Three-level tibial fracture treated by minimally invasive techniques

Abstract

classifications:1. Closed fracture right humeral shaft (spiral frac-ture, proximal third) [AO 12 B1].2. Closed right tibial plateau fracture (Fig. 1b andd) [AO41 B2.2].3. Open (Gustilo II) right multifragmentary middlethird diaphyseal tibial fracture [AO 42 A 1.1](Fig. 1a and c).4. Closed right tibial plafond fracture [AO 43 B 2.2](Fig. 1a and c).The limbs were all neuro-vascularly intact. Intra-venous antibiotics and antitetanus prophylaxis wasadministered in the emergency department and thepatient was taken to the operating room 2 hoursafter admission. Wound debridement and washoutwas performed and internal fixation of the rightopen tibial diaphyseal fracture utilising an eight-hole locking compression plate (L.C.P.) (Stractec,Welwyn, UK).The pilon fracture was reduced using K-wires anda joy sticking technique and was then stabilised bytwo percutaneous lag screws and a buttress plateusing a six-hole L.C.P.The fracture of his humeral shaft was treatednon-operatively with a humeral brace.After further imaging (CT scan of his proximaltibia (Fig. 1d)), he returned to theatre 2 days afterthe initial injury, for delayed primary closure of thewound of his right tibia, as well as for minimallyinvasivefixationofhismedialtibialplateaufracturewith a T plate (L.C.P.).Hispostoperativerecoverywasuneventfulandhemobilisedpartialweightbearingandwasdischargedhome 11 days after his initial accident.On review at 28 weeks, he was pain freewith full function of his lower limb (knee 0—1408,ankle108 dorsiflexion to 458 plantarflexion)