Posted: Oct 17 2019 #(C101305)

Open Tibia Fracture in 29F

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HPI

A 29-year-old female presented to the trauma bay with isolated RLE trauma secondary to a motorcycle collision. The patient complains of RLE pain with some parasthesias. She denies pain in the other extremities.

PMH

Her past medical history is unremarkable except for a previous C Section. She reports occasional alcohol use and denies illicit substance use. She smokes 0.25 pack per day smoker for the last 10 years.

On physical exam she has a open wound extending from mid tibia to the ankle joint anterior and medial consistent with grade 3b open tibia injury. Her sensation is present throughout distally with parasthesias present. She is able to wiggle her toes but her motor exam limited secondary to pain. She has a nNon-palpable DP and PT pulses, but they were present on doppler. CTA demonstrated intact perfusion. Compartments are soft and compressible. The remainder of the extremity exam is unremarkable.

Poll

1 of 8

1. In addition to plain film radiographs, would you obtain any other imaging to guide management?

No - current radiographs are sufficient

47%

670/1402

Yes - additional radiographic views (XR)

33/1402

Yes - CT scan of the tibia (CT)

36%

505/1402

Yes - MRI scan of the tibia (MRI)

10/1402

Yes - CT + XR

96/1402

Yes - MRI + XR

8/1402

Yes - MRI + CT

26/1402

Yes - MRI + CT + XR

17/1402

Outside my area of expertise, best if I do not answer

37/1402

2. Would you classify this open injury to guide management?

No - a classification system would not help me

35/1365

Yes - Gustilo-Anderson grade II

3/1365

Yes - Gustilo-Anderson grade IIIA

69/1365

Yes - Gustilo-Anderson grade IIIB

71%

981/1365

Yes - Gustilo-Anderson grade IIIC

15%

216/1365

Yes - Other

8/1365

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

53/1365

3. What antibiotics would you start upon arrival?

I would not start any antibiotics

10/1375

1st generation cephalosporin (Ancef) only

14%

201/1375

1st generation cephalosporin + Aminoglycoside

52%

724/1375

1st generation cephalosporin + Aminoglycoside + Penicillin

26%

363/1375

Other

44/1375

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

33/1375

4. How would you manage this patient?

Nonoperative

8/1338

Operative

98%

1322/1338

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

8/1338

5. If you choose Operative management, would you temporize this patient with external fixation prior to definitive fixation?

I would not choose Operative management

2/1348

128/1348

Yes

88%

1198/1348

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

20/1348

6. If you choose Operative management, what would be your definitive fixation?

I would not choose Operative management

0/1329

External fixation (ExFix) (includes monoplanar, circular fixation, etc)

27%

361/1329

ExFix + Limited internal fixation (includes percutaneous screws)

16%

215/1329

Intramedullary nail fixation (IMN)

38%

514/1329

Open reduction internal fixation (ORIF)

15%

211/1329

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

28/1329

7. If you choose Operative management, how would you manage the tibial bone loss?

I would not choose Operative management

4/1240

I would not, leave it alone

20%

251/1240

Acute grafting - allograft

85/1240

Acute grafting - autograft

10%

126/1240

Staged grafting (Masquelet technique) - allograft

10%

124/1240

Staged grafting (Masquelet technique) - autograft

34%

424/1240

Bone transport

119/1240

Other

12/1240

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

95/1240

8. If you choose to use Autograft for the tibial defect, what type of graft would you obtain?

I would not choose to use Autograft

11%

140/1194

Iliac crest autograft

57%

683/1194

Reamer Irrigator Aspirator (RIA)

22%

271/1194

Other

32/1194

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

68/1194

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Post-procedure P3

Post-procedure P5

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