Open Fractures Of The Tibia - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video describes open fractures of the tibia.
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25% of tibial shaft fractures can be open. Open fractures can lead to complications including wound problems, osteomyelitis, nonunions, and infected nonunions. The treatment of open fractures of the tibia can be challenging. A lot of the concepts are not black and white; they may be in the grey zone. We don’t know the best time for debridement. We don’t know what the optimal irrigation solution is and what the optimal pressure for the fluid is. We don’t know for sure the ideal duration of giving antibiotic prophylaxis, but we know that it is important to give the appropriate antibiotics early and do meticulous debridement. We know that the IM rod is better than the plate fixation or external fixator, and the result of the reamed IM rod or unreamed IM rod is the same. We need to close or cover the wound before 1 week and the vac can be used provisionally when we cannot close the wound, primarily at the optimal time. A grade I fracture is less than 1 cm. a grade II fracture is 1-10cm. A grade III fracture is more than 10 cm, and there is contamination. Grade III fractures are divided into three types. Grade IIIa fractures require adequate tissue for closure (or skin graft). Grade IIIb fractures require extensive periosteal stripping and the patient will need a flap (rotational or free flap). Grade IIIc fractures have a vascular injury that requires repair or amputation. The relative indication for amputation is warm ischemia for more than 6 hours, absent plantar sensation and severe ipsilateral foot trauma. The most predictive factor for amputation is the severity of the soft tissue injury in the ipsilateral extremity. When comparing limb salvage versus amputation, the patient’s outcome is generally the same at 1-5 years. Lack of plantar sensation does not predict poor outcome after limb salvage. Segmental fractures are Grade III fractures, even if the open fracture is 1 cm. The ideal irrigation solution and the pressure used to controversial. Timing of the initial debridement is controversial. Irrigation and debridement within 6 hours was the gold standard in the past. Debridement is performed as a priority procedure no later than the morning after admission. There is no difference in infection rate for a patient who has the initial surgery before or after 6 hours, including patients with Type III open fractures. More than 40% of the patients usually wait longer than 6 hours for their initial surgery after arrival at the hospital. Delayed surgery for less severe fractures is acceptable as long as the debridement is done as a priority the following day. Unless there is a gross contamination, evidence is not clear as to when is the best time for the debridement. It seems like giving the patient antibiotics promptly is more important than the time of debridement. The preferred solution is normal saline and low pressure irrigation. Low pressure lavage may reduce reoperation rates due to infection, nonunions, and wound healing problems. Normally the tradition is to use 3, 6, and 9 liters of solution for Type I, Type II, and Type III open fractures (just recommendations). There is increased risk of wound healing with antibiotic solution. Meticulous irrigation and debridement of open fractures is important in decreasing the infection risk. Prophylaxis should be started as soon as possible. All patients with open fractures should receive first generation Cephalosporin’s that will cover gram-positive bacteria. You can give penicillin for farm injuries and clostridia prone wounds. You will give clindamycin if there is a penicillin allergy. In Type III open fractures, add aminoglycoside, such as gentamicin. It was found that local antibiotics delivery at the site of injury decreased the infection risk, such as cement beaded loaded with antibiotics. Antibiotic should be given within 3 hours of the time of injury (preferably given as soon as possible). There is reduction of 59% of acute infection in patients with open fractures treated with antibiotics. The infection rate is 1.6 times greater if antibiotics are given after 3 hours. Type I and Type II open fractures require antibiotic coverage for 24 hours after wound closure. For Type III open fractures, antibiotic administration should be given for a period of 72 hours after the injury and no more than 24 hours after wound closure. After the initial debridement, the patient will need staged debridement within 24-48 hours. There is a reduction infection rate, acute and chronic, for Type III open fractures with the use of systemic antibiotics and aminoglycoside cement beads compared with antibiotics alone.
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جزاك الله كل خير عمل ودروس مفيدة ومتقنة جعل الله عملك في ميزان حسناتك. تحياتي وشكري من اليمن
always great contents!
جزاك الله خيرا رجاء دكتور We need videos for types of splints and tractions thanks
thank you, professor!
Wow. Thank you so much. This has made management of compound tibial fractures way easier for me. Thank you once again
Great information thank you Dr Ebs
Very very very helpful.. thank u sir
Very interesting. Greetings
I had a fracture of the Tibia, but not open; however I had an big hematoma in the foot which has remained red and swollen for some while.
جزاك الله خير وكتب أجرك بالعلم النافع Great ⛤ Thanks from l🇸🇦
Thank you ❤
So interesting! Thank you, Nabil!
Thank u sir for this information. I had open fracture of tibiya fabula 27dec 2021. After fixater operation and plastic surgery operation, now after three months today I am going for third rode..nailing operation. It's so panic time when my lil children ask me," Mumma hm aapke sath kb so sakte hai". 😔😔😭😭
@arwamrad8928
2 жыл бұрын
Hey! Seems we might be going through similar experience. I had a gustilo type 3A double fracture if my tibia + head of my fibula in January 20, 2022 (3 months ago)... So add to the bone fracture a lot more things like a severe soft tissue damage (15cmx15cm) and a nerve damage resulting in a foot drop..... I've had a skin graft from my thigh, and it's still bloody painful. I used to love running, but at this point, everything hurts that I'm never sure if it's the bone or the new tight skin..... And looking at your video makes me even more depressed, tibial fractures are tough on their own, open ones, are even worse. 😭😭😭😭 Wish me luck..... I love the outdoors
@sulaimankhan8033
Жыл бұрын
Allah Sabr de - Ameen
@heaven_777.
Жыл бұрын
@@arwamrad8928 brother same problem right now i m suffering..... Skin grafting... External fixator.... Foot drop.... And lot of pain....
@sarojmeena1915
Жыл бұрын
After 2 month, in Dec 2022 I hope for next nail removing surgery. U will be able to run fast soon. Be confident for it. Hope for best s think positive.😊👍👍
@ShadowGamer-uq4tl
Жыл бұрын
@@arwamrad8928 I am also experiencing the same. I had my accident on 10 june 2022... Removed my ext fixator on 14 Sept... & had my internal fixation with plate & screws on 14 Dec 2022 with bone grafting from iliac crest.. I don't know when I will walk.. My knee is also getting stiff full recovery is a distant dream.
Please discuss segmented tibia fractures
My question is bones have a fine tissue covering it and it also caries blood to bone. Does that heal or can you explain what doesn't heal on open fractures.
Interesting...
My whole shin and small bone was cut off totally. They reattached it. Took 2 years.
I had open fracture of tibia , femur ribs, back bone, ankle,hips and head injury ..on 30 June 2022
I will like to see a video of the casting of an open fracture distal fibula
My son had his surgery for his open fracture to the femur after six weeks of injury, it's eight months now since surgery ,his knee is not bending and there is non union , doctor are now going to do a bone graft I must say all the doctors have been helpful to me and my son really grateful to all of them
@tunerindia5878
3 жыл бұрын
I have same situation . Waiting for healing my wound for surgery . What are the things i meed to do
@AmanSharma1997
3 жыл бұрын
@@tunerindia5878 ask your doctor.. any updates?
@tunerindia5878
3 жыл бұрын
@@AmanSharma1997 my operation dons yesterday implanting nail waiting for discharge hospitalil for bed rest
@poojalath7087
2 жыл бұрын
Had u been managed through ilizarov ther would have been no complications.
I suffered a very bad fall and shattered my tibia plateaui had surgery and still feel very terrible pain on an every day and note basis the surgeon used metal plates on each side of my tubes I oft
I often feel a sharp pain in my all area of my knee is it possible all was also damaged?? 😢
Thank you very much sir.use bengali thanks too
Are the reamed and unreamed IM nails in open tibia fracture the same?
@BashirAhmad-oq4dw
2 жыл бұрын
No
Sir I broke my right leg and I will after surgery after 2 years will be run sir
during an open tibia fracture, does the fibula also break apart or is that sometimes?
@PaimasCPGaming
4 жыл бұрын
I just had an open tibia fracture and the fibula is broken too. Its my 4th day of recovery now
@X410zee
3 жыл бұрын
When I broken my tibia (open) my femur broke too
@arwamrad8928
2 жыл бұрын
I had a gustilo type 3A double fracture if my tibia + a type 1 fracture of the head of my fibula in January 20, 2022 (3 months ago)... So add to the bone fracture a lot more things like a severe soft tissue damage (15cmx15cm) and a nerve damage resulting in a foot drop..... I've had a skin graft from my thigh, and it's still bloody painful. I used to love running, but at this point, everything hurts that I'm never sure if it's the bone or the new tight skin..... And looking at your video makes me even more depressed, tibial fractures are tough on their own, open ones, are even worse. 😭😭😭😭 Wish me luck..... I love the outdoors
@englishandhindistenohub9675
6 ай бұрын
@@PaimasCPGamingyou are ok now?
thank you sir
I have open fracture they fixed plate so that is the reason why my delayed union
Mera ra bhi tibia fracture Ho Gaya 3 mahine Ho Gaye abhi tak sahi se chal nahin pa raha hun sir kya Karen
Connor Mcgregor just brought me here.
@Pratyusha_Pattanaik
2 жыл бұрын
My father had the same surgery like McGregor a couple of days back and that's why I'm here 😔
I had a compound fracture of the tibia and fibula. Its been 3months and 3day. The surgery was done within 48hrs with external fixation because the soft tissues were badly damaged and subsequently converted to a fiberglass cast 2 weeks ago. How much longer am I likely to take to start weight bearing?
@lorenajanvier3765
3 жыл бұрын
When I broke my leg the same way the video is showing us it took me 4 months till I was allowed to put weight on it and almost 2-3 month to walk again
@khushboopatel6384
2 жыл бұрын
@@lorenajanvier3765 what if accidently my leg touch feet ?
@arwamrad8928
2 жыл бұрын
I had a gustilo type 3A double fracture if my tibia + head of my fibula in January 20, 2022 (3 months ago)... So add to the bone fracture a lot more things like a severe soft tissue damage (15cmx15cm) and a nerve damage resulting in a foot drop..... I've had a skin graft from my thigh, and it's still bloody painful. I used to love running, but at this point, everything hurts that I'm never sure if it's the bone or the new tight skin..... And looking at your video makes me even more depressed, tibial fractures are tough on their own, open ones, are even worse. 😭😭😭😭 Wish me luck..... I love the outdoors
@khushboopatel6384
2 жыл бұрын
@@arwamrad8928 hey just stay positive
@arwamrad8928
2 жыл бұрын
@@khushboopatel6384 thank you!! Trying my best 🤗
Sir fracture of shaft tibia & fibula bilkul thik ho sakte h kya or kitne time me ho sakte h thik
@maneshbirman3232
3 жыл бұрын
Please tell me sir
@AmanSharma1997
3 жыл бұрын
@@maneshbirman3232 depends on the type of fracture, 2 month me bhi hojate hain.. 1 saal bhi lg sakta
i had this surgery 3 weeks ago, my knee and back of my knee hurts so bad, very painful to stretch my knee, is any body experienced this?
@X410zee
3 жыл бұрын
Yes I broke my tibia and fibula a month ago, back of my knee feels like something is rubbing, popped or something but I only feel it when bending or straightening, never standing or walking
@X410zee
3 жыл бұрын
A short, sharp pain
@rahul_agrawal9683
Жыл бұрын
@@X410zee how's your surgery was done?? ..rods or plate??
Hello dr This is khushboo I have tibia fracture and put 3 plates in my right leg Today its been 5 weeks I accidently put my leg on feet My concern is everything is fine in fracture? I mean with plates n scerw? I dont have any pain in my fractire area. Kindly revert
And this is exactly how my leg was Brocken🥵
@diablo5059
2 жыл бұрын
My also was broken
i just fractured my tiba but i cant feel
@mountainst.manman
2 ай бұрын
How are you now?
My leg broking 1 month
Sir help me
मेरा पिक ओपन टाइम शुरु हुआ है मेरा अभी पैर का पंजा मन्नत नहीं करना
Paul George
😭😭😭
ইংলিশ বুঝতে পারিনা
Y आय लाईक लेक्चर
ekfakshan max kheno