Leg Injuries Flashcards
What is a tibial plafond injury?
Pilon (pestil) tibial plafond fracture: axial force drives the talus into the articular surface of the tiba, causing a grinding/crushing injury (mortar and pestle)
Tibial plafond injuries are associated with?
Pilon fractures may be accompanied by
- compartment syndrome or
- vertebral body fractures, (L1)
MOI for tibial plafond injury
High energy: MVC, includes significant soft tissue and bone injury
Low energy: skiing, minimal soft tissue and bone injury
Management of tibial plafond injury (imaging)
Radiographs may not show the full extent of damage
- get a CT after splinting to better show fracture planes and articular surface damage extent
Goal of treatment of tibial plafond injury
Reduction of fragments and optimal alignment of articular surface soft tissue damage
Why would ortho delay tibial plafond repair?
Soft tissue damage affects their ability to repair.
If significant enough they may opt to do external fixation and do definitive repair when it has healed.
Open fracture management basics
Clean, debride, remove FOB
Copious irrigation
Tetanus
Splint (before radiographs)
Parenteral abx
- (cephazola/ancef 1g)
MC open fracture in long bones?
Tibial shaft - minimal subcutaneous tissue
Guistillo grade I
Open fracture: break in skin less than 1cm
Gustillio grade II
Laceration 1-10cm
W/o
- extensive soft tissue damage
- flaps
- avulsions
Gustilio grade IIIa
Segmental fracture of severely comminuted fracture fragments
With periosteal stripping
- extensive contamination
- no NV injury
Gustilio grade IIIb
Extensive soft tissue loss with periosteal stripping and bony exposure
- extensive contamination
- no NV injury
Requires replacement of bone with a free flap for coverage
Gustilio grade IIIc
Extensive fracture with major arterial injury requiring repair
- severe comminution
- extensive contamination
- no NV injury
