Tibia Fibula Fracture

TIBIA/FIBULA SHAFT FRACTURES
Descriptive Classification
Open vs closed
Location : proximal, middle, distal third
Configuration : transverse, oblique, spiral
Angulation : varus/valgus, anterior/posterior
Rotation
Shortening
Displacement : degree of cortical contact
Comminution : butterfly vs multiple fragments
Mechanism of Injury
Direct : high-energy trauma, causing, comminuted fractures
Indirect : twisting with foot fixed, fall from low heights, causing, minimally
displaced fractures
Examination
Usually obvious haematoma and deformity at fracture site.
Exclude acute compartment syndrome and neurovascular injuries
X-rays
AP and lateral views of tibia/fibula
AP and lateral views of the knee and ankle if appropriate
Management
Minimally displaced fractures :
Consider ORIF vs conservative treatment with casting
If conservative treatment : Long backslab with 10 knee flexion. NWB crutches.
Analgesics. TCU Ortho SOC 1/52
If ORIF : Long backslab. Analgesics. Admit to Ortho Dept
(Discuss with Ortho Surgeon as indications fir surgery is not only dependent on patient preference)
Displaced fractures:
Long backslab. Analgesics. Admit to Ortho Dept
Open Fractures:
Cover the wound with clean gauze
Long backslab
IV cefazolin 1g for wounds < 10cm and mild to moderate contamination IV cafazolin 1g and IV gentamicin 80mg for heavily contaminated wound or those with exposed bones, open flaps. Admit to Ortho Dept for surgery ISOLATED FIBULA FRACTURES
Mechanism of Injury
Direct trauma to the fibula
Examination
Localised tenderness and haematoma over the fibula fracture site
Check the ankle for tenderness to exclude ankle injury
Perform tests such as ankle dorsifleaion and external rotation. Determine mechanism of injury.
X-rays
AP and lateral views of the tibia/fibula
AP and lateral views of the ankle if indicated
Management
Analgesics. If true transverse fracture, need splint.
TCU Ortho SOC 1/52