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2508257903845Tibial Shaft Fracture00Tibial Shaft Fracture26885907903844Epidemiology: most common long bone fracture; high incidence of compound woundsGustillo classification: I minimal STI, skin laceration <1cm II mod STI; wound >1cm; moderate contamination III segmental fracture, vascular, wound >10cm, highly contaminatedA = simple 1 = spiral 2 = oblique (angle >30°) 3 = oblique (angle <30°)B = multifragment wedge 1 = spiral wedge 2 = bending wedge 3 = fragmented wedgeC = multifragment complex 1 = spiral wedge 2 = segmental 3 = irregularToddler’s = undisplaced / minimally displaced spiral fracture of tibia; 1-5yrs following twisting injuryTransverse is usually direct blow; spiral are rotational00Epidemiology: most common long bone fracture; high incidence of compound woundsGustillo classification: I minimal STI, skin laceration <1cm II mod STI; wound >1cm; moderate contamination III segmental fracture, vascular, wound >10cm, highly contaminatedA = simple 1 = spiral 2 = oblique (angle >30°) 3 = oblique (angle <30°)B = multifragment wedge 1 = spiral wedge 2 = bending wedge 3 = fragmented wedgeC = multifragment complex 1 = spiral wedge 2 = segmental 3 = irregularToddler’s = undisplaced / minimally displaced spiral fracture of tibia; 1-5yrs following twisting injuryTransverse is usually direct blow; spiral are rotational15481307903845002508256097905Segond Fracture00Segond Fracture27946356097905Small avulsion fracture of proximal lateral tibia associated with severe joint disruption; signifies tear of menisco-tibial attachment of lateral capsular ligament; all have ACL tear, most have meniscal tears; usually sports injury00Small avulsion fracture of proximal lateral tibia associated with severe joint disruption; signifies tear of menisco-tibial attachment of lateral capsular ligament; all have ACL tear, most have meniscal tears; usually sports injury15481316097905002286001141095Tibial Plateau Fractures00Tibial Plateau Fractures20542255768340Bicondylar fracture and distal oblique shaft fracture00Bicondylar fracture and distal oblique shaft fracture15481305768340VI00VI15481305468620V00V20542255468620Wedge fracture of medial and lateral plateau00Wedge fracture of medial and lateral plateau15481305019675IV00IV20542255019675Wedge fracture of medial plateau; associated with medial meniscus injury; usually older patients (younger if high energy injury)00Wedge fracture of medial plateau; associated with medial meniscus injury; usually older patients (younger if high energy injury)15481304662805III00III15481304186555II00II20542254662805Depression without associated wedge fracture; usually older patients with osteoporosis00Depression without associated wedge fracture; usually older patients with osteoporosis20542254186555Split fragment from articular surface with depressed areas; associated with fibular fracture; ligament injury in 20%; usually older patients00Split fragment from articular surface with depressed areas; associated with fibular fracture; ligament injury in 20%; usually older patients15481303829050I00I20542253829685Wedge fracture of lateral plateau; depression / displacement <4mm; usually in young patients00Wedge fracture of lateral plateau; depression / displacement <4mm; usually in young patients1548130121856540386001141731Epidemiology: especially in elderly cause by femoral condyles being driven into tibial; ligament instability in up to 1/3 Lateral tibial condyle most common (due to valgus stress; associated with ACL and MCL injury) Medial plateau injury associated with PCL and LCL injury Management: I and III - usually conservative II – conservative if <6mm depression and displaced fragment reduced with traction; OT if >1cm depression (>4mm in young), >10° valgus, split fragment not reduced IV – reduction and internal fixationComplications: peroneal nerve injury; popliteal artery injury; ACL, PCL, MCL, LCL injury, DVT, OA00Epidemiology: especially in elderly cause by femoral condyles being driven into tibial; ligament instability in up to 1/3 Lateral tibial condyle most common (due to valgus stress; associated with ACL and MCL injury) Medial plateau injury associated with PCL and LCL injury Management: I and III - usually conservative II – conservative if <6mm depression and displaced fragment reduced with traction; OT if >1cm depression (>4mm in young), >10° valgus, split fragment not reduced IV – reduction and internal fixationComplications: peroneal nerve injury; popliteal artery injury; ACL, PCL, MCL, LCL injury, DVT, OA246380539750Tibial Fractures00Tibial Fractures 2927357026910Tibial Plafond (Pilon) Fracture00Tibial Plafond (Pilon) Fracture37763457026910As talus is driven into bottom of tibiaHigh energy mechanismOften comminutedOften associated with L1 fracture and compartment syndrome00As talus is driven into bottom of tibiaHigh energy mechanismOften comminutedOften associated with L1 fracture and compartment syndrome16052807026910002927354879340Tibial Tubercle Fracture00Tibial Tubercle Fracture26809704879340Quads mechanism inserts onSudden force applied to flexed knee00Quads mechanism inserts onSudden force applied to flexed knee16167104879340002946403493135Tibial Spine Fracture00Tibial Spine Fracture37776153493135Anterior tibial spine fracture10x more common than posterior00Anterior tibial spine fracture10x more common than posterior160528034931350016052802991485Head over obturator foramen; short, abducted, externally rotated; needs reduction under GA00Head over obturator foramen; short, abducted, externally rotated; needs reduction under GA2946402991485Obturator Dislocation00Obturator Dislocation2946402130425Tibial Stress Fracture00Tibial Stress Fracture16052802130425Proximal ? tibia in adolescents; junction of middle / distal ? in runners; point tenderness over area of induration; 2x more common in women; 50% stress fracture in adults are in tibiaXR may be negative early; may show periosteal reactionManagement with decreased activity, maybe casting00Proximal ? tibia in adolescents; junction of middle / distal ? in runners; point tenderness over area of induration; 2x more common in women; 50% stress fracture in adults are in tibiaXR may be negative early; may show periosteal reactionManagement with decreased activity, maybe casting306070539750Tibial Shaft Fracture (cntd)00Tibial Shaft Fracture (cntd)1616710539751Management: splint ASAP; if not for OT, POP and can usually fully weight bear through cast with crutches after 2/52Surgery if: ipsilateral femoral + tibial shaft fracture, intra-articular fracture, segment fracture, bilateral fracture, pathologcal fracture; unstable fracture, spiral fracture, open fracture Associated vascular injury; compartment syndrome Intact fibula <50% cortical overlap; >2cm shortening; >5-10° varus/valgus angulation; >10-15° AP angulation; >5-7° rotationComplications: infection, compartment syndrome (in 20%), neurovascular injury, non union00Management: splint ASAP; if not for OT, POP and can usually fully weight bear through cast with crutches after 2/52Surgery if: ipsilateral femoral + tibial shaft fracture, intra-articular fracture, segment fracture, bilateral fracture, pathologcal fracture; unstable fracture, spiral fracture, open fracture Associated vascular injury; compartment syndrome Intact fibula <50% cortical overlap; >2cm shortening; >5-10° varus/valgus angulation; >10-15° AP angulation; >5-7° rotationComplications: infection, compartment syndrome (in 20%), neurovascular injury, non union ................
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