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Anteroposterior radiograph of the tibia.
A 52-year-old man presents to the emergency department with severe left leg pain and deformity. He sustained the injury after falling off a motorized scooter. Anteroposterior radiograph (Figure) shows a displaced intra-articular fracture of the left tibial plateau with a distal split down the tibial shaft.
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Severe displaced lower extremity fractures often present with significant soft tissue swelling. Severe swelling can cause wound healing issues postoperatively, and surgery is often delayed until swelling subsides. The concept of delayed fixation for 7 to 10 days to allow soft tissue swelling to subside is widely accepted by orthopedic surgeons. In most cases, a well-padded fiberglass or plaster splint can be used to stabilize the fracture. However, in cases of severe fracture comminution or shortening, a spanning external fixator offers improved temporary fixation. An external fixator diminishes motion of fracture fragments better than splinting, which improves pain control. A spanning external fixator holds the fracture to adequate length and stability, which helps facilitate early mobilization. Early mobilization helps reduce the risk of serious cardiopulmonary complications.
This patient underwent placement of a knee spanning external fixator; 3 pins were placed in the distal femur and distal tibia, and an external fixator was then applied while holding the leg in traction. The patient was monitored closely for compartment syndrome with frequent neurovascular checks. The external fixator was removed after 7 days once the soft tissue swelling had subsided. Open reduction and internal fixation with a medial-based tibial plate was performed when the external fixator was removed.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
- GJ Haidukewych. Temporary external fixation for the management of complex intra-and periarticular fractures of the lower extremity. J Orthop Trauma. 2002;16(9):678-685.
- Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J Surg Orthop Adv. 2011;20(1):74-81.
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