-
Non-op tibia fractures
- <5deg varus
- < 10deg AP
- <10deg rotation
- <1.5cm initial shortening
- >50% cortical contact
- fractured fibula
-
Proximal tibia fx falls into:
- valgus (pull from pes insertion)
- procurvatum (patella tendon pull on tibial tubercle)
-
Distal tibia fx falls into:
-
Tscherne Classification of closed fx
- C0 simple fx with little/no soft tissues injury
- C1 mild/mod fx pattern with superficial abrasion
- C2 mod/severe fx pattern with deep contaminationand skin/muscle contusion
- C3 severe fx with extensive/crushing skin/muscle
-
Four compartments of the leg
- Anterior - tib ant, EDL, EHL, deep peroneal N, ant tib art
- Lateral - peroneus longus, peroneus brevis, superfic peroneal N
- Superficial posterior - gastroc, soleus, plantaris
- Deep posterior - tib post, FDL, FHL
- between post compts - peroneal and post tib art, post tib N
-
Irreducible subtalar dislocation
- Lateral - post tib tendon, buttonhole thru retinaculum
- Medial - EDB, extensor retinaculum, talar head button hole through capsule of talonavicular joint
-
Current treatment of tibia fx
- 1. long leg cast, PTB casting, fracture brace
- 2. plate fixation
- 3. IMN
- 4. ex fix
-
Ulna fractures
- aka nightstick fractures
- operative indications: >10deg angulation, >50% displacement of cortex
- greater displacement associated with rotational instability of IOM
- central band of IOM 70% stability, goes prox radial to distal ulna
- LCDC plate goes dorsally
-
Radius fractures
- Galeazzi fractures - distal 1/3 radius fracture with DRUJ disloc/sublux
- LCDC plate, K-wire DRUJ if unstable
- volar Henry approach - between BR and flexor/pronator mass, protect radial art
- dorsal Thompson approach - between ECRB and EDC, PIN at risk
-
Radiographic signs of DRUJ disruption
- 1. displaced fracture of ulnar styloid at its base
- 2. widening of DRUJ space on AP
- 3. Dislocation of radius relative to ulna on true lateral
- 4. shortening of radius 5mm relative to radius
- if displaced dorsally, DRUJ stable in supination
- irreducible DRUJ - ECU tendon entrapped
|
|
