may be done supine with bump under affected limb or in lateral position. Treatment can be nonoperative or operative depending on fracture displacement, ankle stability, presence of syndesmotic injury, and patient activity demands. Copyright 2023 Lineage Medical, Inc. All rights reserved. Diaphyseal tibial fractures are the most common long bone fracture. Fractures of the fibula can be described by anatomic position as proximal, midshaft, or distal. Rarely, a fracture of the fibula may be. It is caused by a pronation-external rotation mechanism. Nielson JH, Sallis JG, Potter HG, et al. At its most proximal part, it is at the knee just posterior to the proximal tibia, running distally on the lateral side of the leg where it becomes the lateral malleolus at the level of the ankle. 2023 Lineage Medical, Inc. All rights reserved. Fractures that involve syndesmotic injury or ankle or knee fracture often require surgical treatment. Fibular avulsion fractures most commonly occur from an inversion of the ankle that causes the ankle ligaments to pull a small piece of bone off of the end of the fibula. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. If a medial malleolar fracture is present, it should be repaired with open fixation. They account for 10 to 15 percent of all pediatric fractures. Patients are counseled that, although fibula fractures. Anteroposterior (A) and lateral (B) radiographic evaluation of the entire length of the fibula is essential to avoid missing a Maisonneuve fracture and the associated syndesmotic injury. Fractures may involve the knee, tibiofibular syndesmosis, tibia, or ankle joint. This is a fracture in the metaphysis, the part of tibia before it reaches its widest point. "use strict";var wprRemoveCPCSS=function wprRemoveCPCSS(){var elem;document.querySelector('link[data-rocket-async="style"][rel="preload"]')?setTimeout(wprRemoveCPCSS,200):(elem=document.getElementById("rocket-critical-css"))&&"remove"in elem&&elem.remove()};window.addEventListener?window.addEventListener("load",wprRemoveCPCSS):window.attachEvent&&window.attachEvent("onload",wprRemoveCPCSS); BONE DYSPLASIAS, METABOLIC BONE DISEASES, AND GENERALIZED SYNDROMES, THE ORTHOPAEDIC MANAGEMENT OF MYELODYSPLASIA AND SPINA BIFIDA, The Diagnosis and Management of Musculoskeletal Trauma, Surgical Reconstruction of the Lateral Collateral Ligament, Staying Out of Trouble with the Hip: The triangular shape of the fibula is dictated by the insertion points of the muscles on the shaft. Weber C Fractures : Wheeless' Textbook of Orthopaedics Treatment may be nonoperative or operative depending on patient age, fracture displacement, and fracture morphology. Usually, it gets worse with activity and better with rest. Maisonneuve fractures with syndesmotic injury imply injury to the medial side of the ankle joint. Fractures of the tibia and fibula are typically diagnosed through physical examination andX-rays of the lower extremities. Obtain AP and lateral views of the shafts of the tibia and fibula. paralyzed), or those unfit for surgery, angulation and rotational alignment are well maintained with casting, however, shortening is hard to control, risk of shortening higher with oblique and comminuted fracture patterns, risk of varus malunion with midshaft tibia fractures and an intact fibula, high success rate if acceptable alignment maintained, non-union occurs in approximately 1% of patients treated with closed reduction, all open tibia fractures require an emergent I&D, surgical debridement within 12-24 hours of injury, wounds should be irrigated and dressed with saline-soaked gauze in the emergency department before splinting, all open tibia fractures require immediate antibiotics, should be administered within 3 hours of injury, standard abx for open fractures (institution dependent), cephalosporin given continuously for 24 hours, after definitive surgery in Grade I, II, and IIIA open fractures, aminoglycoside added in Grade IIIB injuries, tetanus vaccination status should be confirmed and appropriate prophylaxis should be administered if necessary, early antibiotic administration is the most important factor in reducing infection, emergent and thorough surgical debridement is also an, must remove all devitalized tissue including cortical bone, open fractures with soft tissue defects/contamination, uniplanar, circular, hybrid external fixators all available, should be converted to intramedullary nail within 7-21 days, ideally less than 7 days, longer time to union and worse functional outcomes, high rate of pin tract infections; avoid intra-articular placement given risk for septic arthritis, unacceptable alignment with closed reduction and casting, soft tissue injury that will not tolerate casting, ipsilateral limb injury (i.e., floating knee), reamed nailing allows for larger diameter nail, provisional reduction techniques (blocking screws, plating, etc), particularly useful for proximal 1/3 tibial shaft fractures, for closed tibia fractures treated with nailing, risks for nonunion: gapping at fracture site, open fracture and transverse fracture pattern, shorter immobilization time, earlier time to weight-bearing, and decreased time to union compared to casting, decreased malalignment compared to external fixation, improved fracture alignment with suprapatellar nailing, reamed may have higher union rates and lower time to union than unreamed nails in closed fractures (controversial), reamed nails are safe for use with open fractures, with no evidence of decreased nonunion rates in open fractures, recent studies show no adverse effects of reaming (infection, embolism, nonunion), reaming with the use of a tourniquet is not associated with thermal necrosis of the tibial shaft, despite prior studies suggesting otherwise, higher rate of locking screw breakage with unreamed nailing, proximal tibia fractures with inadequate proximal fixation from IM nailing, distal tibia fractures with inadequate distal fixation from IM nail, tibia fractures in the setting of adjacent implant/hardware (i.e.
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