Fracture: Leg

Question 1

typical moi of tibial shaft #?

Answer 1

torsional injury (leads to spiral fracture) or direct force to leg (leads to wedge fracture with possible fibular # too)

Question 2

presentation of tibial shaft #?

Answer 2

inability to WB
pain
deformity

Question 3

clinical signs of tibial shaft #?

Answer 3

i: deformity/angulation/malrotation
p: check for compartment syndrome
m: crepitus
nv: check DP and PT pulses, check DP/DP/sural/tibial/saphenous distribution

Question 4

how are tibial shaft # diagnosed?

Answer 4

plain x-ray

Question 5

mx of tibial shaft #?

Answer 5

if closed, non-operative: closed reduction and immobilisation

if open,
surgical reduction and intramedullary nail or IN RARE CASES ORIF or external fixation

all open tibia fractures need surgical debridement within 12-24h of injury before splinting and abx within 3h of injury

Question 6

comps of tibial shaft #?

Answer 6

compartment syndrome
NV compromise
soft tissue injury
bone loss

Question 7

most common long bone fracture?

Answer 7

diaphyseal tibial fractures

Question 8

what is a bowing fracture?

Answer 8

incomplete fractures of long bones in paediatric patients
occur when angulated longitudinal force is applied to a bone and it bends

Question 9

what does xray show in bowing fractures?

Answer 9

bowing can be seen if xray is taken in a different plane to the direction of bowing BUT no visible fracture line or cortical injury

Question 10

what does microscopy show in a bowing fracture?

Answer 10

microfractures along concave border of bone