Tibial Fracture Fixation/Self-Assessment Framework

This page is part of the Tibial Fracture Fixation syllabus by Medical Makers. It is part of the Global Surgical Training Challenge.This page is not open edit.Read more...

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Part of	Tibial Fracture Fixation
Parent	Tibial Fracture Fixation

This skills module allows medical officers and surgeons who are not orthopedic specialists to become confident and competent in performing irrigation and debridement, power and manual drilling, proper positioning and insertion of Schanz screws, construction of the rod-to-rod modular frame, and fracture reduction and stabilization as part of external fixation procedures for open tibial shaft fractures performed in regions without specialist coverage. To maximize patient safety, this module teaches learners to use a powered drill to insert self-drilling Schanz screws through the near cortex and then manually advance Schanz screws into the far cortex to avoid plunging.

Self-Assessment Framework[edit | edit source]

Self-assessment

After the reduced fracture has been stabilized with the modular external fixator, please follow the 6 steps below, use a cellphone to take 5 post-operative photos ("digital X-rays"), and fill out the printed Training Logbook.

1

Check Post-Reduction Alignment

1. Take an anterior view photo with a ruler in the image to provide scale.
2. Visually inspect the tibial shaft and confirm that the alignment is within acceptable parameters:

• Bone apposition > 50%
• Rotation < 10 degrees
• Angulation < 10 degrees in any plane

1. Use a ruler to measure the distance of the two near Schanz screws from the fracture line:

• Two near Schanz screws were placed at least 2.0 cm (a finger breadth) from the fracture line

1. Visually inspect the fracture line to confirm that the reduction is adequate:

• length discrepancy < 2 cm shortening
• no distraction (lengthening)

2

Confirm Proper Pin Positioning

1. Take a medial view photo.
2. Verify the far Schanz screw in the proximal fragment was inserted medial or distal to the tibial tuberosity.
3. Confirm all four Schanz screws were inserted medial to the anterior tibial crest.

3

Verify No Far Cortex Perforation

1. Take a lateral view photo.
2. Verify that all four Schanz screws did not perforate the far cortex.
3. Visually inspect the tibial crest to confirm that the alignment is within acceptable parameters:

• Bone apposition > 50%
• Rotation < 10 degrees
• Angulation < 10 degrees in any plane

4

Remove Fragments from Vise Clamp

1. Remove the rods and clamps but leave the four Schanz screws in the distal and proximal fragments.
2. Use scissors to cut the cellophane wrap overlying the fracture site to separate the two fragments.
3. Remove each fragment from the vise clamp and place each fragment on a flat surface for inspection of the drill trajectory angles.

5

Check Drill Trajectory Angles for the Proximal Fragment

1. Place a protractor on the cross-section of the proximal fragment as shown in the image. Line up the center vertical black line of the protractor with the center of the vise attachment.
2. Take an overhead ("bird's eye view") photo of the cross-section of the proximal fragment to record the drill trajectory angles relative to the tibial crest. Check that the center vertical black line of the protractor is lined up with the center of the vise attachment in the overhead photo.
3. For the proximal fragment, the drill trajectory angles of both Schanz screws should be between 20°-60° relative to the tibial crest.

Subtract 90° from the protractor angle of each Schanz screw and calculate the absolute value of the drill trajectory angle.

6

Check Drill Trajectory Angles for the Distal Fragment

1. Place a protractor on the cross-section of the distal fragment as shown in the image. Line up the center vertical black line of the protractor with the center of the vise attachment.
2. Take an overhead ("bird's eye view") photo of the cross-section of the distal fragment to record the drill trajectory angles relative to the tibial crest. Check that the center vertical black line of the protractor is lined up with the center of the vise attachment in the overhead photo.
3. For the distal fragment, the drill trajectory angles of both Schanz screws should be between 30°-90° relative to the tibial crest.

Subtract 90° from the protractor angle of each Schanz screw and calculate the absolute value of the drill trajectory angle.

Training Module Certificate of Completion[edit | edit source]

Once the self-assessment framework has been completed:

Get certificate

1. Click the button above.
2. Type in your name, download and print out a certificate of completion for this training module.
3. Photograph your certificate on your cellphone as a backup and file the printed certificate in your training records.

Acknowledgements[edit | edit source]

This work is funded by a grant from the Intuitive Foundation. Any research, findings, conclusions, or recommendations expressed in this work are those of the author(s), and not of the Intuitive Foundation.