$closed fracture of distal end of right fibula$

$closed fracture of distal end of right fibula$

#Closed fracture of distal end of right fibula skin#

One must remember that in multifragmentary intra-articular fractures of the distal tibia (classical pilon fractures), the depressed articular fragments have no soft-tissue attachments and cannot be reduced by indirect closed means (ligamentotaxis) and require direct open reduction. Articular fractures with joint depression should be non-weight-bearing for 12 weeks. Partial weight-bearing on crutches may be started at six to eight weeks in stable, non-displaced fractures. Other indications may include patients who are at extremely high risk for anaesthesia or high risk for surgical complications because of the local soft-tissue condition or the patient’s refusal of surgical treatment.Īfter closed reduction, a carefully padded lower-leg plaster cast is applied. 20Ĭonservative management may play a role in the treatment of non-displaced fractures or fractures that can be reduced and remain stable in a cast.

$closed fracture of distal end of right fibula$

22 The AO soft-tissue grading system allows comprehensive description of all soft-tissue injuries in both open and closed fractures. 21 Closed soft-tissue injuries can be classified according to Tscherne and Oestern. The most commonly used classification of open fractures is that described by Gustilo and Anderson.

#Closed fracture of distal end of right fibula skin#

The safety of a direct approach and open reconstruction of the articular surface early after the injury depends primarily on the condition of the local skin and subcutaneous soft tissues. The condition of the soft tissues plays a key role in the treatment of distal tibial fractures. 43-C1 articular simple, metaphyseal simple 43-C2 articular simple, metaphyseal multifragmentary 43-C3 articular multifragmentary. 43-B1 pure split 43-B2 split depression 43-B3 multifragmentary depression.

$closed fracture of distal end of right fibula$

Adapted with kind permission from AO Foundation, Switzerland. 2a):ĪO/OTA classification of distal tibial fractures. Tornetta and Gorup, 16 on the basis of CT investigations of 22 distal tibial fractures, identified six relatively common fracture fragments ( Fig. It has been shown that in > 80% of cases CT scans provided additional information about the fracture configuration which resulted in a change of the initially planned surgical approach in 64%. With intra-articular fractures, CT is paramount. In extra-articular fractures, plain radiographs provide sufficient information for surgical planning. Radiological evaluation includes plain radiographs and CT scanning. Compartment syndrome must always be suspected in cases with significant swelling, the appearance of fracture blisters or severe pain not responding to analgesics. Local swelling and fracture blisters may develop quickly and will influence the choice and timing of treatment. Up to 50% of distal tibial fractures are open, but significant soft-tissue injury occurs in closed fractures as well. Thorough evaluation and documentation of the local soft-tissue condition is critical. 7Ĭlinical examination of the patient with a distal tibial fracture should be performed according to the Advanced Trauma Life Support protocol, 14 as a significant number of patients may have additional injuries.Ĭlinical examination includes a thorough, systematic clinical assessment to include peripheral pulses and a careful neurological assessment. If the ankle is in a neutral position, usually total involvement of the articular surface is seen with a Y-type separation of anterior and posterior fragments frequently with central joint impaction ( Fig. The opposite situation occurs when the foot is dorsiflexed causing the talar dome to impact on the anterior part of the distal tibial articular surface. With plantarflexion of the foot, most forces are directed to the dorsal (posterior) part of the articular surface and lead to the formation of a relatively large posterior fragment. The severity of the articular injury depends on the amount of energy applied and the position of foot at the time of impact. On the other hand, higher energy axial compression forces lead to intra-articular fractures of the distal tibia when the convex talar dome impacts the concave plafond of the distal tibia. These are usually closed, resulting from low energy and the associated soft-tissue injuries are not usually severe. Rotational forces (torsion) usually lead to a spiral fracture which may be intra- or extra-articular. Mechanisms of injury, epidemiology and concomitant injuriesĭistal tibial fractures are usually caused by two possible types of forces: rotational and/or axial loads.

$closed fracture of distal end of right fibula$