Following is series of xrays of a 62 year old male with closed proximal metaphyseal fracture left tibia with intact fibula. The patient was referred to our institute, a week after the injury.
Here is the xray of the leg after the proximal metaphyseal fracture of tibia.
She had lot of blebs at the time of presentation, which took another week to heal. We could operate on her only after two weeks of injury. Following is the clinical photograph of healed skin before taking the patient for surgery.
Patient was taken for open reduction and internal fixation of proximal metaphyseal fracture of tibia under epidural anaesthesia.
Implant used was proximal tibial locking plate [Synthes]- 4.5 system.
Following two images are taken from C-Arm image intensifier and show the application of a locking plate as a reduction tool by using a cortex screw just distal to the fracture as the very first screw, which could pull the bone close to the plate, thus achieving good reduction.
Here is an image before tightening of the cortical screw in distal fragment.Peroperative Image Showing Placement Of Screw In Distal Fragment
The fracture reduces further as the screw is tightened.Cortex Screw Acting As Reduction Screw – Tightening Resulted In Fracture Reduction
Following photograph is taken after plating
Wound was closed in layers. Staples were used for skin.
The patient was put on physiotherapy beginning from second postoperative day. The fracture united well in about three months as shown below.
Patient achieved a good range of motion of the knee.
This article and xrays have been sent byDr. Sreenivasulu Metikala, Associate Professor,Dept. of Orthopaedics & Traumatology, SVS Medical College & Hospital, Mahabubnagar, A.P., India.
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