Tested Concept, Cast immobilization and use of a bone stimulator, (OBQ04.27) In order to prevent a missed injury that should be addressed during the same surgery, you order the following test Figure B shows a single entry wound located at the left distal humerus. He is also noted to have a grade 1 splenic laceration and lung contusion. At 4 months follow-up, despite some signs of healing, the fracture is not fully united. Tibial Plateau Fractures: Evaluation, Assessment and Treatment Thuan V. Ly, MD Ohio State University. the tibia is the most common site of post-surgical osteomyelitis following surgical treatment of open fractures, delay in defintive soft tissue coverage greater than 7 days. Patient should continue to be observed without intervention. What is the most likely explanation? Proximal tibia epiphyseal fractures are rare injuries seen in adolescents that may be associated with vascular injury. Radiographs are seen in Figures A and B. Upon arrival at the definitive treatment center, the patient is taken for formal debridement and external fixator application. Tested Concept, Internally rotated 45 degree view of the knee, (OBQ06.151) Intramedullary nailing (IMN) is occasionally chosen as fixation for low-grade femoral, or tibial, diaphyseal open fractures. prior studies have shown use in open tibial shaft fractures A 35-year-old male suffers the injury seen in Figures A and B following a motor vehicle collision. A tourniquet is used for the tibial nailing portion of the case, and the tibial isthmus is over reamed to accept a larger nail. 1995 Apr. Laboratory workup for infection is negative. Radiographs of the tibia and fibula are provide in Figures A and B. J Trauma. Although both extra-articular and intra-articular patterns occur with varying severity, the common concern in all of these injuries is the associated soft tissue injury. They represent a … He underwent irrigation and debridement of the wound with 9L of saline solution and was treated with reamed intramedullary nail fixation at 11:45PM. Management of open tibial shaft fractures begins with a thorough patient evalua- All of the following are factors that have been shown to increase infection risk EXCEPT: Tested Concept, TIme to transfer to definitive trauma center, (OBQ11.224) The Orthobullets Podcast In this episode, we review the high-yield topic of Tibial Plafond Fractures from the Trauma section. (OBQ13.196) low-pressure bulb irrigation vs. high-pressure pulse lavage Tested Concept, Tetanus vaccine and tetanus immune globulin, Tetanus vaccine and tetanus immune globulin with a booster vaccine required 6 months from now, Type in at least one full word to see suggestions list, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Motor Vehicle Collision Trauma: Case of the Week - Andrew Swiergosz, MD, 2019 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, Open Fractures: Unique Techniques - Alexandra Schwartz, MD (OTFC 2019, 2.3), What's New From the Swamp? He is a smoker, but is otherwise healthy. reaming does not negatively affect union, infection, or need for additional surgeries in open tibia fractures ; gapping at the fracture site is greatest risk for non-union . It also allows for early weight bearing and adjacent joint motion. Tested Concept, Decreased extensor hallucis longus strength, (OBQ11.54) He has an overlying 3 centimeter wound with exposed bone. A 30-year-old man presents with a distal third tibia fracture that has healed in 25 degrees of varus alignment. The treating surgeon, concerned that his hospital does not have a plastic surgeon available for soft-tissue coverage, arranges for transfer of the patient to a nearby level I trauma center for definitive care. MB BULLETS Step 1 For 1st and 2nd Year Med Students. The current clinical evidence does not support the superiority of reamed or unreamed nailing in the treatment open tibial shaft fractures. Ann Chir Gynaecol. Following surgery, she complains of numbness along the dorsum of her medial and lateral foot. In this episode, we review the high-yield topic of Open Fracture Management from the Trauma section. Physeal fractures about the ankle are the second most common physeal fracture, with only the distal radius being more common. Use of an un-reamed nail increased this patient's risk of non-union. What adjunct treatment has been shown to improve outcomes when using an intramedullary nail? Injury radiographs are shown in Figures A and B. The use of a tourniquet in this case has been most clearly shown to be associated with which of the following? Open fracture of the shaft of the tibia. ORTHO BULLETS Orthopaedic Surgeons & Providers Significant periosteal stripping and soft tissue injury, Significant soft tissue injury (often evidenced by a segmental fracture or comminution), vascular injury requiring repair. You decide to treat this fracture with intramedullary nailing. A 35-year-old male has a closed mid-shaft tibia fracture following a skiing accident. Ankle fractures and sprains, stress fractures of the fibula, and fibula fractures in children are reviewed separately. MB BULLETS Step 1 For 1st and 2nd Year Med Students. A 32-year-old male sustains the injury shown in Figure A and undergoes treatment as shown in Figure B.