MANUAL MINORS
A tibial shaft fracture is an injury affecting the middle portion of the tibia, the primary weight-bearing bone in the leg. This type of fracture is one of the most common in long bones and usually occurs due to high-energy trauma, such as traffic accidents or falls from a height.
It can also occur in low-impact situations, particularly in patients with weakened bones due to conditions like osteoporosis. Fractures can be closed or open and are often associated with fibular injuries.
Diagnosis
Diagnosis is primarily based on clinical presentation and confirmed through imaging. Patients typically present with severe pain, visible deformity, swelling, bruising, and often an inability to bear weight on the affected leg.
A full leg X-ray is the diagnostic tool of choice to confirm the fracture and assess fragment alignment. In complex cases or suspected joint fractures, computed tomography (CT) may be required.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Ankle Sprain | Localised pain in the ankle without visible bony deformity or significant inability to bear weight |
Fibula Fracture | May coexist with tibial fracture, but when isolated, typically causes less deformity and more localised pain |
Bone Contusion | Localised pain without fractures visible on X-ray, more common in the tibia |
Tibial Plateau Fracture | Pain in the upper tibia, usually with joint effusion, more common in high-energy trauma |
Compartment Syndrome | Disproportionate pain with swelling, paleness, and possible neurovascular compromise following a fracture or trauma |
Emergency Management
In the emergency department, management of tibial shaft fractures begins with stabilisation of the affected leg using a long splint or temporary immobilisation. Analgesics are administered to control pain, and distal neurovascular status should be carefully assessed to rule out complications like compartment syndrome, which is a medical emergency. In the case of open fractures, antibiotic prophylaxis should be initiated, tetanus toxoid administered if necessary, and early surgical debridement performed.
Definitive Treatment
Definitive treatment depends on the severity and type of fracture. Displaced or unstable fractures typically require surgical intervention, such as internal fixation with intramedullary nails or plates and screws.
Non-displaced or stable fractures can be treated conservatively with cast or splint immobilisation for 6 to 8 weeks. Post-immobilisation or post-surgical rehabilitation is crucial for restoring function and preventing joint stiffness.
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