Orthopaedics: Tibia

 Tibial Plateau Fracture

 

Mechanism

·                 axial loading (e.g. fall from height)

·                 femoral condyles driven into proximal tibia

·                 can result from minor trauma in osteoporotics

 

Clinical Features

·                 lateral fractures more common than medial

 

Classification

·                 Schatzker classification

 

Investigations

·                 x-rays: AP, lateral, skyline

 

Treatment

·                 if depression on x-ray is <3 mm

straight leg immobilization x 4-6 weeks with progressive ROM weight bearing

·                 if depression is >3 mm

ORIF often requiring bone grafting to elevate depressed fragment

 

Specific Complications (see General Fracture Complications)

·                 ligamentous injuries

·                 meniscal lesions

·                 AVN

·                 infection

 

Tibial Shaft Fracture

 

Mechanism

·                 nunerous, including MVA, falls, sporting injuries

 

Clinical Features

·                 open vs. closed

·                 amount of displacement

·                 neurovascular status

·                 most commonly fractured long bone

·                 most common open fracture

 

Investigations

·                 x-rays: AP, lateral. skyline

 

Treatment

·                 closed

 • minimally displaced: straight leg cast x 4-6 weeks with early weight bearing

 • diapla.ced: ORIF with reamed IM nail. plate and screws, or external fimtor

·                 open

 • external fixation or IM nail

 • vascularized coverage of soft tissue defects (often heal poorly)

 

Specific Complications (see General Fracture Complications)

·                 high incidence of neurovascular injury and compartment syndrome

·                 poor soft tissue coverage