Orthopedic case

Orthopedic case Chief Complaints Inabilty ti use left lower limb for 1 day. History 18 year old female Patient was apparently doin fine till 1 day prior hospital admission after she developed inability to use her left lower limb which occured suddenly after being involved in MTA after being knocked by motorcycle while crossinv the road, and thrown on the road pavements and sustaine an injury on the middle part of the leg being characterized by tenderness, swelling, and abnormal movements with no obvius skin laceration or bleeding. No loss of consoussness no convulsion. No asaociated injury. ROS PAST MEDICAL FAMILY SOCIAL all uneventful Vitals Bp 125/75mmhg Pr 92 beat/min rr 18 breath/min Spo2 98% Temp 37C Physical Examination Patient was alert GCS 15 not pale Not jaundice Not cyanosed Left lower limb immobiled on backslab Local EXAMINATION swelling middle part of the leg on its anterior aspect tender on touch Limited active movements at knwe and ankle joints Distal neurovascular status intact Investigations X ray taken showed communuted fracture of the mid shaft of tibia fibula with angular displacements of distal segment medial Fbc done HB 12 Plat 250 B+ Normal createnine and Urea Diagnosis Communuted mid shaft tibia and fibula Management Managements doctors

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Communuted # both bones of leg Lower 1/3 rd tibia has multiple fragments and displaced So is fibula #fragments are displaced Open reduction and realignment of tibial fragments with intramedullary nailing boe grafting in gap Fibula realignment and need no fixation as it will help in healing and preserving the length of limb Before commencing surgery manage compartment syndrome Secure blood loss replacement Volumic shock to be compensated Rest broadspectrum antibiotics Antiinflamatory

Thanx dr Kute Ankush
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Very bad closed fracture of tibia and fibula wherever bones are crushed at mid shaft level in to pieces Adv Circular external fixator - benefits of external fixation are early weight-bearing, faster functional recovery, correction of the tibial deformity, adequate reduction to appropriate limb length and Ability to facilitate wound coverage. External fixation offers ease of application, Limited effect on blood supply to the tibia, Preservation of microvascular structures of the tibia, Preservation of the periosteum and it's blood supply However because of severe fragmentation, there is a possibility of segmental bone loss which may need illizarov technique of bone lengthening for limb length correction

? COMMINUTED FRACTURES OF.. TIBIA AND FIBULA.. NEED'S.. ORTHOPEDIC SURGEON'S OPINION FOR FURTHER MANAGEMENT..

Tnx Dr Anil Gangani
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Since it is a closed injury and assuming skin is okay: Bridging plate tibia Bone grafting after 6 weeks Intramedullary nail for fibula for stability This look like a high velocity injury: Usually associated with soft tissue damage within. Wound care and iv antibiotics till wound stabilize

agree with @Kute Ankush @Pushker Bhomia @Sandeep Ghodekar Adv. to orthopedic surgeon Opinion and further procedure

Crushed fracture tibia fibula. Circular ext fixation seen.

Commuted # Tibia & fibula Ref to orthopaedic surgeon for treatment

Open reduction Orif

Fracture tibia fibulà

Comminuted fracture of tibia and fibula bone

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