The document summarizes tibia shaft fractures, including:
- They are the most common long bone fractures and typically result from high-energy trauma.
- Types include transverse, oblique, spiral, and comminuted fractures. Treatment depends on the fracture classification and may include casting, external fixation, plates/screws, or intramedullary rods.
- Complications can include compartment syndrome, infection, malunion, delayed healing, and injury to surrounding tissues. Proper diagnosis and management are needed to optimize outcomes and prevent long-term disability.
The document summarizes tibia shaft fractures, including:
- They are the most common long bone fractures and typically result from high-energy trauma.
- Types include transverse, oblique, spiral, and comminuted fractures. Treatment depends on the fracture classification and may include casting, external fixation, plates/screws, or intramedullary rods.
- Complications can include compartment syndrome, infection, malunion, delayed healing, and injury to surrounding tissues. Proper diagnosis and management are needed to optimize outcomes and prevent long-term disability.
The document summarizes tibia shaft fractures, including:
- They are the most common long bone fractures and typically result from high-energy trauma.
- Types include transverse, oblique, spiral, and comminuted fractures. Treatment depends on the fracture classification and may include casting, external fixation, plates/screws, or intramedullary rods.
- Complications can include compartment syndrome, infection, malunion, delayed healing, and injury to surrounding tissues. Proper diagnosis and management are needed to optimize outcomes and prevent long-term disability.
The document summarizes tibia shaft fractures, including:
- They are the most common long bone fractures and typically result from high-energy trauma.
- Types include transverse, oblique, spiral, and comminuted fractures. Treatment depends on the fracture classification and may include casting, external fixation, plates/screws, or intramedullary rods.
- Complications can include compartment syndrome, infection, malunion, delayed healing, and injury to surrounding tissues. Proper diagnosis and management are needed to optimize outcomes and prevent long-term disability.
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Shaft of tibia fractures
Presented by p. sabitha kanna Mpt final year Tibia (Shinbone) Shaft Fractures • The tibia, or shinbone, is the most commonly fractured long bone in the body. • A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. • It typically takes a major force to cause this type of broken leg. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. In many tibia fractures, the smaller bone in the lower leg (fibula) is broken as well. Epidemiology • 26 fractures per 100,000 populations per year • 3 times more frequent in males • The average age: 37 years • Generally attributed to higher energy trauma such as motor vehicle accidents. Anatomy • The lower leg is made up of two bones: the tibia and fibula. The tibia is the larger of the two bones. It supports most of your weight and is an important part of both the knee joint and ankle joint. Types of Tibial Shaft Fractures • Tibia fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). • The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture). In many tibia fractures, the fibula is broken as well. • describe fractures to each other using classification systems. Tibia fractures are classified depending on: • The location of the fracture (the tibial shaft is divided into thirds: distal, middle, and proximal) • The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle) • Whether the skin and muscle over the bone is torn by the injury (open fracture) Contd…, The most common types of tibial shaft fractures include: • Transverse fracture: In this type of fracture, the break is a straight horizontal line going across the tibial shaft. • Oblique fracture: This type of fracture has an angled line across the shaft. • Spiral fracture: The fracture line encircles the shaft like the stripes on a candy cane. This type of fracture is caused by a twisting force. • Comminuted fracture: In this type of fracture, the bone breaks into three or more pieces. Symptoms • A tibial shaft fracture usually causes immediate, severe pain. Other symptoms may include: • Inability to walk or bear weight on the leg • Deformity or instability of the leg • Bone "tenting" over the skin at the fracture site or bone protruding through a break in the skin • Occasional loss of feeling in the foot CLASSIFICATION • Classification for tibial shaft fractures [Orthopaedic Trauma Association (OTA)] • Type A fractures are unifocal and the subdivision into groups is based on the orientation of the • fracture line and the presence or absence of a fibula fracture. • Type B fractures are wedge fractures and are subdivided into spiral bending or fragmented wedges. • Type C fractures are more complex fractures and include complex spiral fractures, comminuted fractures, and segmental fractures. Contd.., OTA Classification Group A: A1: Spiral A2: Oblique A3: Transverse [subclassification: intact fibula; fracture at different level; fracture at same level of tibia and fibula] Group B Subgroups B1.1 Intact fibula B1.2 Tibia and fibula fractures at different level B1.3 Tibia and fibula fractures at same level Contd…, Group B2 Intact bending wedge fractures Subgroups B2.1 Intact fibula B2.2 Tibia and fibula fractures at different level B2.3 Tibia and fibula fractures at same level Group B3 Comminuted wedge fractures Subgroups B3.1 Intact fibula B3.2 Tibia and fibula fractures at different level B3.3 Tibia and fibula fractures at same level Contd…,
Type C: Complex fractures (multifragmentary, segmental, or comminuted
High-energy injuries are typically caused by motor vehicleaccidents, falls from height, direct blows, and gunshots, both civilian and military. • Sporting injuries, falls from standing height, and twisting injuries, usually causes lower-energy injuries. They may also be associated with pathologic conditions of bone. • Complications such as compartment syndrome compared to the low velocity injury. • Low-velocity injuries associated with a muzzle velocity of less than 2000 feet per second are more commonly seen in civilian practice. Contd.., • Lower-Energy Injuries (Sports-Related Injuries) Court-Brown has identified soccer-related injuries as the largest contributor to sports-related tibial shaft fractures, accounting for 80% of sports-related tibial diaphyseal fractures. DIAGNOSIS • 1. Mechanism of injury • 2.high-or low-energy • 3. Tcherne soft tissue classification • 4, Open or closed • 5. Compartment syndrome • 6. Neurovascular system • 7. Polytrauma MANAGEMENT • 1. Back slab • 2. Pain medication • 3. If open fracture: follow protocol • 4. Elevate and watch for any compartment syndrome Radiographic Evaluation
• Fracture patterns. • Joint extension [may require CT] • Assessment of the canal size • If there is evidence of any vascular compromise, referral to a vascular surgeon. Advantages Disadvantage Best use
Casting Non-invasive Difficult to maintain Undisplaced #
Inexpensive MU high EF [power 4; Minimal invasive Pin track infection[50%] Open Type predrlll] Quick procedure Not rigid e MU IIIC Patient dissatisfaction Polytrauma Ring fixator Pin track infection Expertise Complex less Patient dissatisfaction metaphyseal Complex and epiphseal metaphyseal # fractures ORIF Stable fixation and Not as strong as nail in Metaphyseal Early ROM shaft fracture
IM Rod Closed technique Metaphyseal fracture Shaft #
and Radiation Early healing Stable fix TREATED WITH PLATES AND SCREWS. Complications from Tibial Shaft Fractures Tibial shaft fractures can cause further injury and complications, including the following: • The ends of broken bones are often sharp and can cut or tear surrounding muscles, nerves, or blood vessels. • Acute compartment syndrome may develop. This is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. • Unless the pressure is relieved quickly, permanent disability may result. This is a surgical emergency. During the procedure, your surgeon makes incisions in your skin and the muscle coverings to relieve pressure. • Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics. Complications from Surgery • In addition to the risks of surgery in general, such as blood loss and problems related to anesthesia, complications of surgery may include: • Infection • Injury to nerves and blood vessels • Blood clots (these may also occur without surgery) • Malalignment or the inability to correctly position the broken fragments • Delayed union or nonunion (when the fracture heals slower than usual or not at all) • Angulation (with treatment by external fixation) To Top Surgical approaches
