Fractures of the Tibia (eBook)

Nirmal C. Tejwani, MD, Professor, Department of Orthopedics, NYU Langone Medical Center, Hospital for Joint Diseases, Chief of Orthopedic Trauma, Bellevue Hospital, New York, NY, USA

Preface 8
Contents 10
Contributors 14
Part I: Treatment of Proximal Tibia Articular Fractures 19
Chapter 1: Schatzker I/II Tibia Plateau Fracture 20
Clinical History 20
Treatment Considerations/Planning/Tests 21
Timing of Surgery 23
Intraoperative Tips and Tricks for Reduction/Fixation 23
Postoperative Protocol 24
Follow-Up with Union/Complication 25
Salient Points/Pearls 27
Chapter 2: Schatzker III Tibia Plateau Fracture (with Bone Graft Substitute) 28
Short Clinical History 28
Treatment Considerations/Planning/Tests Needed 30
Timing of Surgery 31
Intraoperative Tips and Tricks for Reduction/Fixation 31
Positioning and Equipment 32
Approach 32
Options for Reduction and Bone Grafting 33
Options for Fixation 38
Newer Techniques 38
Postoperative Protocols Including Splint/Cast and Timing of Weight-Bearing 39
Follow-Up with Union/Complications 40
Clinical Pearls 40
References 41
Further Reading 43
Chapter 3: Schatzker IV Tibia Plateau Fracture Treated with Open Reduction and Internal Fixation 44
Case Presentation 44
Initial Imaging 45
Treatment and Timing of Initial Surgery 46
Surgical Tact 49
Position 49
Approach 49
Pearls 50
Definitive Surgery with a Posteromedial Approach 53
Surgical Tact 53
Position 53
Surgical Approach 54
Fracture Reduction 54
Pearls 57
Postoperative Plan 60
Chapter 4: Bicondylar Tibial Plateau ORIF Technique 61
Introduction 61
Case Presentation 61
Treatment Consideration 63
Technique Details 65
Knee-Bridging External Fixation (Fig. 4.3) 65
Open Reduction Internal Fixation (Fig. 4.4) 65
Postoperative Protocol 69
Salient Points/Pearls 70
References 71
Chapter 5: Bicondylar Tibial Plateau Fracture (Schatzker VI) 72
Case: Clinical History 72
Diagnostic Testing and Treatment Considerations 73
Timing of Surgery and Preoperative Planning 74
Intraoperative Tips and Tricks for Reduction and Fixation 77
Technique of Open Reduction and Internal Fixation 79
Postoperative Protocol 81
Follow-Up and Complications 81
Salient Points/Pearls 82
References 84
Chapter 6: Tibial Plateau Schatzker V/VI Treated in Ex Fix/Circular Frame 87
History 87
Treatment Considerations/Planning/Tests Needed 88
Surgical Tact 89
Intraoperative Tips and Tricks for Reduction 91
Postoperative Rehab Protocol 95
Follow-Up 95
Salient Points/Pearls 97
Further Reading 98
Chapter 7: Bicondylar Tibial Plateau Fracture with Compartment Syndrome 99
Case Presentation 99
Injury Films 99
Treatment and Timing of Surgery 101
Surgical Tact 101
Positioning 101
Approach 101
Fixation 101
Postoperative Plan 103
Definitive Fixation and Timing of Surgery 103
Surgical Tact 103
Positioning 103
Approach 103
Fracture Reduction and Fixation 104
Postoperative Plan 104
Outcomes 104
Complications 106
Salient Points/Pearls 106
References 107
Part II: Treatment of Tibia Shaft Fractures 108
Chapter 8: Proximal Third Tibia Fracture Treated with Intramedullary Nailing 109
Clinical Scenario 109
Treatment Algorithm 109
Treatment Considerations with Proximal Third Tibial Nailing 111
Intraoperative Tips and Tricks for Reduction/Fixation 113
Postoperative Protocols 115
Follow-Up with Union/Complications 116
Pearls/Salient Points 117
References 118
Chapter 9: Proximal Tibia Fracture Treated with Plate and Screws 119
Case Presentation 119
Injury Films 119
Treatment and Timing of Surgery 120
Surgical Tact 121
Position 121
Approach 123
Fracture Reduction 123
Postoperative Plan 128
Outcome 129
Complications 130
Salient Points/Pearls 130
Suggested Reading 131
Chapter 10: Mid Shaft Tibia Shaft Fracture Treated with Intra-medullary Nail (IMN) 133
Case Presentation 133
Injury Films 133
Treatment and Timing of Surgery 135
Surgical Tact 135
Position 135
Approach 135
Fracture Reduction 137
Postoperative Plan 139
Outcome 139
Complications 139
Salient Points/Pearls 139
References 142
Chapter 11: Tibia Shaft Distal Third: Treatment with an Intramedullary Nail 143
Background 143
Short Clinical History/Scenario 144
Treatment Considerations/Planning/Tests Needed 144
Timing of Surgery 146
Intraoperative Tips and Tricks for Reduction/Fixation 146
Postoperative Protocols Including Splint/Cast and Timing of Weight-Bearing 149
Follow-Up with Union/Complications 149
Salient Points/Pearls 150
References 150
Chapter 12: Distal Tibia Shaft Fracture Treated with Plate Fixation 152
Case Presentation 152
Injury Films 152
Treatment and Timing of Surgery 153
Surgical Tact 154
Position 154
Approach 154
Fracture Reduction and Fixation 154
Postoperative Plan 155
Outcome 156
Salient Points/Pearls 157
References 158
Chapter 13: Tibia Shaft Fractures of the Distal Third Treated with Plate Fixation of Tibia and Fibula 159
Case Presentation 159
Injury Films 159
Treatment and Timing of Surgery 160
Surgical Tact 160
Position 160
Approach 160
Fracture Reduction 161
Postoperative Plan 161
Outcome 162
Complications 163
Salient Points/Pearls 163
References 164
Part III: Treatment of Open Tibia Fractures 165
Chapter 14: Open Tibia Fractures: Staged Treatment 166
Clinical History/Scenario 166
Treatment Considerations/Planning/Tests Needed 167
Timing of Surgery 168
Intraoperative Tips and Tricks for Reduction/Fixation 169
Postoperative Protocols 170
Follow-Up 170
Salient Points/Pearls 173
References 173
Chapter 15: Open Tibial Fracture with Immediate Fixation and Early Soft Tissue Coverage 174
Case Presentation 174
Injury Films 175
Treatment and Timing of Surgery 175
Surgical Plan 175
Position 175
Surgical Approach 176
Fracture Reduction/Implant Insertion 176
Wound Management 177
Postoperative Plan 179
Outcome 180
Complications 180
Teaching Points 180
Further Reading 184
Part IV: Treatment of Distal Tibia Articular Fractures 186
Chapter 16: Distal Tibia Pilon: Staged Fixation with an Anterolateral Plate 187
Case Presentation 187
Injury Films 187
Treatment and Timing of Surgery 189
Surgical Tact 189
External Fixation 189
Definitive Open Reduction and Internal Fixation 189
Postoperative Plan 192
Complications 192
Salient Points/Pearls 192
References 194
Chapter 17: Distal Tibial Pilon Fracture: Delayed Treatment and Dual Incision Approach 195
Case Presentation 195
Initial Injury Films 195
Treatment and Timing of Temporizing Surgery 196
Postexternal Fixation CT Scan 196
Treatment and Timing of Definitive Surgery 197
Surgical Tact 197
Position 197
Approach 198
Fracture Reduction 200
Postoperative Plan 201
Outcome 203
Complications 203
Salient Points/Pearls 203
References 205
Chapter 18: Treatment of Pilon Fracture in External Fixator 206
Clinical Scenario 206
Treatment Considerations and Planning 207
Surgical Timing 208
Intraoperative Tips and Tricks for Reduction/Fixation 210
Use of CT Scan for Preoperative Planning of Lag Screws Perpendicular to Fracture Line 210
Perfect Circle Technique for Percutaneous Lag Screws 210
Adjustment of Temporary External Fixator to Definitive Treatment Construct 212
Maintenance of Plantigrade Foot in External Fixator 213
Postoperative Protocol 215
Follow-Up 215
Salient Points/Pearls 215
References 217
Chapter 19: Distal Tibia Pilon: Staged Fixation – Fibula Fixation and then Tibia 218
Case Presentation 218
Initial Treatment and Timing of Surgery 219
Surgical Tact 219
Position 219
Approach 219
Fracture Reduction and Closure 220
Definitive Treatment 221
Surgical Tact 221
Position 221
Approach 222
Fracture Reduction and Closure 222
Postoperative Plan 224
Outcome 224
Salient Points/Pearls/Tips and Tricks 224
References 229
Part V: Treatment of Non Union and Mal-Union of Tibia Fractures 230
Chapter 20: Nonunion Tibia Shaft Treated with IMN/Bone Grafting 231
Clinical Scenario 231
Treatment Considerations/Planning/Tests 232
Timing of Surgery 236
Intraoperative Tips and Tricks for Reduction/Fixation 236
Postoperative Protocols 237
Follow-Up 238
Pearls and Pitfalls 238
References 240
Chapter 21: Technique of Masquelet Bone Grafting 241
Case Presentation 241
Treatment and Timing of This Surgery 242
Surgical Tact 242
Position 242
Equipment 242
Follow-Up Surgery 244
Position 245
Equipment 245
Timing 246
Introduction/Summary/Salient Tips/Pearls 254
Bibliography 256
Chapter 22: Modified Clamshell Osteotomy for Treating Acute Tibial Shaft Fracture with Pre-existent Malunion 257
Case Presentation 257
Injury Films 257
Treatment Considerations/Planning/Tests Needed 259
Timing of Surgery 261
Intraoperative Tips and Tricks for Reduction/Fixation 262
Position 262
Approach 262
Fracture Reduction 262
Postoperative Plan 263
Outcome 266
Salient Points/Pearls 266
References 267
Chapter 23: Treatment of Tibia Malunion with Circular External Fixation 269
Clinical History 269
Treatment Considerations 271
Timing of Surgery 274
Intraoperative Tips and Tricks 274
Postoperative Protocols 279
Follow-Up with Union/Complications 283
Pearls/Salient Points 288
References 289
Index 290