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Abstract: The tibiofibula, the human lower leg bone, is the most frequently fractured location of the long tubular bone, and fractures can be caused by direct or indirect violence. The patient in this case was fractured by a vehicle impact on the lower leg while riding an electric bicycle. Immediately after the injury, he developed a calf deformity with severe swelling, and was given symptomatic treatment to reduce swelling after admission. After the swelling subsided, the patient underwent closed reduction intramedullary nail fixation of the fracture, and the incision healed smoothly after surgery, and the fracture healed 1 year after surgery, and normal walking function was restored.
Basic information】Male, 30 years old
Type of disease】Tibiofibular fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】December 2021
Treatment plan】Surgical treatment (fracture closed reduction intramedullary nailing) + intravenous drug treatment (mannitol injection, injectable parecoxib sodium) + oral drug treatment (horse chestnut seed extract tablets)
Treatment period】Inpatient treatment for 14 days, regular outpatient follow up
Treatment effect】The fracture healed and walking returned to normal
I. Initial consultation
After the injury, the lower leg became swollen, deformed, painful and unable to walk. The patient was temporarily immobilized by a splint and sent to the emergency room. X-rays were taken showing multiple fractures of the tibiofibula with deformed fracture ends and significant displacement. The above findings were combined. The fracture was diagnosed as tibiofibular fracture, and after communicating with the patient and his family, he was admitted to the hospital.
II. Treatment process
After admission, the patient was actively given mannitol injection to reduce swelling and injectable parecoxib sodium for pain relief, and was advised to elevate the affected limb and take oral horse chestnut seed extract tablets. The patient was advised to elevate the affected limb and take oral horse chestnut seed extract tablets. The patient was excluded from possible concomitant injuries by completing routine preoperative examinations such as CT triple reconstruction of the tibia and fibula, vascular ultrasound of the lower limb, cardiac chest X-ray, routine blood count, liver and kidney function, and coagulation image. One week after admission, the patient underwent closed reduction intramedullary nail fixation of the fracture under combined lumbar and rigid anesthesia, and the intraoperative incision was only 2 cm, and the intraoperative bleeding was about 100 ml, and no blood was transfused during the operation.
III. Treatment effect
The patient’s calf deformity disappeared after surgery, the incision was painful, there was no obvious discomfort in the fracture area, and there was no obvious blood leakage from the incision. On the 3rd day after surgery, the patient’s incision pain was obviously relieved, the blood seepage from the incision basically disappeared, and the swelling of the lower leg subsided. On postoperative radiographic review, the tibiofibular morphology was restored, the intramedullary pin fixation was tight and effective, and the surgical incision did not show any abnormalities such as necrosis and infection.
Two weeks after surgery, the stitches were removed from the surgical incision, and there was no blood leakage, exudate, necrotic infection, etc. All joints of the lower limbs could be flexed and extended normally in bed, and muscle contraction and stirrups could be performed, which met the discharge criteria. Six weeks after the operation, the patient could go down to the ground with crutches. Three months after the operation, bone scabs appeared at the fracture end. One year after the operation, the patient was followed up by telephone and reported that the fracture had healed and he could walk normally.
IV. Notes
We are glad that after active treatment, the patient’s fracture healed and her walking returned to normal. After going home, the patient should pay attention to active rehabilitation exercises and gradually increase the intensity of rehabilitation exercises according to the degree of recovery. In the early stage of discharge, attention should be paid to elevating the affected limb to promote blood circulation, avoiding prematurely getting off the ground as much as possible, and paying attention to muscle contraction exercises and stirrup exercises in bed to prevent muscle atrophy.
At this time, if there is mild swelling and bruising in the lower leg, it is normal and there is no need to be overly nervous. However, if the swelling and bruising are obvious and there is more obvious pain, you should go to the hospital in time to check the internal fixation.
Patients should visit the hospital to review the fracture healing at 3 months, 6 months and 1 year after surgery. In addition, calcium and vitamin D supplements should be taken to promote fracture healing while the fracture is healing. After the fracture develops a bone scab, the weight-bearing time can be gradually increased, and after the fracture is completely healed, the internal fixation can stay in the body for a long time if there is no discomfort.
V. Personal insight
The tibiofibular fracture can be repositioned and fixed by a variety of surgical methods. This patient in this article suffered a crush injury that resulted in a comminuted tibiofibular fracture with heavy soft tissue damage, so an intramedullary nail closed reduction and fixation procedure was selected. Through intraoperative fluoroscopy, the fracture could be repositioned under a very small incision, thus causing less damage to the soft tissues.
In addition, the intramedullary nail located in the bone marrow cavity overlaps with the human body strength line and has better biomechanical properties than the internal fixation plate, thus allowing early weight-bearing activities, but care should still be taken to avoid excessive weight-bearing.