Tibial Shaft Fractures Flashcards
What injuries are considered Gustillo Anderson Type III injuries?
1) Highly contaminated barnyard
2) Close range shotgun or high velocity GSW
3) presentation >24hrs from injury
What is acceptable alignment for non-op and casting of a tibial shaft fracture?
1) 50% cortical apposition
4)
What increase the risks of malunion in non-operatively treated tibia shaft fractures?
1) loss of reduction; shortening increased with oblique fxs
2) varus; if intact fibula
Compared to closed treatment, IM nailing of tibia shaft fractures have what advantage?
1) Decreased time to union
2) Decreased time to weight bear
Compared to ex-fix, IM nails have less incidence of malalignment
How are tibial shaft fractures treated in children with open physes?
External fixation, plating, casting or flex nails
What affect does reaming have on healing of tibia shaft fractures?
reaming does not negatively affect union, infection, or need for additional surgeries in open tibia fractures
What has the biggest effect on non-union with tibial shaft fractures?
Gapping at the fracture site
What substance can be used to increase union rate in open tibia shaft fractures?
rhBMP-2
accelerate early fracture healing
decrease need for subsequent bone-grafting
decrease need for secondary invasive procedures
decrease infection rate
In an open tibia shaft fracture what is the most important predictor for amputation?
Severity of ipsilateral soft tissue injury
In open tibia shaft fractures, other than timing of abx administration, what has the biggest effect on incidence of infection?
Transfer to a trauma center
What approach should be used when nailing proximal tibia fractures?
Lateral parapatellar
Medial parapatellar is most commonly used for other tibia shaft fxs
What is the starting point for tibial nails?
Medial to the lateral tibial spine on an AP, just anterior to the articular surface on a lateral
In proximal 1/3 fractures cheat starting point lateral
Describe the medial parapatellar approach for tibial nails?
1) incision from inferior pole of patella to just above tibial tubercle
2) identify medial edge of patellar tendon, incise
3) peel fat pad off back of patellar tendon
4) Standard starting point with guide wire
Proximal third tibia fractures have a higher incidence of what type of malunion?
Valus and procurvatum
IM nailing of tibia fractures have a high incidence of what complication?
Anterior knee pain; >50% a/w patellar splitting or paratendon approach
What is true regarding the center of rotation of angulation (CORA) as it refers to tibial diaphyseal angular deformity?
It is the point at which the proximal mechanical axis and distal mechanical axis meet
What is a technique for assessing rotation when nailing tibial shaft fractures?
Obtaining perfect lateral fluoroscopic image of knee, then rotating c-arm 105-110 degrees to obtain mortise view of ipsilateral ankle
What is the incidence of compartment syndrome in patients with tibial shaft fractures?
1-9%
During LISS plate application, which screw holes place the SPN at risk?
11-13
What type of tibia shaft fractures are at risk of varus malunion?
Tibia shaft fractures with intact fibula
Spiral distal tibial shaft fractures have a high association of what injury?
Posterior malleolus fractures; 39%
Must obtain a CT
When angular corrections are performed above or below the level of the apex of the deformity, which secondary deformity type commonly occurs?
Translational
How should a hypertrophic tibial non-union be treated?
Isolated exchange reamed interlocking nailing
What factor has been shown in a clinical trial to be equivalent to autologous bone graft for treatment of tibial nonunions that were treated with intramedullary nailing?
rhBMP-7
What is the most common type of malalignment after intramedullary nailing of distal 1/3 tibia fractures?
rotational (22%)
What percentage of patients will complain of knee pain at the time of union of a tibial shaft fracture treated with a reamed intramedullary nail?
50-75%
