Tibial/fibular Shaft Fracture
Basics
Description
Description
Fracture Description
Tibia
- 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
- Type I:
- 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
Fibula
- 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
Etiology
Etiology
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Tibial/fibular Shaft Fracture." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307722/all/Tibial_fibular_Shaft_Fracture.
Tibial/fibular Shaft Fracture. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307722/all/Tibial_fibular_Shaft_Fracture. Accessed December 11, 2024.
Tibial/fibular Shaft Fracture. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307722/all/Tibial_fibular_Shaft_Fracture
Tibial/fibular Shaft Fracture [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 11]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307722/all/Tibial_fibular_Shaft_Fracture.
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