How to splint a posterior tibial fracture?

From the Guidelines

To splint a posterior tibial fracture, apply a long leg splint from the upper thigh to the toes, with the knee flexed at 15-20 degrees and the ankle in a neutral position, as this technique immobilizes the fracture, preventing further injury and reducing pain, as supported by the most recent guidelines 1. When splinting a posterior tibial fracture, it is essential to prioritize immobilization to prevent further injury and reduce pain. The following steps can be taken:

• Apply a long leg splint from the upper thigh to the toes, with the knee flexed at 15-20 degrees and the ankle in a neutral position (90 degrees to the leg) to maintain proper alignment and reduce muscle spasms.
• Use padding materials like cotton or foam to protect bony prominences and fill any gaps between the splint and the leg, as recommended by general first aid practices.
• Secure the splint with elastic bandages, starting from the foot and working up the leg, but avoid wrapping too tightly to prevent circulation issues, which is crucial in preventing limb-threatening injuries 1.
• Elevate the leg above heart level to reduce swelling, and apply ice packs intermittently (20 minutes on, 20 minutes off) to manage pain and swelling.
• Administer appropriate pain medication, such as ibuprofen 400-600 mg every 6-8 hours or acetaminophen 500-1000 mg every 4-6 hours, as needed, to control discomfort. It is also important to note that while there is a lack of evidence demonstrating clear benefits from fracture splinting in the prehospital first aid setting, fracture immobilization is an essential part of definitive fracture treatment, and splinting as a first aid measure may be helpful to reduce pain, prevent further injury, and facilitate transport 1. Additionally, the American College of Foot and Ankle Surgeons recommends simple immobilization for small, nonarticular, or minimally displaced fracture fragments 1. However, the most recent guidelines from the American Heart Association and American Red Cross should take precedence in guiding first aid practices 1.

From the Research

Surgical Approaches for Posterior Tibial Fractures

• The prone position and direct posterior approach can achieve proper reduction and fixation for posterior column taster tibial plateau fracture, yielding good functional outcome 2.
• The posterolateral approach to the tibia provides access to both the lateral and posterior malleoli, allowing for direct visualization and fixation of displaced posterior malleolar fractures 3.
• The posteromedial and posterolateral approaches for posterior tibial plateau fractures (PTPFs) are beneficial for reduction and fixation, with clear exposure, convenient placement of internal fixation, less trauma, and good clinical outcome 4.

Reduction and Fixation Techniques

• The three-column fixation concept is becoming popular in orthopedic practice, and is used in the diagnosis and treatment of posterior condylar fracture of the tibial plateau 5.
• Fixation of the posterior malleolar fragment before nailing of the tibia is recommended in associated fracture patterns to avoid intraoperative displacement and poor reduction 6.
• The use of an anti-glide buttress plate for fixation of the tibial condyle has been shown to yield good results, with all fractures healing within 6 months and no secondary displacement or post-traumatic osteoarthritis of the knee occurring during follow-up 2.

Clinical Outcomes

• The prone position and direct posterior approach has been shown to result in good functional outcomes, with a mean Lysholm score of 95 and a mean Tegner activity score of 6 at 34.4 months follow-up 2.
• The posteromedial and posterolateral approaches for PTPF have been shown to result in excellent and good results in 90.5% of cases, with a mean Rasmussen score for knee joint functions of 24.2 and a mean Rasmussen radiology score of 15.6 points 4.