Fracture of the tibia

The fracture of the tibia or tibial fracture is the fracture of the largest tubular bone of the lower leg.

The lower leg is formed by two adjacent tubular bones: tibia and fibula
The shin is located in the front area of the lower leg.
Together with the femur, it forms the knee joint and with the calf and ankle bone the ankle joint.

A shin fracture can occur on various occasions, e.g. when touching down after a jump, where the anterior inner part of the lower leg and the ankle joint are stressed by the severity of the impact, or when the ankle rotates when pressure is applied to the shin.
If this force exceeds the resistance of the bone, the shin can break.
This injury is called a tibial fracture.

In order to break the shin, it takes a very violent impact, so the fracture often occurs in conjunction with other injuries, such as the sprain of the ankle joint or other fractures of the foot, fibula and ankle.

Shin fractures are distinguished by position, extent and fracture shape: tear fracture (avulsion fracture), fatigue fracture (stress fracture), pot fracture, inner ankle fracture, meniscus fracture, undisplaced, displaced, incomplete fractures, debris fractures, etc.


Causes of tibial fracture

A shin fracture often occurs in connection with a sprained ankle, especially if the violence takes on certain proportions.

Fractures can be caused by direct or indirect force.
Indirect trauma usually requires less energy than a direct blow, proportionally causes less displacement of bone fragments and less damage to soft tissue. Open fractures are caused by direct rather than indirect trauma.

The shin can break because the bone is weakened by a bone tumor (e.g. osteosarcoma), in this case one speaks of pathological or spontaneous fractures.
Osteoporosis is a sign of aging of the bones, in which the bone structure loses compactness; the bone is thus more fragile and susceptible to fractures.
The different injury models are classified by orthopedic classifications.

Spiral fractures and spiral wedge fractures are caused by indirect torsional forces.
The bone fragments in this case have a large contact area and the soft tissue is minimally damaged.
As a rule, a spiral hernia heals faster, although it can be problematic to maintain the setup of the hernia without fixation.

Oblique wedge fractures are caused by flexion forces.
The force acting on the leg is remarkable, and the injury of soft tissue and periosteum (periosteum) is significant.
Fracture healing (consolidation) can take a lot of time and the surgical measures performed directly at the fracture site lead to further devitalization of the bone.

Transverse fractures and complex fractures are usually caused by extremely strong, direct forces. With normal bone quality and a strongly displaced fracture, the soft tissue is extensively damaged.

Even with uninjured skin, the direct exposure of such fractures means further injuries to soft tissue.
The fracture shape and displacement of the bone fragments thus give an idea of the damage to the soft tissues.
Due to this, the surgeon will choose the most appropriate method of reposition and retension.

Signs and symptoms of tibial fracture

At the moment of injury, the affected person feels a sudden, intense and stabbing pain in the lower leg and/or ankle.
To protect the bone, the patient limps.
In severe cases, especially with a displaced shin fracture, the patient is unable to put weight on the injured leg.
The pain is noticeable at the front or inside of the lower leg or ankle.
It is possible that the symptoms subside quickly; pain remains at the point of fracture, which can be particularly intense at night or in the morning when getting up. Only rarely do symptoms occur in the calf area.
A shin fracture leads to swelling, bruising and pain when touching the affected area. The pain intensifies with certain movements of the foot, ankle and knee, especially when walking and standing.
With severe (displaced) fractures of the shin, a significant deformity is visible. Other possible complaints include tingling or numbness in the lower leg, foot or ankle.

Accompanying injuries

Injury to soft tissues always has an impact on the patient’s treatment.
A closed, simple, undisplaced transverse fracture of the shin shaft can be supplied by intramedullary nailing, plate or external fixation.
A strong skin contusion excludes the insertion of a plate, because the soft tissues would be additionally damaged by the surgical procedure.
With an infected wound, intramedullary nails can not be used, because there is a risk of blood poisoning (sepsis).
In this case, an externally fixed holding system is recommended, a fixator external.
In case of rupture of an artery and compartment syndrome, emergency care must be provided.
In cases where vascular repairs and reduction of muscle pressure are necessary, the associated fracture must be stabilized at the same time.

Concomitant injuries require rapid stabilization and also determine the type of care and urgency of intervention.
A plating of the fracture by incision for vascular repair could be the most sensible treatment method, also because there may not be enough time for alternatives.
The treatment of potentially life-threatening injuries always takes precedence over the treatment of a shaft lesion.

Additional fractures of other bones, such as bilateral shaft fractures of the femur, can practically lead to disability of the patient. Here, stabilization of the fracture by conservative treatment could be considered if it occurs in isolation.

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