Understanding Fracture of the Shafts of Tibia and Fibula

The leg is more exposed to orthopedic trauma. The tibia and fibula, therefore, sustain fracture more often than other long bones of the body. A large surface of the tibia is subcutaneous and compound fracture is, therefore, more common. The blood supply to the shaft of the tibia, especially towards the lower end, is poor. This interferes with the healing process and delayed union or non-union often complicates the problem. Open reduction and internal fixation (of orthopedic implants) are easy to perform because of the superficial location of the tibia. The results of surgery are often met with serious complications in the form of infection and loss of skin covering. Open reduction interferes with the already existing poor blood supply and enhances the chance of non-union or delayed union. The condition must be judged with special merit and lack of judgment has been the cause of loss of many limbs.

MECHANISM OF INJURY

Direct injury: Direct violence may be severe enough to produce the lesion. An automobile accident has been the commonest single cause to produce this type of fracture. The lesion is usually in the form of transverse or comminuted type. The skin is often broken, and the fracture turns out to be a compound one.

Indirect injury: Twisting injury with the foot fixed on the ground can produce a spiral fracture. The level of fibular fracture is usually higher or lower than that of the tibia.

TYPES OF FRACTURES

Various types of fractures are produced with all degrees of severity and displacement. The lesions may be transverse, displaced, undisplacement, oblique, spiral, comminuted, butterfly segment and segmental fracture.

Compound fracture: The fracture may be compound due to loss of skin from outside or the bone spike may project from inside. The severity of lesion may vary from a simple puncture wound to that of extreme loss of skin over the bone.

Fracture of the tibia in relation to fibular fracture: Fracture of the tibia is usually associated with fracture of the fibula. Isolated fracture of the tibia at the site of impact can also happen.

Spiral fracture of the tibia in children is produced by rotational injury.

DIAGNOSIS

Clinical examination: In most cases diagnosis can be made by physical examination. There may be a localized pain, tenderness, deformity and abnormal mobility of the fracture site. In cases of direct violence, skin injury may be of varying severity. In some cases, it is essential to check the circulatory condition of the limb.

X-ray: The diagnosis is established by x-ray.

TREATMENT

1. Immediate emergency measures: These involve the transfer of the patient to the center of treatment. The leg is placed in a splint which extends from the level of the thigh to the ankle. An x-ray should be taken with the leg in a splint.
2. The aim of treatment: During the time of reduction, undermentioned principles must be fulfilled to obtain the perfect result.

1. Perfect alignment: Anatomical alignment of the fracture segment is desirable. Over- riding will most likely lead to non-union.

(ii) Regulatory and rotational deformities: Any rotational and angular deformity will alter the normal weight bearing relationship of the knee and ankle-joint. This may lead to osteo- arthritic changes later.

Associated fracture of the fibula: Attempt is made to reduce the fracture of the tibia. No attempt is made to reduce the fibular segments. Slow progress of union is seen in cases of isolated fracture of tibia with the fibula being intact. This is due to the imperfect apposition of the fractured segments when the twin bones are intact.

Siora Surgical is one of the well-known manufacturers of orthopedic implants. Now a day’s implants used in surgery to join the broken bone. There is various type of implants like bone plates, bone screw.