Overview of tibial fractures in adults
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Fractures of the tibia may result from significant trauma or be the consequence of repetitive use. The latter mechanism leads to stress fractures. An overview of traumatic tibial fractures in adults is presented here. Stress fractures, pediatric fractures of the tibia, and general fracture assessment and management are discussed separately. (See "Overview of stress fractures" and "Overview of tibial fractures in children" and "General principles of fracture management: Bone healing and fracture description" and "General principles of definitive fracture management" and "Splinting of musculoskeletal injuries".)
Tibial fractures occur in both high energy trauma, such as motor vehicle, winter sports (eg, skiing), and cycling accidents, and low energy trauma, such as falls, contact sports, distance running, and other endurance or repetitive impact activities. Injuries caused by high energy trauma are more likely to involve complex and open tibia fractures and fractures in certain locations, such as the tibial plateau ; injuries caused by low energy trauma more often result in simple transverse or linear tibia fractures. Open fractures of the tibia have high rates of complications and long term problems with limitations of function and pain .
In adults and children, closed tibial shaft fractures are the most common long-bone fractures. With greater than 70,000 hospitalizations, 800,000 office visits, and 500,000 hospital days, they have major economic consequences. The elderly suffer many of these fractures from simple falls, and those with significant osteoporosis incur open or more complex fractures, often with high morbidity .
Tibia fractures occur during contact and noncontact sporting events. Several studies demonstrate that a direct, low velocity blow (eg, tackling, kicking) causes approximately 95 percent of sports-related tibial fractures . In one five-year retrospective study of 244 tibial fractures seen at a major trauma center, 24 (9.8 percent) occurred during football (ie, soccer) games . Even when low energy trauma is the cause, concomitant fibular fractures develop in approximately 60 percent of cases. Nevertheless, significant complications develop in fewer than five percent of sports-related tibial fractures and the prognosis is generally good.
Avulsion fractures of the lateral and medial tibia may have diagnostic significance in looking for anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) ligament injuries. The Segond fracture occurs just below the iliotibial band attached to the fibers of the lateral capsule and is associated with ACL tear. Proximal tibial avulsion fractures at the medial aspect of the bone may be a marker of PCL injury [6-9].
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- Locations of fractures
- Skin integrity
- Ligamentous and meniscal integrity
- Neurovascular integrity
- Post-surgical pain and hypersensitivity
- Acute compartment syndrome
- Long-term calf atrophy and sport limitation
- Long-term function and arthritis risk
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