11/18/2023 0 Comments Tibia fibula fracture surgeryThe results of Grosse, 3 who successfully treated a case of bilateral shattered femora with a Grosse-Kempf intramedullary nail encouraged us to proceed. Even if the nail did not pass through the medullary canal of the shattered bone, it would help to realign the limb, restore length and provide support until the comminuted fragments were bridged by callus and consolidation occurred. This left us with the option of a locked intramedullary device. Calcaneal traction would not have provided adequate reduction without additional immobilisation with a posterior splint. If an amputation had been undertaken, it would have been either through- or above-knee.Įxternal fixation was excluded as there were no major cortical fragments which could provide purchase for Schanz pins or tensioned Kirschner wires. The length of tibia for an adequate below-knee stump was not available as the fracture extended to the proximal metaphyseodiaphyseal junction. Our patient was adamant that all efforts should be made to save his limb. The social stigma associated with an amputation is so degrading that many say they would rather die than have an amputation, despite the merits of early amputation and prosthetic fitting. The severity of the injury does not matter and they are willing to undergo protracted periods of treatment with external fixators and many operations in order to retain their limb, regardless of how stiff it may be. Most patients in India opt for retaining a mangled extremity, if given a choice. The Mangled Extremity Severity Score (MESS) 2 was 5, which was in favour of limb salvage. The limb was splinted after the wounds had been thoroughly washed with saline.Īs plantar feeling was intact and the distal vascularity good we decided to aim for limb salvage rather than perform a primary amputation. Intravenous broad-spectrum antibiotics were started after tetanus immunisation. 1).Īnteroposterior and lateral radiographs of the left lower leg at the time of injury. The leg was truly a ‘bag of bones’ ( Fig. The knee did not have an effusion and the femur, hip and opposite limb were clinically normal.įollowing resuscitation with fluids and blood, radiographs showed a completely shattered tibia and fibula from the proximal metaphyseodiaphyseal junction to the ankle. However, there was mild sensory blunting over the dorsum of the foot. The sensation on the sole of the foot was normal. The dorsalis pedis pulse was not palpable and it was only feebly heard with a handheld Doppler. The leg sagged even when supported distally, but, surprisingly, active toe movements were present and the posterior tibial pulse was palpable. There was minimal contamination of the wounds. He was in a state of shock and the skin of the entire left leg had multiple sieve-like punctured wounds through which small spikes of bones were visible. Case reportĪ 32-year-old man, a manual labourer in a granite quarry, presented after heavy equipment had fallen on his left leg while working. To our knowledge, no similar case of successful salvage of a completely shattered tibia has been reported. Limb salvage finally resulted in a fully functional limb after five surgical procedures during three years. This is a report of a patient with a completely shattered type III A fracture of the left tibia sustained at work. Surgeons are faced with the dilemma of deciding whether to amputate or save the extremity. Treatment is protracted with a high incidence of secondary amputation in types III B and III C fractures. 1 These are prone to severe complications such as infection and nonunion. The sparse anterior soft-tissue cover results in many of these injuries being grouped under type III of the Gustilo-Anderson classification.
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