Posted: Jul 7 2020 #(C101519)

Distal Tibial Fracture in a 63F

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HPI

This 63-year-old female presented with severe left ankle pain after stepping off a sidewalk and twisting her ankle.

PMH

Uses tobacco, drink alcohol socially. Otherwise noncontributory.

Physical examination was significant for intact skin, no gross deformity, moderate swelling and global tenderness to palpation about the ankle, and an otherwise neurovascularly intact extremity with a 2+ symmetric DP pulse.

Poll

1 of 10

Would you obtain any imaging in addition to standard ankle films to guide management?

1 No - current radiographs are sufficient

2 Yes - additional radiographic views (aXR)

3 Yes - CT scan of the ankle (CT)

4 Yes - MRI of the ankle (MRI)

5 Yes - aXR + CT

6 Yes - aXR + MRI

7 Yes - CT + MRI

8 Yes - aXR + CT + MRI

9 Outside my area of expertise - best if I dont vote

Other

Submit

P: 117220

Would you use a classification system to guide management?

1 No - a classification system would not help me

2 Yes - Ruedi and Allgower

3 Yes - AO/OTA

4 Yes - Other

5 Outside my area of expertise - best if I dont vote

Other

Submit

P: 117216

How would you definitively manage this injury?

1 Nonoperative

2 Operative

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

Other

Submit

P: 117219

If you choose Operative management, would you temporize this patient with an external fixator?

1 I would not choose Operative management

2 No - I would fix this acutely

3 Yes - for 5-7 days

4 Yes - for 8-14 days (1-2 weeks)

5 Yes - for 15-21 days (2-3 weeks)

6 Yes - for > 21 days (>3 weeks)

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

Other

Submit

P: 117218

If you choose Operative management, what type of Definitive fixation would you choose for the tibia?

1 I would not choose Operative management

2 External fixation (ExFix) only (includes monoplanar, ringed circular fixation, etc)

3 Percutaneous screw fixation only

4 Open reduction internal fixation (ORIF) with plate and screws (includes MIPO)

5 Intramedullary nailing (IMN) only

6 IMN + ORIF

7 IMN + percutaneous screw fixation

8 ExFix + percutaneous screw fixation

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

Other

Submit

P: 117225

If you choose Operative management, would you include fixation of the fibula?

1 I would not choose Operative management of the tibia

2 No - I would not fix the fibula

3 Yes - I would fix the fibula

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

Other

Submit

P: 117234

If you choose to Fix the fibula, what type of fixation would you use?

1 I would not choose to fix the fibula

2 ORIF - separate approach from the tibia

3 ORIF - same approach as the tibia

4 Intramedullary fixation (includes screw, flex nail, wire)

5 Outside my area of expertise - best if I dont vote

Other

Submit

P: 117236

If you choose to Fix the fibula, when would you fix it?

1 I would not choose to Fix the fibula

2 Before the tibia

3 After the tibia

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

Other

Submit

P: 117237

Intra-procedure P1

Post-procedure P1

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