Fracture shaft of tibia by Dr Bipul Borthakur

1. BY: DR. BIPUL BORTHAKUR,
PROFESSOR,
DEPT. OF ORTHOPAEDICS, SMCH
FRACTURE SHAFT OF TIBIA

2. INTRODUCTION
 Tibia is the main bone of the
leg. Also known as ‘shin’.
 It is the 2nd largest bone in the
body.
 It is situated medial to fibula.
 It carries about 80% of the
body weight from femur to the
foot.

3. ANATOMY
 Tibia is a long bone and comprises
of 3 parts : upper and lower end
and shaft.
 Upper end is broad and has medial
and lateral condyle and a tibial
tuberosity.
 Medial condyle is bigger than the
lateral condyle.
 Shaft has:
 3 borders: anterior, medial and
lateral
 3 surfaces: medial, lateral and
posterior

4. ANATOMICAL POSITION AND
SIDE DETERMINATION
 It is hold in a manner that:
Its expanded end with condyles faces
upward.
Its tibial tuberosity and sharp anterior
border faces anteriorly.
Medial malleolus is on the medial side.
The superior surface (tibial plateau) is
placed horizontal.

5. Muscle attachments

6. COMPARTMENTS OF LEG
1. Anterior compartment
2. Lateral compartment
3. Superficial posterior compartment
4. Deep posterior compartment

7.  Anterior compartment
 muscular
 tibialis anterior
 extensor hallucis longus
 extensor digitorum
longus
 peroneus tertius
 neurovascular
 deep peroneal nerve
 anterior tibial vessels
 Lateral compartment
 muscular
 peroneus longus
 peroneus brevis
 neurovascular
 superficial peroneal
nerve
 Superficial posterior
compartment
 muscular
 gastrocnemius
 plantaris
 soleus
 neurovascular
 sural nerve
 Deep posterior
compartment
 muscular
 tibialis posterior
 flexor hallucis longus
 flexor digitorum longus
 popliteus
 neurovascular
 tibial nerve
 posterior tibial vessels

9. FRACTURE SHAFT OF TIBIA
 Most common long bone fracture.
 Accounts for about 4% of all fractures.
 It is usually associated with fibula fracture.

10. MECHANISM OF FRACTURE
1. Low energy pattern
 Result of torsion injury
 Indirect or stress fracture
2. High energy pattern
 Motor vehicle crash
 Gunshot injury
 Associated with fibula fracture

11. Associated conditions
 Soft tissue injury (in open wounds)
 Compartment syndrome
 Bone loss
 Ipsilateral fibula fracture
 Ligamentous injury
 Ipsilateral femur fracture resulting in “floating
knee”

12. Fracture pattern
Transverse
fracture
Oblique fracture
Spiral fracture
Comminuted fracture

13. PRESENTATION
 Pain and swelling
 Inability to walk
 Deformity
 Contusion/ wound
 Abnormal mobility
 Bony crepitus

14. INVESTIGATION
 Radiographs
 Full length AP and Lateral views of the affected leg
 AP and Lateral views of the ipsilateral knee and
ankle
 CT scan
 To rule out any intraarticular fracture extension

15. MANAGEMENT
 Resuscitation of the patient as per ATLS
guidelines
 Airway
 Breathing
 Circulation
 Disability
 Exposure
 Volume stabilization with IV fluids or blood
transfusion
 Proper immobilization of the limb with Above-
knee splint.

16. TREATMENT
 NON-OPERATIVE
 Closed reduction/cast
immobilization
 Indications
 Closed low energy fractures and
undisplaced or acceptable
alignment
 <5 degree valgus-varus
angulation
 <10 degree antero-posterior
angulation

17.  Technique
 Long leg cast and convert to functional patellar
tendon bearing cast after 4 weeks
 Complication:
 Malunion
 Non union
 Risk of compartment syndrome

18. OPERATIVE
 Indication:
 Compound fractures
 Unacceptable alignment
 Segmental fracture
 Comminuted fracure

19. OPERATIVE MODALITIES
 INTRAMEDULLARY
NAILING
 Better outcome
 The intramedullary nail is
screwed to the bone and gives
a better stability
 Not ideal in children

20.  PLATING
 Useful in proximal and distal tibial fractures

21.  External fixation
 As a primary stabilization of fractures
 Useful in gross compound fractures.

22. COMPARTMENT SYNDROME
 Compartment syndrome occurs when excessive
pressure builds up inside an enclosed muscle space
in the body.
 Compartment syndrome usually results from bleeding
or swelling after an injury.
 The dangerously high pressure in compartment
syndrome impedes the flow of blood to and from the
affected tissues.
 It can be an emergency, requiring surgery to prevent
permanent injury.

23. THANK YOU