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Tibial Shaft Fracture External Fixation 20690

 

synonyms:tibial shaft fracture external fixation, ex fix

Tibial Shaft Fracture External Fixation CPT

Tibial Shaft Fracture External Fixation Indications

  • High energy open fracture
  • High energy pediatric fracture
  • Open 3C tibial shaft fracture 
  • Unstable trauma patient

Tibial Shaft Fracture External Fixation Contraindications

Tibial Shaft Fracture External Fixation Alternatives

Tibial Shaft Fracture External Fixation Pre-op Planning

  • Anterior unilateral frames are most effective, particularly when applied with relatively stiff components with a maximal spread between the pins in each main bony fragment. (Bebrens F,CORR 1983;178: 103).
  • Predrilling and inserting pins manually prevents thermal necrosis and cracking.
  • Avoid placement of pins within joint capsules. Knee capsule may extend 14mm distal to the tibial plateau.
  • Conversion to intramedullary nail (when applicable) should be done within 2 weeks to decrease infection risk. (Bhandari M, JOT 2005;19:140).
  • Case Card
  • Converting external fixationto IM Nail: should be done within 7-10 days to minimize the risk of infection. Immediate conversion if without evidence of pin track infection.  Delay of at least 4 days prior to conversion is recommended to allow resolution of the acute inflammatory phase and minimize risk of SIRS. (Della Rocca GJ, J Am Acad Orthop Surg. 2006;14(10 Spec No.):S131-5).

Tibial Shaft Fracture External Fixation Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • Supine position. All bony prominences well padded.
  • General endotracheal anesthesia
  • Prep and drape in standard sterile fashion.
  • 1-cm incision over preplaned pin site on anteriormedial border of tibia.
  • Soft tissues incised to bone.
  • Predrill using a tissue protector.
  • Screw half pin in placed making sure that the pin penetrates both cortices.
  • Ensure pin does not protrude more than 2mm of far cortex using fluoroscopy.
  • Repeat for all half-pins.
  • Apply frame per manufacture recommendations / pre-op plan.
  • Release any skin encroachmnet on the fixator pins.
  • Dress pins with xeroform and 4x4's/
  • Apply bulky Jones dressing with posterior mold to avoid equinus contracture.

Tibial Shaft Fracture External Fixation Complications

Tibial Shaft Fracture External Fixation Follow-up care

  • Converting external fixationto IM Nail: should be done within 7-10 days to minimize the risk of infection. Immediate conversion if without evidence of pin track infection.  Delay of at least 4 days prior to conversion is recommended to allow resolution of the acute inflammatory phase and minimize risk of SIRS. (Della Rocca GJ, J Am Acad Orthop Surg. 2006;14(10 Spec No.):S131-5).
  • Post-op: NWB, Bulky Jones dressing with posterior mold to avoid equinus contracture. Pin site care.
  • 7-10 Days: Evaluate for pin site infection, Review xrays for alignment, Continue Pin site care. Conversion to intramedullary nail should be done within 2 weeks to decrease infection risk. (Bhandari M, JOT 2005;19:140).
  • 3 Weeks: Evaluate for pin site infection, Review xrays for alignment, Continue Pin site care.
  • 6 Weeks: Evaluate for pin site infection, Review xrays for alignment, Continue Pin site care. Advance weight bearing when callus is seen on xray. Consider dynamizing frame. Plan frame removal.
  • 2 Months: Remove frame if abundant callus seen on xray. Place in SLC.
  • 3 Months: Review xrays, Cam walker / fracture brace
  • 6 Months: Advance activity. Consider PT for any knee or ankle ROM limitations.
  • 1Yr: follow-up xrays, assess outcomes.

Tibial Shaft Fracture External Fixation Outcomes

  • (Rommens P, J Trauma 1989;29:630).
  • 31 weeks to union, 18% malunion, for open tibia fractures treated with external fixation. (Aho AJ, CORR 1983;181:154).

Tibial Shaft Fracture External Fixation Review References

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