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Tibial and Fibular Shaft Fractures
Donna G. Blankenbaker, MD, FACR; Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Oblique: angled in single plane
              • Spiral: helical form around shaft
              • Butterfly fragment: triangular comminuted fragment of bone, usually does not involve entire circumference of shaft
              • Ring butterfly fragment: butterfly fragment, which does involve entire circumference of shaft
              • Bayonet apposition: overriding of fracture fragments
              • Shortening is correct term for decreased length, foreshortening is term used in art to describe illusory shortening due to position

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Demographics

                            • Natural History & Prognosis

                              Selected References

                              1. Raducha JE et al: Tibial shaft fractures in children and adolescents. JBJS Rev. 7(2):e4, 2019
                              2. Milenkovic S et al: External fixation of segmental tibial shaft fractures. Eur J Trauma Emerg Surg. 46(5):1123-27, 2018
                              3. Sobol GL et al: The Incidence of posterior malleolar involvement in distal spiral tibia fractures: is it higher than we think? J Orthop Trauma. 32(11):543-7, 2018
                              4. Jung KJ et al: Concomitant ankle injuries associated with tibial shaft fractures. Foot Ankle Int. 36(10): 1209-14, 2015
                              5. Gutowski C et al: Diagnosing segmental wedge fracture of the tibia before performing intramedullary nailing. Am J Orthop (Belle Mead NJ). 42(8):369-71, 2013
                              6. Bhadra AK et al: Nonunion of fibula: a systematic review. Int Orthop. 36(9):1757-65, 2012
                              7. Papakostidis C et al: Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification. Injury. 42(12):1408-15, 2011
                              8. Melvin JS et al: Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Acad Orthop Surg. 18(1):10-9, 2010
                              9. Tarkin IS et al: Soft tissue and biomechanical challenges encountered with the management of distal tibia nonunions. Orthop Clin North Am. 41(1):119-26; table of contents, 2010
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Pathology

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Definitions

                                          • Oblique: angled in single plane
                                          • Spiral: helical form around shaft
                                          • Butterfly fragment: triangular comminuted fragment of bone, usually does not involve entire circumference of shaft
                                          • Ring butterfly fragment: butterfly fragment, which does involve entire circumference of shaft
                                          • Bayonet apposition: overriding of fracture fragments
                                          • Shortening is correct term for decreased length, foreshortening is term used in art to describe illusory shortening due to position

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • CT Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Staging, Grading, & Classification

                                                      CLINICAL ISSUES

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          Selected References

                                                          1. Raducha JE et al: Tibial shaft fractures in children and adolescents. JBJS Rev. 7(2):e4, 2019
                                                          2. Milenkovic S et al: External fixation of segmental tibial shaft fractures. Eur J Trauma Emerg Surg. 46(5):1123-27, 2018
                                                          3. Sobol GL et al: The Incidence of posterior malleolar involvement in distal spiral tibia fractures: is it higher than we think? J Orthop Trauma. 32(11):543-7, 2018
                                                          4. Jung KJ et al: Concomitant ankle injuries associated with tibial shaft fractures. Foot Ankle Int. 36(10): 1209-14, 2015
                                                          5. Gutowski C et al: Diagnosing segmental wedge fracture of the tibia before performing intramedullary nailing. Am J Orthop (Belle Mead NJ). 42(8):369-71, 2013
                                                          6. Bhadra AK et al: Nonunion of fibula: a systematic review. Int Orthop. 36(9):1757-65, 2012
                                                          7. Papakostidis C et al: Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification. Injury. 42(12):1408-15, 2011
                                                          8. Melvin JS et al: Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Acad Orthop Surg. 18(1):10-9, 2010
                                                          9. Tarkin IS et al: Soft tissue and biomechanical challenges encountered with the management of distal tibia nonunions. Orthop Clin North Am. 41(1):119-26; table of contents, 2010