Closed reduction of tibial shaft fractures using a sling.

We wish to report a simple technique for closed reduction of tibial shaft fractures. The patient is put in the supine position. Longitudinal traction is applied through a plaster boot on the corresponding foot and ankle. A gauze sling (Fig. 1) placed behind the calf at the fracture site allows suspension of the limb whilst controlling posterior angulation and displacement. This allows control of the limb whilst alignment is checked with the image intensifier in two planes. When satisfactory reduction is obtained, a long leg plaster can be applied to immobilize the fracture. The technique was applied to 21 closed tibial shaft fractures in 21 patients. Satisfactory results were obtained in 20 patients. Analysis of the initial post-manipulation X-rays showed an average of 5.2 mm shortening (range 0-15 mm). The average coronal angulation was 1.9 degrees (range 0-5 degrees), and sagittal angulation was 2.0 degrees (range 0-8 degrees). Average percentage overlap of the fracture fragments was 79% in the coronal plane (range 40-100%) and 82% in the saggital plane (range 50-100%). We found this technique to be simple and reliable. It is particularly useful as the first phase of non-operative treatment of tibial shaft fractures by functional bracing.

Cicatricial, postburn ectropion and exposure keratitis.

Exposure keratitis can lead to infectious keratitis, corneal perforation, blindness and disfigurement. Chronic exposure of the cornea can occur following facial burns that cause eyelid ectropion. This complication can be difficult to diagnose in the unconscious patient. Five patients have undergone lid ectropion release to 11 eyelids in the early postburn period over the past 5 years. One patient required repeat release. Full-thickness skin grafts were used for the lower eyelid and no graft failure occurred. Operations were performed between 30-50 days postburn. Plastic wrap was used in one patient as a temporary dressing to maintain corneal hydration until surgery could be performed. All the patients were noted to have exposure keratitis on ophthalmological review. Patients most at risk are those with large area burns that include the face, who require prolonged intensive care support. It is important to look out for the development of eyelid ectropion, which should be corrected when first diagnosed to prevent disabling, sight-threatening eye injury.