Tibial Shaft Fracture Flashcards
Where might the tibia be fractured?
One of the most common long bones to be fractured
Proximmaly, distally or along its shaft.
What is the tibial shaft vulnerable to?
Direct injuries from a fall or from a direct blow
Indirect injuries from twisting or bending forces
Why is there an increased risk of open fractures and compartment syndrome in tibial fractures?
There is a lack of significant soft tissue to envelop the bone and the fascial compartments
Clincal features
Hx of trauma
Soft tissue injuries
Severe pain in lower leg
Inability weight bear
Examination findings
Clear deformity like angulation or malrotation
Significant swelling and bruising
Special examinations of TSF
Careful inspection of skin for the possibility of an open fracture.
Full neurovascular examination
Dx
TPF
Ankle fractures
Fibular fractures
Soft tissue injury
Ix
Investigated and managed as per ATLS protocol
Urgent bloods + coagulation + G&S
Full length AP x-ray + lateral X-ray
Both tibia and fibula should be visible.
CT imaging might be indicated.
Indications of CT scanning
Potential intra-articular extension
Spiral fracture of distal tibia to assess fracture of posterior malleolus
Explain associated fibula fractures
Location of fibular fracture correlate to degree of energy of injury.
High energy -> fibula fracture at same level
Low energy -> fibula fracture at different level
Initial management
Realignment ASAP ideally in A&E under analgesia/conscious sedation.
Tibia should be brought approximately to length and rotation.
If there is an open fracture it should be managed accordingly.
Following reduction what should be done?
Above knee backslab in slight flexion to control rotation.
The limb should be elevated immediately and closely monitored for signs of compartment syndrome.
Also post-manipulation X-ray + neurovascular status reassessment
Indications for conservative management
Put in a Sarmiento cast in closed stable tibial fracture.
Most TSF are done surgically.
When is urgent operative intervention indicated?
Acute compartment syndrome
Ischaemic limb
Open fracture
Types of surgical intervention of TSF
Intramedullary nailing
ORIF with locking plates
Temporary external fixation
When is intramedullar nailing done?
Most commonly used and used if they aren’t massively complicated.
It provides a stable construct and is minimally invasive with a high success rate.
Post-op patients should be able to fully weight bear immediately.
When is ORIF with locking plates used?
Proximal or distal fractures that extend into the joint.
When might temporary external fixation be done?
If they are not stable enough to undergo definitive surgery.
What should be done to associated fibular fractures?
Can usually be left alone as they heal very well once the tibial fracture has been stabilised.
Complications
Compartment syndrome
Ischaemic limb
Open fractures
Malunion
Non-union
