Makindo Medical Notes

Related Subjects: |Fractured Neck of Femur |Fractured Shaft Femur |Supracondylar Femur Fractures |Femoral fractures |Fractured Tibia and Fibula

Tibia & Fibula Fractures 🦴🚨 are among the most common long bone fractures. Because the tibia is subcutaneous for much of its length, these fractures have a high risk of open injury, infection, and delayed healing. Always assess neurovascular status and compartment syndrome.

📖 About

• Common long bone fractures in all age groups.
• Tibia = major weight-bearing bone; fibula provides lateral stability and muscle attachments.
• Tibial fractures are often accompanied by fibular fractures.
• Thin soft tissue coverage → higher risk of open fractures.
• Articular involvement possible (tibial plateau, plafond/pilon fractures).

⚙️ Aetiology

• High-energy trauma (RTA, fall from height, sports injuries ⚽).
• Low-energy trauma in osteoporotic or pathological bone.
• Tibial plateau fracture: classically car bumper injury → valgus/varus force through knee.

🩺 Clinical Features

• Severe pain, swelling, deformity, inability to bear weight 🚶❌.
• Localized tenderness, crepitus, bruising, or open wound.
• Check distal pulses & cap refill (popliteal/posterior tibial/dorsalis pedis arteries).
• Assess for compartment syndrome 🚨:
  • Pain out of proportion
  • Pain on passive stretch
  • Paresthesia, pallor, pulselessness, paralysis (late signs)
• Common peroneal nerve (CPN): test ankle dorsiflexion + sensation in 1st web space. ⚠️ Can be injured with fibular neck fracture or tight casts/splints.

⚠️ Complications

• Compartment syndrome → may require fasciotomy.
• Common peroneal nerve injury → foot drop.
• Popliteal artery damage (rare, but limb-threatening).
• Delayed union / nonunion (tibia notorious for slow healing).
• Post-traumatic arthritis (esp. tibial plateau).
• Osteomyelitis (esp. in open fractures).
• Fat embolism, DVT/PE.

🧪 Investigations

• X-ray: AP & lateral of knee, tibia/fibula, ankle (always include joints above and below!).
• CT: for intra-articular fractures (plateau, plafond).
• Bloods: FBC, U&E, coagulation, G&S if major trauma/open injury.

💊 Management

• Initial (ATLS): ABCDE, IV access, analgesia. Assess distal NV status. Splint limb.
• First aid: sterile saline dressings for wounds. Gentle traction if grossly deformed. Avoid tight POP → risk of compartment syndrome.
• Open fracture 🚨: IV antibiotics (e.g., co-amoxiclav or clindamycin), tetanus prophylaxis, urgent ortho referral for washout + debridement.
• Definitive:
  • Undisplaced/minimally displaced → cast or functional brace.
  • Displaced/unstable → intramedullary nail (gold standard for diaphyseal fractures).
  • Tibial plateau → non-weight-bearing + ortho review; ORIF if displaced/incongruent.
  • Pilon/plafond fractures → external fixation (damage control) ± staged ORIF.
• Rehabilitation: physio, gradual weight-bearing as healing progresses.
• VTE prophylaxis: LMWH unless contraindicated.

📌 OSCE / Exam Pearls

• Tibia = commonest long bone for open fractures → always check skin!
• CPN injury → foot drop. Test before and after cast application.
• Tibia = slow healer → high risk of delayed/nonunion → often needs nail/plate fixation.
• Tibial plateau fractures = think meniscal & ligament injuries → MRI if persistent instability/pain.

📚 References

• ATLS®: Advanced Trauma Life Support, 10th edition.
• Rockwood & Green’s Fractures in Adults, 9th edition.
• BOAST Guidelines: Open Fracture Management.