Tibial Shaft Fractures - Pediatric Pathway Posted: 8/8/2020 ID: (C101560)

Open Tibial Shaft Fracture in an 11 Years Male

PRESENTATION

POLLS

12,675

OUTCOMES

EVIDENCE

Comments

CASE DESCRIPTION

AGE	11 / Male
CC	Right leg pain
HPI	This is an 11-year-old male presenting as a trauma after being struck by an automobile while crossing the street.
PMH	He has no significant past medical history.
PE	Significant for a weight of 40kg. There is a 2cm open wound with exposed bone directly over the anterior aspect of the right distal leg, gross deformity, and an otherwise neurovascularly intact extremity with a palpable DP pulse. Compartments are soft.

AGE/GENDER:

11 / Male

CHIEF COMPLAINT:

Right leg pain

HISTORY OF PRESENT ILLNESS:

This is an 11-year-old male presenting as a trauma after being struck by an automobile while crossing the street.

PAST MEDICAL HISTORY:	He has no significant past medical history.
PHYSICAL EXAM:	Significant for a weight of 40kg. There is a 2cm open wound with exposed bone directly over the anterior aspect of the right distal leg, gross deformity, and an otherwise neurovascularly intact extremity with a palpable DP pulse. Compartments are soft.
DIAGNOSIS:	Open Tibial Shaft Fracture in an 11 Years Male

Pre-procedure IMAGES:

https://upload.orthobullets.com/cases/101560/pre.jpg

https://upload.orthobullets.com/cases/101560/pre2.jpg

https://upload.orthobullets.com/cases/101560/6c862ac5-8ac8-40b1-b7e0-26230ff54056_img-20200807-wa0003.jpg

POLLS

OB Community

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

No - Current radiographs are sufficient

Yes - Additional radiographs (XR)

Yes - CT scan of the leg (CT)

Yes - MRI scan of the leg (MRI)

Yes - CT + XR

Yes - MRI + XR

Yes - MRI + CT

Yes - MRI + CT + XR

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

Other

Submit

2) Based on the presentation, would you involve Child Protective Services (CPS)?

Yes

Outside my area of expertise - best I don't answer

Other

Submit

3) How would you classify this fracture?

I would not use a classification system - it would not help me

Gustilo-Anderson Type I

Gustilo-Anderson Type II

Gustilo-Anderson Type IIIA

Gustilo-Anderson Type IIIB

Gustilo-Anderson Type IIIC

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

Other

Submit

4) How would you manage this patient?

Nonoperative (includes bedside irrigation and debridement)

Operative

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

Other

Submit

5) If you choose Operative management, in addition to irrigation and debridement, what would be your definitive fixation?

I would not choose Operative management

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

Closed reduction percutaneous pinning (CRPP) only

Intramedullary nail fixation (includes flexible or rigid nails)

Open reduction internal fixation (ORIF) (includes sub muscular bridge plating, MIPO, and open techniques)

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

Other

Submit

6) If you choose Intramedullary nailing (IMN), what type of nail(s) would you use?

I would not choose IMN

Flexible IMN

Rigid IMN

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

Other

Submit

7) If you choose Flexible IMN, what technique would you use?

I would not choose Flexible IMN

1 retrograde nail

1 antegrade nail

2 retrograde nails

2 antegrade nails

1 retrograde + 1 antegrade nail

Other

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

Other

Submit

8) If you choose Flexible IMN, what type of nail would you select?

I would not choose Flexible IMN

Stainless steel

Titanium

Other

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

Other

Submit

9) If you choose Flexible IMN and attained the construct shown below, would you include supplementary immobilization post-operatively?

I would not choose Flexible IMN

Yes - splint

Yes - cast

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

Other

Submit

10) If you choose Flexible IMN and attained the construct shown below, when would you remove the implants?

I would not choose Flexible IMN

Never

4-6 weeks

7-12 weeks

4-6 months

7-9 months

10-12 months

>12 months

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

Other

Submit

CASE OUTCOMES

PROCEDURE 1: Debridement and irrigation, flexible intramedullary nail fixation
Post-procedure P1

EVIDENCE (19)

SHOW EVIDENCE

Sort by

L1\L2 Evidence

Date