Close follow-up is important to monitor fracture alignment. Most fractures will heal well without complication in 8-12 weeks. Patients who have undergone a closed reduction and casting need follow-up in 1 week in the fracture clinic with an x-ray. Unstable fractures may require general anaesthetic, manipulation and plaster (GAMP) or fixation in theatre ![]() Above-knee cast should typically have the knee flexed to 30-40 degrees and the ankle in neutral dorsiflexionĬhange to patellar tendon-bearing/below-knee cast No reduction is needed, however the patient would benefit from procedural sedation for application of the castĪbove-knee cast for 4-6 weeks (age-and healing-dependent), non-weight bearing. What is the usual ED management for this injury? unable to achieve or maintain reduction (including if ED is not experienced in fracture reduction, splinting or casting)ġ0.Indications for prompt consultation include: Table 1: Acceptable reduction parameters.ĩ. The majority will require closed reduction.ĪP and lateral radiographs of the tibia, including the knee and ankle joints should be obtained immediately after reduction to verify alignment. Reduction is required with any displaced fracture. When is reduction (non-operative and operative) required? The fibula fracture is located in the proximal third. The tibial shaft fracture is located in the distal third. Thus when casting this fracture the cast should be moulded into slight valgus to protect against this.įigure 4: AP and lateral x-ray of tibia and fibula shaft. Most tibial shaft fractures are short oblique or transverse fractures of the middle or distal third.įigure 3: With an intact fibula it will tend to push the tibia into varus during healing. ![]() ![]()
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