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12 Feb 2025
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Tibial and fibula fracture with Metatarsal Fracture-dislocation

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Clinical Details

Clinical and radiological findings:  A 67-year-old female presented with a tibial fracture and fracture-dislocation of the metatarsals. The patient had a history of uncontrolled hypertension and diabetes mellitus, with an initial blood glucose level of 430 mg/dL and an HbA1c of 10%. On the operating table, the patient's SpO2 was 61%, prompting a CT scan to rule out pulmonary embolism.

Preoperative Plan

Planning remarks:  The preoperative plan involved stabilization of the tibial fracture using an external fixator and intramedullary K-wire fixation of the fibula. Additionally, dorsal incisions on the foot were planned for reduction and fixation of the metatarsal fractures using retrograde K-wires.

Surgical Discussion

Patient positioning:  Supine position on the operating table.

Anatomical surgical approach:  The surgical approach included the application of an external fixator spanning the ankle joint for tibial stabilization. An intramedullary K-wire was inserted into the fibula. Two dorsal incisions were made on the foot to allow for reduction of the fracture-dislocation and retrograde K-wire fixation of the metatarsals. A plaster cast was applied to the foot postoperatively.

Operative remarks: 

Due to the patient's compromised general condition, rapid external fixation was necessitated. The external fixator provided immediate stabilization, while the K-wires allowed for alignment and stabilization of the fibula and metatarsals. The patient's critical condition required prompt intervention to prevent further complications.

Postoperative protocol:   Partial weight-bearing was initiated at week 6 postoperatively.

Follow up:   Not specified.

Orthopaedic implants used:   External fixator, Kirschner wires (K-wires).

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Soliman
  • Syria ,
  • Area of Specialty - General Trauma
  • Position - Surgical Fellow
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