The metal rod is called a tibial nail also called an. Treatment of lowenergy tibial shaft fractures plaster cast versus reamed intramedullary nailing acta universitatis tamperensis 829 university of tampere tampere 2001 academic dissertation to be presented, with the permission of the faculty of medicine of the university of tampere, for public discussion in the small auditorium of building b. There are a variety of treatment options, both operative and. A tibial shaft fracture is a break of the larger lower leg bone below the knee joint. These fractures do heal more slowly than fractures in the tibial shaft and may require additional procedures, such as dynamization and or bone grafting. Posterior malleolar fracture morphology in tibial shaft vers. Calf muscle wasting after tibial shaft fracture british. Tibial shaft fractures are the most common long bone fracture and the fourth most common lower extremity fracture, following proximal femur, metatarsal, and ankle fractures. Patients with tibial shaft fractures present with pain and localized swelling. Iii vaisto o, toivanen jak, kannus p, and jarvinen mj 2007. Closed fractures of the tibial shaft in adults orthopaedics and trauma.
J orthop trauma 2007 cannot lower infection rates for type iiib open fractures. Pdf tibial shaft fractures are one of the most common pediatric fractures. Even in closed tibial shaft fractures, air can be identified in the leg. Length of immobilisation was determined from the hospital records. Treatment of tibial shaft fractures is still discussed controversial. In many tibia fractures, the smaller bone in the lower leg fibula is broken as well. The ellis classification for tibial shaft fracture. Fracture of the tibial shaft is among the most common long bone fracture. The most common mechanisms for tibial shaft fractures include falls, sporting accidents and highenergy mechanisms, such as soccer and motorcycle collisions 2. Evaluation and initial wound management abstract open fractures of the tibial diaphysis are often associated with severe bone and softtissue injury. A tibial shaft fracture occurs along the length of the bone, below the knee and. Fractures of the tibial shaft are one of the most common long bone fractures in the body 1. They can generally be considered in the context of a lowenergy mechanism that results in a torsional moment through the tibia or a highenergy mechanism that results in a. Tibial shaft fractures a comparison of conservative treatment and infernal fixafion with conventional plates or a0 compression plates j.
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. Nonunions further worsen the burden of tibia shaft fractures and lead to additional healthcare interventions 9,18. Transverse fracture is present at the proximal fibular diaphysis. They require appropriate diagnosis and treatment to minimize complications. Although tibial shaft fractures are often the result of highspeed trauma, they can also be insidious in onset, such as stress fractures in active individuals. Solid bone union without hypertrophy, fast mobilization and full range of motion without further softtissue damages are the aims of the therapy. The evidence is insufficient to determine the effects of the technology on health outcomes. There was no change during the 30 years in fracture incidence.
Currently, pintobar external fixation for tibial shaft fractures is used more often for initial temporizing stabilization ie, damagecontrol orthopaedics when the patient is too sick for definitive fixation or when the injury to the softtissue envelope is too severe to permit. The tibia is one of two bones that make up the lower leg, the other being the fibula. Download rockwood and greens fractures in adults 9th. A fracture is also seen at the lateral tibial plateau. Tibial shaft fractures acta chirurgiae orthopaedicae et. Tibial shaft fractures are common in the pediatric population. Contamination of the fracture site and devitalization of the softtissue envelope greatly increase the risk of infection, nonunion, and wound complications. Biomechanical analysis of operative methods in the treatment of. Tibial shaft fractures orthopaedic trauma association ota. Fractures of the tibial shaft in adults article pdf available in orthopaedics and trauma 284 august 2014 with 1,419 reads how we measure reads. The management of open tibial shaft fractures article pdf available in bmj online 345sep28 2. Fractures of the tibia and fibula in the pediatric patient. A tibial shaft fracture is a break of the tibia shinbone. There are a variety of treatment options, both operative and non operative, and satisfactory.
Although many of these fractures require surgery, nearly all are stabilized in the ed with a long leg splint or bivalved. The highest incidence is in young men8 per 100 000 persons. Tibia shaft fractures present a substantial burden on patients and the healthcare system. The choice of technique depends on fracture localization, type of fracture, history of concomitant disorders and soft tissue damage.
If distal, short leg cast for 3 4 weeks if proximal, above knee cast with knee flexed 10. Tibial shaft fractures management and treatment options. During the initial evaluation, the patient with a tibial shaft fracture should be evaluated carefully for open wounds at the fracture site, neurovascular sufficiency, and elevated compartment pressures. Malunion is an unfortunate consequence of nailing these fractures, occurring in 84% of patients in one case series, versus up to 37% of all closed tibial shaft fractures. These fractures usually result from high energy injuries such as car accidents in younger patients and most often from falls in the elderly patient. Tibial shaft fractures kodi edson kojima1, ramon venzon ferreira2 rev bras ortop. It typically takes a major force to cause this type of broken leg. Treatment is usually nonoperative with long leg casting but is tailored to the injury type and patient age. There are a variety of treatment options, both operative and nonoperative, and satisfactory outcomes are reliant on a thorough understanding of the strengths and weaknesses of the different treatment modalities, and their most useful applications. Proximal tibial fracture, locking plate, nail, biomechanical study potential. Thus it is the most commonly fractured long bone in the body. Nondisplaced tibial shaft fractures in patients with good compliance can be treated. Nearly a quarter of tibial fractures are open, and of those that are open, greater than 50% are related to motor vehicular injury.
This occurs along the long portion of the bone between the knee and ankle joints. The tibia, or shinbone, is the most commonly fractured long bone in the body. Intramedullary nailing of femoral and tibial shaft fractures. A thorough analysis of both classifications shows that the otaao classification enables a good. Pdf fractures of the tibial shaft in adults researchgate. Due to the location of the tibia, it is frequently injured. The fracture may be closed with minimal displacement, or it may be complicated open fracture where the fracture segment comes out of the skin. Current practice in management of tibial shaft fractures by canadian orthopedic surgeons is uncertain.
Tibial shaft fractures musculoskeletal medicine for medical. Tibial plateau fracture postoperative protocol phase i maximum protection 0 to 1 weeks. Ice and modalities to reduce pain and inflammation use crutches nonweight bearing for 6 weeks brace for 6 weeks in full extension elevate the knee above the heart for the first 3 to 5 days. Tibia fractures during 195055, 455 tibial shaft fractures occurred, and in 198083, 394 fractures table 4. Return rates and returntosport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods. Union rates, infection rate superficial and deep, unplanned return to the operating room. The distribution of posterior malleolar fracture type differed between tibial shaft fractures and ankle fractures. Proximal tibiofibular joint dislocation associated with tibial shaft fractures 7 cases. Type iii fractures, however, are not a homogeneous group. The management of open tibial shaft fractures the bmj. Acute tibial shaft fractures represent one of the most severe injuries in sports. Fractures of the tibial shaft are the most common long bone fractures, with an incidence greater than 75,000 per year in the us. Connect to the shaft fixation distally with 5mm halfpins.
Rotational malalignment after tibial intramedullary nailing. The most common mechanism of injury is motor vehicle accident. Despite their common occurrence, the evidence base to direct the care of tibial shaft fractures is relatively poor. P01 functional analyses after tibial shaft fracture injury. Type b fractures are wedge fractures and are subdivided into spiral bending or fragmented wedges. Minimally invasive plate osteosynthesis with conventional. Johansen department of orthopaedic surgery, frederiksborg county hospital, hillerad, denmark. Rehabilitation guidelines for tibial plateau fracture 4 p a g e cardiovascular exercises treadmill running, bike, ube progression criteria independent with hep passing score on return to sport test with low risk of reinjury reported return to sport references. The most common cause of fracture shaft tibia is vehicular accident followed by fall. Original research article management of fracture tibia with closed. Diaphyseal tibia fracture, conventional compression plate, minimally invasive plate osteosynthesis introduction the diaphyseal tibia fracture is best treated with intramedullary nailing.
Diaphyseal tibial fractures are the most common long bone fracture. The assessment of fracture healing and prediction of complications or functional restrictions after tibial shaft fracture are important for having corrective. Clinical suspicion is the key element for early diagnosis of compartment syndrome. Tibial shaft fractures are the most common cause of compartment syndrome 6 and, without correct and timely diagnosis that leads to an early treatment, can cause irreparable sequelae.
Pdf diaphyseal tibial fractures are the most common long bone fracture. Tibial shaft fracture is the most common type of long bone fracture. Computed tomography scans were performed at fixed points on the lower legs of 23 nonprofessional athletes who sustained closed tibial fractures 16 years previously. In the present series the majority of segmental tibial shaft fractures had a rather unfavourable location prognostically, the lower fracture being located in the distal half of the tibia in 44 cases 81. Although intramedullary fixation has become the mainstay of treatment, many of these fractures are amenable to closed treatment. Bhattacharyya t, routine use of wound vacuumassisted closure does not allow coverage delay for. Closed tibial shaft fractures assessment of the injury nonoperativeoperative options choice of implants their advantages and disadvantages importance of the closed softtissue injury. The metal rod is called a tibial nail also called an intramedullary or interlocking nail. Bone morphogenetic protein and carrier and delivery systems. Commonly seen in road traffic accidents, sports accidents with a high velocity such as skiing, horse riding, and certain water sports. Diagnosis of soft tissue inju ries and compartment syndrome is also more difficult in a cast. Bone morphogenetic proteins are members of the transforming growth factors.
Treatment is usually nonoperative with long leg casting but is. Anterior knee pain and thigh muscle strength after intramedullary nailing of a tibial shaft fracture. Tibial plateau fractures are typically caused by a strong force on the lower leg with the leg in varus or valgus position, or simultaneous vertical stress and flexion of the knee. The incidence of tibial shaft fractures ranges from 1722 per 100,000 patient years. Tibial nailing is an operation to fix a broken tibia using a metal rod see figure 1. A tibial shaft fracture occurs along the length of the tibia shinbone, below the knee and above the ankle. Traditionally, the majority of pediatric tibial fractures have been managed nonoperatively, but surgical rates are increasing. This is an isolated fracture of the tibia with an intact fibula. The debridement of the area of air infiltration, however, is not necessary for prevention of ssi. The fracture anatomy, site, and degree of displace ment of the fractures remained unchanged. Most common long bone most common long bone fracture 492,000 fractures yearly 492,000 fractures yearly average 7. Pdf tibial shaft fractures management and treatment options.
Tibial shaft fractures distal to total knee arthroplasty are rare, but they are likely to become more common with the increasing number of arthroplasty procedures being performed. Closed tibial shaft fractures assessment of the injury nonoperativeoperative options choice of implants their advantages and disadvantages importance of the closed softtissue injury 3. Pdf tibial shaft fractures in children and adolescents. The highenergy nature of these fractures, as well as the contamination of the fracture site and devitalization of the soft tissue envelope, greatly increases the risk of infection, nonunion, and wound complications. There are about half a million tibial shaft fractures annually in the us resulting in greater than 70,000 hospitalizations 3. Open fractures of the tibial shaft remain to be one of the most complex, problematic and controversial orthopaedic injuries3. Ice and modalities to reduce pain and inflammation use crutches nonweight bearing for 6 weeks brace for 6 weeks in full extension elevate the knee above the heart for the first 3 to 5 days initiate patella mobility drills. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. There is comminuted tibial shaft fracture with displaced butterfly fragment.
Treatment of unstable pediatric tibial shaft fractures. In addition, 47% of the type ii posterior malleolar fractures in tibial shaft fractures had an additional fracture line oriented in the sagittal plane, a fracture pattern unique to these injuries that were not observed in the ankle. Tibial shaft fractures philip wolinsky university of california at davis tibial shaft tibial shaft fracturesfractures most common long bone most common long bone fracture 492,000 fractures yearly 492,000 fractures yearly average 7. We present the results of a brief survey designed to explore current management of tibial shaft fractures by canadian orthopedic trauma surgeons.
Tibia shaft fracture an overview sciencedirect topics. Closed segmental tibial shaft fracture, typ 42 c1 with primary external fixation and secondary intramedullary nailing with an adjunctive plate osteosynthesis initially and 6. Here you will be able to download rockwood and greens fractures in adults 8th edition pdf by using our direct download links that have been mentioned at the end of this article. The choice of technique depends on fracture localization, type of fracture, history of. Oct 17, 2018 although tibial shaft fractures are often the result of highspeed trauma, they can also be insidious in onset, such as stress fractures in active individuals. Intramedullary stabilization following closed or open reduction percutaneous and open approach main outcome measures. Tibia shaft fracture is a fracture of the proximal upper third of the tibia lower leg bone. A tibia fracture refers to any crack or breaks in the tibia bone. Keywords air, computed tomography, open fracture debridement, surgical site infection, tibial shaft fracture. This is a pertinent matter since intramedullary nailing is the most common surgical treatment of tibial shaft fractures. Leg hammock for closed reduction of tibial shaft fractures.
Pediatric tibial shaft fractures are one of the most common traumatic fractures seen in children with an average age of 8. Closed segmental tibial fracture with grade iii soft tissue injury with primary external fixation and secondary plate osteosynthesis. Moreover, there is little evidence to support the commonly recommended parameters of acceptable fracture alignment less than 57 degrees of varusvalgus, less than 10 degrees of flexionextension, less than 1. These fracture patterns have been treated in the past either with closed reduction and castingbracing or with open reduction internal. Tibial shaft fractures are the most common long bone fracture and usually affect the fibula too. The highenergy nature of these fractures, as well as the contamination of the fracture site and devitalization of the softtissue envelope, greatly increases the risk of infection. The treatment of tibial shaft fractures is discussed with emphasis given to plate and screw fixation.
Closed tibial shaft fractures orthopaedicsone articles. Comminution of the inter mediate fragment was found in 18 cases 33. Tibial shaft fractures surgical anatomy epidemiology investigations classification treatment plaster cast non operative operative treatment open fractures compartment syndrome 29032018 vemulapalli. These fractures are common and cause physical limitations and pain to the patients. A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. To determine the current evidence for the treatment of and return to sport after tibial shaft. Open reduction of closed pediatric tibial shaft fractures. Among various causes of open tibia fractures bomb blast injury is emerging as the leading cause in our country5. Proximal tibia plating system evos mini plating system cannulated screw 5. Nine months after fixator removal, he presents with a painful oligotrophic nonunion. Tibial shaft fractures are often caused by highenergy trauma with severe concomitant softtissue injuries. Out of a series of 207 consecutive fractures of the tibial shaft, 102 were. Among sports related tibial shaft fractures, soccer accounts for 80%.
Tibial shaft fractures pediatric pediatrics orthobullets. Konda et al 1 described a novel technique for closed reduction of tibial shaft fractures. To study the long term effect of tibial shaft fractures treated by immobilisation in a long leg cast on the calf muscle bulk. Tibial shaft fractures are common injuries in emergency departments eds. Rotational malalignment after tibial intramedullary. A fracture where the bones are broken in no more than two pieces noncomminuted but are not aligned. Five 25% patients had a tibial shaft fracture alone, while 15 75% patients had a tibial shaft fracture accompanied by a fibular fracture table 1.
1465 843 1167 479 1028 609 697 1028 406 1466 1372 582 1160 379 350 16 910 140 885 925 332 318 660 923 1067 1352 1496 830 1215 428 522 1153 813 759 390 296 945 877 1599 642 243 617 810 1218 102 1090 1019 855 1244 193