Tibial/fibular Shaft Fracture



Fracture Description
  • 80% have associated fibular fractures
  • Most common long bone fracture in adults
  • 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 third
    • 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
  • Third most common long bone fracture in children
  • Second 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

Geriatric Considerations
  • Increased risk with use of bisphosphonates
  • Increased risk with obesity


  • 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 comminuted fractures
    • Pedestrian vs. auto, motor vehicle crash (MVC):
    • More proximal
  • Low-energy transverse fractures:
    • Sports related most common: Soccer, Rugby
    • Involve distal 1/3: little soft tissue coverage
    • 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: Age 2–6 yr
    • Foot and lower leg get caught between frame and wheel spoke when riding in passenger seat
    • Crush injury, soft tissue laceration, and shearing injuries accompany this injury
    • 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 (31% with fracture)
  • Toddler fracture:
    • Spiral fracture involving the distal third 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 if not related to sports

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