Posted: Apr 6 2021 #(C101741) 2017 Orthopaedic Summit (OSET 2017)

Tibial Shaft Fracture in 43F

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HPI

A 43-year-old female presented to the ED after falling out of a moving vehicle. She is unable to bear weight or ambulate. She denies pain in her other extremities and did not lose consciousness during the incident. She denies any numbness or tingling to the right lower extremity.

PMH

She has a history of type-2 diabetes mellitus. There is no other relevant medical history

Focused physical examination of the right lower extremity shows swelling and ecchymosis of the mid-leg and ankle without any open wounds. Bony crepitus is noted. She is neurovascularly intact. Compartments are soft and compressible.

Poll

1 of 9

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

1 No - radiographs are sufficient

2 Yes - additional radiographs (XR)

3 Yes - CT scan (CT)

4 Yes - MRI tibia (MRI)

5 Yes - XR + CT

6 Yes - XR + MRI

7 Yes - CT + MRI

8 Yes - XR + CT + MRI

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

Other

Submit

P: 130361

How would you manage this injury?

1 Nonoperative

2 Operative

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

Other

Submit

P: 130362

If you choose Operative management, which fractures would you fix?

1 I would not choose Operative management

2 Tibial shaft only

3 Posterior malleolus only

4 Tibial shaft and posterior malleolus

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

Other

Submit

P: 130363

If you choose Operative management of the tibial shaft fracture, which technique would you choose for definitive management?

1 I would not choose Operative management of the tibial shaft fracture

2 External fixation (ExFix) (includes monoplane, circular fixation)

3 Closed reduction percutaneous fixation 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 fixation (IMN + ORIF)

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

Other

Submit

P: 130364

If you choose Operative management of the tibial shaft fracture with intramedullary nailing (IMN), what approach would you choose?

1 I would not choose MN

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: 130366

If you choose Operative management of the tibial shaft fracture with intramedullary nailing (IMN), how many interlocking screws would you place distally?

1 I would not choose IMN fixation