Fracture Of Tibia and Fibula

INTRODUCTION:

Tibia fractures can occur from many types of injuries and are commonest fracture for lower limb. The tibia, also called the shin bone, is the larger, weight-bearing bone of the lower leg. Of the weight transferred through the leg, about 90% is carried by the tibia. The fibula is the smaller bone on the outside of the leg. It only carries about 10% of your body weight.

MECHANISM OF INJURY:

DIRECT INJURY:

Road traffic accidents

Direct violence

INDIRECT INJURY:

Bending or torsional force

PATHO-ANATOMY:

The fracture may be closed or open and has various patterns.it may occur at different levels(upper,middle,or lower thirds).occasionally it may be a single bone fractureonlt the tibia or fibula may be fractured.

DISPLACEMENTS:

Sideways

Angulatory

Rotational

Tibial Shaft Fractures

Tibial shaft fractures are the most common type of tibia fracture and occur between the knee and ankle joints. Most tibial shaft fractures can be treated in a long leg cast. However, some fractures have too much displacement or angulation and may require surgery to realign and secure the bones.

  • Tibial Plateau Fractures

Tibial plateau fractures occur just below the knee joint. These fractures require consideration of the knee joint and its cartilage surface. Tibial plateau fractures can lead to a chance of developing knee arthritis.

  • Tibial Plafond Fractures

Tibial plafond fractures occur at the bottom of the shin bone around the ankle joint. These fractures also require special consideration because of the ankle cartilage surface. Tibial plafond fractures are also concerning because of potential damage to surrounding soft-tissues.

DIAGNOSIS:

CLINICAL FEATURES:

The patient is brought to the hospital with history of injury to lower leg followed by the classical features of fracture

  • Pain
  • Swelling
  • Deformity
  • There may be a wound communicating with underlying bone.

RADIOLOGICAL FEATURES:

The diagnosis is usually confirmed by X-RAY examination. examination of the anatomical configuration of the fracture on x-ray helps in reduction.

TREATMENT: 

  • Casting
    A cast is appropriate for tibial shaft fractures that are not badly displaced and are well aligned. Patients need to be in a cast that goes above the knee and below the ankle (a long leg cast). The advantage of casting is that these fractures tend to heal well and casting avoids the potential risks of surgery such as infection. Patients with casts must be monitored to ensure adequate healing of the tibia and to ensure the bones maintain their alignment.
  • Intrameduallary (IM) Rodding
    Intrameduallary rodding is a procedure to place a medal rod down the center of the tibia to hold the alignment of the bone. A tibial rodding is a surgical procedure that lasts about an hour and half and is usually done under general anesthesia. Patients will have an incision over the knee joint, and small incisions below the knee and above the ankle. In addition, some fractures may require an incision near the fracture to realign the bones.

IM rods are secured within the bone by screws both above and below the fracture. The metal screws and the rod can be removed if they cause problems, but can also be left in place for life. Tibial rodding provides excellent fixation and alignment of the bones. The most common risk of surgery is knee pain, and the most concerning complication is infection. Infection of the rod may require removal of the rod in order to cure the infection.

Plates and Screws

Plates and screws are less commonly used, but are helpful in some fracture types, especially those closer to the knee or ankle joints (see information ontibial plateau and tibial plafond fractures). Most surgeons choose an IM rod for tibial shaft fractures unless the fracture is too close to the joint to allow for placement of the IM rod. In these fractures close to the joint surface, a plate and screws may be the ideal method of fixation.

  • External Fixator
    An external fixator may also be helpful in some particular fracture types. External fixators tend to be used in more severe fractures, especially open fractures with associated lacerations and soft-tissue damage. In these cases, the placement of IM rods or plates may not be possible because of soft-tissue injury. When there is significant soft-tissue injury, the external fixator may provide excellent immobilization while allowing monitoring and treatment of the surrounding soft-tissues.

COMPLICATIONS:

  • Delayed or nonunion
  • Mal-union
  • Infection
  • Compartment syndrome
  • Injury to popliteal artery
  • Injury to common peroneal and tibial nerve

 PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Relief pain
  • Restoring range of motion
  • Strengthening of muscles
  • Prevention of complications
  • Gait training
  • Restoration of activities of daily living

 

Visit Physioline for the Consultation and treatment