Tibia and fibula, shaft: simple fracture, oblique
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.
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 ).
Operating room setup
General anesthesia is usually recommended for children.