Tibia and Fibula Shaft Fractures

These are relatively common fractures. Because of its subcutaneous nature, the tibia is more frequently fractured, of which the majority are compound. It is often associated with fractures of the neck or shaft of the fibula.

Mechanism of Injury

Fractures most commonly arise as a result of blunt trauma, in particular motorcycle accidents. They may also arise from ski injuries and falls on the foot with the foot fixed. The exact fracture pattern produced is variable and depends upon the nature and mechanism of injury. The risk of complications occurring is directly related to the degree and nature of soft tissue damage.

Classification

Tscherne’s classification (1984) of soft tissue injury and Gustilo’s classification (1990) of open fractures are commonly used:

Tscherne’s classification (1984) of soft tissue injury:

• C0 - minor soft tissue damage with a simple fracture
• C1 - superficial abrasion or contusion from within
• C2 - deep abrasions, soft tissue contusion and swelling, with severe fractures
• C3 - extensive soft tissue damage with a threatened compartment syndrome

Gustilo’s classification (1990) of open fractures:

• Type 1 - simple fracture with a small clean wound
• Type 2 - moderately severe fracture with a wound greater than 1cm and no extensive soft tissue damage
• Type 3 - severe injury with extensive soft tissue damage and contamination of the wound
• 3A - adequate soft tissue coverage
• 3B - skin loss
• 3C - arterial injury

Clinical Features

Depends on the severity and mechanism of injury; the findings may range from pain, tenderness and loss of function to obvious deformity (angulation, rotation or shortening). In compound fractures, there may be a small puncture wound (often inside out) to protrusion of the tibial fragments.

X-rays are needed to confirm the diagnosis: AP and lateral views.