Open fractures occur when the covering skin layer is breached by external force or the fracture fragment injuring from within.
Open fractures are very common occurrence in leg bones because the soft tissue envelopes are very thin around the bones especially tibia in its antero medial aspect.
A 20 year old young male was hit by a motorbike while he was attempting to cross the road. He presented to casualty with large wound over the middle third circumference of the leg.
The tibia and fibula were bared and comminuted fragments could be seen and there appeared a bone loss.
There appeared no neurovascular deficit.
The xray picture is as shown above.
The patient was treated with external fixation followed by soleus flap and skin graft.
After the wounds heal, patient would be treated by illizarov eternal fixation and bone lengthening to compensate the bone loss.
I have a question on how to speed bone healing. I had an external fracture of my tibia and fibula on November 28th, 2009. It has been about 2 months. UCLA put a titanium rod with 4 screws (2 below the knee and 2 above the foot) to stabilize. So far we are seeing no fracture healing so I am not allowed to put weight on the leg yet.
What can I do to help the circulation of this fracture which should increase the healing process? Dr just told me time and elevation. Is there anything else I can do?
Dr Arun Pal Singh Reply:
January 28th, 2010 at 7:42 am
@Michael,
Unfortunately, you cannot force your bone to heal faster.
Joint movement around the fracture is encouraged [Consult your doctor before doing it], to increase circulation of the bone.
But as such there is nothing like faster or speed bone healing, at least till now.
Thank you
I can move my knee and foot….just cannot put weight on my leg.
I take calcium liquid and eat lots of protein. I guess there is not much more I can do to speed things along. I just get impatient…
Dr Arun Pal Singh Reply:
January 28th, 2010 at 9:09 am
@Michael,
I can understand. Injury limits the activity.
But healing takes time. All the best.
I fractured my right foot and had an open fracture of my fibula and tibia in my left leg in Turkey, which required pinning from the knee to the ankle, I had no insurance!! however, I am so pleased to have my legs…. Anyway I am now on my 11th week and although there has been progress it is very slow… I expected to be ok after about 6 to 8 weeks; I am still in a brace for my left leg and still not driving… Anyone else in the same situation??? Trying not to get down.. hubbie does not see the dirt in the house like me!! Must add though, I am a School Bursar at a Special School and did not have a day off!! But…. due to the Ash I did have an extra 2 weeks off! Due to my injuries my husband had to come over to Turkey and look after me and we had to book 2 extra seats for my legs!! Am I ever going to walk normally??
Dr Arun Pal Singh Reply:
July 4th, 2010 at 6:52 am
@June White,
Usually 6-8 weeks time is for bone to unite. The coming back to normal self takes much longer. Even the bone might take longer time to unite in some cases.
Dear Dr.
I had an accident and fractured fibual bone near ankle, Dr. has done POP (cast) on that area and advised me rest for six weeks. Can I move my leg during that tenure without putting weight on that, sleep aside or I should sleep straight and can have intercourse as I am newly married.
plz suggest me.
Dr Arun Pal Singh Reply:
November 4th, 2010 at 7:11 am
@Raja,
With POP on you can keep your leg either way while sleeping.
Do I need to answer the other query?
The decision lies entirely between your discomfort and the desire for pleasure.
dear dr.
my question is i had a compound communitive tibia and fibula fractures its multiple fracture 5 fractures on my left foot on 12 july 2010 so i got a plate nd 2 screw now its all fine bt i also have a screw on in ankle..i cannot move my foot from bootom to top though can move my foot from the toe also my thumb is locked i feel..i need ur help suggest me something…
Dr Arun Pal Singh Reply:
December 29th, 2010 at 12:28 pm
@Mehul,
Would you please post more details. There is not enough information to work upon.
If posible send xray images to contact [at] boneandspine [dot] com.
Dear sir,
I had an external fracture of my tibia and fibula on 16th july 2010. in a bike accident. I underwent an operation after 16 days. There is steel screwed inside. Now, I don’t have any pain in my leg.I can move it either. When can I drive the bike and play football? Please suggest me.
Dr Arun Pal Singh Reply:
February 3rd, 2011 at 2:16 pm
@Bishwa Subedi,
You should ask this to your treating doctor as he would be in better position to answer the query.
Sir,
I am a Nursing student sir, I just like to ask you about the pathophysiology of this diagnosis. I’m having some difficulties how will I start my pathophysio, since I am new to Orthopedic Field. This is the Diagnosis of my patient (Fracture, Open I, Comminuted Middle 3rd, Tibia-Fibula, left secondary to VA OTA (42/B3/3).
one more thing sir, Can you explain to me that diagnosis, because I dont know what is OTA, and (42/B3/3).
thank you Sir.
Dr Arun Pal Singh Reply:
March 31st, 2011 at 10:33 am
@Mishie Akio Morimoto,
OTA stands for ORthopaedic Trauma Association and 42/B3 stands for diaphyseal fracture of tibia with fragmented wedge.
What would you like to know in pathophysiology?
sir,
I met with an bike accident in bangalorel3 month back. there is a internal fracture in both Fibula & Tibia. it has been oparated and put the etitanium rod with 4 screws, 2 below the knee and 2above the foot its already 11 weeks ago drctor advaising me put the wehiht 20-30% weight. can i try to walk…
And please sugest me i can recover narmally or not …howmany days it will takes genarally … pl sujest.
Thank you
Dr Arun Pal Singh Reply:
June 9th, 2011 at 2:47 pm
@DINESHKUMAR MM,
People recover well after trauma. In your case, your treating doctor has more info on you to describe the situation.
I think you should follow his advice.
hey doctor.
i am 23 years old and i fractured my tibia and fibula in my right leg in a bike accident in january 2011. it was a compound fracture (i.e the bone was outta my skin). i would say the fracture site is a little below the mid point of the tibia. the doctors advised me to undergo intramedullary nailing which i got done the same day. the fibula was left as it is.
i was started on physiotherapy the very next day and have good knee movement and satisfactory ankle movement as of today i.e. four months later.
now my query is this. there wasn’t much bone growth in the first two months (i was on crutches then but no POP cast) and then the doc asked me start putting a little weight on my leg and also changed me to an elbow stick.
only after this did i start experiencing pain around my ankle and the achilles tendon. and when i had another look at the x-ray i noticed that my bone alignment was a little skewed. my tibia is actually pointing outward to the right side below the fracture site.
i figured that this was causing me to put weight on the wrong bones and muscles etc. i went to the doctor and he sent me on my way saying there was nothing to worry as a little skewness upto 5 degrees is permissible.
i am not entirely convinced and dont want it to cause me any problems in the future especially to my knee.
what should i do?
p.s. can i send u my x rays on the email you mentioned above?
i know this is a long one but i’m really worried because i was very active before this accident and will
appreciate all the help i can get.
Dr Arun Pal Singh Reply:
June 14th, 2011 at 1:01 am
@vibhor barwadia,
Yes please! You can send the xray. BTW your doctor is right. 5 degree angulation is permissible.
gud day,
i had an accident last may 28,2011 it was an open wound in my right leg due a vehicular accident and fracture my tibia and fibula, IM nailing done on my operation…..i just want to know can i jog after 6 months? because im a police trainee…i want to continue my training….thanks….
Dr Arun Pal Singh Reply:
July 9th, 2011 at 8:27 am
@gladdys pagaran,
If all goes well, you should be able to.