Tibia/ Fibula

The tibia is a major weight-bearing bone in the lower leg.

1. Tibial Shaft Fractures

Definition:

• Proximal Tibia Fracture:

  • Involves the upper portion of the tibia.

  • May extend into the knee joint and involve the proximal physis (growth plate).

• Tibial Shaft Fracture:

  • Involves the diaphyseal (midshaft) region of the tibia.

  • Represents the most common tibial fracture pattern addressed in this context.

• Distal Tibia Fracture:

  • Involves the lower end of the tibia.

  • May extend into the ankle joint and involve the distal physis

• Special Considerations: It is important to know the classification of fracture since it can dictate treatment

  • Treatment

    • Nonoperative: long leg casting for toddler’s fractures and greenstick fractures OR closed reduction and long leg casting (mold cast to decrease likelihood of fracture displacement)

    • Operative:

      • External Fixation:

        • For open/closed fractures with soft tissue injury, length instability, or polytrauma

      • Flexible Nails:

        • For skeletally immature patients with open/closed fractures, multiple long bones, or floating knee

      • Percutaneous Pinning:

        • For unstable, noncomminuted oblique fractures (can be combined with casting)

      • Rigid Nails:

        • For open/closed shaft fractures near skeletal maturity

      • Plate Fixation:

        • For fractures with physeal/articular extension, length instability, nonunion, or malunion

2. Stress Fracture

•  Definition: An overuse injury where normal or abnormal bone is subjected to repetitive stress, resulting in microfractures.

• Special Considerations: These injuries sometimes need more advanced imaging, like an MRI, for diagnosis which may show bony and bone marrow edema (white arrow of MRI). NOTE: X-rays may look normal → high index of suspicion

• Treatment: Limited activity with use of crutches, walker, or brace

3. Distal Tibia/Fibula Fractures (aka Ankle fracture)

• Definition: A break in the distal tibia (medial malleolus), distal fibula (lateral malleolus), or the posterior malleolus. It often results from twisting or impact injuries and may involve disruption of the surrounding ligaments depending on the severity.

• Special Considerations: Uses the SH classifcation system

  • SH type I

  • SH type II

  • SH type III

    • Tillaux fractures

  • SH type IV

    • triplane fractures

• Treatment:

  • SH Type I–II (non-displaced): Casting

  • SH Type III–IV (displaced/intra-articular): ORIF to prevent growth arrest