Tibia and fibula, shaft: simple fracture, oblique


Tibia and fibula, shaft: simple fracture, oblique

Chang-Wug Oh

Case description

An 8-year-old boy sustained a both-bones fracture of his right leg. Initial treatment by percutaneous pinning with long-leg cast was performed. After 3 weeks the reduction was lost because of inadequate immobilization due to the windows made in the cast for wound management. The original fracture pattern was simple and oblique. One month after initial treatment the patient presented at the author‘s hospital with angular deformity of his left lower leg.

Indication for MIPO

Once osteotomy of the malunited site is performed, the technique for fixation is the same as for treatment in acute tibial fractures in children. Titanium elastic nailing is recommended, but it commonly requires external support, such as cast, which in this case is not suitable as the wound still needs to be managed. In addition, the stability of titanium elastic nails may not be sufficient for nonunion treatment. Furthermore the fracture is more distal and it may be unstable after fixing with elastic nailing. Since the physis is open, rigid nailing may not be applicable. Therefore, MIPO is an ideal option for this patient from the points of view of stability and wound care.

a Original injury x-ray. b X-ray after percutaneous pins and long-leg casting show reduction of the fracture in slight valgus position. c Long-leg cast with open windows for wound management.
a–b One month after the initial fracture, AP and lateral x-rays show lost reduction of the simple, oblique diaphyseal fracture of the tibia. Note callus formation at the tibia and fibula fracture sites.

Preoperative planning

Once a decision has been made for MIPO, a good preoperative plan helps to facilitate the subsequent execution of the surgical procedure. The plan should include the surgical approach, a graphic representation of the fracture fragments, the reduction technique, the most appropriate implant, and the sequential steps required in its application ( Fig 23.2-3 ).

a–b In general it is recommended to first fix the plate with cortex screws to hold the plate in the desired position, starting with the proximal part (1). The plate is used as a reduction tool by inserting a cortex screw, which will reduce and correct the valgus deformity (2). At this stage the alignment can be checked by image intensifier with the cable technique by aligning the center of the hip to the center of the knee and the center of the ankle, or by comparing alignment with the uninjured leg. Once alignment is correct, the additional LHSs are inserted (3, 4, 5, 6).

Jul 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Tibia and fibula, shaft: simple fracture, oblique

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