Dyaphiseal fracture of the crus – open and closed.

Question 1

what are the open classification of tibial fractures ?

Answer 1

GUSTILO ANDERSON CLASSFICATION

grade 1 - clean open wound which is less than 1 cm
simple fracture pattern

grade 2 = 1-10cm
without significant soft tissue crushing
simple fracture pattern

grade 3 - more than 10 cm
and there is contamination
with significant soft tissue injury
3a - there is adequate tissue for closure

3b - patient would need flap due to inadequate soft tissue coverage
Treat proximal 1/3 fxs with gastrocnemius rotation flap,
middle 1/3 fxs with soleus rotation flap,
distal 1/3 fxs with free flap

3c - has vascular injury requiring repair or amputation indicated by segmented or comminuted fracture type

segmental fractures are grade three even if the open fracture is 1cm

Question 2

what is the indication for amputation in open tibial fractures ?

Answer 2

warm ischemia for more than 6 hours, absent plantar sensation , several ipsilateral foot trauma

Question 3

before we do surgery for open tibial fractures what needs to e done ?

Answer 3

need to give antibiotic prophylactic and meticulous debriment

Question 4

what is the classification of closed fracture of the tibia ?

Answer 4

ota classification

soft tissue injury classification
grade 0 - negligible soft tissue damage from indirect forces

grade 1 - superficial abrasion with simple fractures

grade 2 - deep abrasion with muscle and skin contusion
impending compartment syndrome

grade 3 - excessive skin contusion , destruction of muscle , acute compartment syndrome
rupture of major blood and vessels

Question 5

what are the indication for closed reduction

Answer 5

closed reduction and cast immobilisation
less than 5 degree varus or valgus angulation
less than 10 degree anterior or posterioir angulation
more than 50 percent cortical contact
less than 10 degree rotational malalignmnet

place in a long leg cast and convert to functional brace at weeks

Question 6

what are the operative ways ?

Answer 6

is not meeting the non operative criteria
most open fractures , segmental fractures , comminuted fractures
ipsilateral tibia fracture

open reduction and intramedullary nail fixation

reamed nail is superior in closed tibial fractures but not open tibial fractures

but reaming can cause disruption of endosteal blood supply , thermal necrosis , fat embolism and intramedullary infection

unreamed rods uses smaller nails but preserves ensoteal blood supply

Question 7

open tibial fractures can lead to what sort of problems ?

Answer 7

osteomyelitis
nonunion
infected nonunion

Question 8

what causes tibial fractures ?

Answer 8

high-energy collision
direct forces often result in wedge or short oblique fx comminution
fibula fx at same level
severe soft tissue injury

low energy
typically caused by a twisting force and result in an oblique or spiral fracture

Question 9

what are the complication in tibial fractures

Answer 9

anterior knee pain with IM nailing occurs with patellar tendon splitting for operational purposes

malunion - valgus and procurvatum

compartment syndrome