Tibia (Shinbone) Shaft Fractures.pptx

A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. It typically takes a major force to cause this type of broken leg. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures.

1. Tibia (Shinbone) Shaft Fractures

2. Introduction: The tibia, or shinbone, is the most commonly fractured long bone in the body. A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. It typically takes a major force to cause this type of broken leg. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. In many tibia fractures, the smaller bone in the lower leg (fibula) is broken as well.

3. Anatomy: The lower leg is made up of two bones: the tibia and fibula. The tibia is the larger of the two bones. It supports most of your weight and is an important part of both the knee joint and ankle joint.

4. Types of Tibial Shaft Fractures: Tibia fractures vary greatly, depending on the force that causes the break. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture). In many tibia fractures, the fibula is broken as well. Doctors describe fractures to each other using classification systems. Tibia fractures are classified depending on: The location of the fracture (the tibial shaft is divided into thirds: distal, middle, and proximal) The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle)

5. Whether the skin and muscle over the bone is torn by the injury (open fracture) The most common types of tibial shaft fractures include: Transverse fracture:  In this type of fracture, the break is a straight horizontal line going across the tibial shaft. Oblique fracture:  This type of fracture has an angled line across the shaft. Spiral fracture:  The fracture line encircles the shaft like the stripes on a candy cane. This type of fracture is caused by a twisting force. Comminuted fracture:  In this type of fracture, the bone breaks into three or more pieces.

6. Open fracture:  If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications—especially infections—and take a longer time to heal.

7. Cause: Tibial shaft fractures are often caused by some type of high-energy collision, such as a motor vehicle or motorcycle crash. In cases like these, the bone can be broken into several pieces (comminuted fracture). Sports injuries, such as a fall while skiing or a collision with another player during soccer, are lower-energy injuries that can cause tibial shaft fractures. These fractures are typically caused by a twisting force and result in an oblique or spiral fracture.

8. Symptoms: A tibial shaft fracture usually causes immediate, severe pain. Other symptoms may include: Inability to walk or bear weight on the leg Deformity or instability of the leg Bone "tenting" over the skin at the fracture site or bone protruding through a break in the skin Occasional loss of feeling in the foot

9. Doctor Examination Medical History and Physical Examination It is important that your doctor know the specifics of how you hurt your leg. For example, if you were in a car accident, it would help your doctor to know how fast you were going, whether you were the driver or the passenger, whether you were wearing your seatbelt, and if the airbags went off. This information will help your doctor determine how you were hurt and whether you may be hurt somewhere else. It is also important for your doctor to know if you have any other health conditions like high blood pressure, diabetes, asthma, or allergies. Your doctor will also ask you if you use tobacco products or are taking any medications.

10. After discussing your injury and medical history, your doctor will perform a careful examination. He or she will assess your overall condition and then focus on your leg. Your doctor will look for: An obvious deformity of the tibia/leg (an unusual angle, twisting, or shortening of the leg) Breaks in the skin Bruises Swelling Bony pieces that may be pushing on the skin Instability (some patients may retain a degree of stability if the fibula is not broken or if the fracture is incomplete) After the visual inspection, your doctor will feel along your tibia, leg, and foot looking for abnormalities. If you are awake and alert, your doctor will test for sensation and movement in your leg and foot.

11. Physical examination which includes checking for: Obvious deformity Skin breaks Bony protrusions under the skin Swelling Bruising Instability Sensations Muscle strength

12. Oestern and Tscherne Classification of Closed Fracture Soft Tissue Injury Grade 0 Injuries from indirect forces with negligible soft-tissue damage Grade I Superficial contusion/abrasion, simple fractures Grade II Deep abrasions, muscle/skin contusion, direct trauma, impending compartment syndrome Grade III Excessive skin contusion, crushed skin or destruction of muscle, subcutaneous degloving, acute compartment syndrome, and rupture of major blood vessel or nerve

13. Gustilo-Anderson Classification of Open Tibia Fractures Type I Limited periosteal stripping, clean wound < 1 cm   Type II Minimal periosteal stripping, wound >1 cm in length without extensive soft-tissue injury damage   Type IIIA Significant soft tissue injury (often evidenced by a segmental fracture or comminution), significant periosteal stripping, wound usually >5cm in length, no flap required.   Type IIIB Significant periosteal stripping and soft tissue injury,  flap required  due to inadequate soft tissue coverage (STSG doesn't count). Treat proximal 1/3 fxs with gastrocnemius rotation flap, middle 1/3 fxs with soleus rotation flap,  distal 1/3 fxs with free flap.    Type IIIC Significant soft tissue injury (often evidenced by a segmental fracture or comminution), vascular injury  requiring repair  to maintain limb viability   For prognostic reasons, severely comminuted, contaminated barnyard injuries, close-range shotgun/high-velocity gunshot injuries, and open fractures presenting over 24 hours from injury have all been included in the grade III group.

14. Imaging Tests X-rays.  The most common way to evaluate a fracture is with x-rays, which provide clear images of bones. X-rays can show whether the tibia is broken or intact. They can also show the type of fracture and where it is located within the tibia. X-rays are also useful for identifying the involvement of the knee or ankle joints and the presence of a fibula fracture. an X-ray to have an image of the tibia Radiographs recommended views full-length AP and lateral views of the affected tibia AP, lateral and oblique views of ipsilateral knee and ankle repeat radiographs recommended after splinting or fracture manipulation a computed tomography (CT) scan, also called a  CAT scan , which is more powerful than an X-ray and gives a 3-D image of the bone a magnetic resonance imaging ( MRI ) scan for a detailed image of the muscles, ligaments, and bones around the tibia

15. Tibia Shaft Fracture Treatment: The doctor considers several factors while planning treatment of tibial fracture. They include - Reason for your injury Severity of injury Extent of damage to soft tissue Overall health

16. Nonsurgical Treatment: Nonsurgical treatment may be recommended for the following patients: Those with closed fractures and with little displacement Those who are less active and hence in a better position to tolerate small degrees of angulation or differences in the length of a leg Those with overall health problems Most people who suffer fractures display swelling for the first few weeks. Hence, the first step may be to apply a splint for comfort and support. Once the swelling subsides, a range of treatment options may be considered.

17. Another effective nonsurgical treatment method is to immobilize the affected leg using a cast for a few weeks, as part of the initial healing process. After this period, the cast may be replaced with a functional brace, for support, until  healing  is complete. The brace may be taken off, if necessary, while taking bath or during physical therapy.

18. Surgical Treatment Surgery is recommended for the following reasons - Fracture that does not heal with non surgical methods An open fracture Fracture with many bone fragments and large degrees of displacement

19. . Intramedullary nailing  is the most popular form of surgical treatment for tibial fractures. Here a specially designed metal rod is inserted into the marrow canal of the tibial bone from the front. The rod passes across the fracture and helps to keep it in position. The intramedullary nails come in sizes and lengths to suit most tibia bones. They are screwed to the bone at both ends to keep them in place during healing. This method is not suitable for children or adolescents as there is a risk of damaging the bone’s growth plates.

20. Plates and screws  are used to treat fractures in which intramedullary nailing is not a good choice of treatment, such as fractures that extend into the knee or ankle joints. Here, the bone fragments are first repositioned into their normal alignment and, then, are held together with metal plates and special screws fixed to the outer surface of the bone. External fixation.  Here, metal pins or screws are fixed to a bar outside the skin, above and below the site of tibial fracture. The bar is a frame that stabilizes the bones and holds them in the proper position to enable healing. Although effective, implants fixed outside the body are not very popular, both with the patients and the doctors who treat them.

21. Complications: Complications of a tibia fracture may include: complications from surgery or the need for further surgeries nerve, muscle, or blood vessel damage compartment syndrome, a serious condition which there is a reduction in blood supply to the leg due to swelling a  bone infection   called osteomyelitis development of a non-union where the bone does not heal In many cases, a tibial fracture will be successfully managed without complication.

22. Mal alignment Infections Nerve and vascular injury Blood clots Nonunion in which bones fail to heal Angulation