TIBIA FRACTURES.

1
TIBIA FRACTURES.

• The tibia is subcutaneous.
• More commonly fractured and more commonly
  sustain an open fracture than any other
  bone.

2
MECHANISM OF INJURY.

• Indirect force spiral . The fibula is
  usually fractured at a different area.
• Direct force transverse . There may be
  a of the fibula at the same level.
• The amount of communition varies according
  to the severity of the force.
• The risk of complications is directly
  related to the extend of soft tissue
  injury.

3
MECHANISM .

• Open s can graded according to the
  severity of injury ( Gustilo and Anderson).
• Grade 1 clean small puncture wound due to
  bony spike.
• Grade 2 wound gt 1,0 cm. No extensive soft
  tissue injury. Moderately severe .
• Grade 3 severe bony and soft tissue
  injury and wound contamination.

4
MECHANISM..

• Grade 3 A adequate soft tissue coverage.
• Grade 3 B There is skin loss.
• Grade 3C There is arterial injury
  requiring repair.
• The incidence of infection ranges from 1
  for Grade I to 30 for Grade III.
• Tibial s usually take about 12 weeks to
  unite but many can take up to six months.
  

5
TREATMENT OF TIBIAL FRACTURES.

• Closed fractures
• C/R plus A/K P.O.P. Usually done for
  stable s.
• C/R plus application of external fixator.
  Unstable / communited s can be managed by
  a fixator.
• The above s can also be managed
  operatively ORIF / IM nailing.
• Bracing stable s.

6
OPEN FRACTURES.

• Open s are never managed by ORIF.
• They must be debrided.
• Stabilization can be achieved by external
  fixation . EX.FIX. Can be used as a
  temporary device or as a definitive mode
  of treatment.

7
COMPLICATIONS.

• EARLY
• Infection.
• Vascular injury.
• Compartment syndrome.
• LATE
• Malunion.
• Delayed union.
• None union.
• Joint stiffness.
• Osteoporosis.
• Regional pain syndrome.

8
FRACTURE OF THE FIBULA ALONE.

• Spiral s are usually associated with knee
  or ankle s.
• Isolated fibular is usually due to direct
  trauma or stress .
• Usually treated conservatively analgesia.
  No further treatment is usually needed.

9
FRACTURES OF THE ANKLE.

• Fracture / fracture - dislocation of the
  ankle very common.
• Commonly due to a twisting injury.
• Commonly closed fractures.
• Often accompanied by severe swelling and
  blister-formation.
• They are regarded as Orthopaedic
  emergencies.

10
CLASSIFICATIONS.

• LAUGE- HANSEN explains the mechanism of
  injury and the extend of the soft tissue
  disruption.
• Danis and Weber This is an anatomical
  description. Explains fibular fracture in
  relation to the syndesmosis.
• TYPE A The fibular is below the
  syndesmosis. Caused by adduction /
  abduction.

11
CLASSIFICATION .

• TYPE B Oblique running upwards from
  the syndesmosis. Caused by external rotation.
• TYPE C ABOVE the syndesmosis. Caused
  by abduction alone or abduction plus
  external rotation. The fracture can be as
  high as the fibular head. There is
  disruption of the interosseous membrane. It
  is very unstable.

12
PRINCIPLES OF TREATMENT.

• Fracture-dislocation . Diagnosis is clinical!
  Reduce the before X-rays. Splint it.
• Closed ALL ankle s are treated
  operatively except those which have a
  minimally displaced lateral malleolus without
  medial tenderness KEY THOUGHT.
• If the ankle is very swollen , splint it
  and elevate the leg.
• Definitive treatment is done once swelling
  has subsided.

13
PRINCIPLES OF TREATMENT ..

• If the fracture is opened, first reduce
  the ( most are fracture- dislocations). The
  must be splinted. The patient must
  taken to theatre for Debride'ment.
• NB the general principles of open
  fractures still hold true for open ankle
  s.
• Ankle s unite in about six to eight
  weeks.
• Patient must be N.W.B. Until union.

14
COMPLICATIONS.

• EARLY. Vascular injury.
• Late .
• Malunion.
• Non- union.
• Joint stiffness.
• Complex regional pain syndrome.
• Osteo-arthritis.