Leg and ankle: An open distal tibia and fibula fracture, fixed with plate and screws

Here I describe the injury of one of my patients who sustained an open tibia shaft fracture. This was a Gustilo type 2 open fracture. The injury was the result of a motorcycle accident.

In addition to the open tibia fracture, the fibula was fractured and was comminuted as well. I ordered an ankle CT which showed intraarticular extension to the middle of the tibial plafond.

In addition to the tibia and fibula fractures and the associated soft tissue injury, the leg had another more proximal soft tissue injury. The depth of this other injury was to the fascial layer.

These are the xrays on presentation.

The injury was treated with meticulous cleaning in the operation room, followed by reduction and internal fixation with plate and screws on both the tibia and the fibula. The principle of bridge plating was applied. Rather than putting a screw on every bone fragment, with the potential for devascularization, the proper alignment of the knee to the ankle is established and is then maintained by the orthopedic hardware. The comminuted area of the fracture is handled gingerly and soft tissues are disturbed to the least extent possible.

The technique allows for healing of the comminuted areas that is similar to healing in a cast. (Why not just use a cast then?? The main answer here is because this fracture was open and bleeding at presentation.)

Postoperative course was complicated by deep vein thrombosis, which was diagnosed on the day after surgery and treated with anticoagulants. Deep vein thrombosis is one of the possible complications with orthopedic injuries. The patient suffered no long term problems from the DVT.

These are xrays at 6 weeks after the injury. The comminuted fractures are obviously not healed at this point.

And here's the appearance of the leg wounds - at this point the scars are still immature, reddish, though fully healed otherwise.

The fracture went on to heal in due course. This patient was allowed to bear weight partially two months after his injury and was advanced gradually. Being pain free, he was allowed full weight bearing at 4 months after the injury.

The following xrays were done 1 year after the injury.

This is a color picture of the irregular open wounds, now healed, on the medial side of the leg of the same patient as above.

Overall an excellent outcome for a potentially problematic injury.