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Chapter: Orthopaedics

Orthopaedics: Tibia

1. Tibial Plateau Fracture 2. Tibial Shaft Fracture



Tibial Plateau Fracture



·                 axial loading (e.g. fall from height)

·                 femoral condyles driven into proximal tibia

·                 can result from minor trauma in osteoporotics


Clinical Features

·                 lateral fractures more common than medial



·                 Schatzker classification



·                 x-rays: AP, lateral, skyline



·                 if depression on x-ray is <3 mm

straight leg immobilization x 4-6 weeks with progressive ROM weight bearing

·                 if depression is >3 mm

ORIF often requiring bone grafting to elevate depressed fragment


Specific Complications (see General Fracture Complications)

·                 ligamentous injuries

·                 meniscal lesions

·                 AVN

·                 infection


Tibial Shaft Fracture



·                 nunerous, including MVA, falls, sporting injuries


Clinical Features

·                 open vs. closed

·                 amount of displacement

·                 neurovascular status

·                 most commonly fractured long bone

·                 most common open fracture



·                 x-rays: AP, lateral. skyline



·                 closed

 • minimally displaced: straight leg cast x 4-6 weeks with early weight bearing

 • diapla.ced: ORIF with reamed IM nail. plate and screws, or external fimtor

·                 open

 • external fixation or IM nail

 • vascularized coverage of soft tissue defects (often heal poorly)


Specific Complications (see General Fracture Complications)

·                 high incidence of neurovascular injury and compartment syndrome

·                 poor soft tissue coverage


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