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The tibia is the only weight-bearing bone in the leg. The fibula is bound to the tibia by the interosseous membrane, which divides into a “Y” both proximally and distally. The proximal arm of the “Y” is composed of the anterosuperior tibiofibular ligament and the posterosuperior tibiofibular ligament. A similar division occurs distally with an anteroinferior and posteroinferior tibiofibular ligament. The upper portion of the fibula is of little importance and can be excised with little consequence. The lower portion cannot, because of its importance in forming the ankle mortise.
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The muscles of the leg are enclosed in four fascial compartments: anterior, peroneal, deep posterior, and superficial posterior compartments. The anterior compartment includes the ankle and the foot dorsiflexors and the posterior compartments (superficial and deep) contain the plantar flexors. The peroneal compartment houses the foot evertors.
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Tibial Shaft Fractures
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Tibial shaft fractures are the most common long bone fractures in the body. Because of the superficial location in the leg, the tibia is also the most common bone involved in open fractures.
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Because the tibia and fibula run parallel to each other and are tightly bound together by ligaments, a displaced fracture of one bone is frequently associated with a fracture of the other bone.
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Tibial shaft fractures are classified on the basis of principles established by Nicoll.1 Three factors determine the outcome of tibial shaft fractures.
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Initial displacement
Comminution
Soft-tissue injury
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Fractures are divided based on displacement into three groups: (1) <50% displacement, (2) >50% displacement, and (3) complete displacement or severely comminuted (Fig. 21–1). Tibial shaft fractures with <50% displacement have a 90% chance of union, whereas fractures with complete displacement have only a 70% chance of union.
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The degree of associated soft-tissue injury is an often unrecognized factor affecting prognosis and treatment of the fracture.2,3 Fractures associated with significant contusion of the overlying skin or muscles are associated with higher infection rates and poorer healing.
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The average healing time for uncomplicated, nondisplaced fractures is 3 months. For displaced, open, or comminuted fractures, the average healing time is 4 to 6 months.
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Multiple mechanisms may result in fractures of the tibia and fibula shafts. Direct trauma is a common cause of injury and usually results in associated soft-tissue injury. These fractures are frequently secondary to automobile collisions and typically result in transverse or comminuted fractures.
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Indirect trauma associated with rotary and compressive forces, as from skiing or falling, usually results in a spiral or oblique fracture. Rotary forces occur when the leg and body rotate around a planted foot and are most ...