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RTA CASE SERIOUSLY INJURED

A RTA CASE A 45 years old ambulance driver seriously injured, bleeding continue, right leg damaged, tibia fibula fractured near of RAINBOW HOSPITAL . what will be the best management ?

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This is compound fracture of tibia and fibula mid shaft with gross laceration of muscles First ensure about the neuro vascular injury or not , clinically to see post tibial artery and arteria dorsalis pedis palpable or not. If palpable then to see for nerve test clinically. If palpable then clean the wound after irrigation with H2O2 and normal saline wash. Reduce the fracture end under visual control and apply external fixator.to maintain the position . Repair the muscles and to close layers as far as possible . Please put stitches not too tight to avoid compartment syndrome.then regular dressing and if necessary skin grafting may be planned if necessary. If there is vasular or nerve injury or both may be refd to higher center.for opinion of team of vascular/ plastic and orthopaedic surgeon .
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This is compound fracture of tibia and fibula mid shaft with gross laceration of muscles First ensure about the neuro vascular injury or not , clinically to see post tibial artery and arteria dorsalis pedis palpable or not. If palpable then to see for nerve test clinically. If palpable then clean the wound after irrigation with H2O2 and normal saline wash. Reduce the fracture end under visual control and apply external fixator.to maintain the position . Repair the muscles and to close layers as far as possible . Please put stitches not too tight to avoid compartment syndrome.then regular dressing and if necessary skin grafting may be planned if necessary. If there is vasular or nerve injury or both may be refd to higher center.for opinion of team of vascular/ plastic and orthopaedic surgeon .
Wash wound throughly with H2O2,NS and diluted betadine lotion under GA and antibiotics cover. Vitals and other bony and vessels damaged assessment and debridement and fracture fixation. Sature the wound and if possible X ray and bone displacement and fB. Inj TT.5 ml I'm stat. Maintain iv infusion line to inj ceftam 1gm iv slowly bd. Inj metrgyl 100ml bd. Inj tramadol 1 amp I'm bd than SOS. Multivitamin through iv drip if needed BT. POP and local support. Chymoral forte TDS . RTA police should be informed and prognosis explained to attendants.
Thanks Dr Taimoor Dr Taimoor
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Open fracture of TIbia and fibula. Gustillo Handerson iii b or iiic depending on the clinical assesment of the distal lower limb segment. Tibia fracture has high risk of open fracture Beacuse its subcutaneous bone. Need to wash out with Normal saline, Git TT vaccine if not given ABCDE for advanced life support for trauma. X ray for AP and Lateral views bases on the rule of two. Best managements is by OPEN REDUCTION AND EXTERNAL FIXATION
Compound #s both bones Monitor vitals Replacement of body fluids Check hb BT for loss Compartment syndrome is to be seen Check extent of damage and vital vessels and nerves Call the team of orthopaedician Plastic surgeon Vascular surgeon if need neurosurgeon Reduction and nail fixation of FRACTURE tibia Reconstruction of damage tissues vessels and nerves Closure in layers immobilization Physiotherapy
Thanx dr Maqusud Ansari
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Check distal neurovascular status If vessels are intact, Plan debridement and fracture fixation Secondary procedures will be needed for soft tissue reconstruction and fracture union. Otherwise need a team approach of vascular surgeons and trauma surgeons.
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Admit rt tibia fibula fracture check nerve & blood supply with power in lower extremity external fixator & stiching orthopedic vascular surgeon physician has role
First stop bleeding give transfusion if needed immediate reduction may lead to compartment syndrome so antibiotics and when oedema is settledconsider final treatment
One screw for tibial condylar # n pop splint. N if fracture lower down also, then external fixator.
Immobilization is must. I pray God for the recovery at the earliest.
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