Posted: Dec 28 2021 #(C101912)

Open Tibial Shaft Fracture 2/2 GSW in 24M

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HPI

A 24-year-old male presents to the hospital for evaluation of left leg pain. The patient states he was minding his own business when he was leaving the store and was shot in the leg. He is complaining of isolated left leg pain. He denies numbness or tingling to the left leg. He smokes daily.

PMH

None

Focused examination of the left lower extremity demonstrates a 1 cm wound noted over anterolateral tibia. Tenderness present to palpation over tibial shaft. EHL/TA/FHL/Gastroc intact +2/4 DP/PT pulses. Cap refill brisk in all toes. SILT L3-S1. Compartments soft and compressible

Poll

1 of 9

In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?

1 No - radiographs are sufficient

2 Yes - additional radiographs (XR)

3 Yes - CT scan (CT)

4 Yes - MRI tibia (MRI)

5 Yes - XR + CT

6 Yes - XR + MRI

7 Yes - CT + MRI

8 Yes - XR + CT + MRI

9 Outside my area of expertise - best if I don't vote

Other

Submit

P: 142211

How would you manage this injury?

1 Nonoperative

2 Operative

3 Outside of my area of expertise - best I don't vote

Other

Submit

P: 142219

If you choose Operative management, and the patient presented at 18:00, when would you plan to take the patient to surgery?

1 I would not choose Operative management

2 Emergently (within 2-3 hours)

3 Urgently (within 4-6 hours, I would NOT wait until following morning)

4 Semi-urgently (within 7-12hrs, first case following morning)

5 Routinely, within 13-24 hours

6 Routinely, within >24 hours

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 142221

If you choose Operative management of the tibial shaft fracture, which technique would you choose for definitive management?

1 I would not choose Operative management of the tibial shaft fracture

2 External fixation (ExFix) (includes monoplane, circular fixation)

3 Closed reduction percutaneous fixation only

4 Open reduction internal fixation (ORIF) only (includes plate, screws, wires, minimally invasive plate)

5 Intramedullary nail (IMN) only (includes limited internal fixation)

6 Hybrid fixation (IMN + ORIF)

7 Outside my area of expertise - best if I don't vote

Other

Submit

P: 142213

If you choose Operative management of the tibial shaft fracture with intramedullary nailing (IMN), what approach would you choose?

1 I would not choose MN

2 Suprapatellar

3 Infrapatellar - tendon splitting

4 Infrapatellar - tendon sparing

5 Outside my area of expertise - best if I don't vote

Other

Submit

P: 142214

If you choose Operative management of the tibial shaft fracture with intramedullary nailing (IMN), how many interlocking screws would you place proximally?

1 1 screw

2 2 screws - monoplanar

3 2 screws - biplanar

4 3 screws

5 3+ screws

6 Outside my area of expertise - best if I don't vote

Other

Submit

P: 142220

If you choose Operative management of the tibial shaft fracture with intramedullary nailing (IMN), how many interlocking screws would you place distally?

1 I would not choose IMN fixation