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A fracture, or break, in the upper part of the shinbone (tibia) may result from a low-energy injury, such as a fall from a height, or from a high-energy injury, such as a motor vehicle accident. Proper identification and management of these injuries will help to restore limb function (strength, motion, and stability) and lessen the risk of Arthritis.

The soft tissues (skin, muscle, nerves, blood vessels, and ligaments) also may be injured at the time of the fracture. Because of this, the orthopaedic surgeon will also look for any signs of soft-tissue damage and include this in plans for managing the fracture.

Whether the injury is treated with surgery or without, both the bony injury (fracture) and any soft-tissue injuries must be treated together.

When determining whether to treat the injury surgically or nonsurgically, the patient's expectations, lifestyle, and medical condition are all considered. There are benefits and risks associated with both forms of treatment.

The decision to treat the patient surgically is a combined judgment made by the patient, the family, and the physician. The preferred treatment is accordingly based on the specific details of the injury and the general needs of the patient.

In an active individual, restoring the joint through surgery is often appropriate because this will maximize the joint's stability and motion, and minimize the risk of arthritis.

In other individuals, however, surgery may be of limited benefit. Medical concerns or pre-existing limb problems might make it unlikely that the individual will benefit from surgery. In such cases, surgical treatment may only expose these individuals to its risks (anesthesia and infection, for example).

If the skin is broken and there is an open wound, there is concern that the underlying fracture may be exposed to bacteria that might cause infection. Early surgical treatment serves to cleanse the fracture surfaces and soft tissues to lessen the risk of infection.

Infrequently, soft-tissue swelling may be so severe as to threaten blood supply to the leg and foot (a condition referred to as compartment syndrome). This may require emergency surgery in which vertical incisions are made to release the skin and muscle coverings. This is called a fasciotomy. These incisions are often left open and then closed or covered days or weeks later as the soft tissues recover and swelling resolves

Nonsurgical treatment may include restrictions on motion and weightbearing, in addition to the application of external devices (braces or casts). Typically, the soft tissues are assessed and X-rays are taken at prescribed intervals. Knee motion and weightbearing begin as the injury and method of treatment allow

If surgical treatment is elected to obtain and maintain alignment, several devices may be considered. rods plates, external fixators.

Some patients choose to live with the injury, interview your patient to make the assesment.

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15y ago

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