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What Is The Ideal Time Period For IM Nail Insertion After Suffering A Spiral Fracture?
Question: I have a 7 day old spiral fracture in my tibia. Which I believe has probably already started healing, but from the X-ray taken after the cast was fixed, I can see it's not fully aligned. I plan to fly back to my home country to have an IM nail inserted, but Im wondering if it will be too late if the surgery is performed 3 - 4 weeks after the accident, because it will have already partially healed, and the IM wont be able to fully align the 2 sections of bone.
IM = Stainless Steel or Titanium Intramedullary Nail
IM = Stainless Steel or Titanium Intramedullary Nail
Brief Answer:
Needs to be fixed earlier
Detailed Answer:
Hi,
Thank you for posting the query.
As you said,it will surely be too late if the fracture is fixed 3-4 weeks after the accident.
Ideally long bone fractures need to be fixed within 1st week after trauma. After this period,soft callus formation starts and the bone starts uniting in whichever position it is,whether it is well aligned or not.
After 15-20 days its almost immobile at the fracture site and so the intra-medullary nailing becomes very difficult to be performed if its to be performed by closed methods (without opening the fracture site )
The only option that will be possible after 4 weeks will be open surgery.
Just check if there are facilities of performing the surgery at the place where you are right now or try to fly over to your native place early.
I hope your query has been answered.
Feel free to get back to me if you have any doubts.
Thank you.
Needs to be fixed earlier
Detailed Answer:
Hi,
Thank you for posting the query.
As you said,it will surely be too late if the fracture is fixed 3-4 weeks after the accident.
Ideally long bone fractures need to be fixed within 1st week after trauma. After this period,soft callus formation starts and the bone starts uniting in whichever position it is,whether it is well aligned or not.
After 15-20 days its almost immobile at the fracture site and so the intra-medullary nailing becomes very difficult to be performed if its to be performed by closed methods (without opening the fracture site )
The only option that will be possible after 4 weeks will be open surgery.
Just check if there are facilities of performing the surgery at the place where you are right now or try to fly over to your native place early.
I hope your query has been answered.
Feel free to get back to me if you have any doubts.
Thank you.
Above answer was peer-reviewed by :
Dr. Prasad
Thanks for a comprehensive answer. My problem is the cost and location, I'm looking at $6000 in Mozambique, a third world country where I don't speak the language. It was incredibly difficult to communicate with the orthopaedic surgeon, even though he supposedly spoke English.
I'm planning to travel to South XXXXXXX in 2 days, where I'll be more confident with the medical care, but cost may again be an issue. So I'm not sure if this allowed, but I have a few questions :
1. How did this happen? I was digging a trench on some land and struck a large concrete block. I kept stamping on the shovel trying to find a point I could get in underneath it and lever it out. I stamped on the shovel maybe 15 times. But it wasn't until 2 days later that my tibia fractured when I was practicing a round house punch. Question is, could I have damaged it digging the trench, or was it solely the round house punch?
2. How safe is it to travel by plane, 16 hour flight to Australia, in a long leg cast that has been fitted for 2-3 weeks?
3. Is there a position I should be trying to keep my leg in, in the mean time, that may help improve alignment? Will standing up help for example with the assistance of gravity? I felt the bone move a little 2 days ago, then move back as I was climbing into bed 2 days ago, raising my leg without using my hands. Excruciating pain. I guess that could have either made the alignment better or worse.
I'm planning to travel to South XXXXXXX in 2 days, where I'll be more confident with the medical care, but cost may again be an issue. So I'm not sure if this allowed, but I have a few questions :
1. How did this happen? I was digging a trench on some land and struck a large concrete block. I kept stamping on the shovel trying to find a point I could get in underneath it and lever it out. I stamped on the shovel maybe 15 times. But it wasn't until 2 days later that my tibia fractured when I was practicing a round house punch. Question is, could I have damaged it digging the trench, or was it solely the round house punch?
2. How safe is it to travel by plane, 16 hour flight to Australia, in a long leg cast that has been fitted for 2-3 weeks?
3. Is there a position I should be trying to keep my leg in, in the mean time, that may help improve alignment? Will standing up help for example with the assistance of gravity? I felt the bone move a little 2 days ago, then move back as I was climbing into bed 2 days ago, raising my leg without using my hands. Excruciating pain. I guess that could have either made the alignment better or worse.
Brief Answer:
Fracture happened due to round house punch
Detailed Answer:
Hi,
1. The fracture seems to have occured solely due to round house punch. It is less likely that you may have fractured it while digging the trench,as it is impossible to walk on a fractured bone for 2 days,as tibia is a weight bearing bone.
2. It is pretty safe to travel for any period of time as long as you have long leg cast. Just keep the leg elevated as far as possible to avoid swelling.
3. Once the limb is plastered,there is no role of gravity or other external forces that could realign the fractured fragments. The only thing that can be done is to get a recent xray done without removing the plaster. According to the degree of misalignment,the plaster can be partially cut and wedging can be done. This has to be done by a specialist orthopaedic doctor.
You should not try to lift the leg without using the hands as this may cause movements at fracture site and cause misalignment and pain.
Thank you
Fracture happened due to round house punch
Detailed Answer:
Hi,
1. The fracture seems to have occured solely due to round house punch. It is less likely that you may have fractured it while digging the trench,as it is impossible to walk on a fractured bone for 2 days,as tibia is a weight bearing bone.
2. It is pretty safe to travel for any period of time as long as you have long leg cast. Just keep the leg elevated as far as possible to avoid swelling.
3. Once the limb is plastered,there is no role of gravity or other external forces that could realign the fractured fragments. The only thing that can be done is to get a recent xray done without removing the plaster. According to the degree of misalignment,the plaster can be partially cut and wedging can be done. This has to be done by a specialist orthopaedic doctor.
You should not try to lift the leg without using the hands as this may cause movements at fracture site and cause misalignment and pain.
Thank you
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Surely the digging could have cause microscopic fractures and weakened the bone. I find it hard to believe the air punch alone would have been the cause.
Brief Answer:
Query answered
Detailed Answer:
Hi,
It may be a possibility,can't say.
Thank you
Query answered
Detailed Answer:
Hi,
It may be a possibility,can't say.
Thank you
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks Doc, I really hope so, because otherwise I'll live my life in fear of having some fun. To think at 42 my bones would be so brittle as to shatter with so much as an air punch.
I have just cut of the top 4 inches of my long leg cast to make it a short leg cast. It's been9 days now. Any tips on making sure I dont make it any worse. I must say this shorter cast is such a relief, so far. It's only been 20 minutes. I'm planning to increase flexion by a few degrees a day, haven't ventured beyond 10 degrees yet.
My girlfriend is driving me into South XXXXXXX tomorrow, it's about a 2.5 hour drive to the nearest major public hospital. With a 20 - 30 customs check where I'll need to alight from the car and stand in queue to have my passport stamped. Any tips for that journey?
With any luck I'll have a date set for surgery and my questions answered there.
Thanks again, really pleased with this service.
I have just cut of the top 4 inches of my long leg cast to make it a short leg cast. It's been9 days now. Any tips on making sure I dont make it any worse. I must say this shorter cast is such a relief, so far. It's only been 20 minutes. I'm planning to increase flexion by a few degrees a day, haven't ventured beyond 10 degrees yet.
My girlfriend is driving me into South XXXXXXX tomorrow, it's about a 2.5 hour drive to the nearest major public hospital. With a 20 - 30 customs check where I'll need to alight from the car and stand in queue to have my passport stamped. Any tips for that journey?
With any luck I'll have a date set for surgery and my questions answered there.
Thanks again, really pleased with this service.
Brief Answer:
Query answered
Detailed Answer:
Hi,
As long as you do not put weight on the broken leg,everything is acceptable.
Even a minor weight bearing episode on the leg,and things will get worse.
Keep leg elevated whenever possible,use walker/crutches whenever you need to ambulate or stand. Sit wherever its possible.
And most important,be in touch with me !
I am there to help you whenever you need me.
Wish you a speedy recovery and all the best for the surgery.
Kind regards.
Query answered
Detailed Answer:
Hi,
As long as you do not put weight on the broken leg,everything is acceptable.
Even a minor weight bearing episode on the leg,and things will get worse.
Keep leg elevated whenever possible,use walker/crutches whenever you need to ambulate or stand. Sit wherever its possible.
And most important,be in touch with me !
I am there to help you whenever you need me.
Wish you a speedy recovery and all the best for the surgery.
Kind regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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