Two Staged Management Of Proximal Tibial Fractures With Impending Compartment Syndrome By Temporary External Stabilisation And Fasciotomy And Delayed Definative Fixation

Abstract

Introduction: High energy proximal tibia fractures with soft tissue involvement presenting with dicolored patches over the leg and severe swelling, compound wounds, blisters with tight compartments and absent or feeble dorsalis pedis or posterior tibial arteries warrant to go in for a staged procedure. In patients with multiple injuries, an external fixator can be applied quickly with minimal blood loss for unstable periarticular fractures around the knee. Two-stage procedures involve (1) early joint spanning external fixators with fasciotomy for the medial and posterior compartments, (2) and late definitive fixation with plates or nails and with skin grafting. Materials and Methods: In our study, we present a short series of 15 proximal tibial fractures with impending compartment syndrome. Patients selected for this study were (1) closed proximal tibia fracture intra- and peri-articular and metaphysis diaphysis junction communited and noncommunited fractures (2) impending compartment syndrome evaluated based on excessive swelling, tight compartments, blisters over skin, feeble or absent dorsalis pedis or posterior tibial pulsations, color Doppler suggestive of severe subcutaneous edema associated with monophasic or absent flow over distal arteries. Exclusion criteria: (1) Low energy proximal tibia fracture without soft tissue insult and compound wounds over the proximal tibia fractures, (2) associated popliteal artery injuries. Conclusion: With the initial application of a bridging external fixator followed by delayed internal fixation protocol for pilon fractures has been successful in reducing the historically high rates of wound complications associated with these high-energy injuries. As well this protocol allows the use of minimally invasive plate osteosynthesis technique which is based on a combination of the principles of stability, restoration of anatomy and early motion while eliminating the need for excessive soft tissue dissection. Keywords: Proximal Tibial fractures, External fixators, Fasciotomy, Definitive fixation.