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
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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 "Basic techniques for 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].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Albuquerque RP, Hara R, Prado J, et al. Epidemiological study on tibial plateau fractures at a level I trauma center. Acta Ortop Bras 2013; 21:109.
- Kohlprath R, Assal M, Uçkay I, et al. [Open fractures of the tibia in the adult: surgical treatment and complications]. Rev Med Suisse 2011; 7:2482, 2484.
- Schmidt AH, Finkemeier CG, Tornetta P 3rd. Treatment of closed tibial fractures. Instr Course Lect 2003; 52:607.
- Cattermole HR, Hardy JR, Gregg PJ. The footballer's fracture. Br J Sports Med 1996; 30:171.
- Chang WR, Kapasi Z, Daisley S, Leach WJ. Tibial shaft fractures in football players. J Orthop Surg Res 2007; 2:11.
- Kaneko K, Miyazaki H, Yamaguchi T. Avulsion fracture of the tibial tubercle with avulsion of the patellar ligament in an adolescent female athlete. Clin J Sport Med 2000; 10:144.
- Peterson CM, Gittins ME. Tibial tuberosity avulsion in an adolescent diver. Clin J Sport Med 1997; 7:141.
- Inoue G, Kuboyama K, Shido T. Avulsion fractures of the proximal tibial epiphysis. Br J Sports Med 1991; 25:52.
- Biedert RM, Friederich N, Müller W. Medial Tibial Avulsion Fragment: Corresponding Lesion to Segond's Fracture? Clin J Sport Med 1994; 4:59.
- Lenehan B, Fleming P, Walsh S, Kaar K. Tibial shaft fractures in amateur footballers. Br J Sports Med 2003; 37:176.
- Tang ZH, Kumar VP. Alendronate-associated ulnar and tibial fractures: a case report. J Orthop Surg (Hong Kong) 2011; 19:370.
- Muller ME, Nararin S, Koch P, et al. Comprehensive Classification of Fracture of Long Bones, Springer-Verlag, Berlin 1990.
- Duke Orthopaedics. Tibia fracture. In: Wheeless' Textbook of Orthopedics. http://www.wheelessonline.com/ortho/menu_for_the_tibia_tibia_frx (Accessed on March 08, 2010).
- Khalid M, Brannigan A, Burke T. Calf muscle wasting after tibial shaft fracture. Br J Sports Med 2006; 40:552.
- Rademakers MV, Kerkhoffs GM, Kager J, et al. Tibial spine fractures: a long-term follow-up study of open reduction and internal fixation. J Orthop Trauma 2009; 23:203.
- Stevens DG, Beharry R, McKee MD, et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001; 15:312.
- Rademakers MV, Kerkhoffs GM, Sierevelt IN, et al. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007; 21:5.
- Brinker MR, Hanus BD, Sen M, O'Connor DP. The devastating effects of tibial nonunion on health-related quality of life. J Bone Joint Surg Am 2013; 95:2170.
- Barata I, Spencer R, Suppiah A, et al. Emergency ultrasound in the detection of pediatric long-bone fractures. Pediatr Emerg Care 2012; 28:1154.
- Bolandparvaz S, Moharamzadeh P, Jamali K, et al. Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED. Am J Emerg Med 2013; 31:1583.
- Waterbrook AL, Adhikari S, Stolz U, Adrion C. The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med 2013; 31:1352.
- Hoffman DF, Adams E, Bianchi S. Ultrasonography of fractures in sports medicine. Br J Sports Med 2015; 49:152.
- McMahon SE, Little ZE, Smith TO, et al. The management of segmental tibial shaft fractures: A systematic review. Injury 2016; 47:568.
- Duan X, Al-Qwbani M, Zeng Y, et al. Intramedullary nailing for tibial shaft fractures in adults. Cochrane Database Syst Rev 2012; 1:CD008241.
- 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
- INFORMATION FOR PATIENTS