Tibia shaft fracture

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Tibia shaft fracture
Tibia (Shinbone) Shaft Fracture.JPG
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, it is frequently injured. Thus it is the most commonly fractured long bone in the body. [1]

Contents

Signs and symptoms

Patients with tibial shaft fractures present with pain and localized swelling. [2] Due to the pain they are unable to bear weight. There may be deformity, angulation, or malroation of the leg. [2] Fractures that are open (bone exposed or breaking the skin) are common.

Mechanism

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. [3] [4] Osteoporosis can be a contributing factor. [3] Skiing and football (soccer) injuries are also common culprits. [4]

Diagnosis

Examination

Prior to realignment and splinting an assessment is performed to ensure there are no open wounds, soft-tissue contusions, or neurovascular injuries. [1]

Radiography

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. [4]

Classification

Two systems of fracture classification are commonly used to aid diagnosis and management of tibia shaft fractures:

Management is dependent on the determination of whether the fracture is open or closed.

Management

Nonoperative treatment

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. [5]

Operative treatment

Surgical treatment is typically indicated for high-energy trauma fractures. [1] Intramedullary nailing is a common technique, but external fixation may have equivalent outcomes. [6]

Epidemiology

Tibia shaft fractures are the most common long bone fractures. They account for approximately 4% of the fractures seen in the Medicare population. [2]

Related Research Articles

Knee Region around the kneecap

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

Compartment syndrome condition in which increased pressure within one of the bodys compartments results in insufficient blood supply to tissue within that space

Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the leg or arm are most commonly involved.

Ankle Region where the foot and the leg meet

The ankle, or the talocrural region, is the region where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular joint. The movements produced at this joint are dorsiflexion and plantarflexion of the foot. In common usage, the term ankle refers exclusively to the ankle region. In medical terminology, "ankle" can refer broadly to the region or specifically to the talocrural joint.

Bone fracture medical condition in which there is physical damage to the continuity of the bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of the bone. In more severe cases, the bone may be broken into several pieces. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

Varus deformity Deformity in which the bone near a joint is angled inward

A varus deformity is an excessive inward angulation of the distal segment of a bone or joint. The opposite of varus is called valgus. EX: Varus deformity results in a decreased Q angle of the knee joint.

Valgus deformity Deformity in which the bone near a joint is angled outward

A valgus deformity is a condition in which the bone segment distal to a joint is angled outward, that is, angled laterally, away from the body's midline. The opposite deformation, where the twist or angulation is directed medially, toward the center of the body, is called varus. Common causes of valgus knee in adults include arthritis of the knee and traumatic injuries.

Stress fracture fatigue-induced fracture of the bone caused by repeated stress over time

A stress fracture is a fatigue-induced fracture of the bone caused by repeated stress over time. Instead of resulting from a single severe impact, stress fractures are the result of accumulated trauma from repeated submaximal loading, such as running or jumping. Because of this mechanism, stress fractures are common overuse injuries in athletes.

Shin splints injury or pain in the lower tibia

A shin splint is pain along the inside edge of the shinbone (tibia) due to inflammation of tissue in the area. Generally this is between the middle of the lower leg to the ankle. The pain may be dull or sharp and is generally brought on by exercise. It generally resolves during periods of rest. Complications may include stress fractures.

Avulsion fracture

An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. This can occur at the ligament by the application of forces external to the body or at the tendon by a muscular contraction that is stronger than the forces holding the bone together. Generally muscular avulsion is prevented by the neurological limitations placed on muscle contractions. Highly trained athletes can overcome this neurological inhibition of strength and produce a much greater force output capable of breaking or avulsing a bone.

Ankle fracture

An ankle fracture is a break of one or more ankle bones. Symptoms may include pain, swelling, bruising, and an inability to walk on the leg. Complications may include an associated high ankle sprain, compartment syndrome, decreased range of motion, and malunion.

Hip dislocation

A hip dislocation is a disruption of the joint between the femur and pelvis. Specifically it is when the ball–shaped head of the femur comes out of the cup–shaped acetabulum of the pelvis. Symptoms typically include pain and an inability move the hip. Complications may include avascular necrosis of the hip, injury to the sciatic nerve, or arthritis.

Patella fracture

A patella fracture is a break of the kneecap. Symptoms include pain, swelling, and bruising to the front of the knee. A person may also be unable to walk. Complications may include injury to the tibia, femur, or knee ligaments.

Open fracture

Open fracture is a type of bone fracture in orthopedics, frequently caused by high energy trauma. It is a bone fracture associated with a break in the skin continuity which can cause complications such as infection, malunion, and nonunion. Gustilo open fracture classification is the most commonly used method to classify open fractures, to guide treatment and to predict clinical outcomes. Advanced trauma life support is the first line of action in dealing with open fractures and to rule out other life-threatening condition in cases of trauma. Cephalosporins are generally the first line of antibiotics. The antibiotics are continued for 24 hours to minimize the risk of infections. Therapeutic irrigation, wound debridement, early wound closure and bone fixation are the main management of open fractures. All these actions aimed to reduce the risk of infections.

Supracondylar humerus fracture type of bone fracture

A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.

The Bosworth fracture is a rare fracture of the distal fibula with an associated fixed posterior dislocation of the proximal fibular fragment which becomes trapped behind the posterior tibial tubercle. The injury is caused by severe external rotation of the ankle. The ankle remains externally rotated after the injury, making interpretation of X-rays difficult which can lead to misdiagnosis and incorrect treatment. The injury is most commonly treated by open reduction internal fixation as closed reduction is made difficult by the entrapment of the fibula behind the tibia.

The Gustilo open fracture classification system is the most commonly used classification system for open fractures. It was created by Ramón Gustilo and Anderson, and then further expanded by Gustilo, Mendoza, and Williams.

Femoral fracture

A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter.

Tibial plateau fracture

A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint. Symptoms include pain, swelling, and a decreased ability to move the knee. People are generally unable to walk. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.

Pilon fracture

A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Pilon fractures are rare, comprising 3 to 10 percent of all fractures of the tibia and 1 percent of all lower extremity fractures, but they involve a large part of the weight-bearing surface of the tibia in the ankle joint. Because of this, they may be difficult to fixate and are historically associated with high rates of complications and poor outcome.

In the human skeleton and that of at least other mammals, a tubercle, tuberosity or apophysis is a protrusion or eminence that serves as an attachment for skeletal muscles. The muscles attach by tendons, where the enthesis is the connective tissue between the tendon and bone. A tuberosity is generally a larger tubercle.

References

  1. 1 2 3 4 5 Terry Canale, S.; Azar, Frederick M.; Beaty, James H. (2016-11-21). Campbell's operative orthopaedics. Azar, Frederick M.,, Canale, S. T. (S. Terry),, Beaty, James H.,, Preceded by: Campbell, Willis C. (Willis Cohoon), 1880-1941. (Thirteenth ed.). Philadelphia, PA. ISBN   9780323374620. OCLC   962333989.
  2. 1 2 3 "Tibia Shaft Fractures - Trauma - Orthobullets.com". www.orthobullets.com. Retrieved 2017-10-01.
  3. 1 2 Grütter, R.; Cordey, J.; Bühler, M.; Johner, R.; Regazzoni, P. (September 2000). "The epidemiology of diaphyseal fractures of the tibia". Injury. 31 Suppl 3: C64–67. doi:10.1016/s0020-1383(00)80035-2. ISSN   0020-1383. PMID   11052384.
  4. 1 2 3 "Tibial shaft fractures in adults". www.uptodate.com. Retrieved 2017-10-01.
  5. Busse, Jason W.; Morton, Emily; Lacchetti, Christina; Guyatt, Gordon H.; Bhandari, Mohit (October 2008). "Current management of tibial shaft fractures: a survey of 450 Canadian orthopedic trauma surgeons". Acta Orthopaedica. 79 (5): 689–694. doi: 10.1080/17453670810016722 . ISSN   1745-3682. PMID   18839377.
  6. Littenberg, B.; Weinstein, L. P.; McCarren, M.; Mead, T.; Swiontkowski, M. F.; Rudicel, S. A.; Heck, D. (February 1998). "Closed fractures of the tibial shaft. A meta-analysis of three methods of treatment". The Journal of Bone and Joint Surgery. American Volume. 80 (2): 174–183. doi:10.2106/00004623-199802000-00004. ISSN   0021-9355. PMID   9486723.
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