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* Mishra AK (Dr) Major
*Graded Specialist Orthopaedics, Military
Hospital Jalandhar Cantt,
Jalandhar – 144005, Punjab-India.
Address for Correspondence
Mishra AK (Dr)
Major
Graded Specialist Orthopaedics,
Military Hospital Jalandhar Cantt, Jalandhar – 144005,
Punjab-India. |
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Abstract
Tibial shaft fractures are one of the
commonest long bone fractures amongst the two-Wheeled- vehicle
drivers seen in day today’s orthopaedic practice. These
fractures are Usually displaced, comminuted and compound due to
high velocity trauma. Polypropylene protection device secured
around the leg similar to the ‘safety helmet’ can help in
reducing the incidence of tibial shaft fractures and its
compounding in two wheeler drivers.
Key words: Two wheeler drivers; tibial shaft fractures;
polypropylene protection device.
J.Orthopaedics 2006;3(1)e7
Introduction:
Tibial shaft fractures are the commonest long
bone fractures resulting in considerable amount of morbidity.
In today’s mechanized society most of these fractures are caused
by high velocity injuries especially involving two wheelers as
they are highly unstable and offer little protection to its
rider as compared to the car [1, 2]. By its very location the
tibia is prone to frequent injuries. Tibia is most frequent site
of an open fracture, with incidence ranging from 49.4% to 63.2%
[3]. Furthermore, the blood supply of the tibia is more
precarious than bones that are enclosed by heavy muscles.
High-energy tibial fractures are associated with compartment
syndrome or neural or vascular injuries.
Delayed union, non-union and infections are
relatively common complications of the tibial shaft fractures
[4].The use of ‘crash helmets’ has been shown to lower the
mortality in major accidents involving motor cyclists. A similar
light weight Polypropylene protection device around the leg
extending from the knee to the ankle can be quite useful in
prevention of or reducing such injuries in two wheeler drivers.
Construction: The proposed device is
fabricated by polypropylenesheets that are being used regularly
in making of artificial limbs and various orthopedic braces. It
can be easily moulded according to the shape required. The
device has an outer smooth surface of polypropylene and inner
sponge padding of approximately 5 cm to absorb the kinetic
energy and reduce the impact over the tibia.
Placement: The device is secured in front and
around the leg with the help of three Velcro straps (Fig 1).
Conclusion:
India has the highest road accident rates in
the world - one of every forty two vehicle in country had met
with an accident in 1986. In US and Europe the average is 1 in
every 100 vehicles[2]. A large proportion of vehicles involved
were two wheelers. The lower Limbs are involved in 49 .6 % of
motor cycle accidents with soft tissues and bony damage being
particularly severe below the knee. It has been recommended that
anterior and lateral aspect of the tibia should be protected by
the motorcyclist wearing knee length over boots. Casserly
reported that the wearing of ‘Levis’ jeans by motorcyclists made
increasingly popular by recent television commercial offers
little protection to the endangered knee and have recommended
those commercially available kneepads to be worn by all
motorcyclists [5]. The proposed polypropylene device for the
tibia is definitely stronger and much safer than leather
clothing’s, knee length over-boots, or ‘Levis’ jeans. This will
certainly reduce the incidence of tibial shaft fractures and
or its Compounding in high velocity trauma resulting from two
wheeler accidents. Further research can prove the effectiveness
of the device and develop better alternatives.
Reference :
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Thomas AR. Fractures of the Tibia and Fibula. In : Rockwood CA.
Jr, Green DP,Bucholz RW, editors. Rockwood and Green’s fractures
in adults. 3rd ed. Philadelphia: JB Lippencott, 1991; 1915-82.
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Park K. Accidents. In Park’s Text Book of Preventive and Social
Medicine.16th ed.M/s Banarsidas Bhanot, 1167, Premnagar,
Jabalpur, 2000; 301-4.
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Monti K, Michael JB. David BH, et al. Outcome in open tibia
fractures: Relationship Between delay in treatment and
infection. Journal of Trauma2003; 55: 955-58.
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Whittle AP. Fractures of lower extremity. In: Cannale ST,
editors. Campbell’s Operative Orthopaedics . 9th ed.
Philadelphia: Mosby-Yearbook.1998; 2042-179 .
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Casserly H. ‘Levis’ jeans and motorcycle knee injuries. Injury
1991; 22: 422 -23.
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