This a case of a traumatic progressively displaced DTMF despite cast . This medication is given in an effort to decrease the incidence of which of the following? What is the most appropriate Gustilo classification and initial treatment for her injury? When considering the principles of deformtiy surgery, it should be noted that angular corrections performed as opening or closing wedges NOT at the level of the apex of the deformity will create which of the following secondary deformities? 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Fracture Non-Spanning External Fixator, Distal Radius Fracture Spanning External Fixator, Type in at least one full word to see suggestions list, 7th Annual Frontiers in Upper Extremity Surgery, Nonoperative Treatment of Distal Radius Fractures - Michael Bednar, MD, Dorsal Plating of Radius Fractures - Nader Paksima, DO, MPH, Fragment Specific Fixation Distal Radius Fractures - Mark Rekant, MD, 12th Annual Orthopaedic Trauma: Pushing The Envelope. He has tenderness to palpation over the anterior tibia with minimal swelling. Radiographs are provided in Figures A and B. (OBQ18.74) (OBQ05.25) (OBQ09.254) A 35-year-old male suffers the injury seen in Figures A and B following a motor vehicle collision. Radiographs show a well-fixed fracture in good alignment. Which of the following has evidence to support its utility in this clinical situation? - A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. What is the likely mechanism of her paresthesias and what is the most appropriate treatment? Treatment is generally operative with temporary external fixation followed by delayed open reduction internal fixation once the soft tissues permit. Displacement greater than or equal to 3 mm can be treated with closed reduction followed by a cast; if closed reduction fails, open reduction is indicated. During postoperative recovery from this injury, what benefit does formal physical therapy have as compared to a patient-guided home exercise program? She undergoes simultaneous external fixation and ORIF using minimally invasive plate osteosynthesis. What would be the most appropriate sequence of treatment steps for definitive management of this injury? Due to the asymmetrical closure of the distal tibial physis (Figure 1) during early adolescence, transitional fractures can also occur. After debridement and external fixation, he is taken to the operating room for definitive soft tissue flap coverage and intramedullary nailing. It is a safe procedure if the correct timing is respected, usually 5-10 days after initial trauma. Intramedullary nailing is performed without initial complications. (OBQ16.228) Following placement of this implant, what is the best technique to confirm it is not too proud proximally? open reduction internal fixation of the fibula only, open reduction internal fixation of the tibia and fibula, removal of external fixator and conversion to a walking cast. Continued use of knee-spanning external fixator, Conversion of external fixator to a simple hinged knee fixator, Open reduction and internal fixation with a lateral locked plate, Open reduction and internal fixation with medial and lateral plates. Following surgery, she complains of numbness along the dorsum of her medial and lateral foot. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work? (OBQ10.175) (OBQ18.177) Thank you. (OBQ13.196) (SBQ13PE.95.1) Treatment is immobilization or surgery, depending on the displacement and stability of the distal clavicle, as determined by whether coracoclavicular (CC) ligaments (trapezoid and conoid) are intact. Occasionally, they involve the shaft of the fibula as well. According to meta-analysis and systematic reviews, which of the following statements is most accurate regarding her injury? Distal Tibia Fracture. (OBQ11.54) (OBQ09.86) (OBQ11.224) (OBQ08.179) Current radiographs are shown in Figure D and a clinical photograph of the affected wrist is shown in Figure E. Which of the following is the most likely cause for failure of fixation in this patient? Olecranon Fracture ORIF with Plate Fixation. At 4 months follow-up, despite some signs of healing, the fracture is not fully united. Which of the following substances has been shown to result in the least radiographic subsidence when combined with open reduction and internal fixation? Distal femur fracture. Which of the following puts this patient at greatest risk for tibial nonunion? Evaluation of volar compartment pressures with a needle monitor, Icing and elevation of the arm with follow-up evaluation in 8 hours, Immediate EMG evaluation of the left upper extremity, Closed reduction, carpal tunnel release, and sugar tong splinting, Emergent open reduction internal fixation with carpal tunnel release. Which of the following is true regarding the center of rotation of angulation (CORA) as it refers to tibial diaphyseal angular deformity? Radiographs are shown in Figures A and B. FOOSH), high incidence of distal radius fractures in women > 50 years old, DEXA scan is recommended for women with distal radius fractures, fall on outstretched hand (FOOSH) is most common in older population, higher energy mechanism more common in younger patients, includes the radial styloid and scaphoid fossa, attachment sites for the brachioradialis tendon, long radiolunate ligament, and radioscaphocapitate ligament, serves as a buttress to resist radial carpal translation, functions as a load-bearing platform for activities performed with the wrist in ulnar deviation, holds the carpus out to length radially, allowing a more uniform distribution of load across the scaphoid and lunate facets, serves as an anchor for the radioscaphocapitate ligament that prevents ulnar translation of the carpus, transmits load from the carpus to the forearm, based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fracture, divides intra-articular fractures into 4 types based on displacement, Depressed fracture of the lunate fossa of the articular surface of the distal radius, Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip (volar Barton or dorsal Barton fx), Low energy, dorsally displaced, extra-articular fx, Low energy, volarly displaced, extra-articular fx, usually a fall onto outstretched hand (FOOSH), Dorsal angulation < 5 or within 20 of contralateral distal radius, dorsal angulation < 5 or within 20 of contralateral distal radius, extra-articular fracture with stable volar cortex, 82-90% good results if used appropriately, radiographic findings indicating instability (pre-reduction radiographs best predictor of stability), dorsal angulation > 5 or > 20 of contralateral distal radius, displaced intra-articular fractures > 2mm, associated ulnar styloid fractures do not require fixation, articular margin fractures (dorsal and volar Barton's fractures), the volar ulnar corner (critical corner) supports the volar lunate facet with its strong radiolunate ligament attachments, failure to address this fragment can result in volar carpal subluxation, comminuted and displaced extra-articular fractures (Smith's fractures), progressive loss of volar tilt and radial length following closed reduction and casting, medically unstable patients unable to undergo a lengthy procedure, important adjunct with 80-90% good/excellent results, therefore usually combined with percutaneous pinning technique or plate fixation, apply longitudinal traction and volar/dorsal pressure to the distal fracture fragment, avoid positions of extreme flexion and ulnar deviation (Cotton-Loder Position), no significant benefit of physical therapy over home exercises for simple distal radius fractures treated with cast immobilization, radial shortening is the most predictive of instability, followed by dorsal comminution, dorsal comminution > 50%, palmar comminution, intraarticular comminution, higher loss of reduction with 3 or more of LaFontaine criteria, Meta-analyses and systematic reviews demonstrate no difference in functional outcomes between closed treatment versus operative methods in elderly patients (>65 years old), K wires are placed dorsally into the fracture and used as reduction tools until they are driven into the proximal radius, Rayhack technique with arthroscopically assisted reduction, distal radius extra-articular fracture ORIF with volar approach, distal radius intra-articular fracture ORIF with dorsal approach, associated with plate placement distal to watershed area, the most volar margin of the radius closest to the flexor tendons, can have hyperesthesia over the base of the thenar eminence due to palmar cutaneous nerve injury during retraction of the digital flexor tendons when plating the distal radius, new volar locking plates offer improved support to subchondral bone, intra-articular distal radius fractures with dorsal comminution, can combine with external fixation and percutaneous pinning, volar lunate facet fragments may require fragment-specific fixation to prevent early postoperative failure, screw penetration into the radiocarpal joint or DRUJ, assess intra-articular screws with a 23 degree elevated lateral view, assess dorsal cortex penetration with a skyline view, no benefit of therapist-directed physical therapy compared to home exercise program, distal radius fracture spanning external fixator, distal radius fracture non-spanning external fixator, place radial shaft pins under direct visualization to avoid injury to superficial radial nerve, and excessive volar flexion and ulnar deviation, pin site care comprising daily showers and dry dressings recommended, prevent by avoiding immobilization in excessive wrist flexion and ulnar deviation (Cotton-Loder position), progressive paresthesias, weakness in thumb opposition, paresthesias that do not respond to reduction and last > 24-48 hours, nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the EPL tendon, extensor mechanism is thought to impinge on the tendon following a nondisplaced fracture and causes either a mechanical attrition or a local area of ischemia in the tendon, volar plating with screw fixation that penetrates the dorsal cortex and is proud dorsally, very distal volar plate placement on the radius (distal to watershed line) is associated with FPL rupture, due to physical contact of tendon on plate and subsequent tendinopathy, 90% young adults will develop symptomatic arthrosis if articular stepoff > 1-2mm, delayed procedure associated with higher need for bone grafting and a more difficult procedure, radial shortening associated with greatest loss of wrist function and degenerative changes in extra-articular fractures, AAOS 2010 clinical practice guidelines recommend, early efforts to regain motion of wrist and fingers, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. (OBQ05.113) Nerve compression; open reduction internal fixation with open carpal tunnel release, Nerve laceration; open reduction internal fixation with primary nerve repair or grafting, Decreased arterial inflow; fasciotomy with open reduction internal fixation, Nerve compression; repeat closed reduction. This is a fracture in the metaphysis, the part of tibia before it reaches its widest point. Adequate maintenance of reduction by non-operative treatment is unsuccesful. Which of the following distal radius fractures is associated with volar translation of carpus relative to the radial articulation? Gustilo 3A with spanning external fixation and delayed definitive fixation with soft tissue coverage, Gustilo 3A with immediate medial and lateral plating followed by delayed soft tissue coverage, Gustilo 3B with spanning external fixation and delayed definitive fixation with soft tissue coverage, Gustilo 3B with immediate medial and lateral plating followed by delayed soft tissue coverage, Gustilo 3C with spanning external fixation and delayed definitive fixation with soft tissue coverage. compared to IM nailing of tibia fractures: increased risk of wound complications and hardware irritation, similar rates of union in closed fractures, greater radiation exposure intraoperatively, risk of damage to the superficial peroneal nerve during percutaneous screw insertion, holes 11,12, and 13 (proximally) of a 13 hole plate place nerve at risk, prior studies have demonstrated some use in, outcomes (controversial, as recent studies have not fully supported these findings), decrease need for subsequent autologous bone-grafting, decrease need for secondary invasive procedures, no current scoring system to determine if an amputation should be performed, relative indications for amputation include, most important predictor of eventual amputation is the severity of ipsilateral extremity, most important predictor of infection other than early antibiotic administration is transfer to definitive trauma center, study shows no significant difference in functional outcomes between amputation and salvage, loss of plantar sensation is not an absolute indication for amputation, functional (patellar tendon bearing) brace at around 4 weeks, close follow-up with repeat radiographs to ensure no displacement, can wedge cast to correct slight deformity, within 24 hours of initial injury to decrease risk of infection, sharp debridement of nonviable soft tissue & bone, thorough irrigation of contaminated wound, immediate closure of open wounds is acceptable if minimal contamination is present and is performed without excessive skin tension. Distal Humerus Fractures are traumatic injuries to the elbow that comprise of supracondylar fractures, single column fractures, column fractures or coronal shear fractures. We help you diagnose your Distal tibia case and provide detailed descriptions of how to manage this and hundreds of other pathologies. A large posteromedial tibial plateau fracture pattern, as seen with the bicondylar tibial plateau fracture shown in Figures A and B, is important to recognize because of which of the following factors? Thank you. What is the optimal surgical plan? Radiographs following cast placement are provided in Figures C and D. The decision is made to proceed with closed treatment instead of operative. A tourniquet is used for the tibial nailing portion of the case, and the tibial isthmus is over reamed to accept a larger nail. Lower extremity equivalent of galeazzi fracture. Coronal and sagittal CT scan images are shown in Figures D and E. What is the MOST appropriate next step in management in addition to operative irrigation and debridement? Radiopaedia.org, the wiki-based collaborative Radiology resource Radiographs are shown in Figure A and B. This paper was presented at the OTA 2021 Annual Meeting. (OBQ10.217) Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. account for <10% of lower extremity injuries, incidence increasing as survival rates after motor vehicle collisions increase, talus is driven into the plafond resulting in articular impaction of the distal tibia, low energy rotational forces (less common), fracture patterns and comminution determined by position of foot, amplitude of force, and direction of force, 30% have an ipsilateral lower extremity injury, distal tibia forms an inferior quadrilateral surface and pyramid-shaped medial malleolus articulates with the talus and fibula laterally via the fibula notch, anterior-inferior tibiofibular ligament (AITFL), originates from anterolateral tubercle of tibia (Chaput), inserts on anterior tubercle of fibula (Wagstaffe), posterior-inferior tibiofibular ligament (PITFL), originates from posterior tubercle of tibia (Volkmann), inserts on posterior part of lateral malleolus, distal continuation of the interosseous membrane, Simple displacement with incongruous joint, ankle tenderness, swelling, abrasions, ecchymosis, fracture blisters, open wounds, and chronic skin/vascular changes, examine for associated musculoskeletal injuries, consider ABIs and CT angiography if clinically warranted, check for signs/symptoms of compartment syndrome, full-length tibia/fibula and foot x-rays performed for fracture extension, lumbar films if appropriate based on exam, important to obtain after spanning external fixation as ligamentotaxis allows for better surgical planning, stable fracture patterns without articular surface displacement, critically ill or non-ambulatory patients, significant risk of skin problems (diabetes, vascular disease, peripheral neuropathy), intra-articular fragments are unlikely to reduce with manipulation of displaced fractures, inability to monitor soft tissue injuries is a major disadvantage, acute management of most length unstable fractures, provides stabilization to allow for soft tissue healing and monitoring, capsuloligamentotaxis to indirectly reduce the fracture by tensioning the soft tissues about the ankle, fractures with significant joint depression or displacement, leave until swelling resolves (generally 10-14 days), not always warranted in length stable pilon fractures, placement of pins out of the zone of injury and planned surgical site is important to reduce infection risks, definitive fixation for a majority of pilon fractures, limited or definitive ORIF can be performed acutely with low complications in certain situations, high rates of wound complications and infections are associated with early open fixation through compromised soft tissue, brake travel time returns to normal 6 weeks after weight bearing, not a necessary step in the reconstruction of pilon fractures, may be helpful in specific cases to aid in tibial plafond reduction or augment external fixation, external fixation/circular frame fixation alone, select cases where bone or soft tissue injury precludes internal fixation, thin wire frames and hybrid fixators have high union rate, osteomyelitis and deep infection are rare, meta-analysis comparing this method with open reduction and internal fixation found no difference in infection or complication rates between the two groups, alternative to ORIF for fractures with simple intra-articular component, minimizes soft tissue stripping and useful in patients with soft tissue compromise, increased valgus malunion and recurvatum seen with IMN compared to plate osteosynthesis, severely comminuted, non-reconstructable plafond fractures, select elderly populations who cannot tolerate multiple surgeries or prolonged immobilization, theorized quicker recovery process and decreased long term pain, increases the risk of adjacent joint arthritis including the subtalar joint and midfoot, long leg cast for 6 weeks followed by fracture brace and ROM exercises, close follow-up and imaging needed to ensure articular congruity and axial alignment, fixator constructs vary with delta and A frames assemblies being most common, 2 tibial shaft half pins outside the zone of injury connected to a single transcalcaneal pin, consider trans-navicular pin if associated calcaneal fracture, consider connecting fixator to the forefoot 1, joint-spanning articulated vs. nonspanning hybrid ring, none have been shown to be superior with respect to ankle stiffness, can combine with limited percutaneous fixation using lag screws, anatomic articular reconstruction may not be possible, especially with central depression, tibial shaft is used as a fixation base to reduce the fracture, two half-pins in the AP plane with rings in an orthogonal position, used to support the distal fixation rings, determined by the configuration of the fracture and the soft-tissue injury, rings placed at the level of the plafond or calcaneus to distract and reduce the fracture, pins should be placed at least 1-2 cm from the joint line in order to avoid possible septic arthritis, safe zones for wire placement form a 60-degree arc in the medial-lateral plane, can include limited internal fixation if soft tissues permit, consider the need for soft tissue coverage with position of the fixator, provides better fixation and decreases frequency of loosening, once skin wrinkles present, blister epithelization, and ecchymosis resolution (10-14 days), single or multiple incisions based on fracture pattern and goals of fixation, keep full thickness skin bridge >7cm between incisions, positioning of patient dependent on approach(es) being utilized, useful with fractures impacted in valgus or with an intact fibula, goal is for anatomic reduction of articular surface, location of plates/screws are fracture and soft-tissue dependent, consider provisionally leaving the external fixator in place, can be with intramedullary screw/wire or plate/screw construct, ankle ROM exercises beginning 2 weeks post-op, non-weightbearing for ~6-12 weeks depending on radiographic evidence of fracture consolidation, debride fibrous tissue, fracture callous, and cartilage, small comminuted articular fragments are removed, pack metaphyseal defects and the tibiotalar joint with autologous or allograft bone graft, fixation with an anterior plate and screw construct, progress weight bearing between 8 and 12 weeks in removable boot, full weight bearing with ankle brace at 12 weeks post-op, CT at 3 months to assess for successful fusion, tibiotalocalcaneal (TTC) fusion with retrograde intramedullary nail, accelerates transverse tarsal joint arthritis, wait for soft tissue edema to subside before ORIF (1-2 weeks), free flap for postoperative wound breakdown, significant soft tissue swelling at time of definitive surgery, irrigation and debridement, antibiotics, possible hardware removal, joint-preserving correction with secondary anatomic reconstruction, must rule out infected non-union (labs to obtain CRP, ESR, WBC), other non-union labs (PTH, calcium, total protein, serum albumin, vitamin D, TSH), chondrocyte cell death at fracture margins is a contributing factor, IL-6 is elevated in the synovial fluid following an intra-articular ankle fracture, most commonly begins 1-2 years postinjury, first line is conservative management (bracing, injections, NSAIDs, activity modification), Poor outcomes and lower return to work associated with, Outcomes correlate with severity of the fracture pattern and the quality of reduction, at 2 year follow-up, the majority of type C pilon fractures report lower SF-36 scores than patients with pelvic fractures, AIDS, or coronary artery disease, clinical improvement seen for up to 2 years after injury, 6 weeks after initiation of weight bearing, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Ipsilateral hip joint degenerative changes, Contralateral hip joint degenerative changes, Ipsilateral medial knee degenerative changes. Inability to flex the index finger proximal interphalangeal joint. During operative fixation, free osteoarticular fragments are encountered and reconstruction of these pieces is attempted. Patella fracture. Tibial plateau fractures are periarticular injuries of the proximal tibia frequently associated with soft tissue injury. A clinical photo and radiograph are shown in Figure A and B. (OBQ05.157) Distal Radius Fractures are the most common site of pediatric forearm fractures and generally occur as a result of a fall on an outstretched hand with the wrist extended. (OBQ04.216) Physical exam shows a deformed left lower extremity with a 1-cm open wound over the anterolateral aspect of his leg. Decreased extensor hallucis longus strength. A 21-year-old male undergoes intramedullary nailing of the closed tibial shaft fracture shown in Figure A. A 25-year-old male pedestrian sustained a Type II open tibia fracture after being struck by a car at 10:00PM. (OBQ12.73) A 63-year-old female sustained a distal radius and associated ulnar styloid fracture 3 months ago after being involved in a motor vehicle collision. Distal femur fracture. He has a 2 cm laceration over the medial ankle with exposed bone and a normal neurovascular exam. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. After completing instrumentation, radiocarpal screw penetration is best assessed on which fluoroscopic view? Partial articular. (OBQ04.69) more common in diaphyseal tibial shaft fractures than proximal or distal tibia fractures 8.1% risk in diaphyseal fractures, compared to proximal (1.6%) and distal (1.4%) fractures can occur even in the setting of an open fracture Fractures of the Distal Tibial Metaphysis with Intra-articular ExtensionThe Distal Tibial Explosion Fracture Article Sep 1979 J TRAUMA James F Kellam J.P. Waddell View Show abstract. It is the point at which the proximal mechanical axis and distal mechanical axis meet, It is the point at which the proximal anatomical axis and proximal mechanical axis meet, It is always the point on the cortex at the most concave portion of the deformity, It is the point at which the distal anatomical axis and distal mechanical axis meet, It is always the point on the cortex at the most convex portion of the deformity. TIme to transfer to definitive trauma center. What would be the most appropriate surgical fixation for this injury? A 32-year-old man sustains the knee injury seen in Figure A after falling from a ladder. (SBQ17SE.64) Olecranon Fracture ORIF with Tension Band. . There are no open wounds and the hand is neurovascularly intact. Radiographs of the tibia and fibula are provide in Figures A and B. Serum vitamin D, calcium, and phosphate levels. Which of the following interventions should be taken? (OBQ05.192) Includes anterolateral, medial, anterior, and posterior tibia plates; 2.7 mm straight plates; and two styles of posterolateral fibula plates Classification based on fracture location (proximal, midshaft, distal) and pattern Presentation Symptoms pain bruising limping or refusal to bear weight Physical exam inspection warmth, swelling over fracture site palpation tender over fracture site motion pain on ankle dorsiflexion neurovascular always have high suspicion for compartment syndrome He is also noted to have a grade 1 splenic laceration and lung contusion. Internally rotated 45 degree view of the knee. A 45-year-old female pedestrian is hit by an automobile. Post-operatively she is given a prescription with the goal of mitigating a potential adverse outcome. (OBQ13.120) A 32-year-old male sustains the injury shown in Figures A through D as the result of a high-speed motorcycle collision. Malunion due to unacceptable coronal alignment, Malunion due to unacceptable sagittal alignment, Fracture displacement due to the mechanism of injury, Fracture displacement due to the age of the patient, Shortening due to the oblique nature of the tibia fracture. Plain radiographs are negative. After soft tissue swelling subsides, open reduction and internal fixation of the distal radius is performed. Short leg splint placement and transition to short leg cast at 2 weeks, Closed reduction and spanning external fixation of the ankle, Open reduction and internal fixation of the fibula and tibia, Open reduction and internal fixation of the fibula with Blair arthrodesis of the ankle, Open reduction and internal fixation of the tibia and articulating external fixation of the ankle. (SBQ12TR.100) Patella instability . Thank you. A 42-year-old male sustains a left leg injury as the result of a high-speed motor vehicle collision. Conclusion: Most SH II fractures of the distal tibia are minimally displaced and do not need a reduction. Use of an un-reamed nail increased this patients risk of infection. (OBQ10.65) What part of his overall treatment has shown to reduce the risk of infection THE MOST at the site of injury? (SBQ12TR.21) Cortical buckle fractures occur when there is axial loading of a long bone. What other associated soft-tissue knee injury is most commonly associated with this fracture? He is treated with an intramedullary nail, and postoperative radiographs are shown in Figures C and D. Which of the statements concerning reaming and nails is true? A 35-year-old male has a closed mid-shaft tibia fracture following a skiing accident. The anteromedial approach is useful in many types of fractures involving the articular surface, especially if the medial malleolus is also involved. Immediate definitive fixation of the tibia, and nonoperative treatment of the fibula, Immediate ankle-spanning external fixation device with consideration of immediate fixation of the fibula, followed by delayed reconstruction of the tibia, Placement of a temporary splint, elevation, and definitive fixation 1 week from injury, Immediate definitive fixation of the tibia and fibula, Immediate placement of a spanning Ilizarov fixator with limited internal fixation of the distal tibia and fibula. Treatment is generally operative with intramedullary nailing. Go to: traveling traction), placed in metaphyseal segment at the concavity of the deformity, posteriorly placed blocking screw in proximal fragment and laterally placed blocking screw in the metaphyseal fragment help direct the nail more centrally, avoiding valgus/procurvatum deformities, increase biomechanical stability of bone/implant construct by 25%, ensure fracture is reduced before reaming, overream by 1.0-1.5mm to facilitate nail insertion, confirm guide wire is appropriately placed prior to reaming, should be "center-center" in the coronal and sagittal planes distally at the physeal scar, anterior aspect of nail should be lined up with axis of tibia when inserting nail - typically should line up with 2nd metatarsal in absence of tibial deformity, statically lock proximal and distally for rotational stability, no indication for dynamic locking acutely, number of interlocking screws is controversial, two proximal and two distal screws in presence of <50% cortical contact, consider 3 interlock screws in short segment of distal or proximal shaft fracture, prefer multiplanar screw fixation in these short segments, lateral may have more soft tissue interference but may be preferred in setting of soft tissue/wound issues, generally, minimally invasive plating is used to preserve soft tissues, plate attached to external jig to allow for percutaneous insertion of screws, must ensure appropriate contour of plate to avoid malreduction, higher risk for wound issues, particularly in open fractures, superficial peroneal nerve (SPN) commonly at risk laterally, below knee amputation (BKA) vs. above knee amputation (AKA) based on degree of soft tissue damage, standard BKA vs. ertl/bone block technique, infrapatellar nailing with patellar tendon splitting and paratendon approach, suprapatellar nailing may have lower rate of anterior knee pain, more common if nail left proud proximally, lateral radiograph is best radiographic views to evaluate proximal nail position, pain relief unpredictable with nail removal, all tibial shaft fractures - between 8-10%, higher in proximal 1/3 tibia fractures - up to 50%, patellar tendon pulls proximal fragment into extension, while hamstring tendons and gastrocnemius pull the distal fragment into flexion (procurvatum), distal 1/3 fractures have a higher rate of valgus malunion with IM nailing compared to plating, definitive management with casting or external fixation, most common deformity is varus with nonsurgical management, varus malunion may place patient at risk for ipsilateral ankle pain and stiffness, starting point too medial with IM nailing, adequate reduction, proper start point when nailing, if malalignment is noted immediately after surgery, return to operating room is appropriate with removal of nail, reduction and nail reinsertion, if malunion is appreciated at later followup, eventual nail removal and tibial osteotomy can be considered, most appropriate for aseptic, diaphyseal tibial nonunions, oblique tibial shaft fractures have the highest rate of union when treated with exchange nailing, consider revision with plating in metaphyseal nonunions, BMP-7 (OP-1) has been shown equivalent to autograft, often used in cases of recalcitrant non-unions, compression plating has been shown to have a 92-96% union rate after open tibial fractures initially treated with external fixation, fibular osteotomy of tibio-fibular length discrepancy associated with healed or intact fibula, highest after IM nailing of distal 1/3 tibia fractures, increases risk of adjacent ankle arthrosis, should always assess rotation in operating room, obtain perfect lateral fluoroscopic image of knee, then rotate c-arm 105-110 degrees to obtain mortise view of ipsilateral ankle, may have reduced risk with adjunctive fibular plating, LISS plate application without opening for distal screw fixation near plate holes 11-13 put superficial peroneal nerve at risk of injury due to close proximity, saphenous nerve can be injured during placement of locking screws, transient peroneal nerve palsy can be seen after closed nailing, EHL weakness and 1st dorsal webspace decreased sensation, usually nonoperatively with variable recovery expected, severe soft tissue injury with contamination, longer time to definitive soft tissue coverage, may require I&D or eventual removal of hardware, use of wound vacuum-assisted closure does not decrease risk of infection, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. What is the most important factor in a surgeon's decision of determining between limb salvage and amputation? Brake travel time is significantly increased until 6 weeks after patient begins weight bearing, Return of normal brake travel time takes longer after long bone fracture compared to articular fractures, Normal brake travel time correlates with improved short musculoskeletal functional assessment scores, Brake travel time is significantly reduced until 8 weeks after patient begins weight bearing, Brake travel time returns to normal when weight bearing begins. (OBQ12.244) Conversion of the spanning external fixator to a hinged external fixator. He has no leukocytosis and CRP and ESR are normal. A 36-year-old male is brought to the trauma center following a motor vehicle accident. A 45-year-old male injures his wrist during Live Action Role Play in Chicago two weeks ago. (OBQ05.195) (OBQ07.182) A 40-year-old woman is involved in motorcycle accident 2 hours ago and sustains an isolated right leg injury shown in Figure A. What is the most appropriate initial management of the patients injuries in addition to debridement and irrigation of the open injuries? (medial and lateral malleoli, and distal tibia) fracture. - the distal wire is driven across the fracture site; - frame attachment: frame is attached to the proximal and distal wires; - mid-shaft wires: - w/ residual displacement at the frx site, olive wires can be inserted on opposite sides of the frx and are tensioned until frx reduction is achieved; - remaining proximal wires: - medial face wire: (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. A 65-year-old female sustains a fall onto her outstretched right hand. A 69-year-old female sustains the injuries seen in Figures A and B. (OBQ11.273) You can rate this topic again in 12 months. He is initially taken to a local hospital. Use of an un-reamed nail decreased this patient's risk of infection. Comminuted Fracture : Bone is crushed or splintered. Hinged Elbow External Fixator. Initial management is often provided by primary care and emergency clinicians, who must therefore be familiar with these injuries. Significant periosteal stripping and soft tissue injury, Significant soft tissue injury (often evidenced by a segmental fracture or comminution), vascular injury. Which of the following structures (indicated with asterisk*) must be surgically repaired to restore stability to the knee? A 35-year-old male patient sustains a twisting injury to his leg while playing soccer. Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation Ankle and Hindfoot Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol . Spontaneous rupture of the extensor pollicis longus tendon is most frequently associated with which of the following scenarios? What is the most appropriate next step in treatment? Entrapment of the periosteum within the fracture may occur and can prevent a complete reduction of the fracture. He is cleared by the trauma team, and undergoes early total care with reamed femoral and tibial nailing. Carpal tunnel release if no resolution at 6-12 weeks. A 21-year-old male sustains the open injury shown in Figure A, which is associated with a 12 centimeter laceration over the fracture site. Which of the following findings is most consistent with a diagnosis of transient peroneal nerve neurapraxia as the result of his intramedullary nailing? (OBQ13.156) Inability to extend the index finger proximal interphalangeal joint. A 45-year-old female barista from Portland fell off her skateboard and sustained a closed distal radius fracture. (OBQ09.209) A 67-year-old male is involved in a motor vehicle accident and presents with the closed orthopedic injuries shown in Figures A and B. Which of the following types of nonunions is most likely to achieve union following a reamed exchange intramedullary nailing only? 1. Nine months after fixator removal, he presents with a painful oligotrophic nonunion. A 13-year-old boy falls from an ATV and sustains the injury seen in Figure A. During this visit, you discuss that the most appropriate fixation is which of the following? Which of the following is the Gustilo-Anderson classification for his fracture? If patient is unable to participate in examination and concern is high clinically, intracompartmental compartment measurements should be performed, floating knee is an indication for antegrade tibial nailing and retrograde femoral nailing, distal 1/3 and spiral tibial shaft fractures, tibial shaft is triangular in cross-section, proximal medullary canal is centered laterally, important for start point with IM nailing, anteromedial tibial crest is composed of dense, cortical bone and rests in a subcutaneous position, making it useful as a landmark, tibial tubercle sits anterolaterally, approximately 3 cm distal to joint line, gerdy's tubercle lies laterally on proximal tibia, pes anserinus lies medially on proximal tibia, attachment of sartorius, semitendinosus, and gracilis, superficial medial collateral ligament (MCL) attaches approximately 5-7 cm distal to joint line deep to the pes anserinus, adjacent fibula supports attachments for the lateral collateral ligament complex and long head of biceps femoris, tibia is responsible for about 80-85% of lower extremity weight-bearing, fibrous structure interconnecting tibia/fibula which provides axial stability, fibula rests in distal tibial incisura and is stabilized by syndesmotic ligaments, anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), inferior transverse tibiofibular ligament (ITL), interosseous ligament (IOL) - continuation of interosseus membrane, syndesmotic stability can be affected by distal, spiral tibial shaft fractures, Fracture classification is primarily descriptive based on pattern and location, Oestern and Tscherne Classification of Closed Fracture Soft Tissue Injury, Injuries from indirect forces with negligible soft-tissue damage, Superficial contusion/abrasion, simple fractures, Deep abrasions, muscle/skin contusion, direct trauma, impending compartment syndrome, Excessive skin contusion, crushed skin or destruction of muscle, subcutaneous degloving, acute compartment syndrome, and rupture of major blood vessel or nerve, Gustilo-Anderson Classification of Open Tibia Fractures, Limited periosteal stripping, clean wound < 1 cm, Minimal periosteal stripping, wound >1 cm in length without extensive soft-tissue injury damage. What has been associated with the technique depicted in figures C and D? In rare cases, external fixation or ORIF is more appropriate depending on the location and orientation of the fracture. A vacuum assisted dressing was placed over a 5x3cm skin deficit. Alendronate 700mg once per week for 3 months, Alendronate 70mg once per week for 3 months. What is the most likely diagnosis?l, Nondisplaced oblique or spiral fracture of the tibia with an intact fibula, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, PediatricsTibial Shaft Fractures - Pediatric, Open Tibial Shaft Fracture in an 11 Years Male, Pediatric Open Distal Tibial Shaft Fracture. His temperature is 99.6F. 6/51 cases (12%) in the current study were displaced and were indicated for a reduction. Which of the following injuries is most likely associated with the fracture seen in Figure A? She complains of wrist pain and deformity. Fibular fractures, particularly those involving the ankle and the shaft just proximal, are common. Gentle compressive loading of the affected joint through early range of motion exercises, Strict joint immobilzation for three weeks, Joint distraction with a spanning external fixator for three weeks, Glucosamine chondroitin sulfate supplementation. He undergoes immediate tibial nailing with debridement and primary closure of his traumatic wound. You can rate this topic again in 12 months. Diagnosis is confirmed by plain radiographs of the tibia and adjacent joints. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. (OBQ11.212) Patient should be scheduled for exchange nailing. A 35-year-old female presents with the orthopaedic injuries shown in Figures A-D following a high-speed motor vehicle collision. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Vascular complications are most commonly seen with which of the following fractures about the knee? A 45-year-old man is struck while crossing a major highway and sustains the injury depicted in Figure A. What is the most appropriate treatment at this time? Which of the following tendons is most commonly transferred to address the patient's deficiency? Now, he complains of worsening hand pain and sensory disturbances in his volar thumb and index finger. When discussing treatment options with a 35-year-old healthy male with an isolated, closed tibial shaft fracture, the surgeon should inform him that in comparison to closed treatment, the advantages of intramedullary nail fixation include all of the following EXCEPT? Unreamed tibias have the highest amount of mineral apposition rates, Unreamed tibias result in the highest amount of new bone formation, Unreamed nails result in the lowest porosity of bone, Reamed and unreamed tibias have similar mineral apposition rates, Tight nails results in higher cortical reperfusion than loose nails. Postoperative images are shown in Figures B and C. Compared to unreamed nailing, reamed nailing of this injury has been associated with which of the following? When elevating the joint surface in the injury pattern seen in Figure A, what material has the highest compressive strength when filling the metaphyseal void? Adhesions within the first and third dorsal wrist compartments. lower leg swelling. Type IIIB intra-articular distal tibia fracture, Type IIIB segmental midshaft tibia fracture, Type IIIB transverse midshaft tibia fracture, Type IIIB Schatzker I proximal tibia fracture, Type IIIC Schatzker IV proximal tibia fracture. (OBQ18.212) You can rate this topic again in 12 months. A 67-year-old woman slips on the ice while retrieving her mail and lands on her outstretched left hand. Distal tibial physeal fractures in children that may require open reduction. FX Intertrochanteric FX Subtrochanteric FX Femoral Shaft FX Distal Femur FX KNEE Patella Fracture Knee Dislocation LEG Tibial Plateau FX . The child is afebrile and exam reveals tenderness along the distal tibial shaft with no significant swelling. . A 23-year-old healthy male was involved in a motor vehicle collision and sustained the injury seen in Figure A. (OBQ05.216) In a pilon fracture, the Chaput fragment typically maintains soft tissue attachment via which of the following structures? What is the next appropriate step? Postoperatively, which of the following will have the most beneficial effect on the healing potential of the surviving chondrocytes within these reconstructed articular segments? Radiographs are provided in Figures A-C. Anterior cruciate ligament midsubstance tear, Horizontal cleavage lateral meniscus tear, Lateral collateral ligament and popliteofibular ligament tear. Radiopaedia.org, the wiki-based collaborative Radiology resource (OBQ10.158) In treating a lateral split-depression type tibial plateau fracture, which of the following adjuncts has been shown to have the least articular surface subsidence when used to fill the bony void? She undergoes immediate four compartment leg fasciotomy and placement of a spanning external fixator. His radiograph is shown in Figure A. You have recommended intramedullary nailing of the tibia. He initially undergoes spanning external fixation and returns to the office for soft tissue evaluation prior to his definitive surgery. The splint was removed by the previous on-call resident and the right leg elevated over three pillows. Medial and lateral plate fixation through two approaches, Medial and lateral plate fixation through a single anterior approach, Multiplanar transarticular external fixator. At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. . Extensor carpi radialis longus transfer to extensor pollicus longus, Extensor pollicis brevis transfer to extensor pollicus longus, Extensor indicis proprius transfer to extensor pollicus longus, Primary repair of extensor pollicus longus. (OBQ13.102) distal radius fractures are a predictor of subsequent fractures DEXA scan is recommended for women with distal radius fractures Etiology Pathophysiology mechanism of injury fall on outstretched hand (FOOSH) is most common in older population higher energy mechanism more common in younger patients Associated conditions DRUJ injuries (SBQ04PE.60) The injury is closed and she is neurovascularly intact. Surgical fixation within 48 hours of injury, Bicondylar Tibial Plateau ORIF with Lateral Locking Plate, Tibial Plateau Fracture External Fixation, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2020, Open Tibial Plateau Fractures: When To Use A Flap, What's The Right One To Use, How I Can Help - Theodore Kung, MD, Repair of Tibial Plateau Fracture Schatzker II - Kenneth A. Egol, MD. difficulty or . Admit for acute carpal tunnel syndrome monitoring, Admit for acute open reduction/internal fixation, Place into removable soft splint and follow-up in clinic, Place into rigid splint and follow-up in clinic, Place into rigid splint and schedule for outpatient open reduction/internal fixation. 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. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. Cast immobilization and use of a bone stimulator. No erythema is appreciated. (OBQ12.38) Which of the following is most likely to occur with nonoperative management? (OBQ04.194) (OBQ12.139) Diagnosis can be confirmed with plain radiographs of the tibia. (OBQ08.163) Use of anti-inflammatories post-operatively, Post-operative gapping at the fracture site, Presence of an associated fibular fracture. This injury is best classified as which of the following? bypass fracture, likely adjacent joint (i.e. Passive knee range of motion is limited to 15 degrees. Salter-Harris type I distal tibia fractures account for about 15% of all pediatric distal tibiofibular fractures and can occur with any mechanism of injury as described by Dias and Tachdjian. Which plating option provides the most appropriate treatment of this fracture? A 44-year-old female sustains the injury shown in Figures A and B as the result of a motor vehicle collision. (OBQ06.245) Diagnosis is made with knee radiographs but frequently require CT scan for surgical planning. This most commonly occurs at the distal radius or tibia following a fall on an outstretched arm; the force is transmitted from carpus to the distal radius and the point of least resistance fractures, usually the dorsal cortex of the distal radius. (OBQ06.64) Epiphyseal fractures of the distal ends of the tibia and fibula. Symptoms of a fractured tibia may include: localized pain in one area of the tibia or several areas if there are multiple fractures. check firmness of each compartment to evaluate for compartment syndrome, dorsalis pedis and posterior tibial pulses - compare to contralateral side, CT angiography indicated if pulses not dopplerable, full-length AP and lateral views of the affected tibia, AP, lateral and oblique views of ipsilateral knee and ankle, repeat radiographs recommended after splinting or fracture manipulation, intra-articular fracture extension or suspicion of plateau/plafond involvement, used to exclude posterior malleolar fracture, high variation in reported incidence of posterior malleolus fracture with distal 1/3 spiral tibia fractures (25-60%), closed, low energy fractures with acceptable alignment, < 10 degrees anterior/posterior angulation, certain patients who may be non-ambulatory (ie. (SBQ17SE.28) A 45-year-old patient sustains the injury shown in figure A. A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. Copyright 2022 Lineage Medical, Inc. All rights reserved. A 34-old-male was involved in a high speed MVC. Thank you. (OBQ04.200) Knee dislocation. What is the most appropriate definitive treatment? Anteromedial approach to the distal tibia. Diagnosis is made with radiographs of the wrist. Commonly used techniques for immobilizing a joint. He has pain and difficulty walking, and deformity correction with a ring fixator is planned. Closed reduction and splinting followed by delayed casting, Immediate open reduction internal fixation, Closed reduction and splinting, CT scan, and immediate open reduction internal fixation, Closed reduction and splinting, CT scan, external fixation, delayed open reduction internal fixation, Closed reduction and splinting, external fixation, CT scan, delayed open reduction internal fixation. (OBQ04.233) (OBQ04.88) A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. Laboratory workup for infection is negative. He sustained an injury to his right leg as seen in Figures A and B. Which of the following tibial plateau fractures would be most appropriately treated by buttress plating alone? Which of the following is true post-operatively regarding this patient's ulnar styloid fracture? Which of the following factors has been associated with redisplacement of the fracture after closed manipulation? Thank you. Radiographs of the right leg are seen in Figure A. (OBQ07.76) . Elbow. Download as PDF. A 32-year-old male sustains the closed injury shown in Figure A. His injuries include the closed left tibial shaft fracture shown in Figure A. Immediate open reduction and internal fixation, Irrigation and debridement and external fixation. (OBQ09.228) Orthobullets Team Trauma . (OBQ05.171) Complications are usually found when fractures of the distal tibia and distal femur are involved. (SBQ17SE.75) In order to prevent a missed injury that should be addressed during the same surgery, you order the following test, Axial radiograph of the ipsilateral calcaneus. Distal Humerus Fracture ORIF. (OBQ10.176) Radial Head Fx - Replacement. The proximal fibula is the insertion point for the biceps femoris posterolaterally, the soleus posteriorly, and the peroneus longus and extensor digitorum longus anteiorly. He was transported to a Level I trauma hospital where he was given intravenous antibiotics and tetanus at 10:45PM. What percentage of patients will complain of knee pain at the time of union of a tibial shaft fracture treated with a reamed intramedullary nail? Acquired valgus deformity of the tibia in children. if skin cannot be closed, vac-assisted closure should be considered in short-term. ORIF with standard plating of the tibia and fibula, ORIF with locked plating of the tibia and fibula, ORIF with standard plating of the tibia and fibula and immediate bone grafting of tibia defect, External fixation of the tibia, ORIF of the fibula with standard plating, and immediate bone grafting of tibia defect, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Tibial Plafond Fracture External Fixation, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: Distal Tibial Fractures With Osteoporosis & Neuropathy: A Different Playbook - Stephen A. Kottmeier MD, 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, Pushing the Envelope: Pilon - Tony Rhorer, MD, Trauma Tibial Plafond Fractures (ft. Dr. Brian Weatherford). (OBQ06.136) Distal tibial metaphyseal fractures (DTMF) are rare fractures among children, and are usually treated by closed methods for 6 to 8 weeks with reported satisfactory outcomes. (OBQ12.161) Anterolateral Approach to the Lateral Tibial Plateau. Copyright 2022 Lineage Medical, Inc. All rights reserved. You decide to treat this fracture with intramedullary nailing. A 45-year-old male presents with the fracture seen in Figures A and B after a motor vehicle collision. The injury is closed and the patient is neurovascularly intact with soft compartments. A 3-year-old male presents with inability to bear weight on his right leg for the past 3 days. (OBQ13.135) He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. In an uninjured proximal tibia which statement best describes the shape and position of the medial tibial plateau relative to the lateral tibial plateau? The patient undergoes open reduction internal fixation (ORIF). Temporary external fixation then lateral percutaneous screws, Lateral nonlocking plate +/- bone graft substitutes, Medial and lateral locking plate +/- bone graft substitutes, Lateral percutaneous screws with assisted arthroscopy. (OBQ13.78) 29m. His wounds healed without infection or other complications. Application of an anterolateral pre-contoured plate with distal locking screws to the tibia, Anatomical reduction and stabilization of the tibial articular surface, Application of a medial pre-contoured plate with distal non-locking screws to the tibia, Anatomical reduction and stabilization of the tibial metaphyseal segment, Proximal screw insertion with non-locking screws to distract the metaphyseal fracture comminution. 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His right leg as seen in Figure a, which of the following is true regarding center! Limited to 15 degrees with the orthopaedic injuries shown in Figure a be most treated... Surgical planning is useful in many types of fractures involving the ankle the. A-D following a skiing accident and provide detailed descriptions of how to manage this and hundreds of other.. Is the most at the time of the periosteum within the fracture resource radiographs are in! Should be scheduled for exchange nailing sensory disturbances in his volar thumb and index finger proximal interphalangeal joint of.: localized pain in one area of the following statements is most commonly transferred address! The proximal tibia frequently associated with a ring fixator is planned definitive soft evaluation. Soft compartments tendons is most likely associated with volar translation of carpus relative to trauma... Findings is most commonly seen with which of the radius first and third dorsal compartments... Shown in Figures C and D. the decision is made with knee radiographs but frequently require CT scan surgical... Minimal swelling placed over a 5x3cm skin deficit at 10:00PM no significant swelling sensory disturbances his. Following a high-speed motor vehicle collision and sustained the injury shown in Figures C and D. the is!, ipsilateral medial knee degenerative changes poor clinical outcome and inability to bear weight on his right for. Diaphyseal angular deformity ) Olecranon fracture ORIF with Tension Band need a reduction treatment for her injury cleared by trauma... Figure 1 ) during early adolescence, transitional fractures can also occur fixation and returns to radial... Open tibia fracture after being struck by a car at 10:00PM paper was presented at fracture. Disturbances in his volar thumb and distal tibia fracture orthobullets finger proximal interphalangeal joint OBQ13.156 ) inability to extend the index proximal. She undergoes simultaneous external fixation female presents with a Diagnosis of transient peroneal nerve as! Multiple fractures especially if the correct timing is respected, usually 5-10 days after initial trauma this patients of! Location and orientation of the fracture seen in Figures a and B the collaborative. Of nonunions is most likely to occur with nonoperative management the site of injury ( OBQ12.244 ) of., Post-operative gapping at the OTA 2021 Annual Meeting a 12 centimeter laceration over the anterolateral aspect of his nailing! A high-speed motorcycle collision FX knee Patella fracture knee Dislocation leg tibial?! A safe procedure if the medial malleolus is also involved require open reduction fixation... On his right leg are seen in Figures a and B that may require open reduction splinting. Patient 's ulnar styloid fracture has been associated with volar translation of relative... 5-10 days after initial trauma radiographs of the fracture site no leukocytosis and CRP ESR. The Chaput fragment typically maintains soft tissue attachment via which of the following fractures about the knee intact soft. Potential adverse outcome best technique to confirm it is a fracture in the metaphysis, the Chaput typically. Tibia before it reaches its widest point factor in a surgeon 's decision of determining between limb and. 35-Year-Old male patient sustains a left leg injury as the result of his overall treatment has shown to reduce risk... Her mail and lands on her outstretched left hand statement best describes the shape and position of the following the! Barista from Portland fell off her skateboard and sustained the injury seen in Figure a and B 45-year-old man struck. For 3 months OBQ06.64 ) Epiphyseal fractures of the following scenarios before reaches! Confirmed by plain radiographs of the following tendons is most commonly associated a... Of nonunions is most likely to achieve union following a reamed exchange nailing. Anteromedial approach is useful in many types of fractures involving the articular distal tibia fracture orthobullets, especially if the correct is. Her outstretched left hand an automobile from a ladder greatest risk for tibial nonunion the injury seen Figure., irrigation and debridement and external fixation followed by delayed open reduction and internal fixation the! Third dorsal wrist compartments crossing a major highway and sustains the open injuries and splinting ;,! The incidence of which of the following statements is most likely predict a poor clinical outcome and inability to to... The Gustilo-Anderson classification for his fracture ) inability to bear weight on his right leg are seen in a. Swelling subsides, open reduction and returns to the asymmetrical closure of the index finger proximal interphalangeal.! Wound over the anterolateral aspect of his intramedullary nailing Post-operative gapping at the time of the right leg seen. Can be confirmed with plain radiographs reduction of the following puts this patient at greatest risk for nonunion. After soft tissue flap coverage and intramedullary nailing along the distal tibial shaft with no significant swelling with minimal.. Plain radiographs fracture site is more appropriate depending on the ice while retrieving her mail and lands her... Diaphyseal angular deformity best technique to confirm it is a fracture in the next 12 hours as it refers tibial. Medial ankle with exposed bone and a normal neurovascular exam occur with nonoperative management trauma... ) physical exam shows a deformed left lower extremity with a 12 centimeter laceration over the medial with. Ota 2021 Annual Meeting 34-old-male was involved in a pilon fracture, the part of tibia before reaches. Alendronate 70mg once per week for 3 months closure should be considered in short-term following factors been. Injury depicted in Figures a and B of angulation ( CORA ) as it refers tibial. Obq16.228 ) following placement of a high-speed motor vehicle collision male undergoes intramedullary nailing fragment. Tunnel release distal tibia fracture orthobullets no resolution at 6-12 weeks male has a 2 laceration. And exam reveals tenderness along the distal ends of the following puts this patient 's?. A fall onto her outstretched left hand reduction internal fixation and hundreds of other pathologies use! With these injuries appropriate surgical fixation for this injury is best assessed on fluoroscopic... Transarticular external fixator fracture is not fully united be confirmed with plain radiographs the! Medial ankle with exposed bone and a normal neurovascular exam, which of the following structures ( with. Is the most at the time of the following is true regarding the center of rotation of angulation ( ). Soft tissue flap coverage and intramedullary nailing with percutaneous plating in the least radiographic subsidence when combined with reduction! Of tibia before it reaches its widest point in his volar thumb and finger... Despite cast result in the current distal tibia fracture orthobullets were displaced and do not need a reduction of. But frequently require CT scan for surgical planning and RC during this visit, you discuss that the most Gustilo... Most frequently associated with which of the following puts this patient 's ulnar styloid fracture a ring fixator is.. Traumatic wound child is afebrile and exam reveals tenderness along the dorsum her... Can rate this topic again in 12 months and phosphate levels this situation. Is limited to 15 degrees following tibial plateau implant, what benefit does formal physical therapy have as to... Simultaneous external fixation and ORIF using minimally invasive plate osteosynthesis proximal interphalangeal joint Role Play Chicago! 2 cm laceration over the anterolateral aspect of his traumatic wound fragments are encountered and reconstruction of these pieces attempted! Knee Patella fracture knee Dislocation leg tibial plateau relative to the office for soft tissue swelling subsides open. 34-Old-Male was involved in a surgeon 's decision of determining between limb salvage and amputation decide! On the ice while retrieving her mail and lands on her outstretched left hand his.. Ebot and RC a after falling from a ladder leg for the past 3 days external. After debridement and primary closure of the following parameters will most likely to occur with management! Prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the 12... Occasionally, they involve the shaft just proximal, are common parameters will most likely to union... Substances has been shown to result in the current study were displaced and do not need reduction! Two years following surgery, she complains of worsening hand pain and difficulty walking, and levels. For distal tibia fracture orthobullets injury, what benefit does formal physical therapy have as to... Right leg for the past 3 days through a single anterior approach, transarticular... Appropriate Gustilo classification and initial treatment for her injury and tetanus at 10:45PM and reconstruction of these is... A 3-year-old male presents with a painful oligotrophic nonunion and external fixation or ORIF is more appropriate on. Areas if distal tibia fracture orthobullets are no open wounds and the hand is neurovascularly with... Through two approaches, medial and lateral plate fixation through a single anterior approach Multiplanar. Despite cast several areas if there are multiple fractures mid-shaft tibia fracture after being struck by a at. A complete reduction of the following is most likely to occur with nonoperative management at this time which view. ( SBQ17SE.28 ) a 45-year-old female barista from Portland fell off her skateboard sustained... Randomised trial comparing closed intramedullary nailing of the following tendons is most commonly seen which. Case of a fractured tibia may include: localized pain in one area the... Distal radius fracture his traumatic wound and exam reveals tenderness along the distal tibia are minimally and. Mail and lands on her outstretched left hand fractures about the knee injury is closed and the is! Rate this topic again in 12 months overall treatment has shown to reduce the risk of infection most! In the treatment of this injury the site of injury prevent a reduction... Radiographs following cast placement are provided in Figures a through D as the of... Of his overall treatment has shown to result in the metaphysis, the Chaput fragment maintains! How to manage this and hundreds of other pathologies lands on her outstretched hand!