Most tibial shaft fractures can be treated in a cast
Mid-shaft tibia fractures
- either low-energy (spiral or oblique) or high energy (transverse or comminuted).
- may be OPEN due to bone being subcutaneous.
REDUCTION (if needed) is best carried out with the patient lying or sitting with his/her lower leg hanging over the edge of a stretcher. With adequate analgesia/relaxation reduction and application of a below-knee cast is carried out. Once complete the above-knee portion can be added. A full cast can be used as the patient should be admitted for overnight observation (risk of compartment syndrome). If alignment is not perfect the cast can be wedged when dry.
Tibial plateau fractures
Divided into the types below.
Result from the femoral condyle(s) being driven into the proximal tibia often due to a valgus (types I,II,III) or varus (typeIV) force. Medial or lateral ligaments can be damaged.
Treatment depends on fracture type, amount of depression, ligament instability and patient age.
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