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Fractures of tibia and fibula

Fractures of tibia and fibula . Tibial shaft fracture. Most common long bone fractures Isolated tibial fracture – 23 % Both tibia and fibular fractures – 77 % 77 % of tibial fractures are closed 23 % are open fractures . Features of tibial fractures . Most common of all long bone fractures

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Fractures of tibia and fibula

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  1. Fractures of tibia and fibula

  2. Tibial shaft fracture • Most common long bone fractures • Isolated tibial fracture – 23 % • Both tibia and fibular fractures – 77 % • 77 % of tibial fractures are closed • 23 % are open fractures

  3. Features of tibial fractures • Most common of all long bone fractures • Subcutaneous and hence incidence of open fracture is high • Distal one third has a deficient blood supply and a fracture in this area is known for delayed union and nonunion • Bounded above and below by hinge joints • Respond well to conservative treatment • Only 5 % need operative treatment

  4. Mechanism of injury • RTA – 37 % • Sports – 25 % • Assaults – 5 % • Falls – rest • Direct voilence due to RTA (common ) , fall , assault , etc. Open fractures are common • Indirect voilence due to falls , twisting force due to sports injuries .

  5. Grades of severity 1 minor 2 moderate 3 major Features Undisplaced Not angulated Minor comminution Minor open fracture Total displacement Small degree of comminution Minor open wound Complete displacement Major comminution Major open fracture Classification ( Ellis )

  6. Tscherne Classification • Grade Soft Tissue Injury (Superficial) Soft Tissue Injury (Deep) Compartments 0 Absent or negligible Absent or negligible Soft and/or normal . 1 Superficial abrasion Contusion from within Soft and/or normal 2 Deep contaminated abrasion Significant contusion Impending compartment . syndrome . . 3 Crushed skin, subcutaneous Crushed devitalized Compartment syndrome avulsions Muscle .

  7. Clinical features • Pain • Deformity • Investigation : • Acute cases : AP and Lateral view • Delayed cases : AP ,Lateral and oblique view showing knee joint and ankle joints

  8. Treatment Conservative management : - • Closed reduction under general anaesthesia and a long leg cast application Indication : • Closed fractures • Undisplaced fracture • Low energy trauma • Young adults • # with minor or moderate displacements

  9. Method of reduction • Two methods of closed reduction : 1 . The patient is supine and limb held parallel to the table , the # is reduced by traction and countertraction method and a long leg cast is applied Disadvantage : - • Posterior angulation develops at the fracture site due to the gravitational forces 2 . Commonly followed method :- • Position : sitting or supine ( under anaesthesia) • Patient is brought to the edge of the table and both the legs are kept dangling . • Holds the leg of the patient and manipulates the fracture and a long leg cast is applied

  10. Criteria of acceptable reduction • Ankle and knee joint surface should be parallel • Acceptable varus or valgus angulation is 5 degree in AP view • Anterior or posterior angulation of 10 degree in the lateral view • Shortening of 5 – 7 mm is acceptable Advantages : • Traction and countertraction do not require an assistant • Patient`s own weight of the leg provides traction through the gravity • Easy to compare with the normal leg regarding the accuracy of closed reduction by looking at the control of rotation and angle

  11. Sarmiento`s total contact below knee cast • After reduction of the fracture and application of a long leg cast for 2 to 3 weeks , a total below knee cast which is moulded around the tibial condyles and patella in the fashion of patellar tendon bearing prosthesis is applied (PTB casts or brace ) Advantages • Allows early knee movements • Ease of ambulation for patients with bilateral fracture • Decreases the incidence of delay union and nonunion

  12. Cont.. Functional braces ( allows both ankle and knee joints ) Pins above and below the fracture: • Indication : • For moderate and severe fracture • Unstable fracture • Open fracture

  13. Surgical treatment • Open reduction and internal fixation • Indication : • Tibial fracture with vascular or neural injuries • Segmental fractures • Inadequate reduction • Associated plafond fracture

  14. Complications • Delayed union (bone grafting ) • Nonunion (rigid internal fixation with compression plating and bone grafting ) • Malunion ( osteotomy ) • Shortening • Infection • Compartmental syndromes • Joint stiffness • Refracture • Fat embolism

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