• Clinical science

Tibial fracture

Abstract

Tibial fractures are the most common type of long bone fractures. They are usually caused by direct trauma and may occur proximally (tibial plateau fracture), at the shaft, or distally. The fracture may solely involve the tibia or the fibula, or it may involve both. As only a small amount of tissue covers the bone structures, there is a higher risk of open fracture, neurovascular injury, compartment syndrome, and wound infection. Depending on the location and stability of the fracture, treatment may involve casting, intramedullary nailing, open reduction and internal fixation, or external fixation.

Classification

Clinical features

References:[1]

Diagnostics

  • Clinical examination: peripheral perfusion, motor function, and sensation
  • X-rays: knee and ankle (anteroposterior and lateral views)
    • Even when no obvious fracture is detected, tibial plateau fractures may cause lipohemarthrosis. This is visible as a fat-fluid level on x-ray.
  • MRI: can be useful to assess injuries to the meniscus and the ligaments associated with tibial plateau fractures.
  • Joint aspiration: can be performed
    • Bloody effusion (hemarthrosis) with fatty spots indicates an osteochondral fracture.
  • See general principles of fractures.

References:[1][2]

Treatment

  • Conservative treatment
    • Isolated fibula fractures
      • Splinting and partial weight bearing
    • Non-displaced proximal tibial fractures
      • Hinged knee brace and no weight bearing for 6 weeks
      • Brace gradually flexed over weeks
      • Serial x-rays to assess healing and determine whether the brace can be removed
    • Non-displaced tibial shaft fractures
      • Long leg cast (if the long leg cast fails to ensure proper healing, then surgical treatment is indicated)
  • Surgical treatment
    • Indication: open or displaced tibial shaft fractures
      • Open fractures require urgent irrigation and debridement
      • Open reduction and internal fixation with plate, screw, or intramedullary nail
      • External fixation may be used, especially for complex fractures.
  • See general management of fractures.

References:[3][4][5][6]

Complications

References:[1]

We list the most important complications. The selection is not exhaustive.