Tibia fracture

Case
A 23-year-old recreational player presented with lower leg pain after a heavy tackle. He described being kicked in the lower leg and experiencing immediate pain. He was however able to get up and limp off. He was seen at a local emergency department where he was diagnosed with a contusion. Three weeks later he re-presented for review as he was still unable to walk without pain.

On examination he walked with an antalgic gait. He had localised tenderness over the mid-third of his tibia and was unable to hop.

Findings
There is a fracture at the junction of the middle and distal thirds of the tibia. This has a transverse orientation.

Discussion
Given the delayed diagnosis, the stable fracture configuration and the patient’s reducing level of pain the decision was made to treat this patient non-surgically. He spent a total of six weeks in a walking cast. At this point he used a walking (removable) boot for comfort only for a further four weeks. He followed a progressive return to training programme and returned to football six months following his injury.

The management (and prognosis) of tibial shaft fractures is influenced by their location in the bone (proximal, middle, or distal third) and their orientation (transverse, oblique, spiral, or comminuted). Displacement and angulation are also considerations. The goal of treatment is to establish bony union and to preserve the normal length, alignment, and rotation of the bone. Fractures can be treated surgically (most often with intramedullary nailing or external fixation) or with closed treatment (usually cast immobilisation followed by functional bracing).

Non-operative management may be considered when there is minimal soft tissue injury and when there is no substantial displacement or deformity of the fracture. The upper limits of tolerable deformity have been reported to be 5° angulation in the coronal plane, 10° angulation in the sagittal plane, 5° rotational deformity and shortening less than 1 cm. A transverse fracture pattern, as seen in this case, is generally stable and can be effectively treated without surgery.

In most cases intramedullary nailing has become the standard for treating displaced tibial shaft fractures. This technique generally results in quicker union, lower rates of malunion, and a faster return to work and sport.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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