tibia

Region specific approaches

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

Lower Limb

Thigh

Epidemiology

Athletic / high impact exercises

Aetiology

First described in ballet dancers (Burrows 1956)

- tension side of bone / lateral side

- progression to complete fracture has been well documented in athletes

Signs

Point tenderness

- lateral aspect of tibia

Over time develop bony lump

Issues

Complex / high energy injuries

Management of soft tissues critical

- restore length with external fixation

- await for swelling to reduce

Restoration of alignment & joint surface imperative

Outcome guarded

Epidemiology

Most common long bone fracture

Aetiology

Young patients / sports

Elderly / simple falls

MVA - often compound

Tscherne Soft Tissue Classification

Grade 0

- nil ST injury

Grade 1

Displaced Tibial Shaft Fractures

Acceptable reduction

- varus / valgus < 5^o

- anterior / posterior < 5^o

- rotation 5^o

- shortening 10 mm

Poor remodelling potential

- valgus 

- apex posterior angulation  / recurvatum

- rotational alignment does not remodel

- shortening / in 2-10 year old average overgrowth is only 5mm

Definition

Anterolateral bowing

True bone dysplasia

- hamartomatous area in the tibia

- non union or potential non union through pathological fracture in this region

The defect in the bone is filled with mature, fibrous connective tissue

- not really a pseudoarthrosis

- by definition, a pseudarthrosis has a cleft lined by fibrocartilage containing fluid and bounded by a capsule