The Orthobullets Podcast CoinFlips | Trauma | Subacute Segmental Tibia-Fibula Fx in Schizophrenic 65M
Oct 26, 2025
Dr. Lisa Canada, an orthopedic trauma surgeon at UNC, and Dr. Neela Ferdagand from the Core Institute share their expertise on managing complex tibia-fibula fractures. They discuss the unique challenges posed by a subacute fracture in a 65-year-old schizophrenic patient, emphasizing the importance of choosing the right fixation techniques. The risks of compartment syndrome and the effectiveness of continuous monitoring tools like MyO1 are highlighted, along with strategies for managing noncompliant patients. Tune in for essential insights into orthopedic decision-making!
AI Snips
Chapters
Transcript
Episode notes
Stepwise Reduction Before Open Fixation
- Start reductions minimally and escalate: try percutaneous tricks, steering pins, then limited open before full open reduction.
- Avoid immediate plating in homeless, noncompliant patients and favor intramedullary nailing when possible.
Use Blocking Screws Strategically
- Use blocking screws to guide nail placement when the canal is tight or segments malalign.
- Choose blocking location based on how the proximal or distal fragment behaves under reduction.
Open Tight Canals With Small Reamers
- For very tight tibial canals, use small hand reamers or humeral reamers to gradually open the canal.
- Avoid aggressive powered reaming that risks distal cortical fracture; build up reamer size carefully.