Orthopaedics: Tibia

Tibial Plateau Fracture

 Mechanism

• axial loading (e.g. fall from height)
• femoral condyles are driven into the proximal tibia
• can result from minor trauma in osteoporotic

 Clinical Features

• lateral fractures more common than medial

 Classification

• Schatzker classification

 Investigations

• x-rays: AP, lateral, skyline

 Treatment

• 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

 Mechanism

• numerous, including MVA, falls, sporting injuries

 Clinical Features

• open vs. closed
• amount of displacement
• neurovascular status
• most commonly fractured long bone
• most common open fracture

Investigations

• x-rays: AP, lateral. skyline

Treatment

• closed
• minimally displaced: straight leg cast x 4-6 weeks with early weight-bearing
• displaced: ORIF with reamed IM nail. plate and screws, or external factor
• 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