The tibia provides primary support for weight bearing. The tibia has a thick cortex, and significant force is required to fracture it. Proximally, the tibia splays out to form the medial and lateral plateaus that articulate with the femoral condyles. The lateral plateau is higher and smaller than the medial and is more susceptible to fracture. The distal tibia articulates with the fibula laterally and the talus inferiorly. A dense interosseous membrane connects the tibia and fibula. The distal tibial articulation is supported by the ankle syndesmosis, a series of ligaments inferior to the interosseous membrane. The fibula has a small diameter and lies lateral and posterior to the tibia. It bears little weight but is more easily fractured than the tibia.
The lower leg is divided into four compartments, each coursing parallel to the tibia (Figure 275-1). The compartments are enclosed by nonexpandable bones and connective tissue that limit the compartment size and prevent compartment expansion if its volume increases. Each compartment contains muscles and nerves that may sustain permanent damage with elevated tissue compartment pressure (Table 275-1). (See also chapter 278, "Compartment Syndrome.")
TABLE 275-1Lower Leg Anatomy ||Download (.pdf) TABLE 275-1 Lower Leg Anatomy
| ||Compartments |
| ||Anterior ||Lateral ||Superficial Posterior ||Deep Posterior |
|Muscles ||Dorsiflex foot and ankle ||Plantarflex and evert foot ||Flex knee and ankle ||Plantarflex toes, inversion of foot |
|Nerve ||Deep peroneal ||Superficial peroneal ||Sural ||Posterior tibial |
|Sensation ||First dorsal web space ||Dorsum of foot ||Lateral aspect of foot and distal calf ||Sole of foot |
|Artery ||Anterior tibial ||— ||— ||Posterior tibial |
A cross-section at the midcalf level shows the anterior compartment enclosed by the tibia, interosseous membrane, and anterior crural septum (Table 275-1 and Figure 275-1). Muscles in the anterior compartment group dorsiflex the foot and ankle. The deep peroneal nerve courses within the anterior compartment and exits to provide sensation to the dorsal web space between the first and second toes.
The lateral compartment is bordered by the anterior crural septum, the fibula, and the posterior crural septum. Its muscles plantarflex and evert the foot. The superficial peroneal nerve in this compartment provides sensation to the dorsum of the foot. The superficial posterior compartment contains muscles that flex the knee and the tibiotalar joints. Its sural nerve provides sensation for the lateral aspect of the foot and the distal calf. The muscles of the deep posterior compartment plantarflex the foot and toes and invert the foot. The posterior tibial nerve that exits this compartment provides sensation to the sole of the foot.
The history may give clues about the mechanism ...