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Case• ชาย ไทย อาย 41 ปCC : ตกจากรถ 10 ลอ 1 hr. PTA

1 hr.PTA ขณะขนของ ผปวยเกดผลดตกจากรถ 10 ลอ ขาขวากระแทกพน หลงจากนนมขาขวาผดรป ปวดบวม บรเวณหนาแขง เดนลงนำาหนกไมได ไมมศรษะกระแทกพน ไมมอาการเจบบรเวณอน

Primary survey•Airway : Alert ,can speak ,C-spine not tenderness •Breathing : RR 22 /min , symmetrical chest movement ,no cyanosis ,chest compression test : negative •Circulation : BP 135/70 mmHg , Pulse 92 bpm full regular ,good consciousness ,warm skin ,no active bleeding•Disability : GCS E4V5M6 ,Pupil 3 mm RTLBE•Exposure : No other wound

Past History Allergy : ไมแพยา/อาหาร Medication : ไมมยารบประทานประจำา Past illness : ปฎเสธโรคประจำาตว Last meal : 19.00 น. Environment/Event :พลดตกจากทสง

Secondary survey

Head : good of consciousnessMaxillofacial : no deformities Cervical spine : Not tender along C- spineChest : symmetrical chest movement , trachea in midline ,resonance on percussion , clear ,no adventitious soundAbdomen : Soft, not tenderExtremities: Swelling ,tender and deformity right leg

Initial managementFilm : Rt. leg AP , Lateral

Tibia Shaft Fractures

Mechanism• low energy fx pattern• result of torsional injury• indirect trauma results in spiral fx

• fibula fx at different level• Tscherne grade 0 / I soft tissue injury

• high energy fx pattern• direct forces often result in wedge or short oblique fx and sometimes significant

comminution• fibula fx at same level• severe soft tissue injury• Tscherne II / III• open fx

Associated conditions• soft tissue injury (open wounds)• compartment syndrome• ipsilateral skeletal injury• extension to the tibial plateau or plafond• posterior malleolar fracture• most commonly associated with spiral distal third tibia fracture

Presentation• Symptoms• pain, inability to bear weight, deformity

• Physical exam

• inspection and palpation• deformity / angulation / malrotation• contusions• blisters• open wounds• compartments

• neurologic• deep peroneal n.• superficial peroneal n.• sural n.• tibial n.• saphenous n.

• pulse• dorsalis pedis• posterior tibial

Treatment of Closed Tibia Fractures• Nonoperative• closed reduction / cast immobilization

indications closed low energy fxs with acceptable alignment• < 5 degrees varus-valgus angulation• < 10 degrees anterior/posterior angulation• > 50% cortical apposition• < 1 cm shortening• < 10 degrees rotational malalignment• if displaced perform closed reduction under general anesthesia• certain patients who may be non-ambulatory (ie. paralyzed), or

those unfit for surgery

place in long leg cast and convert to functional brace at 4 weeks

Operative treatment Fail closes reduction ไม

สามารถ accept alignment ได Ipsilaterar fracture femur , tibia ( Floating knee ) Multiple trauma Fx with compartment syndrome , Vascular injury Open fracture

Treatment of Open Tibia Fractures•  หลกการรกษา Open Fracture Tibia  

• 1.      Antibiotic therapy• 2.      Adequate debridement• 3.      Fracture stabilization• 4.      Adequate soft tissue coverage• 5.      Rehabilitation after fracture heals 

• http://ortho.md.chula.ac.th/student/hip.htm

• http://www.orthobullets.com/trauma/1045/tibia-shaft-fractures

Reference