Concluded Case

How to fix compound tibial fracture with significant bone loss

30 year old male with history of GUNSHOT injury on 8/12/2020, sustained open tibial fracture with loss of dorsalis pedis pulsations. Managed with Ex- Fix, primary repair of anterior tibial artery. Now came to our hospital, x ray is shown below. On examination patient has 1. Active discharge from proximal most pin 2. EHL power 0/5 3. Distal pulses + but reduced volume 4. Limb shortening of 3 cm Discuss the management options..

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If wound healed remove the ex-fix Check for infection Culture sensitivity Put him on above knee slab untill pin tract healing Once confirming seldom of infection Go for ilizarov ring fixator application along with fibular bone grafting.

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Look like frame in Antero lateral plane One option is change to LRS in antero medial plane Osteotomy and bone transport aimed to dock at fracture site eventually Technically speaking, it can be done with available bone

Could be osteomyelitis. Consider amoxyclav Clindamycine Netilmycin. Send discharge sample for culture and sensitivity test. Arterial Doppler study.

How to manage the bone defect and how to restore the limb length ?
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Compound butterfly #both bones of leg with h/o discharge It seems fixators are not keeping in situ callous seen in upper part but rest of gap is as it is and not in alignment I feel fixators should be removed first let infection to resolve Gap should be bonegrafted and healing achieved in bed rest Second possibility is illiasaver technique to achieve the length of leg Third possibility Intramedulary nailing with bone graft Ofcourse broadspectrum antibiotics and NSAIDs

Removing the fixator and keeping a comminuted fracture without stabilization by just bed rest is not advisable
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If wound healed remove the ex-fix Check for infection Culture sensitivity Put him on above knee slab untill pin tract healing Once confirming seldom of infection Go for ilizarov ring fixator application along with fibular bone grafting.

tibial shaft fracture:-A tibial shaft fracture is a break of the larger lower leg bone below the knee joint. This occurs along the long portion of the bone between the knee and ankle joints. These fractures usually result from high energy injuries accidents in younger pataint. The tibia can be broken into many pieces or just crack slightly depending on the quality of bone and the type of injury. Nonsurgical treatment is also recommended for adults with poor overall health, fragile or chronically infected skin, less active patients and in fractures with near perfect alignment. If non-operative care is chosen, regular follow-up care for a physical exam and x-rays is important to ensure that the fracture stays in good position and heals appropriately. Cutting down or quitting smoking and tight blood sugar control if you are a diabetic is important for the healing process. One fall or continued lack of compliance with casting, bracing or early walking against medical advice can cause bones to move and result in the need for surgery. Depending on health and injury pattern this bone can take 3-4 months to heal without surgery. In the initial few weeks, fractures treated without surgery tend to be painful or uncomfortable until the healing process matures over a few weeks. Physical therapy for knee and ankle range of motion is started around 6 weeks once bone has healed enough to prevent displacement with motion. Surgical Treatment Surgeons may recommend an operation to fix the broken tibia if the pieces are displaced, if the bone sticks out of the skin, if skin is at risk for dying or if the bone is unstable due to the fracture type. The tibia can be fixed with metal plates and screws placed through large incisions or intramedullary nails which use small incisions. The type of fracture usually dictates what type of metal and surgery needs to be done. The most common treatment for tibial shaft fractures is an intramedullary nail because it can be done with percutaneous small incisions, has a very high healing rate and patients can often bear weight and walk on this right after surgery. Metal plates and screws are used in children who need surgery to avoid the growth plates and in adults with fractures close to or involving the knee or ankle joints. Surgery usually takes 1 to 2 hours. Most patients are admitted overnight after tibial nailing procedures to watch for any breathing problems or development of compartment syndrome. In cases where there is severe injury to the muscles, nerves or arteries or there is significant contamination with dirt, rocks or grass from the injury, some patient require external fixation prior to definitive surgical treatment. This is an operation where metal pins are placed into the bone through small cuts and connected to bars to give some stability to the bone. After secondary operations to clean the wound or recovery of skin injuries, the external fixator can be removed and an intramedullary nail or plates and screws can be placed. Ideally, surgeons like to perform this surgery acutely or at most within 1-2 weeks of injury. Thus, patients have time to seek a second opinion regarding treatment if more information or additional surgeon input is desired. It is important to choose your surgeon wisely. Extensive surgical experience can be helpful in achieving a good result and avoiding complications. Collectively, ROC orthopedic surgeons have performed more tibia operations than any practice in Northern Nevada and take pride in outstanding surgical results. After surgery, patients are often placed in a splint or walking boot and often can bear weight immediately. If the smaller ankle bone (the fibula) is badly broken, weight bearing may be delayed. Gentle motion is begun early to prevent stiffness. Gradually this motion is increased and physical therapy is begun around 6 weeks after surgery if the patient has residual knee or ankle stiffness.

Compound fracture both bones leg with infection. With shortening. First c/ s. And appropriate A .B. if possible ilizrav technoque to achive lenth after bone. grafting. And continue A B. Completr bed rest with cast with window for dressing will help. Or refer to your near by Ortho surgeon whom you dont like and go ro bed.

Dx Compound Fracture ??? Adv. Refer to Orthopaedic Surgeon

Good post needs ORTHOPEDIC SURGEON OPENION

Exercise and physiotherapy

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