Related Subjects:
|Fractured Neck of Femur
|Fractured Shaft Femur
|Supracondylar Femur Fractures
|Femoral fractures
|Fractured Tibia and Fibula
Tibia & Fibula Fractures 🦴🚨 are among the most common long bone fractures.
Because the tibia is subcutaneous for much of its length, these fractures have a high risk of open injury, infection, and delayed healing.
Always assess neurovascular status and compartment syndrome.
📖 About
- Common long bone fractures in all age groups.
- Tibia = major weight-bearing bone; fibula provides lateral stability and muscle attachments.
- Tibial fractures are often accompanied by fibular fractures.
- Thin soft tissue coverage → higher risk of open fractures.
- Articular involvement possible (tibial plateau, plafond/pilon fractures).
⚙️ Aetiology
- High-energy trauma (RTA, fall from height, sports injuries ⚽).
- Low-energy trauma in osteoporotic or pathological bone.
- Tibial plateau fracture: classically car bumper injury → valgus/varus force through knee.
🩺 Clinical Features
- Severe pain, swelling, deformity, inability to bear weight 🚶❌.
- Localized tenderness, crepitus, bruising, or open wound.
- Check distal pulses & cap refill (popliteal/posterior tibial/dorsalis pedis arteries).
- Assess for compartment syndrome 🚨:
- Pain out of proportion
- Pain on passive stretch
- Paresthesia, pallor, pulselessness, paralysis (late signs)
- Common peroneal nerve (CPN): test ankle dorsiflexion + sensation in 1st web space.
⚠️ Can be injured with fibular neck fracture or tight casts/splints.
⚠️ Complications
- Compartment syndrome → may require fasciotomy.
- Common peroneal nerve injury → foot drop.
- Popliteal artery damage (rare, but limb-threatening).
- Delayed union / nonunion (tibia notorious for slow healing).
- Post-traumatic arthritis (esp. tibial plateau).
- Osteomyelitis (esp. in open fractures).
- Fat embolism, DVT/PE.
🧪 Investigations
- X-ray: AP & lateral of knee, tibia/fibula, ankle (always include joints above and below!).
- CT: for intra-articular fractures (plateau, plafond).
- Bloods: FBC, U&E, coagulation, G&S if major trauma/open injury.
💊 Management
- Initial (ATLS): ABCDE, IV access, analgesia. Assess distal NV status. Splint limb.
- First aid: sterile saline dressings for wounds. Gentle traction if grossly deformed. Avoid tight POP → risk of compartment syndrome.
- Open fracture 🚨: IV antibiotics (e.g., co-amoxiclav or clindamycin), tetanus prophylaxis, urgent ortho referral for washout + debridement.
- Definitive:
- Undisplaced/minimally displaced → cast or functional brace.
- Displaced/unstable → intramedullary nail (gold standard for diaphyseal fractures).
- Tibial plateau → non-weight-bearing + ortho review; ORIF if displaced/incongruent.
- Pilon/plafond fractures → external fixation (damage control) ± staged ORIF.
- Rehabilitation: physio, gradual weight-bearing as healing progresses.
- VTE prophylaxis: LMWH unless contraindicated.
📌 OSCE / Exam Pearls
- Tibia = commonest long bone for open fractures → always check skin!
- CPN injury → foot drop. Test before and after cast application.
- Tibia = slow healer → high risk of delayed/nonunion → often needs nail/plate fixation.
- Tibial plateau fractures = think meniscal & ligament injuries → MRI if persistent instability/pain.
📚 References
- ATLS®: Advanced Trauma Life Support, 10th edition.
- Rockwood & Green’s Fractures in Adults, 9th edition.
- BOAST Guidelines: Open Fracture Management.
