This document discusses fractures of the tibia shaft. It begins by providing an overview of tibia anatomy, noting that it is the second largest bone and carries 80% of body weight from the femur to the foot. It then describes the anatomy of the tibia in more detail. Mechanisms of tibia shaft fractures are discussed as well as common fracture patterns, clinical presentation, diagnostic imaging, and treatment approaches including non-operative and operative options like intramedullary nailing and plating. Compartment syndrome is also covered as a potential complication.

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