Tibia and fibula, shaft: simple fracture, transverse—42-A3

10.1055/b-0034-87657

Tibia and fibula, shaft: simple fracture, transverse—42-A3

Chang-Wug Oh

Case description

A 62-year-old man injured his left lower leg in a bicycle accident sustaining a Gustilo-Anderson type II open transverse, simple fracture of the tibial shaft. He had a previous lateral condylar fracture that had been fixed with a T-plate. The new fracture line was 2 cm below the end of the original plate.

Indication for MIPO

Nailing should be considered to be the gold standard for the treatment of simple transverse fractures of the tibial shaft. In this case, however, the existing plate prevents nailing unless it is first removed. Plate removal may expose the fracture site and impair fracture healing. Therefore, MIPO is the best choice for fixation of this fracture.

a–b Preoperative AP and lateral x-rays show the simple, transverse diaphyseal fracture of the tibia just below a previous implant. c–d Preoperative zero opacity CT images show the simple, transverse diaphyseal fracture of the tibia.

Preoperative planning

Once a decision has been made that the case is suitable for MIPO, a good preoperative plan helps to 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 implants, and the steps required in their application ( Fig 20.3-2 ).