Stabilization of Distal Tibia Metaphysis Extra-Articular Fracture Accompanying Soft Tissue Defect in the Medial Supramalleolar Area and Wound Management: A Case Report

A 19-year-old patient who fell from a horse 3 h ago was evaluated in the emergency department of a tertiary trauma hospital. He had left tibia distal metaphysis extra-articular fracture with a wound of 5 × 3.5 cm2on the medial side of the supramalleolar region. The wound was mechanically cleansed and covered with sterile dressings. A long leg splint was applied. Medical treatment including antibiotic therapy and tetanus prophylaxis was immediately started. Distally wedged tibial nailing fixation and interlocking using distal supportive bolt locking screw of the nailing system wereperformed. The screw surface was covered with available soft tissues of the wound. The treatment was continued using the vacuum-assisted closure system. Next, soft tissue reconstruction was done using the Yin-Yang flap. Two months later,a dynamization procedure was performed on the patient, whose soft tissue defect was resolved. His fracture healed in the postoperative fifth month. The wound was stable in the postoperative 13th month. All inserted implants were removed onthe patient’s request, and treatment was successfully completed.Distal supportive bolt locking screw was inserted most distally and covered with available soft tissue to stabilize distal tibial metaphyseal extra-articular fracture accompanying soft tissue defect in the supramalleolar region. Possible infections due to the exposure of distal interlocking screws of standard nailing fixation were prevented. A powerful fixation was achieved using the aforementioned nailing system. This fixation system not only created quite stable fixation to restore osseous pathology, but also could create a suitable environment to resolve soft tissue defect via proper treatment options and strategies.