case of segmental tibia n fibula in a young male patient closed injury n no associated injuries. opinion of the house regarding management options n do we need to fix fibula? how many do prefer/ perform tibial nailng in 30 deg flexion.
Lokesh BhatiaI will prefer to fix distal fracture fibula with plate and screws or elastic nail which will address both,having fixed fibula Tibial Interlocking nailing can be done. With appropriate nail design.
Awadhesh YadavDear….i do these cases with simple table n break the distal side comfortably……positioning is very imp…not a simple straight forward nailing….i will stabilize the fibula first with k wire or thin tens…..to get the correct length….then 30 or 90 degree bend at knee would be made depending upon the. Sx.preferance….putting guide wire would be easy but no reaming n reducing butterfly most of the time require small opening at one#site….it will also help in assesing the rotation of tibia…….ETN type nails r best with multiple distal holes….gental back slap can be done …looking at the fibula….now it may cause distraction at one #site in tibia….can be managed easily at the expense of fibula….. Central distal tip of nail is a must….
Awadhesh YadavDearSatyendra Singhsegmental tibia are dificult one to get reduce easily ….more so if caused by high velocity trauma….had revised 3 _4 cases …one eas a young just married girl…x rays wete perfect with 3 circilage wire…done open outside….presented to me with big exposed ant.bony fragment and obviously…..pus discharge….x .rays r not everything….managing that patient. Could have been better…..all of us has some good/bad exp. Of particular #..learning from others mistakes n improving our own surgical skills based on others good results is what …this forum is for ,i think….
Anuj AgrawalThe distal fibular fracture has to be fixed in this. The tibia can be managed both by a nail or plate, depending upon surgeon’s preference. The proximal tibial fracture is comminuted, and requires closed reduction with relative stability, either by a nail or locked plate in bridge mode. The distal fracture is simple, and can be fixed with either relative (with nail) or absolute stability (with compression plate). Achieving relative stability with plate would be difficult, as the screws on both sides will be close to the fracture, resulting in a short working length.
I would use a medial DT-LCP in combination mode in this case, with open reduction and compression across the distal fracture (with fibular plating), and proximal fracture fixed in a MIPO fashion.