Tibia and Fibula Fracture Management in the ED Workup

Updated: Dec 12, 2022
  • Author: Jonathan E Dangers, MD, MPH; Chief Editor: Trevor John Mills, MD, MPH  more...
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Imaging Studies


Radiographs of the knee, tibia/fibula, and ankle should be obtained as indicated (see the image below). Pedestrians struck by motor vehicles with lower extremity fractures have a high incidence of concomitant spine, chest, or intra-abdominal injuries. [24] These patients may need additional radiographic tests to rule out these injuries when clinically indicated.

Radiograph demonstrating a displaced tibial shaft Radiograph demonstrating a displaced tibial shaft fracture with associated fibula fracture.

Computed tomography

Computed tomography (CT) is indicated for severely injured patients if diagnostically sufficient radiographs of the knee cannot be obtained. [25, 26]

For patients with tibial plateau fractures, tibial plafond fractures, and maisonneuve fractures, CT can assist evaluation of fracture extent. [27]  In a study of CT evaluation of characteristics of tibial plateau fractures, the diagnostic accuracy of fracture characteristics ranged from 70 to 89% for (1) a posteromedial component, (2) a lateral component, (3) a tibial tubercle component, and (4) a tibial spine (central) component. [28]

(See the CT images of tibial plateau fractures below.)

Tibial plateau fractures. CT image through the tib 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. Coronal reformatted CT. 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.

In tibial plateau fractures, radiographs may underestimate the degree of articular depression when compared to CT. This is important because patients with articular depression greater than 3 mm may be considered for surgery.


Point-of-care ultrasound has demonstrated promise for identifying long bone fractures and for confirming proper reduction. [29]  Sensitivity has been found to be as high as 99% in identifying long bone fractures. [30]  Sensitivity for adequate reduction has ranged from 94 to 100%. [29]   

For stress fractures

Radiographic findings usually are seen after 2-8 weeks of symptoms; radiographs may not be very sensitive during early stages of symptoms.

Radionucleotide scanning and MRI are more sensitive than radiography in diagnosing stress fractures and stress injuries.