[18] Tibia and Fibula Fractures Flashcards
What are the tibia and fibula?
Bones of the leg
What is the most frequent site of fracture in the tibia and fibula?
The tibial shaft
Where else in the tibia and fibula can fractures occur?
- Tibial plateau
- Tibial and fibular diaphysis
- Ankle
Why is the tibia prone to trauma?
Due to its superficial position in the leg
Are open fractures of the tibia common?
Yes
What dictates the type of tibia fracture?
The mechanism of injury
What movements cause low-energy tibia fractures?
Twisting, inversion, or eversion
What do low-energy tibia fractures often occur following?
Falling from standing height
What are high-energy fractures of the tibia caused by?
Typically by a direct blow to the tibia or fibula
What do high energy fractures of the tibia lead to?
- Fracture comminution
- Soiling of the wound
How should any patient with a fracture or trauma be initially assessed?
A-E approach, resuscitated as required
What should be done when a patient presents with a tibia or fibula fracture?
- Detailed history, including mechanism of injury
- Examination of limb
- Check neurovascular status
- Assess for evidence of compartment syndrome
What should the limb be examined for in tibia or fibula fracture?
- Swelling and bruising
- Deformity
- Skin tenting or piercing
When is it particularly important to assess for evidence of compartment syndrome?
In high energy injuries
What investigations should be done in suspected tibia or fibula fracture?
Plain radiograph
What should be included in the plain radiograph for suspected tibia and fibula fractures?
The entire tibia and fibula, with the knee and ankle joints included
When is a CT scan required in tibia or fibula fractures?
In tibial plateau fractures and Pilon fractures, to aid in operative planning
What are Pilon fractures?
Intra-articular fractures of the ankle joint
What should be termed ‘ankle fractures’?
Only extra-articular fractures of the ankle joint
What can ankle fractures be classified according to?
The Weber Classification
What is the Weber classification useful for?
Determining treatment
What is a Weber A fracture?
Fracture occuring below the syndesmosis
What is a Weber B fracture?
A fracture occuring at the level of the syndesmosis
What is a Weber C fracture?
A fracture occuring above the level of the syndesmosis
Give two examples of other classification systems for tibia and fibular fractures?
- Schatzker Classification for tibial fractures
- Ruedi and Allgower Classification for Pilon fractures
What do efforts need to be made to do in tibia and fibula fractures?
- Preserve the skin
- Limit soft tissue damage
How is fracture reduction typically performed in tibia or fibula fractures?
Under sedation
Is speedy fracture reduction required in tibia and fibulda fractures?
Yes
How should a tibia or fibula fracture be managed initially?
Place in back-slab
What should be done once the limb has been placed in a back-slab following a tibia or fibula fracture?
- Repeat neurovascular examination
- Obtain a repeat plain film radiograph
Should the back-slab applied for tibia and fibula fractures be above knee or below knee?
- Above knee for tibial plateau and diaphyseal fractures
- Below knee for Pilon and ankle fractures
What should be done if reduction is found to not be adequate on repeat radiograph in tibia or fibula fracture?
Repeat reduction attempts will be required
What should be done if there are signs of compartment syndrome in tibia or fibula fractures?
Any signs of compartment syndrome should be recognised and managed early
How is compartment syndrome prevented in many centres?
A compartment monitor is inserted for all high-energy injuries and diaphyseal fractures
What is the definitive management of tibia or fibula fractures?
Skeletal stability - almost all these injuries require surgical fixation
When might tibial plateau fractures be treated conservatively?
Schatzker 1 injuries in elderly patients with low functional demand
What fractures will always require fixation?
Tibial diaphysis and Pilon fractures
When may ankle fractures be treated conservatively?
If deemed intrinsically stable
What needs to be done if a tibia or fibula fracture is open?
Additional management is warranted to reduce the risk of contamination and infection
How should the risk of contamination and infection be reduced in an open tibia or fibula fracture?
- Wound cleaned, any gross contamination removed
- Photograph of the wound should ideally be taken, before being covered with saline-soaked guaze
- Start patient on IV antibiotics as per local policy
How quickly should definitive management be performed in open tibia or fibula fractures?
It should be expedited, however management can be delayed if presenting overnight to ensure a properly equipped theatre is accessed
What are the immediate complications of tibia or fibula fractures?
- Compartment syndrome
- Neurovascular compromise
What are the delayed complications of tibia or fibula fractures?
- Infection
- Wound dehiscence
- Malunion
- Non-union
- Joint stiffness
What is hallux valgus?
A deformity at the first metatarsophalangeal joint
What is hallux vagus characterised by?
Medial deviation of the first metatarsal, and lateral deviation +/- rotation of the hallux, with associated joint subluxation
How common is hallux valgus?
It is one of the most common foot problems in the adult population, with a prevalence of around 35% in those aged >65%
Which gender is hallux valgus more common in?
Women
What should happen to the digits during the gait cycle?
The digits should remain parallel to the long axis of the foot
What allows the digits to remain parallel to the long axis of the foot in the gait cycle?
Balance between the static stabilisers (bones and ligaments) and dynamic stabilisers (muscles and tendons)
