Comminuted Segmental Fracture of Left Tibia Shaft and Fibula

A 48 year old female was brought to Aster Hospital’s Emergency on the evening of 20th October 2017. She was brought in the ambulance on a stretcher complaining of severe pain and deformity of her left leg with blood soaked POP slab.

The patient was unable to move her left leg because of severe pain which made it difficult to shift her to the bed from the stretcher. The patient had a history of a trivial fall at her residence where she slipped and fell on the floor while hitting the edge of a bed. She was treated initially at another hospital with pop slab and later was brought to Aster Hospital’s ER by her colleagues.

An x-ray was taken which showed Comminuted Segmental Fracture shaft of tibia and lower third of fibula of the left side. She also had a punctured wound over the lower end of tibia with bleeding and exposed bone fragment. She was immediately admitted and the necessary blood investigations were performed. A CT scan of her left leg was done to see the fracture configuration and plan the treatment.

After appropriate investigation and planning, the patient was posted for surgery on 21st October 2017. Considering the fracture configuration and the comminution, the patient was explained in detail the treatment plan. Prior to the surgery, the patients consent was taken and began preparing for the surgery.

After thorough planning Synthes Tibia Intramedullary nailing system was used to fix the fracture and the surgery was started.

The surgery was successfully completed as planned with good fracture reduction and good limb alignment. Closed intramedullary nailing was performed with ORIF of fibula. Post op recovery was good and the swelling reduced with good wound healing on subsequent follow ups.

The patient was on physiotherapy post operatively and was mobilized with walker.

She was advised to walk non weight bearing for 6 weeks while continuing physiotherapy to strengthen her muscles and to mobilize her joints. On regular follow up she had good recovery with good signs of bone healing. Currently, at 4 months post op, the patient is walking without support, full weight bearing and independent.

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