From the Guidelines
For a spiral tibial fracture, early definitive osteosynthesis within the first 24 hours is recommended in the absence of severe visceral injury, circulatory shock, or respiratory failure to reduce morbidity and mortality. This approach is particularly crucial for tibial shaft fractures, which are at high risk of respiratory complications 1. The treatment should be tailored based on the patient's clinical status and the presence of associated injuries.
In cases where there are severe visceral injuries, circulatory shock, or respiratory failure, a delayed definitive osteosynthesis is probably recommended within the first 24 hours to minimize the risk of systemic complications 1. Temporary stabilization using an external fixator or osseous traction may be necessary for initial management, followed by definitive osteosynthesis once the patient's clinical status is stabilized.
Key considerations in the management of spiral tibial fractures include:
- Initial haemodynamic instability as an aggravating factor for morbi-mortality risk, prompting aggressive resuscitation and management of other emergent injuries 1
- The use of a sequential surgical approach, such as damage control orthopaedic surgery (DCO), for patients at high risk of complications 1
- The importance of CT scans in detecting massive bleeding or unstable injuries to identify patients at risk of developing fat embolism syndrome or other systemic complications 1
Overall, the management of spiral tibial fractures requires a multidisciplinary approach, taking into account the patient's overall health, the severity of the fracture, and the presence of associated injuries to minimize morbidity and mortality 1.
From the Research
SpinLtibial Fracture Overview
- A spinltibial fracture, also known as a tibial shaft fracture, is a common injury that can occur due to high-energy trauma, such as road traffic accidents 2, 3.
- The treatment of tibial shaft fractures is still a topic of discussion, with both conservative and operative treatment options available 2, 3.
Treatment Options
- Non-displaced tibial shaft fractures in patients with good compliance can be treated conservatively, with the aim of achieving solid bone union without hypertrophy, fast mobilization, and full range of motion without further soft-tissue damages 3.
- Operative treatment can be performed with several different implants, including intramedullary nailing, plate osteosynthesis, and external fixation 3.
- Intramedullary nailing with a huge biomechanical stability seems to be the implant of choice, while plate osteosynthesis is only rarely indicated 3.
- External fixation is still the implant of choice in first-line treatment of multiple trauma according to the damage control principles, but its use has declined 3.
Complications and Challenges
- Open fractures with precarious blood supply and weak soft tissue covering are vulnerable to complications, such as infection, and remain a challenge for every treating surgeon 4, 5, 3.
- Compartment syndrome remains the most significant early complication encountered when treating tibial shaft fractures in children and adolescents by either closed or surgical methods 2.
- Reconstruction of axis, length, and rotation is essential for a good outcome, and the choice of technique depends on fracture localization, type of fracture, history of concomitant disorders, and soft tissue damage 3.
Antibiotic Prophylaxis
- Infection is one of the main complications of open fractures, and broad-spectrum antibiotics have been used for prophylaxis and treatment of infection in these fractures 4.
- The duration of antibiotic prophylaxis remains controversial, especially for the different types and grades of open fractures 4.
- A short course of antibiotics may be as effective as a long course in infection prophylaxis, but further research is needed to establish an agreed protocol for the optimal length of prophylactic antibiotic administration in open tibial fractures 4, 5.