Injuries of the knee and leg
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Low-energy fractures can in certain circumstances be treated by non-operative methods. If the fracture is undisplaced or minimally displaced, a full-length cast from upper thigh to metatarsal necks is applied with the knee slightly flexed and the ankle at a right angle (Figure 31.20). Displacement of the fibular fracture, unless it involves the ankle joint, is unimportant and can be ignored. Apposition need not be complete but alignment must be near-perfect and rotation absolutely perfect. The position is checked by X-ray. Minor degrees of angulation can still be corrected by making a transverse cut in the plaster and wedging it into a better position. If there is excessive swelling, the cast is split. After 2 weeks the position is checked by X-ray. A change from an above- to a below-the-knee cast is possible around 4–6 weeks, when the fracture becomes ‘sticky’. An alternative is a ‘Sarmiento’ cast which allows knee flexion but confers some additional stability. The cast is retained (or renewed if it becomes loose) until the fracture unites, which is around 8 weeks in children but seldom under 12 weeks in adults.
Orthopedic Treatment of the Traumatized Lower Extremity
Armstrong Milton B. in Lower extremity Trauma, 2006
For more severe, closed soft-tissue injuries, a temporary external fixator is often applied to maintain the appropriate length and alignment of the limb until swelling subsides. In general, this requires one to two weeks. Mini-open reduction of the articular surface with percutaneous fixation may be carried out at the time of the initial surgery (95), or it may be done at the time of the second operation using a more conventional open technique (96). Plate fixation of the tibia is then performed using either percutaneous or traditional open technique. Modern implants, which are low profile, contoured to the shape of the distal tibia, and designed to be applied percutaneously, are useful in this regard. Some surgeons prefer to plate an uncomplicated fibula fracture at the time of the initial operation in order to assist in determining limb length and alignment; others feel that it is unnecessary to perform this acutely.
Tibia and fibula diaphyseal fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
The classification system most commonly used for tibial diaphyseal fractures is the AO/OTA15 system. The basic fracture types delineated by this classification system are shown in Figure 40.4. Type A fractures are simple fractures with A1 fractures being spiral fractures, A2 fractures being oblique fractures with an angle ≥30 degrees and A3 fractures being oblique fractures with an angle of <30 degrees. Type B fractures are wedge fractures with B1 fractures having a spiral wedge, B2 fractures a bending wedge and B3 fractures a fragmented wedge. Type C fractures are complex fractures with C1 fractures having a spiral morphology. C2 fractures are segmental fractures and C3 fractures are irregular, comminuted fractures. The suffix .X is used to define an associated fibular fracture in type A and B fractures. Thus .1 means that the fibula is intact, .2 means that the fibular fracture is not at the same level as the tibial fracture and .3 means that it is at the same level. In type C fractures the suffixes .1, .2, and .3 detail the amount of damage to the diaphysis.
The intersection of cerebral fat embolism syndrome and traumatic brain injury: a literature review and case series
Published in Brain Injury, 2020
Taron Davis, Alan Weintraub, Michael Makley, Eric Spier, Jeri Forster
A 63-year-old female, pedestrian struck by a motor vehicle. Her initial GCS rating was 12 and her head CT scan showed small subdural hematomas and cortical contusions. Additional injuries include severe skull trauma, thoracic and lumbar spine fractures, pelvic, and retroperitoneal hematoma, left tibia fracture, left fibula fracture, and left ulna and distal radius fracture. She underwent ORIF of left tibia and left ulnar fractures. She had an acute prolonged disorder of consciousness postoperatively, and subsequent serial neuroimaging as part of the work up. On post-injury day three, MRI demonstrated innumerable foci of supratentorium and infratentorial restricted diffusion. CT scan showed a diffuse axonal injury, hemorrhagic contusions in bilateral inferior frontal hemispheres, subdural hemorrhage, and subarachnoid hemorrhage. Her admission and discharge FIM scores were 12 and 38, respectively. She was discharged home to the care of her family. At 6 months her GOS was a 3 indicative of severe disability.
Orthopedic treatment for open fracture of lower extremities and soft tissue defects in young children and rapid rehabilitation after operation
Published in The Physician and Sportsmedicine, 2020
Paerhati Rexiti, Tie-Cheng Zhang, Chugulike Batuer, Li Cao
After an operation for tibia and fibula fracture, tendon injury and peripheral nerve injury in the lower limbs, young children usually require to be immobilized and fixed for approximately three weeks, in order to protect tissues and promote bone healing. After approximately three weeks of early rehabilitation treatment, children can cooperate with the physical rehabilitation physician on resistance training, step by step from light to heavy, according to the healing of fracture revealed by the X-ray film of their lower limbs. Furthermore, muscles are forced to contract at the greatest ability to enhance muscle force, increase the range and sense of joint activity, improve the ability of coordination, and attempt to use auxiliary braces, in order to promote and consolidate the treatment effect [15].
Comparison of pediatric sports fracture outcomes based on provider type
Published in The Physician and Sportsmedicine, 2021
Emily A. Sweeney, David R. Howell, Morgan N. Potter, Alexia G Gagliardi, Jay C. Albright, Aaron J. Provance
We also used injury location-specific patient-reported functional outcome measures. Participants who sustained a tibia or fibula fracture completed the Foot and Ankle Ability Measure (FAAM) [26]. For this questionnaire, participants answered 21 questions about activities of daily living and eight questions specific to sports regarding their condition in the previous week. Responses were given a numeric value from 0 (no difficulty) to 4 (unable to do) and all responses were summed to provide an overall value. Similarly, participants who sustained a radius or ulna fracture completed the Disabilities of the Arm, Shoulder, and Hand (DASH) Scale [27]. They completed 30 questions pertaining to symptoms and ability to perform activities of daily living related to upper extremity function. Scores were calculated as the sum of responses, which were rated from 0 (no difficulty) to 4 (unable to perform). Therefore, 0 indicates the least upper extremity disability and 100 indicates the most disability.
Related Knowledge Centers
- Bone
- Fibula
- Tibia
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- Bone Fracture
- Leg
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- Bumper Fracture