[Ortho] crush distal ttibia

[Alexander Lerner]

Dear Marek,
I am fully agreed with d-r Alexander Chelnokov that the skin and soft tissue condition are crucial at these stage of the treatment and also in the future. The treatment process must be staged due to high-energy trauma with severe soft tissue damage. 
By my opinion, at this stage the lower limb must be fixed using unilateral Ex Fix (tibio-calcaneal bridging due to severe trauma to the ankle joint) or using hybrid Ex Fix (unilateral proximal half-pins tibial fixation combined with distal ring / 5/8ring with thin wires).
Sorry, we haven't clinical pictures. Is a radical repeat wound debridement needed? 
Then, the early free microsurgical flap is a good option for closure the exposed tibial bone fragments and the fracture site. Temporary acute limb shortening or/and angulation for diminishing of the extensive soft tissue wound can be also performed.
The final skeletal stabilization may be performed using IM nailing with additional medial malleolus fixation and also positional screw for syndesmotic fixation. 
Or, you can perform conversion of primary unilateral EX.Fix to finally Ilizarov frame fixation (trans-ankle), especially if the temporary acute shortening or/and angulation was chosed at early stage of the treatment.  Graduate re-alignment and length restoration using Ilizarov method must be performed after wound healing. 
With best wishes
D-r Alex Lerner



--- On Thu, 11/6/08, Marek Kolasniewski <orthoforum на weborto.net> wrote:

> From: Marek Kolasniewski <orthoforum на weborto.net>
> Subject: [Ortho] crush distal ttibia
> To: ortho на weborto.net
> Date: Thursday, November 6, 2008, 9:46 AM
> Dear 
> Could You give us an advice ? 
> 48 yo male, crush injury (esp. Gustilo IIIA ) of distal
> tibia managed nonoperatively ( cast ! ABX) for 2 days, was
> transferred to us. 
> 
> There,s no signs of infection but condition of skin is bad
> ( large contusion, Tscherne 3 ) What kind of treatment:
> definitivly or staged ? Internal fixation (plate) or maybe
> nail + screws ? Ilizarov is an option... <br>
> 
> Best regards
> Marek Kolasniewski
> Orthopedic Trauma Unit
> Military Hospital
> Poznan
> Poland
> Marek Kolasniewski
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