comminution

Minor open fracture

Total displacement

Small degree of comminution

Minor open wound

Complete displacement

Major comminution

Major open fracture

Classification ( Ellis )
tscherne classification
Tscherne Classification
  • Grade Soft Tissue Injury (Superficial) Soft Tissue Injury (Deep) Compartments

0 Absent or negligible Absent or negligible Soft and/or normal

.

1 Superficial abrasion Contusion from within Soft and/or normal

2 Deep contaminated abrasion Significant contusion Impending compartment . syndrome

. .

3 Crushed skin, subcutaneous Crushed devitalized Compartment syndrome

avulsions Muscle

.

clinical features
Clinical features
  • Pain
  • Deformity
  • Investigation :
  • Acute cases : AP and Lateral view
  • Delayed cases : AP ,Lateral and oblique view showing knee joint and ankle joints
treatment
Treatment

Conservative management : -

  • Closed reduction under general anaesthesia and a long leg cast application

Indication :

  • Closed fractures
  • Undisplaced fracture
  • Low energy trauma
  • Young adults
  • # with minor or moderate displacements
method of reduction
Method of reduction
  • Two methods of closed reduction :

1 . The patient is supine and limb held parallel to the table , the # is reduced by traction and countertraction method and a long leg cast is applied

Disadvantage : -

    • Posterior angulation develops at the fracture site due to the gravitational forces

2 . Commonly followed method :-

    • Position : sitting or supine ( under anaesthesia)
    • Patient is brought to the edge of the table and both the legs are kept dangling .
    • Holds the leg of the patient and manipulates the fracture and a long leg cast is applied
criteria of acceptable reduction
Criteria of acceptable reduction
  • Ankle and knee joint surface should be parallel
  • Acceptable varus or valgus angulation is 5 degree in AP view
  • Anterior or posterior angulation of 10 degree in the lateral view
  • Shortening of 5 – 7 mm is acceptable

Advantages :

  • Traction and countertraction do not require an assistant
  • Patient`s own weight of the leg provides traction through the gravity
  • Easy to compare with the normal leg regarding the accuracy of closed reduction by looking at the control of rotation and angle
sarmiento s total contact below knee cast
Sarmiento`s total contact below knee cast
  • After reduction of the fracture and application of a long leg cast for 2 to 3 weeks , a total below knee cast which is moulded around the tibial condyles and patella in the fashion of patellar tendon bearing prosthesis is applied (PTB casts or brace )

Advantages

  • Allows early knee movements
  • Ease of ambulation for

patients with bilateral fracture

  • Decreases the incidence of

delay union and nonunion

slide12
Cont..

Functional braces ( allows both ankle and knee joints )

Pins above and below the fracture:

  • Indication :
  • For moderate and severe fracture
  • Unstable fracture
  • Open fracture
surgical treatment
Surgical treatment
  • Open reduction and internal fixation
  • Indication :
  • Tibial fracture with vascular or neural injuries
  • Segmental fractures
  • Inadequate reduction
  • Associated plafond fracture
complications
Complications
  • Delayed union (bone grafting )
  • Nonunion (rigid internal fixation with compression plating and bone grafting )
  • Malunion ( osteotomy )
  • Shortening
  • Infection
  • Compartmental syndromes
  • Joint stiffness
  • Refracture
  • Fat embolism