Tibial shaft fractures are one of the most difficult long bone fractures to treat for two reasons. First it takes a significant amount of energy to fracture the tibia. Second, and more important is the lack of any soft tissue (muscle) around one third of the bone (anterior-medially) which in addition to the lack of a soft tissue envelope in which the fracture can heal makes for difficulty in wound closure in open fractures.
The usual rules that apply to evaluating other fractures apply to tibia fractures as well. That includes:
- Mechanism of injury
- Other injuries (e.g. rule out posterior malleolar fractures in fractures of distal third of the shaft)
- Open or closed
- Neurovascular status
- Patient’s overall health and social history
There are a variety of ways of treating tibial shaft fractures depending on the above. These include casting, intramedullary rodding, plates, axial and ring external fixators. Each of the above may have to be modified or changed depending on soft tissue coverage. For example a Grade II open fracture may initially be treated with a simple axial fixator and irrigation and debridement. Several days later after making sure there is minimal risk of infection the fixator can be removed and an intramedullary rod inserted.
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Orthopedic Surgery for AP students, an Introduction 