Tibiofibula Transposition in High-Energy Fractures

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomechanics

Background:

• High-energy lower limb fractures often involve both tibia and fibula.
• Closed reduction is the initial management strategy for many fractures.
• Complications can arise from the complex nature of severe trauma.

Purpose of the Study:

• To report a previously undescribed complication of high-energy tibial fractures.
• To highlight the challenges in achieving closed reduction with this complication.
• To recommend appropriate management strategies.

Main Methods:

• Case report of two patients with high-energy tibial and fibula fractures.
• Description of failed closed reduction attempts under sedation and anesthesia.
• Surgical exploration revealing distal fibula transposition into the tibial medulla.
• Reduction technique involving simulation of the injury mechanism.

Main Results:

• Two cases of failed closed reduction for tibial fractures with fibula fractures were identified.
• Distal fibula fragment was found transposed and entrapped within the proximal tibial fragment's medulla.
• Successful reduction was achieved only after simulating the injury mechanism.
• Tibiofibula transposition was identified as a rare complication preventing closed reduction.

Conclusions:

• Tibiofibula transposition is a novel complication of high-energy lower limb fractures.
• This entrapment can significantly impede successful closed reduction.
• Open reduction and stabilization in the operating room are recommended upon identification of this complication.