Tibia and fibula, shaft: simple fracture, oblique


Tibia and fibula, shaft: simple fracture, oblique

Chang-Wug Oh

Case description

A 12-year-old boy was hit by a car and sustained a closed oblique simple fracture of the right tibial shaft. The leg was severely swollen and the patient complained of severe posterior lower-leg pain when his ankle was dorsiflexed passively. An emergency fasciotomy was performed to release compartment pressure.

Indication for MIPO

Conservative treatment after reduction using plaster cast is the treatment of choice for pediatric tibial shaft fractures. However in this case, the patient required fasciotomy to treat compartment syndrome. It is difficult to maintain fracture reduction after fasciotomy and to treat the soft tissue using only a cast. For adults, nailing should be considered for treatment of simple transverse tibial shaft fractures. But in this case, nailing will damage the patient‘s open physes. In addition the narrow tibial intramedullary canal hinders the rigid nailing. Therefore MIPO is the most appropriate option as it provides sufficient stability.

a–b Preoperative AP and lateral x-rays show a simple, oblique diaphyseal fracture of the tibia.
a–b The lower leg of the patient was severely swollen. Compartment pressure was over 40 mmHg.

Preoperative planning

Once a decision has been made for MIPO, a good preoperative plan helps 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 23.3-3 ).

The fasciotomy must first be treated by opening the anterolateral and posteromedial compartments. In this case plate fixation is applied on the medial side, so it will not compromise the anterolateral wound of the fasciotomy.

In general it is recommended to first fix the plate with cortex screws to hold the plate in the right position. Cortex screw (1) is inserted in the fourth hole from distal to hold the plate. Manual traction is performed to reduce the fracture and an LHS inserted in the fifth hole from proximal. Length and alignment are checked using image intensification, and if correct, LHSs are inserted in the last distal and last proximal holes, respectively (5, 6). Lastly unicortical screws (7, 8) are inserted.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

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

Full access? Get Clinical Tree

Get Clinical Tree app for offline access