FRACTURE: Minimally invasive technique of fixation of comminuted long bone fracture
73 year old male person was hit
by a car while he was on morning walk. He was brought to triage with swollen
painful right leg with undue mobility in bone. Overlying skin had few abrasions.
The knee joint was swollen. After initial resuscitation, x rays were done. The patient
was found to have comminuted fracture patella, depressed fracture lateral
condyle tibia. Comminuted fracture metaphysis tibia extending upto mid 1/3
distal 1/3 junction and fracture fibula. The patient was initially kept in a
plaster slab and surgery was planned. Once the swelling decreased and wrinkling
of skin was there, surgery was done. Fracture patella was fixed with standard
tension band wiring techniques. Fracture lateral condyle tibia was opened and
the depression elevated. The bone gap beneath the elevated fragment was filled
with cancellous bone harvested from right iliac crest. The fixation has held
with long k wires. The long comminuted fracture tibia was not opened. Long
locking lateral tibia head plate was passed beyond the most distal fracture
line percutaneously. The distal fracture fragments were to be held with 2 lag
screws inserted percutaneously. In this surgery, skin incisions were kept long
to allow soft handling of the soft tissues and minimal stripping of periosteum
was done. The patient had to be kept in back slab plaster for 4 weeks to allow
wound healing and also because of the fracture patella. After 4 weeks, the limb
was mobilized non weight bearing and monitored closely for fracture union.
After 3 months, fracture united with a good range of motion and well healed
wounds.one very important element in management of this fracture is use of bone
graft. The bone graft was used for joint elevation and buttressing, rather than
the common use of graft at fracture site to increase chances of union. Since
percutaneous technique was used and soft tissues were preserved, the fracture