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Tibia/Fibular Shaft Fractures

Categories
  • Education
  • Joint/Tendon
Tags
  • Tibia/fibular injuries
Tibia/fibular icon

Lower Limb/Ankle Anatomy

Lower limb/ankle anatomy
Bone Structure

Tibia Fractures

Tibia shaft fractures are one of the most commonly affected fracture area. It may be due to low or high energy trauma and may be a closed or open injury. There may be an associated ipsilateral limb/joint fracture and exclude compartment syndrome in high energy fractures.

Tibia fractures

Injury Mechanism:

  • Either low or high energy injury
  • Direct forces or indirect mechanism

Causes:

  • Twisting/rotational movements with significant force loading during activity especially during sport activities
  • Falls from a height
  • Motor vehicle accidents

Presentation:

  • Pain
  • Swelling
  • Deformity
  • Inability to walk with pain that worsens with standing or walking

Clinically:

  • Bruising
  • Bone tenderness
  • Pain
  • Deformity
  • Open wounds
  • Compartment syndrome

Tibia Fracture Type

Tibia fracture type

Open fracture

Gustilo classification of open fractures

Gustilo classification of open fractures

AO Classification Tibia Diaphyseal (42) Shaft Fracture

AO Classification tibia diaphyseal (42) shaft fracture

Investigations

X-ray Tibia:

  • AP, Lateral & oblique

X-ray joint above and below fracture
CT: for intra-articular fracture evaluation and surgical planning

Management

  • Stabilize according to the ATLS guidelines
  • Maintain hydration
  • Splint
  • Nondisplaced stable tibia fractures can be managed nonoperatively with Plaster of Paris

Acceptable malalignment:

  • < 5° varus-valgus shaft angulation
  • < 10° anterior/posterior or rotational angulation
  • < 1cm shortening
  • Surgery for significantly displaced, unstable fractures or nonunion

Surgery Tibia Nail and Screw Fixation

Surgery tibia nail and screw fixation

Nail and screw fixation

Surgery Tibia External Fixation

Surgery tibia external fixation

Surgery Tibia Ring External Fixation

Surgery tibia ring external fixation
Stages of Healing Bone Fracture

Surgery Technique

Surgery

Surgery Tibia Nail and Screw Fixation

Suprapatellar or Infrapatellar Approach
  • Approach: Incision either Suprapatellar or Infrapatellar
  • Ream canal
  • Nail insertion
  • Proximal and distal screw fixation

Tibia External Fixation

Tibia external fixation
  • Pins inserted proximal and distal to fracture
  • External fixator applied
Repair of fractures

Complications:

  • Nonunion
  • Malunion
  • Compartment syndrome
  • Osteomyelitis after open fracture and/or post-surgery

References

  1. Management of segmental fracture of the tibia treated by ilizarov external fixation. AU Makhdoom, BJ Shaikh, RA Baloch, HR Malah, ZH Tunio, MF Jokhio. J Ayub Med Coll Abbootabad. 2020 Jul-Sep;32(3): 291-294.
  2. Suprapatellar nailing of fractures of the tibia. MH Hessmann, M Buhl, C Finkemeier, A Khoury, R Mosheiff, M Blauth. Oper Orthop Traumatol. 2020 Oct;32(5): 440-454.

Contributor:

Prof S Maqungo

Learn More

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