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

Open Tibial Shaft Fracture in an 11M

0%
PRESENTATION
3
0%
POLLS
12,333
0%
OUTCOMES
2
0%
EVIDENCE
19
0%
Comments
17
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.
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
74%
(1006/1347)
Yes - Additional radiographs (XR)
12%
(171/1347)
Yes - CT scan of the leg (CT)
8%
(116/1347)
Yes - MRI scan of the leg (MRI)
0%
(10/1347)
Yes - CT + XR
1%
(20/1347)
Yes - MRI + XR
0%
(2/1347)
Yes - MRI + CT
0%
(3/1347)
Yes - MRI + CT + XR
0%
(1/1347)
Outside my area of expertise - best if I don't vote
1%
(18/1347)
2) Based on the presentation, would you involve Child Protective Services (CPS)?
No
75%
(960/1280)
Yes
17%
(220/1280)
-0.0
+0.0
+
Outside my area of expertise - best I don't answer
7%
(100/1280)
3) How would you classify this fracture?
I would not use a classification system - it would not help me
4%
(54/1301)
Gustilo-Anderson Type I
8%
(115/1301)
Gustilo-Anderson Type II
64%
(837/1301)
Gustilo-Anderson Type IIIA
14%
(195/1301)
-0.0
+0.0
+
Gustilo-Anderson Type IIIB
4%
(53/1301)
Gustilo-Anderson Type IIIC
0%
(11/1301)
Outside my area of expertise - best if I don't vote
2%
(36/1301)
4) How would you manage this patient?
Nonoperative (includes bedside irrigation and debridement)
3%
(47/1283)
Operative
95%
(1230/1283)
-0.0
+8.5
+
Outside my area of expertise - best if I don't vote
0%
(6/1283)
5) If you choose Operative management, in addition to irrigation and debridement, what would be your definitive fixation?
I would not choose Operative management
0%
(12/1298)
External fixation (ExFix) only (includes monoplanar, ringed circular fixation, etc)
20%
(272/1298)
Closed reduction percutaneous pinning (CRPP) only
11%
(145/1298)
-0.0
+9.0
+
Intramedullary nail fixation (includes flexible or rigid nails)
41%
(539/1298)
-0.0
+7.0
+
Open reduction internal fixation (ORIF) (includes sub muscular bridge plating, MIPO, and open techniques)
23%
(308/1298)
Outside my area of expertise - best if I don't vote
1%
(22/1298)
6) If you choose Intramedullary nailing (IMN), what type of nail(s) would you use?
I would not choose IMN
17%
(216/1230)
Flexible IMN
71%
(882/1230)
-0.0
+7.0
+
Rigid IMN
7%
(95/1230)
Outside my area of expertise - best if I don't vote
3%
(37/1230)
7) If you choose Flexible IMN, what technique would you use?
I would not choose Flexible IMN
11%
(134/1201)
1 retrograde nail
2%
(31/1201)
1 antegrade nail
6%
(78/1201)
2 retrograde nails
27%
(327/1201)
-0.0
+0.0
+
2 antegrade nails
42%
(508/1201)
1 retrograde + 1 antegrade nail
5%
(67/1201)
Other
0%
(4/1201)
Outside my area of expertise - best if I don't vote
4%
(52/1201)
8) If you choose Flexible IMN, what type of nail would you select?
I would not choose Flexible IMN
9%
(107/1150)
Stainless steel
13%
(159/1150)
Titanium
71%
(824/1150)
-0.0
+0.0
+
Other
0%
(6/1150)
Outside my area of expertise - best if I don't vote
4%
(54/1150)
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
6%
(68/1103)
No
10%
(113/1103)
Yes - splint
46%
(515/1103)
-0.0
+7.0
+
Yes - cast
34%
(381/1103)
-0.0
+9.0
+
Outside my area of expertise - best if I don't vote
2%
(26/1103)
10) If you choose Flexible IMN and attained the construct shown below, when would you remove the implants?
I would not choose Flexible IMN
5%
(62/1140)
Never
1%
(17/1140)
4-6 weeks
6%
(73/1140)
7-12 weeks
19%
(222/1140)
4-6 months
32%
(366/1140)
-0.0
+0.0
+
7-9 months
9%
(111/1140)
10-12 months
11%
(128/1140)
>12 months
11%
(127/1140)
Outside my area of expertise - best if I don't vote
2%
(34/1140)
CASE OUTCOMES
PROCEDURE 1: Debridement and irrigation, flexible intramedullary nail fixation
Post-procedure P1
https://upload.orthobullets.com/cases/101560/8e00d1a3-5718-450a-ae8c-1cad060c185a_screenshot_20200807-181956__01.jpg https://upload.orthobullets.com/cases/101560/38a1821d-fe80-4691-af8c-51df1f717fe0_screenshot_20200807-182041__01.jpg
EVIDENCE (19)
EXPERT COMMENTS