Tibia and Fibula Fracture Follow-up

  • Author: Jeffrey G Norvell, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 16, 2011
 

Further Inpatient Care

Tibia and fibula fractures

Open fractures require debridement and irrigation in operating room.

Inpatient admission may be advised to observe development of compartment syndrome.

Continuous compartment pressure monitoring in asymptomatic patients with tibia fractures is not recommended.[7]

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Further Outpatient Care

Patient should see primary care physician or be referred to an orthopedic surgeon within 1 week for further evaluation and treatment of isolated fibula fractures.

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Transfer

Transfer is reasonable if approved by patient (for insurance or other reasons) or if a hospital bed or an orthopedic surgeon is unavailable at the transferring institution.

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Complications

The following complications may be noted:

  • Neurovascular compromise
  • Compartment syndrome
  • Peroneal nerve injury
  • Infection
  • Gangrene
  • Osteomyelitis
  • Delayed union, nonunion, or malunion
  • Amputation or skin loss
  • Posttraumatic arthritis
  • Fat embolism
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Prognosis

Tibia and fibula fractures

Prognosis is generally good yet is dependent on degree of soft-tissue injury and bony comminution.

Prognosis is good for isolated fibula fractures.

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Patient Education

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Contributor Information and Disclosures
Author

Jeffrey G Norvell, MD  Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine

Jeffrey G Norvell, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mark Steele, MD  Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City

Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Thomas M Cooper, MD  Resident Physician, Department of Emergency Medicine, University of Kansas Medical Center

Thomas M Cooper, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Emergency Physicians, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. Sep 1998;29(7):529-34. [Medline].

  2. Howard M, Court-Brown CM. Epidemiology and management of open fractures of the lower limb. Br J Hosp Med. Jun 4-17 1997;57(11):582-7. [Medline].

  3. Horwitz DS, Kubiak EN. Surgical treatment of osteoporotic fractures about the knee. Instr Course Lect. 2010;59:511-23. [Medline].

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  5. Louie KW. Management of open fractures of the lower limb. BMJ. Dec 17 2009;339:b5092. [Medline].

  6. Grottkau BE, Epps HR, Di Scala C. Compartment syndrome in children and adolescents. J Pediatr Surg. Apr 2005;40(4):678-82. [Medline].

  7. Harris IA, Kadir A, Donald G. Continuous compartment pressure monitoring for tibia fractures: does it influence outcome?. J Trauma. Jun 2006;60(6):1330-5; discussion 1335. [Medline].

  8. Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am. Jul 2003;34(3):365-75. [Medline].

  9. Fredericson M, Jennings F, Beaulieu C, Matheson GO. Stress fractures in athletes. Top Magn Reson Imaging. Oct 2006;17(5):309-25. [Medline].

  10. Germann CA, Perron AD, Sweeney TW. Orthopedic pitfalls in the ED: tibial plafond fractures. Am J Emerg Med. May 2005;23(3):357-62. [Medline].

  11. Haller PR, Harris CR. The tibia and fibula. In: Emergent Management of Skeletal Injuries. St Louis: Mosby-Year Book; 1995:499-517.

  12. Khalily C, Behnke S, Seligson D. Treatment of closed tibia shaft fractures: a survey from the 1997 Orthopaedic Trauma Association and Osteosynthesis International--Gerhard Kuntscher Kreis meeting. J Orthop Trauma. Nov 2000;14(8):577-81. [Medline].

  13. Konstantakos EK, Dalstrom DJ, Nelles ME, Laughlin RT, Prayson MJ. Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg. Dec 2007;73(12):1199-209. [Medline].

  14. Krieg JC. Proximal tibial fractures: current treatment, results, and problems. Injury. Aug 2003;34 Suppl 1:A2-10. [Medline].

  15. McKoy BE, Stanitski CL. Acute tibial tubercle avulsion fractures. Orthop Clin North Am. Jul 2003;34(3):397-403. [Medline].

  16. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk?. J Bone Joint Surg Br. Mar 2000;82(2):200-3. [Medline].

  17. Miller NC, Askew AE. Tibia fractures. An overview of evaluation and treatment. Orthop Nurs. Jul-Aug 2007;26(4):216-23; quiz 224-5. [Medline].

  18. Mustonen AO, Koskinen SK, Kiuru MJ. Acute knee trauma: analysis of multidetector computed tomography findings and comparison with conventional radiography. Acta Radiol. Dec 2005;46(8):866-74. [Medline].

  19. Newton EJ, Love J. Emergency department management of selected orthopedic injuries. Emerg Med Clin North Am. Aug 2007;25(3):763-93, ix-x. [Medline].

  20. Ritsema TS, Kelen GD, Pronovost PJ, Pham JC. The national trend in quality of emergency department pain management for long bone fractures. Acad Emerg Med. Feb 2007;14(2):163-9. [Medline].

  21. Roberts DM, Stallard TC. Emergency department evaluation and treatment of knee and leg injuries. Emerg Med Clin North Am. Feb 2000;18(1):67-84, v-vi. [Medline].

  22. Russell TA. Fractures of the tibia and fibula. In: Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996:2127-2201.

  23. Sproule JA, Khalid M, O'Sullivan M. Outcome after surgery for Maisonneuve fracture of the fibula. Injury. Aug 2004;35(8):791-8. [Medline].

  24. Taketomo CK, Hodding JH, Kraus DM. Naproxen. In: Pediatric Dosage Handbook. Vol 6. 1999-2000:632-633.

  25. Yang JP, Letts RM. Isolated fractures of the tibia with intact fibula in children: a review of 95 patients. J Pediatr Orthop. May-Jun 1997;17(3):347-51. [Medline].

 
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Shown is an intra-articular fracture of the medial condyle of the tibial plateau.
Standard anteroposterior radiograph of a tibial shaft fracture with intramedullary nail fixation. Note the commonly associated fibular fracture that is also apparent.
Radiograph demonstrating a displaced tibial shaft fracture with associated fibula fracture.
Type II tibial plateau fracture in a young active adult with good bone stock treated with percutaneous elevation and cannulated cancellous screw fixation without bone grafting.
Type III tibial plateau fracture with central depression in an elderly person treated surgically using percutaneous elevation, bone grafting, and cancellous screw fixation.
Tibial plateau fractures. Line drawings of Schatzker types I, II, and III tibial plateau fractures. Type I consists of a wedge fracture of the lateral tibial plateau, produced by low-force injuries. Type II combines the wedge fracture of the lateral plateau with depression of the lateral plateau. Type III fractures are classified as those with depression of the lateral plateau but no associated wedge fracture.
Tibial plateau fractures. Line drawings of Schatzker types IV, V, and VI tibial plateau fractures. Type IV is similar to type I fracture, except that it involves the medial tibial plateau as opposed to the lateral plateau. Greater force is required to produce this type of injury. Type V fractures are termed bicondylar and demonstrate wedge fractures of both the medial and lateral tibial plateaus. Finally, type VI fractures consist of a type V fracture along with a fracture of the underlying diaphysis and/or metaphysis.
Tibial plateau fractures. CT image through the tibial plateau shows a fracture of the posterior aspect of the lateral tibial plateau, which is the source of the lipohemarthrosis.
Tibial plateau fractures. Axial CT image through the tibial shows a fracture through the lateral tibial plateau with slight diastasis between the fragments. This is a Schatzker II injury.
Tibial plateau fractures. Coronal reformatted CT. This image demonstrates a bicondylar fracture of the tibial plateau along with a fracture of the tibial diaphysis, a Schatzker VI fracture. Note the articular incongruity.
Classification of tibial tuberosity fractures.
 
 
 
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