Posted: Nov 14 2021 #(C101848)

Proximal 1/3rd Segmental Tibial Shaft Fracture in 63F

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HPI

A 63-year-old female presents to the trauma bay after an MVC complaining of right leg pain. She was the restrained driver in an MVC and has no other complaints.

PMH

PMHx: Osteoporosis PSHx: ORIF right femur

A focused exam of the right lower extremity demonstrates diffuse tenderness about the right proximal and mid tibia with moderate swelling. No open wounds or abrasions about the knee. She does have extensive scarring from previous surgeries around the right knee and thigh The patient is neurovascularly intact with soft and compressible compartments

Poll

1 of 8

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

1 No - current radiographs are sufficient

2 Yes - additional radiographs (XR)

3 Yes - CT scan (CT)

4 Yes - MRI scan (MRI)

5 Yes - XR + CT

6 Yes - XR + MRI

7 Yes - CT + MRI

8 Yes - XR + MRI + CT

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

Other

Submit

P: 139377

Would you use a classification system for this injury to guide management?

1 No - a classification would not help me

2 Yes - AO/OTA

3 Yes - Schatzker

4 Yes - Hohl and Moore

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

Other

Submit

P: 139378

How would you manage this injury?

1 Nonoperative

2 Nonoperative

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

Other

Submit

P: 139379

If you choose Operative management, would you plan to temporize this patient prior to definitive management?

1 I would not choose Operative management

2 No - I would fix acutely

3 Yes - Splint

4 Yes - External fixator

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

Other

Submit

P: 139380

If you choose Operative management, what technique would you use for definitive treatment?

1 I would not choose Operative management

2 External fixation only (includes monoplanar, ringed circular fixation, etc.) (Includes limited internal fixation

3 Closed reduction percutaneous pinning (CRPP) 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 (IMN + ORIF)

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

Other

Submit

P: 139381

If you choose Intramedullary nail (IMN), what approach would you use for the nail?

1 I would not choose IMN

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: 139382

If you choose Intramedullary nail (IMN), how would you prevent mal-reduction at the proximal tibia?

1 I would not choose IMN

2 Blocking (Poller) screws/wires/pins

3 Unicortical mini-frag plate

4 External distraction device

5 Semi-extended with a more lateral start point

6 Nothing required to prevent mal-reduction

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

Other

Submit

P: 139383

If you choose Operative management and attained the construct shown below, what would be your postoperative weight-bearing status?

1 I would not choose the construct below

2 Weight-bearing as tolerated (WBAT)

3 Partial (25-50%) weight-bearing (PWB)

4 Touch-down weight-bearing (TDWB)

5 Non-weight-bearing (NWB)

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

Other

Submit

P: 139384

Intra-procedure P1

Post-procedure P1

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