![]() The goals of treatment are pain-free function of the lower limb. Types 2 and 3 injuries almost always are managed operatively, with poorer outcomes related to the severity of soft tissue injury and fracture comminution. Finally, Type 3 injuries include extensive skin and muscle damage, often caused by a crush injury, a severe fracture pattern, and compartment syndrome. High-energy fractures and deep abrasions with associated swelling comprise Type 2 injuries, often with impending compartment syndrome. Type 1 represents mild to moderately severe fractures with superficial abrasions or contusions. These fractures can be managed operatively or closed depending on the severity of displacement and angulation and convey a good prognosis. A Type 0 injury usually results from an indirect, torsional force resulting in a simple fracture pattern and minimal soft tissue injury. Tscherne and Gotzen developed a classification system to evaluate soft tissue injury in closed tibial shaft fractures. This classification is not frequently used clinically, but helps standardize fracture descriptions for research purposes. The AO/OTA classification designates the region of the bone by a letter (A, B, C) for the severity of the fracture, and a number (1, 2, 3) indicating increasing complexity and comminution. Displacement and angulation play a role when determining treatment. Management and prognosis of tibial shaft fractures are influenced by their location in the bone (proximal, middle, or distal third) and their orientation (transverse, oblique, spiral, or comminuted). Plain film radiography is often sufficient to show the injury and delineate the best treatment option for the patient. Rather, the diagnostic challenges are to exclude an open fracture when there are associated breaks in the skin, an incipient compartment syndrome, or an associated injury to the ligaments of the knee and ankle. In addition, bleeding or swelling in the soft tissues can increase the interstitial pressure and block blood flow, leading to ischemic necrosis of muscle or nerve, ie, compartment syndrome.īecause the tibia is subcutaneous, the diagnosis of a fracture is usually obvious. Because the bone is subcutaneous, a closed fracture can easily become an open fracture, as the bone spikes through the skin. Īttention must be paid to the soft tissue. Although these mechanisms usually cause a spiral, nondisplaced fracture pattern with minimal soft tissue damage, more complicated patterns can occur in patients with osteoporotic bone. Elderly patients often sustain indirect, torsional, low-energy injuries. Sports-related injuries usually result from a bending mechanism, producing a spiral or oblique fracture, and occasionally a butterfly fragment. These injuries often cause a displaced, comminuted fracture pattern often accompanied by substantial soft tissue damage. The majority of tibial shaft fractures in younger patients result from a direct, high-energy mechanism of injury.
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