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TIBIAL
SHAFT FRACTURES
Fractures in this region are often open because of the proximity
of the anterior tibia to the skin surface.
Fracture patterns include: (Figure 18.54)
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Figure
18.54
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Spiral
fractures, from low energy injuries (A) |
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Short
oblique fractures (B) |
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Transverse
fractures (C). |
The
amount of soft tissue (skin, muscle, nerve artery) damage
influences the rate of healing and the chance of subsequent
infection.
Evaluation
Inspect the skin closely for any wounds. Full thickness breaks
in the skin indicate an open fracture and you should prepare
for debridement and lavage of the fracture.
During the initial examination, check the neurological and
vascular function to the foot. Signs of a developing compartment
syndrome include:
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Increasing
pain |
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Coolness
and pallor of the foot and toes |
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Pain
with passive extension or flexion of the toes or ankle |
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Increasing
tight feeling in the compartments in the calf. |
Treat with surgical release of the four leg compartments
as soon as possible (see pages 18–34 to 18–35).
Treatment
| 1 |
Immediately
debride open fractures. |
| 2 |
Reduce
tibial fractures by hanging the leg over the end of the
examination table and apply longitudinal traction. |
| 3 |
Place
the limb in a long leg three way splint with the knee
in 10–20 degrees of flexion. |
| 4 |
In
2–3 weeks, remove the splint and apply a long leg
cast. |
| 5 |
Recheck
the patient about every three weeks. X-rays are useful
to check the position of the fracture and the extent
of healing. |
| 6 |
When
the fracture position feels stable, place the patient
in a patella tendon bearing cast (see page 17–9)
and begin knee motion and weight bearing. The healing
time for uncomplicated tibial fractures is about six
months. |
Open
fractures that require dressing changes or skin grafts and
unstable comminuted fractures are best managed using an external
fixation frame (see pages 17–10 to 17–11).
Use either a unilateral or a bilateral frame. When the
skin has been closed and the fracture is stable, remove
the frame and apply a cast for the remainder of the treatment
period.
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Healing
response and complication rate are related to the extent
of soft tissue injury
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Open
fractures are common and require immediate debridement
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Closed
reduction and cast application is appropriate for most
fractures
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External
fixation is useful for fractures associated with open
wounds or severe comminution and instability
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Complications
include compartment syndrome, non-union and infection.
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