Third Degree Open Tibial Fracture

Nancy D Baker, MD

May 17, 1994

Presentation

Imaging Findings

Anteroposterior radiograph shows acute comminuted fractures of the tibia and fibula at junction of middle and distal thirds. There is complete lateral translocation of the distal fragments. Soft tissue laceration can be seen medially, below the fractures, and laterally, at the fracture site.

Lateral radiograph shows no angulation or displacement in the sagittal plane.

Following closed reduction of the fractures, a second frontal radiograph demonstrates stabilization using an external fixation device. This device utilizes horizontal pins placed percutaneously through the tibial shaft on either side of the fracture.

A popliteal arteriogram outlines a normal popliteal artery (arrow), bifurcating into the peroneal artery (arrow) laterally and the anterior tibial artery medially. Note the transverse pins in the tibia, compressing the proximal portion of the external fixator.

A below knee angiogram shows a large, well-filled anterior tibial artery. Laterally, the peroneal artery is interrupted at the level of the fracture (arrow).

A frontal intraoperative radiograph shows placement of myocutaneous-vascular pedicle graft (arrows) medially and superomedially, bone graft along the medial aspect of the fracture (arrow), and a compression plate laterally across the tibial fracture with the compression-measuring device still attached to the plate proximally. Surgical clips over the fibula indicate repair of the peroneal artery.

A lateral intraoperative radiograph shows the soft tissue graft posteriorly (arrows) and the compression device anteriorly.

A frontal postoperative radiograph through a fiberglass cast after one month.

Diagnosis

Discussion

References

• Return to the Teaching Case Database search page
• Return to Professional Education
  
• About BrighamRAD

Dear Visitors: Nothing on this World Wide Web site should be considered medical advice. Only your own doctor can help you make decisions about your medical care. It is not the policy of the Brigham and Women's Hospital Department of Radiology to provide consultation on the World Wide Web or via e-mail. If you have a specific medical question or are seeking medical care, please call the Brigham and Women's Hospital toll-free physician referral line at 1-800-294-9999.

Is this a mirrored page?
The official homepage of the BrighamRAD Teaching Case Database is http://brighamrad.harvard.edu/education/online/tcd/tcd.html