[Ortho] crush distal ttibia

[Cory Collinge]

First, cases like this are difficult and perhaps inappropriate to comment on definitively from afar. I agree with previous comment that the soft tissues are the key component to success, and we have no ability to accurately assess that component of the injury. 
 
Soft tissue questions that may help make decisions:
 
1. Your description of the soft tissue injury is unclear. Is this an open or closed injury?….both Gustilo and Tscherne soft tissue grading systems are mentioned. 
2. Where is the open wound (if it exists)? Can the wound be used to aid in reduction to allow for an easy early nailing? If so, why stage procedures, just nail it. This is a metadiaphyseal fracture with significant soft tissue trauma and even if MIPO plated it will likely take a longtime to heal with a high% requirement for bone graft.
3. How are the lateral soft tissues? Plating the fibula (or PerQ nailing) may provide assistance for a) tibial reduction and b) construct stability to prevent valgus collapse 
4. How are the soft tissues at the medial malleolus? Open vs. perQ screw fixation are options.
5. Finally, and likely most importantly…..are the soft tissues evolving/ progressively dying off? If so, make plans for early soft tissue coverage before it gets infected.
 
Cory Collinge, MD
cell 817-253-9392 
Cory Collinge