B4. Proximal and middle shaft lower leg fractures
Proximal tibial and tibial shaft fractures have the highest ratio of open to closed fractures among all fractures. Fractures of the tibia occur due to high energy trauma (most common), low energy trauma, or repetitive use (stress fractures). Treatment is most frequently surgical. External fixation may be used temporarily in case of open fractures or polytrauma. Malunion, nonunion, compartment syndrome, neurovascular injury, and infection are relatively common complications.
Distal tibial fractures are considered ankle fractures.
Classification
Tibial fractures are classified according to the AO/ASIF classification.
Clinical features
Typical features of fractures, including pain, inability to bear weight, swelling, haematoma. Open or complex injuries may cause compartment syndrome, neurovascular injuries, and infection.
Diagnosis and evaluation
Plain x-ray is usually sufficient.
Treatment
Tibial fractures are treated conservatively or with surgery.
Conservative treatment is indicated for isolated tibial fractures, low energy fractures, or when surgery is contraindicated. Conservative treatment involves skeletal traction, cast, or brace.
Surgical treatment may involve plate fixation (LISS, LCP) or intramedullary nailing. External fixation may be used for open fractures or polytrauma. Open fractures and polytrauma may also require irrigation, debridement, and antibiotics.
Complications
- Malunion or nonunion (relatively common)
- Compartment syndrome
- Neurovascular injury
- Infection