Tibial/fibular Shaft Fracture
Tibial/fibular Shaft Fracture
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- 80% have associated fibular fractures
- Open (24% are open) vs. closed
- Extent of soft tissue damage
- Gustilo–Anderson classification of open fractures:
- Type I:
- Wound <1 cm
- Little soft tissue damage
- No crush injury
- Type II:
- Wound >1 cm
- Moderate soft tissue damage
- Little or no devitalized soft tissue
- Type III—severe soft tissue injury:
- A—adequate soft tissue coverage of bone
- B—tissue loss/periosteal stripping
- C—neurovascular injury requiring surgery
- Anatomic location:
- Proximal, middle, or distal 3rd
- Articular extension
- Degree of shortening
- Spiral, transverse, or oblique
- Comminuted, with butterfly fragment or multiple fragments
- Associated with peroneal nerve injury
- Disruption of ankle syndesmosis (Maisonneuve fracture)
- 3rd most common long bone fracture in children
- 2nd most common long bone fracture in nonaccidental trauma (usually apophyseal or metaphyseal corner)
- Nonphyseal fracture patterns:
- Compression (torus): Distal metaphysis
- Incomplete tension–compression (greenstick)
- Plastic/bowing deformity of fibula may occur.
- Complete fractures
- Physeal fracture patterns:
- Tibial shaft fractures may extend to the physis in Salter–Harris II pattern.
- High- vs. low-energy injury
- Amount of soft tissue injury is prognostic and determined by the degree of energy involved.
- Indirect force—frequently low-energy trauma:
- Rotary and compressive forces often result in oblique and spiral fractures.
- Skiing, fall, child abuse
- Direct force—high-energy trauma:
- Direct blow to leg often results in transverse and comminuted fractures.
- Pedestrian vs. auto, motor vehicle crash (MVC):
- Bending force over a fulcrum often produces comminution with a wedge-shaped butterfly fragment.
- Skier's boot top, football tackle, MVC
- Bicycle spoke injury:
- Foot and lower leg get caught between frame and wheel spoke
- Crush injury is the primary problem.
- Initial benign appearance of the soft tissues is often deceiving:
- Full-thickness skin loss can occur in days.
- Orthopedic surgery consultation should be obtained for all spoke-injury patients with associated fractures.
- Toddler fracture:
- Spiral fracture involving the distal 3rd of the tibia with intact fibula secondary to rotational force (turning on planted foot)
- Age range is 9 mo–6 yr, most often when learning to walk.
- Fractures in midshaft or more transverse are suggestive of nonaccidental trauma.
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