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Old 04-17-2011
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Rheumatology/Orthopedics skateboarding injury

A young man had sport injury an hour ago and presented to Emergency department with closed tibial shaft fracture?

What's the next step of management?

I came cross this question and I got it wrong? Just to share with you all!
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Old 04-17-2011
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Default choices

Choices are

1.
Long cast

2. Patellar-tendon bearing cast

3. Posterior splint

4. Open fixation
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Old 04-17-2011
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hmmm toughie !!


4. Open fixation ??
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Old 04-18-2011
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I would go with a cast that will stabilize the knee joint..I am guessing the long cast here means the above knee cast ,so i ll go with that...the PTB cast will not completely stabilize the knee joint...there is no clue given here that it was a displaced fracture so I would not prefer open fixation..

Whats the answer?
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Old 04-18-2011
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Quote:
Originally Posted by docsur View Post
I would go with a cast that will stabilize the knee joint..I am guessing the long cast here means the above knee cast ,so i ll go with that...the PTB cast will not completely stabilize the knee joint...there is no clue given here that it was a displaced fracture so I would not prefer open fixation..

Whats the answer?
+1 for long cast
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Old 04-19-2011
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Default correct answer

Posterior splint is the correct answer.

Initially, all tibial shaft fractures should be stabilized with a long posterior splint with the knee in 10-15 of flexion and the ankle flexed at 90.

Casting of tibial fractures should be delayed for 3-5 days to allow for early swelling to diminish. Initially, all tibial shaft fractures should be stabilized with a long posterior splint.

(source: usmle consult)
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Old 04-19-2011
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Quote:
Originally Posted by 1TA2B View Post
Posterior splint is the correct answer.

Initially, all tibial shaft fractures should be stabilized with a long posterior splint with the knee in 10-15 of flexion and the ankle flexed at 90.

Casting of tibial fractures should be delayed for 3-5 days to allow for early swelling to diminish. Initially, all tibial shaft fractures should be stabilized with a long posterior splint.

(source: usmle consult)
good question!.This wasnt on my recall...
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Old 04-21-2011
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Default posterior splint definitely

principles of orthopedic treatment:

1. first do no harm (dont look for crepitation or cause any more damage or HURT the patient further)

2. PROTECTION (splinting is protecting to reduce swelling and cleaning of any wound is present)

3. IMMOBILIZATION with reduction (here a cast can be used)

4. definitive treatments (may or may not be needed. in children, since bone growth is still active and fast, a skin traction without internal fixations is enough. for adults if the tibial fracture came with comminuted fragments, then an open reduction and external fixation will be needed)
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