Fibula fracture and tibia fracture: description
A tibia fracture occurs most often near the ankle joint because the bone has the smallest diameter there.
AO classification
Tibia and fibula fractures are classified into different fracture types according to the AO classification (Arbeitsgemeinschaft für Osteosynthesefragen) depending on the type and location of the fracture:
- Type A: only one bone fracture line, two bone fracture pieces
- Type B: wedge-shaped bone fracture line, three bone fracture pieces
- Type C: comminuted fracture with three or more bone fragments
Fibula fracture and tibia fracture: symptoms
A tibia or fibula fracture can be open or closed. In an open fracture, the skin and soft tissues are injured so that the fracture ends are visible. An open tibial fracture occurs particularly often because the front edge of the tibia is surrounded by only a small amount of soft tissue. There is always a high risk of wound infection, because bacteria can easily penetrate via the open wound.
Symptoms are rare in an isolated fibula fracture. The fracture can often be overlooked because the tibia is the weight-bearing bone, and patients can often still walk normally despite the fractured fibula.
In a Maisonneuve fracture, where the fibula is broken high up and the medial malleolus is broken, symptoms usually occur only at the ankle.
Fibula fracture and tibia fracture: causes and risk factors
Direct trauma usually requires greater force. Such a fracture occurs in traffic accidents, for example, when a pedestrian is hit by a car, or in sports, for example, when a soccer player kicks the leg of a teammate. This often results in additional soft tissue damage.
An isolated fibula fracture occurs when a direct force is applied to the outer side of the lower leg or as a twisting trauma.
Fibula fracture and tibia fracture: examinations and diagnosis.
A doctor of orthopedics and trauma surgery is the right contact person for the diagnosis and treatment of tibia and fibula fractures. He or she will first ask you about exactly how the accident happened and about your medical history (medical history). Questions the doctor might ask include:
- Can you describe exactly how the accident happened?
- Are you in pain?
- Can you put weight on your leg?
- Can you move your foot or bend your knee?
The doctor will then examine your leg closely, looking for any accompanying injuries. When examining the lower leg, an audible and palpable crunch (crepitation) can be a sure indication of a lower leg fracture. Furthermore, the physician will check peripheral pulses, sensibility on the foot, and motor function of the foot muscles.
Fibula fracture and tibia fracture: imaging
If the pulse can no longer be felt or if there is a visible circulatory disorder, a special ultrasound examination (Doppler sonography) is performed immediately. If the examination does not reveal any clear findings, a vascular X-ray (angiography) may be of further help.
Fibula fracture and tibia fracture: treatment
Depending on the type of fracture, a fibula fracture and tibia fracture are treated conservatively or surgically.
Tibia and fibula fracture: Conservative treatment
Until the swelling has subsided, the leg is immobilized in a split cast. After that, the cast can be circulated (closed). It must be worn for about two to four weeks. After that, the patient is given a walking cast for four weeks or a Sarmiento cast, which can also be used to bend the knee.
Tibia and fibula fracture: surgery
Surgery is always performed when there is an open fracture, displaced fracture, comminuted fracture, fracture with vascular and nerve injury, or impending or existing compartment syndrome.
In comminuted or defect fractures with significant soft tissue damage, the lower leg is first stabilized externally with an external fixator. This is often done in multiply injured (polytraumatized) patients until definitive surgical treatment is possible.
Implanted material (such as plates, intramedullary nails) is later surgically removed again – after twelve months at the earliest.
Fibula fracture and tibia fracture: course of disease and prognosis
The duration and course of the healing process vary and depend largely on the accompanying soft tissue injuries. If the soft tissues are intact, the healing process is significantly better. In contrast, fractures with soft tissue injuries and defect fractures are often associated with complications.
A number of complications can occur with a fibula and tibia fracture. For example, vessels and nerves may also be damaged. If the bone heals with a delay, pseudoarthrosis can develop. If a fracture does not heal in the correct position, this can lead to an axial rotation defect. Other possible complications of a fibula and tibia fracture include infection and wound healing problems.
