Tibial Shaft Fracture

Question 1

What is compartment syndrome?

Answer 1

• Increased pressure within fascial compartment
• Can be due to vascular injury, inflammation or oedema within compartment
• Results in compression of blood supply and ischaemia to muscles
• Surgical emergency

Question 2

Examination findings for compartment syndrome

Answer 2

• Pain - much more pain you would usually get with injury seen, worse when passive stretch of muscle belly
• Pallor
• Parasthesia
• Paralysis
• Palpate - feels tense, not swollen though as fascia cannot stretch

Question 3

Measurement for compartment syndrome

Answer 3

• Can do needle manometry - measures resistance of muscle to injection of saline into compartment and measures pressure
• A form of intracompartmental pressure monitoring

Question 4

How many compartments in lower leg?

Answer 4

• 4 = anterior, lateral, superficial and deep posterior

Question 5

Compartment syndrome vs acute limb ischaemia

Answer 5

• ALI - pulselessness is a feature, due to blockage within arterial supply, diagnosed with doppler USS or angio, need revascularisation eg angioplasty/thrombolysis
• Compartment syndrome - due to compression of outside of arterial supply, usually following crush injury/#, need fasciaotomy

Question 6

Management of compartment syndrome

Answer 6

• Fasciotomy within 6 hours with debridement of necrotic muscle
• Remove tight bandages, elevate limb to height of heart, maintain good BP

Question 7

Surgical management for spiral tibial shaft fracture

Answer 7

• Open reduction
• Internal fixation
• Often with intramedullary nail if not involving knee/ankle joint
• If is, screws and plate often used

Question 8

Expected time for union of tibial fracture

Answer 8

4-6 months to heal completely
Even longer if smoke or multiple pieces when # occured

Question 9

How long off work for tibial shaft spiral #?

Answer 9

• If lifting - need 6-12 weeks
• Driving - need AT LEAST 6 weeks - need to be able to emergency stop a car safely and adequately

Question 10

Discharge info for patient following tibial shaft #

Answer 10

• F/u in 2 weeks with fracture nurses for removal of clips etc
• Week 12 seen in fracture clinic - surgeon and x-ray
• Signs of infection, DVT/PE, loose screw if prominent lump near scar
• Can return to contact sport in 12 weeks

Question 11

Compartment syndrome pathophysiology

Answer 11

• Fracture
• Bleeding, oedema or inflammation
• = increase pressure
• = reduced capillary flow
• = muscle ischaemia
• = more oedema as venous pressure increases so fluid moves out
• = more ischaemia
• = viscious circle
• In 12 hrs or less necrosis of muscle and nerves

Question 12

Consequence of compartment syndrome

Answer 12

• Necrosis of nerve and muscle
• Nerves can regenerate
• Muscle replaced by ineslastic fibrous tissue eg Volkmanns ischaemic contracture