| Tibia shaft fracture | |
|---|---|
 | |
| Open fracture of the shaft of the tibia. | |
| Specialty | Orthopedics |
Tibia shaft fracture is a fracture of the proximal (upper) third of the tibia (lower leg bone). Due to the location of the tibia on the shin, it is the most commonly fractured long bone in the body. [1]
Tibial shaft fractures are some of the most common long bone fractures in humans. They account for approximately 17% of lower extremity fractures. They also account for approximately 4% of fractures among Medicare patients. [2] Tibial shaft fractures occur more often in males than females. The age distribution of these fractures is bimodal, with peaks in younger (20's) and older adults (50's-60's). [3] Younger patients often sustain tibial shaft fractures from high energy trauma mechanisms such as motor vehicle accidents and sports injuries. In older adults, low-energy mechanisms like falls are most common. [4] Tibial shaft fractures can be anatomically categorized by diaphysial location. Fractures of the midshaft are most frequent. Proximal and distal third fractures are less common. [5]
Low energy tibial shaft fractures usually result from indirect torsional forces such as falls from standing heights, twisting injuries, or rotational forces applied to the leg. These mechanisms create rotational stress along the diaphysis. This typically results in a spiral fracture pattern. Spiral tibial fractures from these mechanisms are often associated with a fibular fracture at a different level. They also involve less severe soft tissue injury compared with high-energy mechanisms. [6]
High energy fractures result from direct trauma such as motor vehicle accidents, falls from significant heights, or severe sports injuries. These mechanisms usually produce wedge or short oblique fractures with comminution. They are often associated with a fibular fracture at the same level. High energy fractures have a higher likelihood of severe soft tissue injuries, having associated compartment syndrome, and of being open fractures. [7]
Proximal third fractures necessitate thorough assessment of the knee to exclude extension into the tibial plateau. Articular involvement may be difficult to detect on x-ray and in such instances may require a CT scan. [8] Due to deforming muscular forces, proximal third fractures are prone to valgus and procurvatum malalignment during intramedullary nailing. In particular, the procurvatum results from the gastrocnemius pulling the distal fragment in to flexion while the patellar tendon pulls the proximal fragment in to extension. Valgus malalignment results from the per anserinus pulling the proximal fracture fragment in to varus. [9]
Patients with tibial shaft fractures present with pain and localized swelling. [10] Due to the pain they are unable to bear weight. There may be deformity, angulation, or malrotation of the leg. [10] Fractures that are open (bone exposed or breaking the skin) are common.[ citation needed ]
Since approximately one third of the tibia lies directly beneath the skin, open fractures are common compared to other long bones. [1] These open fractures are most commonly caused by high velocity trauma (e.g. motor vehicle collisions), while closed fractures most commonly occur from sports injuries or falls. [11] [12] Osteoporosis can be a contributing factor. [11] Skiing and football (soccer) injuries are also common culprits. [12]
Prior to realignment and splinting an assessment is performed to ensure there are no open wounds, soft-tissue contusions, or neurovascular injuries. [1]
Anteroposterior (AP) and lateral radiographs the include the entire length of the lower leg (knee to ankle) are highly sensitive and specific for tibial shaft fractures. [12]
Two systems of fracture classification are commonly used to aid diagnosis and management of tibia shaft fractures:[ citation needed ]
Management is dependent on the determination of whether the fracture is open or closed.[ citation needed ]
Nonsurgical treatment of tibia shaft fractures is now limited to closed, stable, isolated, minimally displaced fractures caused by a low-energy mechanism of injury. [1] This treatment consists of application of a long-leg cast. [13]
Surgical treatment is typically indicated for high-energy trauma fractures. [1] Intramedullary nailing is a common technique, [14] but external fixation may have equivalent outcomes and be preferred under certain patient conditions that may preclude intramedullary nailing, such as the presence of a total knee arthroplasty. [15] [16]
Tibia shaft fractures are the most common long bone fractures. They account for accounting for 1.9% of all fractures in adults [15] and approximately 4% of the fractures seen in the Medicare population. [10] Tibia shaft fractures are particularly common injuries in certain sports, such as in MMA, where a successful check against an incoming low kick (a defensive technique in which the receiver's shin is used to block the low kick) can result in the practitioner of the kick fracturing their own shin. [17] [18]
{{cite book}}: CS1 maint: location missing publisher (link)Runners with anterior tibial stress fractures treated surgically will typically receive an intramedullary nail. Runners treated conservatively are treated with rest and restricted weight bearing with a gradual return to activity. Classically, anterior tibial shaft stress fractures present in runners as anterior leg pain or poorly localized discomfort.