Tibio-Fibular Fractures - Classification and Treatment Modalities

Introduction

The tibia is more significant and present on the medial side, whereas the fibula is more petite and located laterally. The tibia is thicker than the fibula and is the prominent weight-bearing bone. The fibula supports the tibia by stabilizing the ankle and lower leg muscles. Fractures usually occur in the tibia or fibula when the person exerts excess pressure on the legs or due to a sudden blow.

What Are the Characteristic Features of the Diagnosis and Treatment of the Fractures of the Tibia and Fibula?

• Tibia fractures are the most typical lower leg fractures in children.

• 10 to 15 percent of fractures in children involve the tibia and fibula.

• Such fractures are diagnosed by physical examination and medical imaging such as X-rays.

• Treatment may range from casting and immobilization to surgery, depending on the type and severity of the injury.

What Are the Different Types of Tibia and Fibula Fractures According to Their Origin?

Tibia and fibula fractures can be classified into two types;

1. Low Energy: This type of fracture is caused by twisting. Falls from standing height may also result in such fractures.

2. High Energy: Such fractures are caused by high-impact events, such as traffic accidents or falling from great heights.

How Are Tibia and Fibula Fractures Classified According to the Location of the Fracture?

The treatment of tibio-fibular fractures depends upon its types. According to the location of the fracture, tibia and fibula fractures may be classified as follows;

• Proximal Fractures: Proximal fractures, also called tibial plateau fractures, occur in the knee end of the tibial bone. The commonly occurring types of proximal fractures include;

  • Proximal Epiphyseal Fracture: When the top portion of the bone, also known as the epiphysis and the growth plate, is affected, it is termed an epiphyseal fracture. A heavy impact force usually causes it. Such fractures need to be appropriately corrected as they may affect future growth and cause deformities if left malaligned. The treatment involves a nonsurgical setting of the bone with surgical insertion of pins or screws to secure the bone while it heals.

  • Cozen's Fracture: When the neck of the bone, also known as the metaphysis, is affected, it is Cozen's fracture. Children between two to eight years are most prone to suffer from this fracture type. When an impact occurs on the side of the knee while the leg is extended, such types of fractures can occur. Surgery is not usually done, and a cast is used to immobilize the set bone for about six weeks. Valgus deformity or knock knee is one of the principal potential complications after this fracture.

• Shaft Fractures: When the middle or shaft of the bone, also known as diaphysis, is fractured, it is termed a shaft fracture. These may be of three types enlisted as follows;

  • Nondisplaced Fractures: It is termed a nondisplaced fracture when a fracture does not cause the bone to be misaligned. It is usually seen in children under age four and can be caused by a mildly traumatic event such as a fall while standing or a twisting injury resulting in the breaking of the bone. A limp is the first sign of such a fracture. Clinical examination usually reveals tenderness or swelling at the lower part of the tibia or fibula. The treatment involves immobilizing the set bone in a short- or long-leg plaster cast. The duration of immobilization is three to four weeks for toddlers and six to ten weeks for older individuals.

  • Displaced Fracture, Noncomminuted Type: The broken bones have no more than two pieces in this type of fracture. Thus, they are termed as noncomminuted. But the bones are misaligned. This type of fracture is isolated, leaving the other bone unaffected. It is the most common type of shaft or diaphysis fracture and is usually due to a rotational or twisting force while playing sports injury or a fall from a certain height. Treatment modalities include setting the bone nonsurgically and immobilization using a long-leg cast with the knee bent. Unstable fractures, however, may require surgery and postoperative rehabilitation.

  • Displaced Fracture, Comminuted Type: A fracture is said to be comminuted where the bones are broken in more than two fragments and are misaligned. High-impact traumas, such as vehicular accidents, can cause such fractures. The treatment modalities include setting the bone nonsurgically and a long-leg cast worn to immobilize the set bone for four to eight weeks. Some cases may require a short-leg weight-bearing cast. Unstable fractures may require surgical intervention and postoperative therapy.

• Distal Fractures - The fractures that occur at the ankle end of the tibia and fibula are termed distal fractures. They are also called plafond fractures. The distal tibial metaphyseal fracture is most typically seen in children, where the bone fractures just above or below the widest point. These fractures are usually characterized by either transverse (across) or oblique (diagonal) breaks in the bone, which are seen clearly in an X-ray as fracture lines. However, these fractures usually have exceptional healing without any surgical procedure or a cast to immobilize the set bones. However, there is a potential risk of full or partial early closure of the growth plate leading to growth arrest in the form of leg length discrepancy or other deformities.

What Are the Treatment Modalities for the Fractures of the Tibia and Fibula?

Standard bone fracture treatment procedures suffice to treat tibiofibular fractures. The treatment modality depends upon the severity of the injury, the extent of the damage, and the child's age suffering from it. The following approaches may be used for the treatments either as a standalone procedure or in combination with two or more modalities;

• Closed Reduction and Immobilization: This is the nonsurgical setting of the bone and its consequent immobilization in a long-leg or a short-leg cast for four to ten weeks depending upon the patient's age. This procedure is mainly done to allow healing and reduction of pain. In addition immobilization helps stabilize the joints after realignment.

• Open Reduction: It is a surgical procedure typically performed on open fractures where the bone has punctured the skin and muscle and extends outside the body cavity. The method usually includes either internal or external fixation, followed by immobilization for a definite period depending upon the child's age.

• Internal Fixation: This surgical procedure uses pins, plates, and screws to hold the bone in place. This procedure aims to connect the bones physically so that the healing does not occur in an abnormal manner. Hence, this procedure ensures that the bones remain in a proper position during and after the healing.

• External Fixation: It is a surgical procedure similar to internal fixation, where the pins and screws are applied from the outside. The primary aim of this procedure is to maintain the alignment and length of the fractures. In addition the attached devices can be adjusted externally to ensure proper healing.

• Percutaneous Pinning: This procedure involves the fixation of the broken fragments using wires, which are removed once the fracture has healed.

• Medications: Pain management and antibiotic pharmacotherapy are necessary to control the pain and prevent infections in the affected area.

Conclusion

The tibia and fibula are the long bones found beneath the femur. The tibia is larger and present on the medial side, whereas the fibula is smaller and located laterally. The patient should immediately consult the doctor to know more about the management of tibio-fibular fractures.