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CASE REPORT

University of Cincinnati

Evolving Concepts in Orthopaedic Trauma 2023

3

(P: 160820) If you choose I&D and Temporizing Ex-Fix of the RIGHT femur and tibia, how would you diagnose/manage a potential compartment syndrome of the leg.

I would not choose Temporizing Ex-Fix of the RIGHT femur and tibia

3%

26/806

I would not be concerned for a Compartment Syndrome

5%

44/806

Perform Prophylactic Compartment Release - No need to measure compart pressures.

14%

114/806

Measure Compartment Pressure and Perform Fasciotomy if Elevated

64%

520/806

Other

8%

72/806

Outside of my area of expertise - best if I don't vote

3%

30/806

Agree with staging with external fixator after initial assessment and debridement. I would address the contralateral tibia at that time as well and return several days later once the dust has settled with the patient. Definitively, IMN of both femur and tibia after controlling for intraarticular ext...ension and hoffa components with little hesitation for the use of blocking screws

Depends on the time of day, and what other things need to be taken care of other than this patient. It is always “safe” to start with debridement reduction (gross) and spanning external fixation. The right proximal tibia could be a little tricky. If the patient is rock stable, and there’s nothing el...se to do, after debridement of tibia, while I’m staring at it, some mini fragment plates, to hold it together, grossly, looks like you need some lags across the plateau as well, and then drop a nail in. Would probably do that through an open arthrotomy that allowed me to than directly visualize the distal femur, lag that together after reduction, and then reduce, and now the metaphyseal fracture. Another option for the open proximal tibia instead of spanning, external fixation, is temporary plate fixation, but this is not as appealing with the distal femur, then also need some sort of temporary treatment. This is also an option. If you decide you need to prioritize the femur after your debridement of the open fracture. Debridement, temporary plate, fixation, address, femur, and then keep going or fight another day.

The wound on the open side will often be the primary factor (along with patient status overall, of course) in determining staging or fixing acutely. Doing the other tibia will help give them a limb to start mobilizing on to transfer/etc early if possible. Lots of conversation points for these ty...pes of cases but start points are key, and use of blocking screws can also help; the newer generation nails with fixed angle screws and more screw options also helps us hold these previously more difficult fractures in position. Would also have picked nails and peri-articular lag screws as needed for this injury; not a huge fan of temporary plates as I prefer blocking screws/bits, but its also a valid tool for those who like them. Most interested in WB status answers here from the polls, but to those who are limiting ROM - any particular reasoning?

This is a great case and the images you provided are fantastic. Thank you so much for sharing this. Looking forward to hearing what the trauma experts have to say about this case.

eerie doppelgänger of this which i posted the 6m follow up to today. definitely a handful of a fracture. staged management, soft tissue care, careful assessment of plate/construct dynamics and stress/strain concentration https://t.co/AZrckbVx1E

Updated: Dec 27 2021

Extensor Carpi Radialis Longus

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                        Summary

                        Extensor Carpi Radialis Longus

                        Origin

                        Lateral supracondylar ridge of humerus

                        Insertion

                        Base of 2nd metacarpal

                        Action

                        Wrist extension and wrist abduction (radial deviation)

                        Innervation

                        Radial nerve (C6,C7)

                        Arterial Supply

                        Radial artery