Tibia shaft fracture

Tibia shaft fracture is a fracture of the proximal (upper) third of the tibia (lower leg bone). Due to the location of the tibia, it is frequently injured. Thus it is the most commonly fractured long bone in the body.[1]

Tibia shaft fracture
Open fracture of the shaft of the tibia.
SpecialtyOrthopedics

Signs and symptoms

Patients with tibial shaft fractures present with pain and localized swelling.[2] Due to the pain they are unable to bear weight. There may be deformity, angulation, or malroation of the leg.[2] Fractures that are open (bone exposed or breaking the skin) are common.

Mechanism

Since approximately one third of the tibia lies directly beneath the skin, open fractures are common compared to other long bones.[1] These open fractures are most commonly caused by high velocity trauma (e.g. motor vehicle collisions), while closed fractures most commonly occur from sports injuries or falls.[3][4] Osteoporosis can be a contributing factor.[3] Skiing and football (soccer) injuries are also common culprits.[4]

Diagnosis

Examination

Prior to realignment and splinting an assessment is performed to ensure there are no open wounds, soft-tissue contusions, or neurovascular injuries.[1]

Radiography

Anteroposterior (AP) and lateral radiographs the include the entire length of the lower leg (knee to ankle) are highly sensitive and specific for tibial shaft fractures.[4]

Classification

Two systems of fracture classification are commonly used to aid diagnosis and management of tibia shaft fractures:

  • Oestern and Tscherne Classification
  • Gustilo-Anderson Classification

Management is dependent on the determination of whether the fracture is open or closed.

Management

Nonoperative treatment

Nonsurgical treatment of tibia shaft fractures is now limited to closed, stable, isolated, minimally displaced fractures caused by a low-energy mechanism of injury.[1] This treatment consists of application of a long-leg cast.[5]

Operative treatment

Surgical treatment is typically indicated for high-energy trauma fractures.[1] Intramedullary nailing is a common technique, but external fixation may have equivalent outcomes.[6]

Epidemiology

Tibia shaft fractures are the most common long bone fractures. They account for approximately 4% of the fractures seen in the Medicare population.[2]

References
  1. Terry Canale, S.; Azar, Frederick M.; Beaty, James H. (2016-11-21). Campbell's operative orthopaedics. Azar, Frederick M.,, Canale, S. T. (S. Terry),, Beaty, James H.,, Preceded by: Campbell, Willis C. (Willis Cohoon), 1880-1941. (Thirteenth ed.). Philadelphia, PA. ISBN 9780323374620. OCLC 962333989.
  2. "Tibia Shaft Fractures - Trauma - Orthobullets.com". www.orthobullets.com. Retrieved 2017-10-01.
  3. Grütter, R.; Cordey, J.; Bühler, M.; Johner, R.; Regazzoni, P. (September 2000). "The epidemiology of diaphyseal fractures of the tibia". Injury. 31 Suppl 3: C64–67. doi:10.1016/s0020-1383(00)80035-2. ISSN 0020-1383. PMID 11052384.
  4. "Tibial shaft fractures in adults". www.uptodate.com. Retrieved 2017-10-01.
  5. Busse, Jason W.; Morton, Emily; Lacchetti, Christina; Guyatt, Gordon H.; Bhandari, Mohit (October 2008). "Current management of tibial shaft fractures: a survey of 450 Canadian orthopedic trauma surgeons". Acta Orthopaedica. 79 (5): 689–694. doi:10.1080/17453670810016722. ISSN 1745-3682. PMID 18839377.
  6. Littenberg, B.; Weinstein, L. P.; McCarren, M.; Mead, T.; Swiontkowski, M. F.; Rudicel, S. A.; Heck, D. (February 1998). "Closed fractures of the tibial shaft. A meta-analysis of three methods of treatment". The Journal of Bone and Joint Surgery. American Volume. 80 (2): 174–183. doi:10.2106/00004623-199802000-00004. ISSN 0021-9355. PMID 9486723.
Classification
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