PRESENTATION AND MANAGEMENT OF BILATERAL TIBIAL SHAFT FRACTURE: A PROSPECTIVE CASE SERIES OF RARE ENTITY AND REVIEW OF LITERATURE.
Abstract
Introduction: Unlike unilateral tibia fracture bilateral tibia fractures are rare and often associated with multiple systemic injuries results from high energy trauma in motor vehicle accidents, sports or falls from height. Management and complications of such injuries are little existing in the literature. Materials and methods: Demographics, the severity of the injury, fracture pattern, the extent of the open fracture, associated injuries and treatments were documented in a prospective, single center study of nine cases. Complications and outcome were recorded in follow-up.
Results: Eight were an adult male and one was a female child. Mean age was 24.55 year (range, 3 to 33). 11.11% had bilateral closed, 22.22% sustained bilateral open, and 66.66% had unilateral open fracture. The most common associated injury was fracture distal radius in 44.44% followed by shoulder dislocation (22.22%) and fracture proximal humerus (11.11%). The New Injury Severity Score was range from 18 to 27. 27.77% (5, tibia) cases (Total 18 tibia) managed with definitive casting and remaining 72.22% cases were treated with immediate (11, tibia) and delayed intramedullary nailing (2, tibia). Complications were included superficial wound infection, wound necrosis and delayed union, required additional surgeries. Average hospital stay was 19.88 days (range, 7-45 days). 66.66% of cases went on heal without complication. The average follow-up was 8 months (range, 3-12 months).
Conclusion: Bilateral tibial shaft fractures can associate with musculoskeletal injuries in other region and show a high rate of open fractures which may require additional procedures.
Downloads
References
2. Court-Brown CM, Will E, Christie J, Mc- Queen MM. Reamed or unreamed mailing for closed tibial fractures: a prospective study in Tscherne C1 fractures. J Bone Joint Surg. 1996;78:580-3.
3. Kraus R, Berthold LD, Heiss C, La¨ssig M. Consecutive bilateral proximal tibial fractures after minor sports trauma. Eur J Pediatr Surg 2009; 19:41–43.
4. Marcus RE, Hansen ST Jr. Bilateral fractures of the tibia: a severe injury associated with multiple traumas. J Trauma. 1987; 27:415--419.
5. Raman R, Sidhom S, Pape HC, peter V Giannoudis. Systemic effects of bilateral tibial versus bilateral femoral shaft fractures. Is there a difference? Acta Orthop Belg. 2004; 70:134--141.
6. Lichte P, Weber C, Sellei RM, Hildebrand F, Lefering R, Pape HC et al. Are bilateral tibial shaft fractures associated with an increased risk for the adverse outcome? Injury. 2014; 45:1985--1989.
7. Tschopp O, Stern RE. Bilateral fracture of the tibial shaft with intact fibulae. Am J Orthop (Belle Mead NJ). 2001; 30:341--343.
8. Kortbeek JB, Al Turki SA, Ali J, Antonie JA, Bouillon B, Brasel K et al. Advanced trauma life support, 8th edition, the evidence for change. J Trauma. 2008; 64(6):1638-1650.
9. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997 Dec; 43(6):922-5; discussion 925-6.
10. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, Decoster TA et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database, and outcomes committee. J Orthop Trauma. 2007; 21:S1-133.
11. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty‑five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am. 1976; 58:453‑8.
12. Shari Cui, Jennifer. M, Bauer, Hassan Mir, Lisa K. Cannada. Bilateral tibial shaft fractures: a multicenter analysis. Current Orthopaedic Practice.2017; 28:365-370.
13. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14:187—196.
14. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. J Trauma. 1988; 28:69--77.
15. Champion HR, Sacco WJ, Copes WS. Injury severity scoring again. J Trauma. 1995; 38:94--95.
16. M. J. G. Andriessen, E. C. J. L. Mattens, C. Sleeboom, H. A. Heij. Bilateral proximal tibia fracture. Eur J Orthop Surg Traumatol. 2011; 21:199–20.
17. Watson JT. Treatment of unstable fractures of the shaft of the tibia. J Bone Joint Surg Am. 1994; 76:1575--1584.
18. Milner SA, Davis TR, Muir KR, Greenwood DC, Doherty M. Long-term outcome after tibial shaft fracture: is malunion important? J Bone Joint Surg Am. 2002; 84-A: 971--980.
19. Hamza KN, Dunkerley GE, Murray CM. Fractures of the tibia. A report on fifty patients treated with intramedullary nailing. J Bone Joint Surg Br. 1971;53:696--700.
