Tibia shaft fracture

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.

Signs and symptoms

Patients with tibial shaft fractures present with pain and localized swelling. Due to the pain they are unable to bear weight. There may be deformity, angulation, or malrotation of the leg. 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. 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. Osteoporosis can be a contributing factor. Skiing and football (soccer) injuries are also common culprits.

Diagnosis

Examination

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

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.

Classification

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

• Oestern and Tscherne Classification
• Gustilo-Anderson Classification

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. This treatment consists of application of a long-leg cast.

Operative treatment

Surgical treatment is typically indicated for high-energy trauma fractures. Intramedullary nailing is a common technique, 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.

Epidemiology

Tibia shaft fractures are the most common long bone fractures. They account for accounting for 1.9% of all fractures in adults and approximately 4% of the fractures seen in the Medicare population. 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.