eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Tibia and Fibula: Follow-up

Author: Jeffrey G Norvell, MD, Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine
Coauthor(s): Mark Steele, MD, Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City; Thomas M Cooper, MD, Resident Physician, Department of Family Medicine, Research Medical Center, Kansas City
Contributor Information and Disclosures

Updated: Oct 1, 2009

Follow-up

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.5

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.

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.

Complications

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

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.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize and treat associated life-threatening injuries
  • Failure to consider ankle injury with proximal fibula fracture (Maisonneuve fracture)
  • Failure to recognize open injuries and obtain timely orthopedic consultation
  • Failure to recognize compartment syndrome

Special Concerns

  • Toddler fracture
    • Typically, this type of fracture is nondisplaced spiral fracture of distal tibia unrelated to child abuse.
    • Midshaft tibial fractures, unrelated to a history of major trauma, should alert emergency physician to possibility of child abuse.
 


More on Fracture, Tibia and Fibula

Overview: Fracture, Tibia and Fibula
Differential Diagnoses & Workup: Fracture, Tibia and Fibula
Treatment & Medication: Fracture, Tibia and Fibula
Follow-up: Fracture, Tibia and Fibula
Multimedia: Fracture, Tibia and Fibula
References
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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. 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].

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

  5. [Best Evidence] 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].

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

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

  8. 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].

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

  10. 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].

  11. 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].

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

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

  14. 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].

  15. 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].

  16. 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].

  17. 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].

  18. 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].

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

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

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

  22. 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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Further Reading

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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 Family Medicine, Research Medical Center, Kansas City
Thomas M Cooper, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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