Loughenbury Peter R, Gledhill Rebecca A, Evans Nick
Scarborough Hospital, Scarborough, UK.
Case Rep Emerg Med. 2016;2016:6718679. doi: 10.1155/2016/6718679. Epub 2016 Oct 11.
We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia. Open reduction and exposure of the fracture sites revealed that the distal fibula fragment was "transposed" and entrapped in the medulla of the proximal tibial fragment. Reduction required simulation of the mechanism of injury in order to disengage the fragments and allow reduction. Tibiofibula transposition is a rare complication of high-energy lower limb fractures which has not previously been reported and may prevent adequate closed reduction. Impaction of the distal fibula within the tibial medulla occurs as the limb is realigned by paramedic staff before transfer to hospital. We recommend that when this complication is identified the patient is transferred to the operating room for open reduction and stabilization of the fracture.
我们报告了两例闭合复位高能胫骨骨折伴腓骨骨折失败的病例。第一例是一名39岁男性，遭遇高速摩托车碰撞；第二例是一名14岁男性，从三米高处坠落致腿部受伤。事故现场的紧急医疗服务人员报告称，受伤肢体有90度外翻畸形，双下肢在现场进行了复位并固定。在镇静或麻醉下手法操作无法实现胫骨的充分对线。切开复位并暴露骨折部位后发现，腓骨远端骨折块“移位”并嵌顿于胫骨近端骨折块的髓腔内。复位需要模拟损伤机制以分离骨折块并实现复位。胫腓骨移位是高能下肢骨折的一种罕见并发症，此前未见报道，可能会妨碍充分的闭合复位。在护理人员将患者转运至医院之前对肢体进行复位时，腓骨远端会嵌入胫骨髓腔内。我们建议，一旦发现这种并发症，应将患者转至手术室进行切开复位和骨折固定。
