Tibia and fibula, shaft: complex fracture—42-C3


Tibia and fibula, shaft: complex fracture—42-C3

Chang-Wug Oh

Case description

A 49-year-old woman injured her left lower leg in a high-energy motor vehicle accident and sustained a Gustilo-Anderson type I complex segmental fracture of the tibial shaft. There were no associated neurological or vascular problems.

Indication for MIPO

In this case, the fracture can be treated by plating or nailing by the principle of relative stability. When plating is used, MIPO should be considered as this helps to preserve the blood supply of the fracture fragments.

a–b Preoperative AP and lateral x-rays show the complex segmental diaphyseal fracture of the tibia. c A 1 cm open wound on the proximal third of the anterior leg.

Preoperative planning

Once a decision has been made that the case is suitable for MIPO, a good preoperative plan helps facilitate the subsequent execution of the surgical procedure. The plan should include a graphic representation of the fracture fragments, the surgical approach, the reduction technique, the most appropriate implant, and the steps required in its application ( Fig 20.5-2 ).

a–b Preoperative plan. One LHS is inserted proximally to hold the plate at the right level (screw number 1). After manual traction the LHS (screw number 2) is inserted most distally to maintain the fracture in the proper length and alignment. The proximal fracture is approximately reduced and one cortex screw is inserted as a lag screw. Verification of the fracture reduction is made for correct length, axis, and rotation. Additional proximal and distal LHSs are inserted.

Jul 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Tibia and fibula, shaft: complex fracture—42-C3

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