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Tibial Shaft Fractures
Posted: Jul 31 2021 #(C101776)
C

Open Tibial Shaft Fracture with Proximal Tibiofibular Joint Dislocation in a 30M

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HPI

The patient is a 30-year-old male that was involved in a motorcycle versus motor vehicle accident. He was going approximately 30 miles per hour when he collided with another vehicle making a turn. He noticed immediate right leg pain and deformity.

PMH

No significant past medical or surgical history.

PE

Gross deformity of the right leg with significant swelling. 1x1 cm poke hole wound present over the distal third of the leg with steady venous bleeding. Pain with palpation with soft compartments. Digital active motion intact. Sensation intact to light touch. 2+ DP pulses.

Poll
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In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
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P: 144173
What antibiotic prophylaxis would you recommend for this patient?
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P: 144181
How would you manage this injury?
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P: 144174
Would you address the proximal tibiofibular joint disruption at the time time of tibial fixation?
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P: 144180
If you choose to address the proximal tibiofibular injury, what fixation would you use?
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P: 144184
If you choose Operative management of the tibial shaft fracture, which technique would you choose for definitive management?
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P: 144175
If you choose Operative management of the tibial shaft fracture with intramedullary nailing (IMN), what approach would you choose?
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P: 144176
If you choose Operative management of the tibial shaft fracture with intramedullary nailing (IMN), how many interlocking screws would you place distally?
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P: 144177
If you choose Operative management of the tibia fracture with intramedullary nailing (IMN), would you choose a reamed or unreamed nailing technique?
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P: 144178
If you choose Operative management of the fibula fracture, what technique would you use for definitive management?
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P: 144179
If you choose Operative management of the tibia fracture with intramedullary nailing (IMN), would you assess the syndesmosis after IMN?
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P: 144182
If you choose Open reduction internal fixation (ORIF) and the syndesmosis is found to be unstable, how would you fix the syndesmosis?
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P: 144185
If you choose Syndesmotic stabilization, what is the PRIMARY method by which you would assess syndesmotic reduction?
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P: 144186
If you choose Syndesmotic stabilization with screw fixation, how many syndesmosis screws would you place
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P: 144187
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