Stabilization of Distal Tibia Metaphysis Extra-Articular Fracture Accompanying Soft Tissue Defect in the Medial Supramalleolar Area and Wound Management: A Case ReportErdem Y. Uymur1, Levent Demir2, Ahmet Köse1, Şafak Aktar3, Orhan Karsan4
1Department of Orthopedics and Traumatology, Region Research and Education Hospital, Erzurum, Turkiye.
2Department of Underwater and Hyperbaric Medicine, Region Research and Education Hospital, Van, Turkiye.
3Department of Plastic, Aesthetic and Reconstructive Surgery, Esteworld Etiler Plastik Cerrahi Hastanesi, İstanbul, Turkiye.
4Department of Orthopedics and Traumatology, Atatürk University, Medical Faculty, Erzurum, Turkiye.
This study aimed to present the case of a patient with distal tibia metaphysis extra-articular fracture accompanying soft tissue defect.Keywords: Distal supportive bolt locking screw, supramalleolar defective wound, tibia distal metaphysis extra-articular fracture
A 19-year-old patient who fell from a horse 3 h ago was evaluated in the emergency department of a tertiary trauma hospital. He had left tibia distal metaphysis extra-articular fracture with a wound of 5 × 3.5 cm2on the medial side of the supramalleolar region. The wound was mechanically cleansed and covered with sterile dressings. A long leg splint
was applied. Medical treatment including antibiotic therapy and tetanus prophylaxis was immediately started. Distally wedged tibial nailing fixation and interlocking using distal supportive bolt locking screw of the nailing system were performed. The screw surface was covered with available soft tissues of the wound. The treatment was continued using
the vacuum-assisted closure system. Next, soft tissue reconstruction was done using the Yin-Yang flap. Two months later, a dynamization procedure was performed on the patient, whose soft tissue defect was resolved. His fracture healed in the postoperative fifth month. The wound was stable in the postoperative 13th month. All inserted implants were removed on the patients request, and treatment was successfully completed.
Distal supportive bolt locking screw was inserted most distally and covered with available soft tissue to stabilize distal tibial metaphyseal extra-articular fracture accompanying soft tissue defect in the supramalleolar region. Possible infections due to the exposure of distal interlocking screws of standard nailing fixation were prevented. A powerful fixation was
achieved using the aforementioned nailing system. This fixation system not only created quite stable fixation to restore osseous pathology, but also could create a suitable environment to resolve soft tissue defect via proper treatment options and strategies.
Erdem Y. Uymur, Levent Demir, Ahmet Köse, Şafak Aktar, Orhan Karsan. Stabilization of Distal Tibia Metaphysis Extra-Articular Fracture Accompanying Soft Tissue Defect in the Medial Supramalleolar Area and Wound Management: A Case Report. Med J Islamic World Acad Sci. 2016; 24(4): 127-129
Corresponding Author: Erdem Y. Uymur, Türkiye