Reamed IM nailing gives excellent stabilization of tibial fractures. IM nailing is the treatment of choice at Parkland Memorial Hospital. Plating, as a means of surgical stabilization, is not used at Parkland Memorial Hospital. Inability to maintain reduction with closed methods c. Ipsilateral femur fracture (floating knee) ii.Ĭoncomitant vascular injury requiring repair iv. The following are commonly quoted as indications for surgical management: i. Operative fixation provides excellent stabilization and maintenance of reduction. <10 degrees of anterior or posterior angulation iii. <5 degrees of varus or valgus malalignment ii. The following indications for cast treatment are commonly quoted: i. Remanipulation or cutting wedges out of the cast to move the fracture is occasionally necessary. g.Ĭlose monitoring and frequent radiographs are necessary. Maintenance of reduction can be difficult. Union commonly takes from 3 to 5 months in tibia fractures (longer in smokers). e.Ĭast immobilization is continued until the fracture unites. Progressive weight bearing is allowed as fracture callus is seen on radiographs. This is followed by a patellar tendon-bearing cast. Treatment starts with a long-leg, bent-knee cast for about 4 weeks. Nonoperative treatment can give good functional results in many low-energy tibial fractures. Most surgeons describe fractures according to site (proximal, middle, or distal third), pattern (transverse, oblique, butterfly, or comminuted), and displacement. No accepted classification for tibial fractures exists. 2.Ī thorough examination of the soft tissues and neurovascular structures must be carried out to avoid missing an injury. B.ĪP and lateral views of the ankle, knee, and tibia should be obtained. The severely mangled leg remains one of the most difficult injuries to treat. Soft tissue damage and bone loss can be extensive. Since much of the tibia is subcutaneous, open fractures are very common. Tibial fracture is one of the most common long bone injuries seen in trauma centers. If the fracture is allowed to heal in excessive rotational malalignment, surgical correction may be necessary. If adequate radiographic assessment cannot be made by matching cortical widths of the proximal and distal fragments, CT, including views of the opposite intact tibia, can be helpful. Any degree of malrotation should be avoided. It is important that accurate rotational alignment be achieved during reduction of a tibial fracture with the use of either nonoperative or operative techniques. Yue and associates 113 reported one malrotation in 16 patients with ipsilateral femoral and tibial fractures treated nonoperatively and none in the 13 patients (14 extremities) treated by operative stabilization. Bohn and Durbin 10 reported no rotational malalignment in 30 children (32 limbs) with ipsilateral femoral and tibial fractures monitored for a mean of 5.1 years. All three children were 12 years or older at injury. These deformities persisted after 3.9 years of follow-up. In Shannak’s series, 94 three of 117 children (3%) had rotational deformities: two internal and one external. It may also produce internal rotation at the knee joint level and supination of the foot.įortunately, the incidence of functionally significant rotational malunion is low. Internal rotation of the distal fracture fragment results in an in-toed gait. External rotation of the distal fracture fragment results in an out-toed gait, as well as increased stress along the medial aspect of the knee and pronation of the ankle and foot. Pediatric tibial fractures that are allowed to heal in a malrotated position will not correct or remodel with subsequent skeletal growth. Son-Hing, in Green's Skeletal Trauma in Children (Fifth Edition), 2015 Malrotation
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