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Tibial Shaft Fractures
Posted: Jul 27 2019 #(C101212)
A

Open Tibial Shaft Fx in 34F

HPI

A 34 year old female complaining of left leg pain after she was struck by a moving vehicle. She Denies pain elsewhere.

PMH

None Non-smoker

PE

3.5 x 3 cm open wound about the medial aspect of left leg with exposed bone. Otherwise skin intact. Compartments are soft and compressible. She has appropriate pain with passive range-of-motion of the toes and ankle. Motor/sensory intact L2-S1. Palpable DP and PT pulse. Brisk capillary refill in all 5 toes.

Poll
1 of 10
1. According to Gustilo-Andersen, how would you classify this fracture?
Type I
2%
45/2101
Type II
64%
1348/2101
Type III
33%
708/2101
2. How would you treat this fracture?
Nonoperative (Immobilization with protected weight bearing)
0%
20/2003
Operative
99%
1983/2003
3. When performing a debridement and irrigation, what solution would you choose?
Normal Saline
86%
1776/2045
Castile Soap
1%
39/2045
Betadine
9%
187/2045
Chloropactin
1%
28/2045
I would not perform an I&D
0%
15/2045
4. If choosing operative treatment, what type of treatment would you do?
IM nail
74%
1533/2045
ORIF with plate
6%
136/2045
External Fixation
18%
374/2045
I would not perform operative treatment
0%
2/2045
5. If performing IM nailing, how would you start the nail?
Suprapatellar - Midline Transtendinous
20%
389/1908
Suprapatellar - Medial to Tendon
6%
127/1908
Suprapatellar - Lateral to Tendon
2%
49/1908
Infrapatellar - Midline Transtendinous
37%
725/1908
Infrapatellar - Medial to Tendon
23%
453/1908
Infrapatellar - Lateral to Tendon
6%
116/1908
I would not do an IM nail
2%
49/1908
6. If performing IM Nailing, would you ream?
Yes - I would ream
77%
1475/1892
No - I would not ream
20%
383/1892
I would not do an IM nail
1%
34/1892
7. If performing IM nailing, would you use Bone Morphogenetic Protein-2 (BMP-2 / rhBMP-2)?
Yes - I would use BMP-2
8%
154/1783
No - I would not use BMP-2 because I don't think the benefits outweigh the costs
74%
1332/1783
No - I would like to use it but it is not available
13%
246/1783
I would not do an IM nail
2%
51/1783
8. If you performed IM nailing, what would be your weight-bearing protocol post-op?
WBAT
58%
1036/1771
TDWB
26%
477/1771
NWB
13%
231/1771
I would not do an IM nail
1%
27/1771
9. What prophylactic antibiotics would administer for this injury postoperatively?
Cephalasporin (Ancef)
46%
863/1860
Vancomycin
1%
25/1860
Cephalosporin +Gentamicin
40%
756/1860
Cephalosporin+ Tobramycin
2%
55/1860
Cephalosporin + Tobramycin + Penicillin
1%
37/1860
Cephalosporin + Gentamicin + Penicillin
6%
124/1860
10. What duration of IV antibiotic would you give postoperatively?
One dose postop
2%
54/1840
24 hours IV Only
26%
479/1840
48 hours IV Only
16%
307/1840
72 hours IV Only
19%
351/1840
One dose postop + 3-10 days oral abx
4%
81/1840
24 hours IV + 3-10 days oral abx
7%
144/1840
48 hours IV + 3-10 days oral abx
7%
140/1840
72 hours IV + 3-10 days oral abx
15%
284/1840
PROCEDURE #1

1. Debridement and irrigation with IM nailing (suprapatellar portal) of the left tibia

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
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