MANUAL MINORS
Tibiofibular shaft fractures are traumatic injuries affecting the tibia and/or fibula, the two long bones of the lower leg. These fractures can be isolated (only the tibia or only the fibula) or combined, and are usually caused by high-energy trauma, such as traffic accidents or falls from heights.
The tibia, being the primary weight-bearing bone, is more prone to fractures than the fibula, and these injuries can lead to significant instability and limb deformity.
Diagnosis
Diagnosis is based on clinical presentation and imaging studies. Patients typically present with acute pain, swelling, visible deformity in the leg, and difficulty or inability to bear weight on the affected limb.
Plain radiography is the initial diagnostic tool to confirm the fracture and assess its extent. In some cases, computed tomography (CT) may be required to evaluate fragment alignment or in complex fractures.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Ankle Sprain | Localised pain in the ankle joint, without bony deformity or significant inability to bear weight |
Bone Contusion | Localised pain following trauma, with no fractures visible on X-ray, more common in the tibia |
Tibial Plateau Fracture | Pain and swelling in the upper tibia, typically from direct trauma, may be associated with ligament injury |
Femoral Shaft Fracture | Severe pain and deformity in the thigh, inability to bear weight, assessed by femoral X-ray |
Compartment Syndrome | Disproportionate pain on examination, with extreme swelling, paleness, and neurovascular involvement |
Emergency Management
Initial management of tibiofibular shaft fractures in the emergency department includes immobilising the affected leg with a splint to stabilise bone fragments and prevent further injury.
Adequate pain relief is administered, and distal neurovascular signs are monitored to rule out complications such as compartment syndrome or vascular injury. In the case of open fractures, antibiotics are given, and urgent surgical debridement is required. Referral to the trauma or orthopaedics department is essential for definitive assessment and surgical management, if necessary.
Definitive Treatment
Definitive treatment depends on the location, severity, and type of fracture. Displaced or unstable fractures generally require surgical fixation using intramedullary nails, plates and screws, or external fixation.
Stable and non-displaced fractures may be managed conservatively with immobilisation using a cast or splint. Postoperative or post-immobilisation rehabilitation is crucial to restore functionality and prevent joint stiffness.
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