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Orthopaedics
Tibia
Built from Orthopedic Trauma Essentials
What’s inside
13 sections · 115 slides
Overview
- What this topic is about
- Two very different injuries in one bone
- The nine questions
Knowing the bone
Why the tibia is unforgiving
- The tibia, front and back
- What that picture is telling you
- Why the tibia punishes mistakes
- A broken tibia and fibula on X-ray
- Words used throughout
Open shaft fractures: when to debride
The rise and fall of the 6-hour rule
- The question on the table
- Where the 6-hour rule came from
- Testing the clock: the pooled evidence
- Testing the clock: a single-centre review
- Testing the clock where delay is unavoidable
- So what should actually happen
- The open tibia pathway
Getting the wound covered
The clock that does matter
- Why covering the wound is its own problem
- The safe window after fixation
- The strongest single predictor
- Counting from admission instead
- 0–2 d
- What to do about coverage
When bone is missing
Induced membrane and bone transport
- Why bone goes missing here
- Two routes across the same gap
- How the induced membrane technique works
- Why the cement spacer matters
- Induced membrane: the disappointing series
- Induced membrane: the excellent series
- Pooling the induced membrane data
- Masquelet against a vascularised graft
- A ring frame on the lower leg
- What bone transport actually does
- Bone transport: the reported results
- Frame type changes the outcome
- Head to head in severe open tibias
- Pooling the comparison
- How much to trust any of this
- Choosing between them
Should you fix the fibula?
Stability against stiffness
- The fibula problem in one slide
- Tibial nail with the fibula plated
- What the picture shows you
- The mechanics: what the fibula contributes
- Does fibular fixation cause nonunion?
- The study that found harm
- Fibular fixation in distal tibia fractures
- What the pooled reviews found
- The case each way
- Why the studies keep disagreeing
- Where this leaves you
Where to start the nail
Suprapatellar against infrapatellar entry
- Two doors into the same bone
- An intramedullary nail inside the tibia
- The randomised trial: INSURT
- Statistical against clinical significance
- A second randomised trial
- What the retrospective reviews add
- The pooled reviews
- What did not differ
- Suprapatellar against infrapatellar
- What to do about entry point
The pilon fracture
Acute fixation against the staged protocol
- What a pilon fracture is
- The ankle joint on X-ray
- Why the joint surface changes everything
- Why early surgery got a bad name
- Span, scan and plan
- An external fixator bridging the ankle
- Why the question reopened
- What surgeons actually do
- Acute against staged: the first cohort
- Flanagan: the complication numbers
- Changing a whole institution's protocol
- What actually predicted wound problems
- The largest series
- What did predict complications
- How you operate matters too
- What really drives pilon complications
- When acute fixation is reasonable
- When staged fixation stays the standard
Pin sites and infection
Does overlap with the plate matter?
- The worry about pin tracts
- Pins entering the tibia through the skin
- The study that started the concern
- Why that study only goes so far
- The first attempt to reproduce it
- The second attempt
- The largest cohort
- Living in a frame
- What to do about pin placement
When the joint cannot be rebuilt
Primary ankle arthrodesis
- What arthrodesis means
- Which fractures raise the question
- The signs that reconstruction will fail
- The comparison study
- Patient factors that tip the balance
- What acute fusion is trying to achieve
- The honest trade-off
Getting back on the leg
When weight bearing can start
- The tension after pilon surgery
- What the classic teaching says
- The studies that challenged it
- The limit of that evidence
- The feasibility trial
- What to tell the patient
Planning the incisions
How far apart the cuts must be
- Why incision planning is surgery
- Approach or strategy?
- What the consensus documents say
- The one prospective study
- What later work added
- The working rule
Carrying it away
What to remember from all of this
- The shaft, in six lines
- The pilon, in six lines
- The habit of mind behind all nine answers
- References
- References (2)
- References (3)
- References (4)
- References (5)
- References (6)
- References (7)
- Orthopedic Trauma Essentials 2026