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Chapter-189 Diaphyseal Fractures of Tibia and Fibula in Adults

BOOK TITLE: Textbook of Orthopedics & Trauma (4 Volumes)

Author
1. Rajasekaran S
ISBN
9789385891052
DOI
10.5005/jp/books/12869_190
Edition
3/e
Publishing Year
2016
Pages
26
Author Affiliations
1. Ganga Hospital, Coimbatore - 641009, India, Ganga Hospital, Coimbatore, Tamil Nadu, India, Ganga Hospital Mettupalayam Road, Coimbatore, India, Ganga Hospital, Coimbatore, Ganga Hospital, 313 Mettupalayam Road Coimbatore: 641043, Dr MGR Medical University, Coimbatore, Tamil Nadu, India, Tamil Nadu Medical University, Coimbatore, Tamil Nadu, India, Ganga Medical Centre and Hospitals, Coimbatore, Tamil Nadu, India, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India
Chapter keywords
Tibia, fibula, blood supply, compartment syndrome, functional cast bracing, plate fixation, biological plating, locking plate, external fixation, interlocking nail, reaming, interlocking screw, distal third fracture

Abstract

Fractures of the tibia and fibula can range from undisplaced fractures with minimal soft-tissue damage to severely mangled injuries and traumatic amputations. There are certain anatomic considerations that make tibial fractures more challenging in management. The blood supply is more precarious compared to other long bones, which are circumferentially covered by muscles. Highenergy tibial fractures are associated with compartment syndrome due to the presence of closed osseofascial compartments of the leg. Due to the close proximity of bifurcation of the popliteal artery at the proximal third, there is a high incidence of vascular injury with fractures at this level. There are several well-accepted techniques for the treatment of tibial fractures. Conservative management utilizing casts and functional orthosis is indicated for minimally displaced and axially stable fractures. Unstable diaphyseal closed fractures and Gustilo-Anderson type I, II and IIIA open fractures are preferably treated with closed intramedullary interlocking nailing. Biological locking plate fixation is preferred in fractures with proximal or distal extension. External fixation is commonly used as a temporary fixation in damage control orthopedics.

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