Tibial/fibular Shaft Fracture

Tibial/fibular Shaft Fracture is a topic covered in the 5-Minute Emergency Consult.

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Fracture Description
  • 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
  • Displacement
  • Degree of shortening
  • Angulation
  • Configuration:
    • Spiral, transverse, or oblique
    • Comminuted, with butterfly fragment or multiple fragments
  • Proximal:
    • Associated with peroneal nerve injury
    • Disruption of ankle syndesmosis (Maisonneuve fracture)
  • Middle
  • Distal

Pediatric Considerations
  • 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

Pediatric Considerations
  • 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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