T&O: Tibia Fibular Fracture

Question 1

Outline the pathophysiology of a Tibia/fibular Fracture

Answer 1

Open fractures are common, tibia is very superificial

Low-energy fractures = twisting, inversion, eversion injuries, often occur following a fall from standing height

High-energy fractures = direct blow to the tibia and fibula, resulting in fracture comminution and soiling of the wound

Types:

• Pilon fracture = intra-articular ankle #
• Ankle fracture = extra-articular #
• Tibial plateau fracture
• Tibial diaphysis fracture
• Fibular diaphysis fracture

Question 2

Outline the symptoms of a Tibia/fibular Fracture

Answer 2

Acute pain

Limb deformity

Unable to weight bare

Open = wound, bleeding

Question 3

How would you investigate a Tibia/fibular Fracture?

Answer 3

Detailed history should be obtained, including the mechanism of injury

X-ray = the entire tibia and fibula with the knee and ankle joints

Assess neurovascular status

Assess for compartment syndrome

Tibial plateau = CT scan (aid operation planning)

Question 4

How would you manage a Tibia/fibular Fracture?

Answer 4

A-E approach

Fracture reduction

Backslab = above-knee for tibial plateau and diaphyseal fractures and below-knee for Pilon and ankle fractures

Any signs of compartment syndrome should be recognised and managed early

Open fracture = tetanus, IV Abx, cover wound with saline-soaked gauze, photograph

Tibial plateau = nearly all require fixation

Tibial diaphysis and Pilon fractures (unless undisplaced) = require fixation

Ankle fractures = predominantly require surgical fixation, however if deemed intrinsically stable may be treated conservatively

Question 5

What are the complications of a Tibia/fibular Fracture?

Answer 5

Compartment syndrome

Neurovascular compromise

Infection

Wound dehiscence

Malunion = the degree of angulation is important as it can lead to early onset osteoarthritis and further osteotomies maybe required for correct alignment.

Non-union – high energy fractures with bone loss may cause slow bone healing and needs bone grafting to allow the bones to heal.

Joint stiffness

Question 6

How can ankle fractures be classified?

Answer 6

Weber Classification Type A, B, C

A = below syndesmosis

B = level of syndesmosis

C = above syndesmosis