Tibial Fracture

Question 1

What things would to look for on physical examination of a pt with tibial fracture?

Answer 1

General - signs of head injury, look well

Obvious deformities, swelling, erythema, skin changes
Feel for pulses, tightness (compartment syndrome), temp
Move toes for passive flexion, ROM

Question 2

What investigations would you do for tibial fracture?

Answer 2

Bedside: Obs, ECG
Bloods: FBC, U&Es, G&S, Clotting screen.
Imaging: trauma series, CXR, X-ray - AP/lateral views

Question 3

What is the the initial management before theatre of a tibial fracture?

Answer 3

Realignment of tibia + analgesia/consiousis sedation
Above knee backslab
Elevate limb - compartment syndrome
Post manipulation x-ray + neurovascular status

Question 4

What are indications for urgent surgery in tibial fractures?

Answer 4

Compartment syndrome
Ischaemia limb
Open fracture

Question 5

What is the non surgical management for tibial fracture?

Answer 5

Sarmientio cast

Question 6

What surgical options for tibial fractures?

Answer 6

IM nail
ORIF
Temporary external frame fixation - if wound not possible cause wound

Question 7

Why is IM nail the preferred treatment?

Answer 7

High success and immediately weight bear

Question 8

What is the expected time for healing in tibial fractures?

Answer 8

Low energy - 10-13 weeks
High energy - 13-20 weeks
Type 3B & 3C open fracture requires 30-50 weeks for consolidation

Question 9

What are the complications of surgery for tibial fractures?

Answer 9

Infection, bleeding, damage to surrounding structures, compartment syndrome, malunion/non-union, DVT, anterior knee pain with IM nails