B4. Proximal and middle shaft lower leg fractures

Page created on October 25, 2021. Last updated on October 27, 2021 at 10:51


  • Tibial fractures are some of the most frequent open fractures. They’re mostly a result of high energy trauma. Treatment is most frequently surgical. External fixation may be used temporarily in case of open fractures or polytrauma. Malunion, nonunion, compartment syndrome, neurovascular injury, and infection are relatively common complications.

Proximal and middle shaft lower leg fractures

Definition and epidemiology

Tibial fractures have the highest ratio of open to closed fractures among all fractures. Fractures of the tibia occur due to high energy trauma, low energy trauma, or repetitive use (stress fractures).

Distal tibial fractures are considered ankle fractures and are covered in topic B6.


Tibial fractures are classified according to the AO/ASIF classification.

Clinical features

Typical features of fractures, including pain, inability to bear weight, swelling, haematoma. Open or complex injuries may cause compartment syndrome, neurovascular injuries, and infection.

Diagnosis and evaluation

Plain x-ray is usually sufficient.


Tibial fractures are treated conservatively or with surgery.

Conservative treatment is indicated for isolated tibial fractures, low energy fractures, or when surgery is contraindicated. Conservative treatment involves skeletal traction, cast, or brace.

Surgical treatment may involve plate fixation (LISS, LCP) or intramedullary nailing. External fixation may be used for open fractures or polytrauma. Open fractures and polytrauma may also require irrigation, debridement, and antibiotics.


  • Malunion or nonunion (relatively common)
  • Compartment syndrome
  • Neurovascular injury
  • Infection

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