Tibial Shaft Fractures

Question 1

What injuries are considered Gustillo Anderson Type III injuries?

Answer 1

1) Highly contaminated barnyard
2) Close range shotgun or high velocity GSW
3) presentation >24hrs from injury

Question 2

What is acceptable alignment for non-op and casting of a tibial shaft fracture?

Answer 2

1) 50% cortical apposition

4)

Question 3

What increase the risks of malunion in non-operatively treated tibia shaft fractures?

Answer 3

1) loss of reduction; shortening increased with oblique fxs

2) varus; if intact fibula

Question 4

Compared to closed treatment, IM nailing of tibia shaft fractures have what advantage?

Answer 4

1) Decreased time to union
2) Decreased time to weight bear

Compared to ex-fix, IM nails have less incidence of malalignment

Question 5

How are tibial shaft fractures treated in children with open physes?

Answer 5

External fixation, plating, casting or flex nails

Question 6

What affect does reaming have on healing of tibia shaft fractures?

Answer 6

reaming does not negatively affect union, infection, or need for additional surgeries in open tibia fractures

Question 7

What has the biggest effect on non-union with tibial shaft fractures?

Answer 7

Gapping at the fracture site

Question 8

What substance can be used to increase union rate in open tibia shaft fractures?

Answer 8

rhBMP-2
accelerate early fracture healing
decrease need for subsequent bone-grafting
decrease need for secondary invasive procedures
decrease infection rate

Question 9

In an open tibia shaft fracture what is the most important predictor for amputation?

Answer 9

Severity of ipsilateral soft tissue injury

Question 10

In open tibia shaft fractures, other than timing of abx administration, what has the biggest effect on incidence of infection?

Answer 10

Transfer to a trauma center

Question 11

What approach should be used when nailing proximal tibia fractures?

Answer 11

Lateral parapatellar

Medial parapatellar is most commonly used for other tibia shaft fxs

Question 12

What is the starting point for tibial nails?

Answer 12

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

Question 13

Describe the medial parapatellar approach for tibial nails?

Answer 13

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

Question 14

Proximal third tibia fractures have a higher incidence of what type of malunion?

Answer 14

Valus and procurvatum

Question 15

IM nailing of tibia fractures have a high incidence of what complication?

Answer 15

Anterior knee pain; >50% a/w patellar splitting or paratendon approach

Question 16

What is true regarding the center of rotation of angulation (CORA) as it refers to tibial diaphyseal angular deformity?

Answer 16

It is the point at which the proximal mechanical axis and distal mechanical axis meet

Question 17

What is a technique for assessing rotation when nailing tibial shaft fractures?

Answer 17

Obtaining perfect lateral fluoroscopic image of knee, then rotating c-arm 105-110 degrees to obtain mortise view of ipsilateral ankle

Question 18

What is the incidence of compartment syndrome in patients with tibial shaft fractures?

Answer 18

1-9%

Question 19

During LISS plate application, which screw holes place the SPN at risk?

Answer 19

11-13

Question 20

What type of tibia shaft fractures are at risk of varus malunion?

Answer 20

Tibia shaft fractures with intact fibula

Question 21

Spiral distal tibial shaft fractures have a high association of what injury?

Answer 21

Posterior malleolus fractures; 39%

Must obtain a CT

Question 22

When angular corrections are performed above or below the level of the apex of the deformity, which secondary deformity type commonly occurs?

Answer 22

Translational

Question 23

How should a hypertrophic tibial non-union be treated?

Answer 23

Isolated exchange reamed interlocking nailing

Question 24

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?

Answer 24

rhBMP-7

Question 25

What is the most common type of malalignment after intramedullary nailing of distal 1/3 tibia fractures?

Answer 25

rotational (22%)

Question 26

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?

Answer 26

50-75%