Open tibia and fibula fracture

Presentation

Road traffic accident. Child bought unconscious with profuse bleeding from the left lower leg.

Patient Data

Age:
7 years

Gender:
Male

X-RAY

There are comminuted segmental fractures of the upper/mid third of tibia and fibula.

Clinical photo

PHOTO

This picture shows the tibial shaft exposed externally. High grade soft tissue laceration also noted.

Post operative study

X-RAY

Frontal

Lateral

Postoperative fixation with titanium elastic nails system (TENs)
in situ. Also seen are antibiotic-loaded beads. Soft tissue thickening noted.

Four weeks later

X-RAY

Frontal

Lateral

The fractured ends shows mild sclerosis, suggestive of early callous formation.

Also the post operative fixation and antibiotic beads insitu.

In particular, no features of osteomyelitis.

Limb in plaster of paris.

Case Discussion

This is a case of pediatric open tibia and fibular fracture.

Tibia particularly has poor remodeling ability, hence prone for later deformities. This calls for regular follow-up imaging.

Antibiotic beads are pharmaceutical grade calcium sulphate loaded with antibiotics (here it was vancomycin). These beads are removed in a particular time frame (days-to-weeks), decided by the orthopedic surgeon. However if postponed, they get consolidated into the callous formation.