Tibial Shaft Fractures

Question 1

Which type of tibial shaft fracture will usually result from the following movements:

a) Bending
b) Rotational energy
c) Bending and rotational energy

Answer 1

a) Transverse fracture
b) Spiral fracture
c) Comminuted fracture

Question 2

Which type of fracture has the highest incidence of compartment syndrome?

Answer 2

Tibial shaft fractures

(anterior compartment of leg is most common)

Question 3

Why are open fracture relatively common with tibial shaft fractures?

Answer 3

The tibial shaft is subcutaneous

Question 4

Which type(s) of tibial shaft fractures require only non-operative management?

Answer 4

1. Up to 50% displacement
2. 5º angulation in any plane

An above knee cast would be utilised

Question 5

If there is a tibial shaft fracture which does not also involve a fibular fracture, which direction is the tibia most likely to drift?

Answer 5

Varus

(if the fibula is also fractured, valgus alignment is more common)

Question 6

What are the benefits for internal fixation in tibial shaft fractures that require such treatment?

Answer 6

1. The position of the fracture is well controlled
2. Ability for early joint motion
3. Potentially quicker rehabilitation

Question 7

What is one major downside to breaking the tibia?

Answer 7

It is one of the slowest bones to heal

(around 16 weeks to union and 1 year to heal)

Question 8

What is the downside to ORIF when treating tibial shaft fractures?

Answer 8

Dissection to fracture site reduces peristeal blood supply slowing healing further

Question 9

What is one of the most common side effects of intramedulary nailing when treating tibial shaft fractures?

Answer 9

Anterior knee pain

(nail is inserted behind patellar tendon)

Question 10

What are the treatment options for non-unions in tibial shaft fractures?

Answer 10

1. Bone grafting
2. Special circular frames which can be adjusted to alter angulation, rotation or length allowing for maintained compression at the fracture site