MyPACS.net: Radiology Teaching Files > Case 49008054

Never visited SPIRAL FRACTURE OF TIBIA AND FIBULA
Contributed by: Peter Douglas, Resident, Royal Alexandra Hospital, Paisley, United Kingdom.
Patient: 38 year old
History: 38 year old patient: simple trip whilst climbing stairs
Images:[small]larger

Fig. 1: Original fracture

Fig. 2: Original fracture

Fig. 3: Post manipulation

Fig. 4: Post manipulation

Fig. 5: Post operative

Fig. 6: Post operative
Findings:

Oblique/spiral fracture at border of middle and distal third of left tibia. Also spiral fracture of proximal fibula.

Example of Maisonneuve fracture.

Manipulation was attempted to avoid open reduction and internal fixation, however the post manipulation films show almost complete 'off-ending' of tibial fracture and an intramedullary nail was used.

Diagnosis:

Oblique/spiral fracture at border of middle and distal third of left tibia. Also spiral fracture of proximal fibula.

Example of Maisonneuve fracture

Discussion:

IM nailing of the tibia results in a vertical scar directly over the patella. A significant proportion of patients have long term pain associated with this scar, especially patients who kneel frequently. The patient was a manual labourer and would often kneel for ling periods at work, hence the attempted manipulation using entonox for analgesia.

The orthopaedic consultant who was carrying out the manipulation said it was the patient tensing due to pain that prevented the successful manipulation, and that in retrospect some heavier sedation might have resulted in a  better reduction.

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Additional Details:

Case Number: 49008054Last Updated: 12-31-2010
Anatomy: Skeletal System   Pathology: Trauma
Modality: Conventional RadiographAccess Level: Readable by all users
Keywords: maisonneuve spiral tibia fibula

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