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Tibial Fractures (Radiology (Mortise view: part of the 3 view series of…
Tibial Fractures
Radiology
Mortise view: part of the 3 view series of distal lower leg. Leg is rotated internally to assess articulation of tibial plafond and 2 malleoli with the talar dome
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Clinical presentation
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Examination: inspection, ROM & stability, neurovascular status
Tibial Plateau fractures
Background
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Mechanism
High Impact: young patients, associated with soft tissue injuries
Low impact: old patients, usually insufficiency fractures
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Associated conditions: meniscal tears, ACL injury, compartment syndrome
Management
Operative
Options: external fixation, ORIF, etc
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Non-operative
Indications: minimally displaced fracture, low energy mechanism with minimal varus/valgus alignment, nonambulatory patients
Hinged knee brace, PWB for 8-12 weeks, immediate passive ROM
Not performed very often, most patients receive operative management
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Tibial shaft fractures
Background
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Associated conditions: soft tissue injury, compartment syndrome, bone loss, ipsilateral skeletal injury
Mechanism
Low energy: indirect trauma or torsional injury, associated with fibular fracture at different level, minimal soft tissue injury
High energy: direct trauma, fibula fracture at the same level, significant soft tissue injury
Management
Non-operative
Indications: closed, low energy fractures, acceptable alignment, unfit for surgery
Closed reduction, long leg cast and conversion to functional brace at 4 weeks
Operative
Options: external fixation, IM nailing, percutaneous lock in plate
Tibial plafond fractures
Background
Mechanism
High energy axial load e.g. MVA, fall from height
Associated conditions: fibula fracture (75%), soft tissue injury, neurovascular injury
Management
Non-operative
Indications: stable fracture w/o articulation surface displacement or if significant risk of skin problems (e.g. PVD, DM)
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Operative
Temporizing spanning external fixation (for up to 2 wks) across ankle joint to provide stabilisation allow soft tissue healing
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