Tibial shaft 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
Tibial fractures are common long-bone injuries. National Center for Health Statistics cites 492,000 tibial fractures per year in the United States. Open fractures generally occur from high velocity trauma (eg, automobile collision). Closed injuries may occur from falls or sports-related trauma.
This topic will review issues related to tibial shaft fractures. Tibial shaft fractures in children and a general overview of tibial fractures in adults are presented separately. (See "Tibial and fibular shaft fractures in children" and "Overview of tibial fractures in adults".)
Greater than 70,000 hospitalizations, 800,000 office visits, and 500,000 hospital days have been attributed to tibial shaft fractures in the United States annually . The presence of significant osteoporosis increases the risk for compound or more complex fractures associated with higher morbidity and mortality [2,3]. More severe tibia fractures stem from high-energy trauma, most often motor vehicle collisions [2,4,5]. In Europe, closed tibial fractures are often associated with football (soccer) [6,7]. Shin guards may provide some protection, but many players who sustain tibial fractures are using shin guards at the time of injury . Skiing is another sport commonly associated with low-energy, often torsional, tibia fractures .
The tibia is the major weight-bearing bone of the lower leg (picture 1 and picture 2). The proximal portion of the bone, the tibial plateau, forms the lower surface of the knee joint (figure 1 and picture 3). The tibial shaft bridges the distance to the distal tibia which contributes the superior articular surface of the ankle joint at the tibiotalar articulation as well as the medial malleolus. Another key bony landmark is the tibial tuberosity which sits several centimeters below the joint line and the inferior patellar pole and serves as the attachment site for the patellar tendon .
A strong fibrous structure, the interosseous membrane, or syndesmosis, (figure 2) connects the tibia and fibula along the length of the two bones. Proximally, this structure, reinforced by strong anterior and posterior ligaments, forms a synovial joint, the proximal tibiofibular articulation. Distally, the interosseous membrane and three ligaments, the anterior, posterior, and transverse tibiofibular ligaments stabilize the superior ankle joint.
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- CLINICAL ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR ORTHOPEDIC REFERRAL
- INITIAL TREATMENT
- DEFINITIVE TREATMENT
- Long leg casting
- Operative interventions
- FOLLOW-UP CARE
- RETURN TO SPORT OR WORK
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS