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Ortho
- 1. E x tC o n f e r e n c e 1 Ext Chaiwat Limthongsittikhun Ext Nunchaya Roongsrisawad
- 2. Case • Case: ผู้ป่วยเด็กหญิง9ปี 5เดือน • No known underlying disease • Chief complaint: ปวดขาขวา 2 ชม. PTA
- 3. Primary Survey • A:able to talk, no cervical tenderness, full ROM of neck • B: clear, equal breath sound, CCT –ve • C: PR 120/min, BP110/66mmHg, no external bleeding • D: E4V5M6, pupil 2mm RTLBE • E: no back wound, right ankle deformity, marked tenderness and swelling
- 4. Secondary Survey • A:no food/drug allergy • B: no current medication • P: no known underlying disease • L: last meal 10:00 AM • E: 2 ชม PTA ขณะกาลังหัดขับรถจักรยานยนต์ ขับรถล้มเอง ศรีษะไม่กระแทก ไม่สลบ จาเหตุการณ์ได้ ไม่คลื่นใส้อาเจียน รถทับขา ข้อเท้าขวาปวด บวม ลงน้าหนักไม่ได้ ไม่มีแผล
- 5. PE • GA: alert,good consciousness • HEENT: not pale conjunctivae, anictericsclerae • Heart: normal s1s2, no murmur • Lungs: clear, equal breath sound • Abdomen: soft, not tender, no rebound, no guarding • Ext: deformity, swelling, tenderness right ankle, limited ROM due to pain, DPA 2+, cap refill <2 sec, normal sensation, no external wound
- 6. Investigation • Film rightankle AP, lateral, Mortise
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- 11. Radiologic Finding • Closetransverse fracture right distal tibia with minimal displacement • Close multifragmentary fracture right distal fibula with displacement
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- 15. Diagnosis • Close fractureboth bone right leg
- 16. Management Ortho -Pain control -close reduction -longleg posterior slab -observe sign of compartment syndrome
- 17. T i bi a a n d F i b u l a f r a c t u r e G E N E R A L K N O W L E D G E 17 Ext Chaiwat Limthongsittikhun Ext Nunchaya Roongsrisawad
- 18. Tibia and Fibulashaft fracture • Low energy • Common > 50 years old • Mechanism - Fall from height, sporting injury • High energy • Common <30 years old • Mechanism – vehicular trauma
- 19. • 70% :isolated pediatric tibial fracture • <11 years old : torsional force , location - distal 3rd of tibial diaphysis • Isolated transverse or comminuted fracture : direct trauma • Intact fibula prevent shortening of tibia • 60 % develop varus angulation within 1st 2 weeks of injury Tibia and Fibula shaft fracture • 30% : associated with fibula fracture • Valgus malalignment • Isolated fibula shaft fracture : rare in children • Resulted from direct blow to lateral aspect of leg • None displace fracture : supportive care
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- 26. Distal tibia metaphysisfracture • Often greenstick injury : “Robert Gillespie fracture” • Mechanism : Increase compressive force along anterior tibial cortex (axial load on dorsiflex foot) • Posterior cortex is usually displaced, Periosteum is usually torn • Common : valgus and recurvatum deformity
- 27. Sign and Symptoms •Pain • Swelling • Tenderness • Deformity • Refuse to ambulate • Palpable bony prominent • Rare neurovascular impairment (except in fibula neck fracture)
- 28. Radiology • Knee AP,Lateral • Ankle AP, Lateral, Mortise • Technetium radionuclide scans
- 29. Treatment • Cast immobilization •Metaphysis (non displaced) • Long or short leg cast with moderate plantar flexion -> return to neutral position after 3-4 weeks with short leg walking cast • Operative treatment • Metaphysis (unstable displaced) • Close reduction with percutaneous pinning • ORIF if associated with fibula fracture
- 30. Treatment • Cast immobilization •Diaphysis (stable) • Close reduction • short leg cast with varus or valgus mold • Diaphysis (unstable) • Bent-knee long leg cast • Plantar flexion (20 degree in middle, distal 3rd ; 10 degree proximal 3rd )
- 32. Associated Complication • Compartmentsyndrome • Vascular injury • Angular deformity • Malrotation • Leg length discrepancy • Anterior tibial physeal closure • Delayed union / nonunion
- 33. HEADING 33 HEADING 33 THANK YOU Tibiatexttext text text Fibulatext text text Casttext text Surger ytext text