- Location of the fracture,
- Displacement of the fracture,
- Alignment of the fracture,
- Associated injuries,
- Soft-tissue condition around the fracture, and
- Patient general health.
- Tibial Shaft Fractures
Tibial shaft fractures are the most common type of tibia fracture and occur between the knee and ankle joints. Most tibial shaft fractures can be treated in a long leg cast. However, some fractures have too much displacement or angulation and may require surgery to realign and secure the bones.
- Tibial Plateau Fractures
Tibial plateau fractures occur just below the knee joint. These fractures require consideration of the knee joint and its cartilage surface. Tibial plateau fractures can lead to a chance of developing knee arthritis.
- Tibial Plafond Fractures
Tibial plafond fractures occur at the bottom of the shin bone around the ankle joint. These fractures also require special consideration because of the ankle cartilage surface. Tibial plafond fractures are also concerning because of potential damage to surrounding soft-tissues.
Tibial Shaft FracturesTibial shaft fractures are common injuries that can occur after falls, car accidents, sports injuries, and other activities. A tibial shaft fracture can be treated by several methods depending on the type of fracture and alignment of the bone. The most common treatments include:
A cast is appropriate for tibial shaft fractures that are not badly displaced and are well aligned. Patients need to be in a cast that goes above the knee and below the ankle (a long leg cast). The advantage of casting is that these fractures tend to heal well and casting avoids the potential risks of surgery such as infection. Patients with casts must be monitored to ensure adequate healing of the tibia and to ensure the bones maintain their alignment.
- Intrameduallary (IM) Rodding
Intrameduallary rodding is a procedure to place a medal rod down the center of the tibia to hold the alignment of the bone. A tibial rodding is a surgical procedure that lasts about an hour and half and is usually done under general anesthesia. Patients will have an incision over the knee joint, and small incisions below the knee and above the ankle. In addition, some fractures may require an incision near the fracture to realign the bones.
IM rods are secured within the bone by screws both above and below the fracture. The metal screws and the rod can be removed if they cause problems, but can also be left in place for life. Tibial rodding provides excellent fixation and alignment of the bones. The most common risk of surgery is knee pain, and the most concerning complication is infection. Infection of the rod may require removal of the rod in order to cure the infection.
- Plates and Screws
Plates and screws are less commonly used, but are helpful in some fracture types, especially those closer to the knee or ankle joints (see information on tibial plateau and tibial plafond fractures). Most surgeons choose an IM rod for tibial shaft fractures unless the fracture is too close to the joint to allow for placement of the IM rod. In these fractures close to the joint surface, a plate and screws may be the ideal method of fixation.
- External Fixator
An external fixator may also be helpful in some particular fracture types. External fixators tend to be used in more severe fractures, especially open fractures with associated lacerations and soft-tissue damage. In these cases, the placement of IM rods or plates may not be possible because of soft-tissue injury. When there is significant soft-tissue injury, the external fixator may provide excellent immobilization while allowing monitoring and treatment of the surrounding soft-tissues.
Bono CM, et al. "Nonarticular Proximal Tibia Fractures: Treatment Options and Decision Making" J Am Acad Orthop Surg May/June 2001; 9:176-186.