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.

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

X-ray Tibia:

• AP, Lateral & oblique

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

• 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

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

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.