Subject(s)
Child Welfare/statistics & numerical data , Obesity/epidemiology , Age Distribution , Child , Child, Preschool , Female , Humans , Kentucky/epidemiology , Male , PrevalenceABSTRACT
This study reviews 24 patients with ipsilateral fractures of the distal tibia metaphysis and ankle joint. All fractures were evaluated and categorized by the mechanism of injury--that is, bending force versus torsion. All--tibial fractures in this series were managed by a statically locked intramedullary nail with appropriate stabilization of the ankle injury as indicated by the fracture or injury pattern. This treatment protocol resulted in an excellent clinical result with only 3 patients requiring a secondary procedure: 2 dynamizations and 1 exchanged intramedullary nail. The results indicate that fibular fractures not involving disruption of the syndesmosis or minimally displaced distal fibular fractures may be treated nonoperatively. Conservative management or minimal internal fixation may be recommended for minimally displaced fractures of the medial malleolus or tibial plafond. Displaced fractures of the medial malleolus or distal fibula or fractures in which the syndesmosis has been disrupted are best treated with standard open reduction and internal fixation following placement of the intramedullary nail.
Subject(s)
Ankle Injuries/surgery , Fracture Fixation, Intramedullary , Fractures, Bone/surgery , Tibial Fractures/surgery , Ankle Injuries/diagnostic imaging , Bone Nails , Follow-Up Studies , Fractures, Bone/diagnostic imaging , Humans , Radiography , Tibial Fractures/diagnostic imaging , Treatment OutcomeABSTRACT
The management of musculoskeletal infection as a result of acute extremity injury remains a challenge to the experienced surgeon. The current treatment of acute debridement and wound irrigation remain the most important factors in the prevention of acute or chronic infection. Skeletal stabilisation and appropriate soft tissue coverage are also imperative in the standard care of these complicated traumatic wounds. Once stabilised, severe open fractures remain at risk as a result of the compromised vascularity of the bone and soft tissue. Parenteral broad-spectrum antibiotics are recommended as a prophylaxis to the open wound contamination. In such injuries the therapeutic levels of the antibiotics are frequently diminished by the impaired tissue perfusion, vasospasm, edema and vascular damage.
