Tibia fracture

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  • Fractures of shafts of tibia and fibula
    • Tibia and fibula frequently fracture together, and are referred to as ‘fracture both bones of leg’.
    • Characteristics of Tibia – Surgical anatomy
      • Tibia is subcutaneous bone
        • This is responsible for the large number of open tibial fractures (MCQ)
        • often there is loss of bone through the wound.
      • Massive loss of skin in Tibial frature
        • Fractures in this region are often associated with massive loss of skin, necessitating care by plastic surgeons, early in the treatment.
      • Precarious blood supply of Tibia
        • The distal-third of tibia is particularly prone to delayed and non union because of its precarious blood supply. (MCQ)
        • The major source of blood supply to the bone is the medullary vessels.
        • The periosteal blood supply is poor because of few muscular attachments on the distal-third of the bone.
        • The fibula, on the other hand is a bone with many muscular attachments, and thus has a rich blood supply.
      • Tibia has hinge joints proximally and distally(rotational malalignment is noticeable)(MCQ)
        • Both, the proximal and distal joints (the knee and ankle) are hinge joints.
        • So, even a small degree of rotational malalignment of the leg fracture becomes noticeable.
        • This is unlike a fracture of the femur or humerus, where some degree of rotational mal-alignment goes unnoticed because of the polyaxial ball and socket joint proximally.

 

  • Treatment
    • Closed fractures:
      • Treatment of closed fractures, both in children and in adults, is by closed reduction under anaesthesia followed by an above-knee plaster cast
      • In children, it is possible to achieve good alignment in most cases, and the fracture unites in about 6 weeks.
      • In adults, the fracture unites in 16-20 weeks. (MCQ)
      • Open reduction and internal fixation – indications
        • If closed reduction is not achieved
        • If fracture displaced in the plaster.
      • Minimally invasive technique  of closed interlocknailingis becoming popular.
    • Open fractures:
      • The aim in the treatment of open fractures is to convert it into a closed fracture by judicious care of the wound, and maintain the fracture in good alignment.
      • Grade I: (MCQ)
        • Wound dressing through a window in an above-knee plaster cast, and antibiotics.
      • Grade II: (MCQ)
        • Wound debridement and primary closure (if less than 6 hours old), and above-knee plaster cast.
      • Grade III: (MCQ)
        • Wound debridement, dressing and external fixator application
        • The wound is left open.
      • Evolving trend in care of open tibial fractures : operative treatment is more practiced than a primarily conservative treatment
      • Wedging (MCQ)
        • Clinical Scenario : Sometimes, after a fracture has been reduced and the plaster applied, check X-ray shows a little angulation at the fracture site.(MCQ)
        • Instead of cutting open the plaster and reapplying it, it is better to wedge the plaster
        • The plaster is cut circumferentially at the level of the fracture, the angulation corrected by forcing open the cut on the concave side of the angulation, and the plaster reinforced with additional plaster bandages.
        • Once the fracture becomes ‘sticky’ (in about 6 weeks), above-knee plaster is removed and below-knee PTB (patellar tendon bearing) cast is put.
  • Operative treatment: has now become a method of preference
    • Open reduction and internal fixation(MCQ)
      • internal fixation device used may be a plate or an intra-medullary nail
      • Interlock nailing provides the possibility of internally fixing a wide spectrum of tibial shaft fractures.
  • Complications ;
    • Delayed union and non-union:
        • Fractures of the tibia sometimes take unusually long tounite; more so the ones in the lower-third.(MCQ)
        • Failure of union results in pain and inability to bear weight on the leg.
        • Treatment:
          • Treatment of delayed union and nonunion is essentially by bone grafting, with or without internal fixation. (MCQ)
          • Nailing with bone grafting (MCQ)
            • This is indicated in cases of non-union, where the alignment is not acceptable, or there is free mobility at the fracture site.
          • Phemister grafting: (MCQ)
            • What is technique inPhemister grafting
              • In this technique, grafting is performed without disturbing the sound fibrous union at the fracture site.
              • The aim is to stimulate bone formation in the ‘fibro-cartilaginous tissue’ already bridging the fracture
              • Cancellous bone grafts are placed after raising the osteo-periosteal flaps around the fracture
              • In addition, petalling i.e lifting slivers of cortical bone attached at base) is carried out around the fracture.
              • This results in bony union in about 3-4 months
          • Prerequisites forPhemister grafting:(MCQ)
              • There is minimal or no mobility at the fracture site (fibrous union).
              • The fracture has an acceptable alignment.
              • The knee joint has a good range of movement.
        • Ilizarov’s method
          • This method is useful in treatment of difficult non-unions of tibia including(MCQ)
              • non-unions with bone gap
              • non-union withinfection
              • non-union with bad overlying skin.

 

        • Malunion: (MCQ)
          • Some amount of angulation is acceptable in children as it gets corrected by remodelling.
          • In adults, displacements especially angulations and rotations are not acceptable.
          • These cause problems in walking and result in early osteoarthritis of the knee and ankle.
          • Treatment requires correction of the deformity by redoing the fracture and fixing it by plating or nailing, and bone grafting.
        • Infection:
          • Ilizarov’s method is the treatment of choice in infected non-unions.
        • Compartment syndrome(MCQ)
        • Injury to major vessels and nerves:
          • Fracture of the tibia, especially in the upper-third of the shaft may be associated with injury to the popliteal artery or the common peroneal and tibial nerves(MCQ)







Tibia fracture CRIF (IM Nailing)
In this movie shows the closed reduction and intramedullary nailing diaphyseal fractures of the tibia
Max Kuszaj’s Tibia Surgery after Harley Accident
WARNING: NOT FOR THE WEAK STOMACHED! Professional Freeskier and BASE Jumper, Max Kuszaj’s second surgery to repair a tibia fracture to his left leg.
Tibial Fracture repair with Titanium Intramedullary Rod
Tibial shaft fracture repaired by driving a titanium rod (nail) down the intramedullary canal and across the fracture site. The rod placement is then secured with the insertion of screws into tibia through separate stab wound incisions.
Mountain bike tibia fracture Part 1
Really bad spiral tibia fracture resulting of a long recovery
Mountain bike tibia fracture Part2
Tibial Plateau Fracture Fixation, Proximal Tibia – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing proximal tibial plateau fractures.
Tibia Plateau—Bicondylar Fracture C3LCP 4 55 0 Proximal Tibia Plate PTP) and the Application of a Bo
Surgery for Open Tibia Fracture (Rough Draft)… Kevin Ware
This animation video describes the surgery for an injury similar to Kevin Ware’s.
Tibial Plateau Fracture with Metal Plate Fixation
Open reduction and internal fixation of tibial plateau fracture. Side plate and multiple screws used to hold fracture fragments together. Fracture lines run into the knee joint and, once healed, can develop into an abrasive opposing surface for the femoral condyles. This situation can eventually result in joint arthrosis and possible total knee replacement.
Recovery from Fractured Ankle ORIF Surgery Distal Tibia Broken Fracture
What to expect with ORIF Ankle surgery. A patients story
Tibial Plateau Fractures Proximal Tibia Fractures – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing classification of proximal tibial plateau fractures.
Schatzer Classification.
Tibia Shaft Fracture CRIF Nailing
Tibia Shaft Fracture CRIF Nailing / Antegrade Locked Intramedullary Osteosynthesis. Surgical Operation performed in HR at Academician Z. Tskhakaia West Georgian National Centre of Interventional Medicine’s (NMC-National Medical Clinic) Orthopaedic and Traumatology Surgery Department.
Orthopaedic Lecture: Tibia Fracture
This is the Orthopaedic Trauma Series Lecture from Upper Chesapeake Medical Center in Bel Air, Maryland. The moderator is Spiro Antoniades, M.D.
Fracture of Tibia and Fibula 6 Months Part 5
After six months of recovery, I have to get my top two screws removed. This should help compress a “gap” that still exists in my Tibia. The fibula looks okay at this point but typically this injury is healed by now. I discuss vitamin supplements and my bone stimulator.
Tibial Fracture Repair with Titanium Rod
Distal tibia fracture with open wound initially treated with external fixation frame and pins. Ultimately an intramedullary titanium rod is placed down tibial shaft and held with fixation screws until fracture heals. In most cases the rod and screws are removed following healing so that the bone can begin to support weight on its own again.
Fractured Tibia Repair
This recording represents only a small period of the surgery. This recording is intended for fellow surgeons or those with a keen interest in surgery.
Tibial Plateau Fracture Surgery (Arthroscopically Assisted) – HD – Dr Al Muderis
Tibial Plateau Fractures are complicated injuries which have in the past required surgical measures resulting in large scars and soft tissue damage. For this, the Arthroscopically Assisted minimally invasive technique has been developed. Dr Al Muderis takes you through the steps involved in this very effective operation.
Tibial Plateau Fractures
Fracture of Tibia and Fibula 2 months Part 2
I was horse collar tackled and some. I receive some really tough news about my bone healing and deal with a little grief. I discuss my situation with my polish in laws. Both of them are polish dentists.
Childhood Accidental Spiral Tibial Fracture
The patient shown in this video has a Childhood Accidental Spiral Tibial (C.A.S.T.) Fracture that may also be called a “Toddler’s Fracture”.
how i fractured my tibia and fibula
Tibial Eminence Fracture – ORV – Paul Caldwell, M.D.
Tibial Eminence Fracture – ORV – Paul Caldwell, M.D. in association with Arthrex