TIBIAL FRACTURE SCHATZKER I

An investigation into Tibial Fractures and the treatments used

Abstract

Arthroscopy is a valuable tool for the assessment of tibial plateau fractures and is the treatment of choice for associated intra-articular pathology. In addition, (all)-arthroscopic reduction and internal fixation (ARIF) is recommended for type III fractures and is a consideration for types I, II, and IV. Published outcome studies of ARIF of tibial plateau fractures describe results that appear to equal outcomes of open reduction and internal fixation, but these studies suffer from susceptibility bias.Table of Contents

Introduction5

Definition of Tibial Fracture5

Description of Tibial Fracture5

Literature Review8

Methods8

Surgical Technique21

Clinical and Radiologic Assessment23

Statistical Methods24

Clinical Assessment24

Discussion26

Anatomy26

Epidemiology27

Mechanisms of injury27

Evaluation27

Imaging28

Classification30

Associated injuries31

The role of arthroscopy33

Arthroscopic technique36

Clinical outcome studies39

Summary42

References44

Appendix52

Table 1.52

Table 2.54

Table 3.57

Table 4.58

Table 5.60

Introduction

Definition of Tibial Fracture

The tibia is the second longest bone of the skeleton, located at the medial side of the leg. It articulates with the fibula laterally, the talus distally, and the femur proximally, forming part of the knee joint. It attaches to the ligament of the patella and to various muscles, including the popliteus and the flexor digitorum longus. It also is called the shin bone.

Description of Tibial Fracture

The tibia is fractured more frequently than any other long bone. Fractures of the tibia and fibula can occur anywhere along the length of the bones. Fractures may be open (compound) or closed (simple), displaced or undisplaced, angulated or not angulated, stable or unstable.

Fractures of the tibia can be associated with acute compartment syndrome. A closed fracture is a fracture in which the skin of the lower leg is not broken. An open fracture is classified according to the degree of skin disruption, and whether or not there is significant soft tissue loss, blood vessel disruption, or gross contamination.

Severe open fractures of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization is by external fixation but the advent of small diameter locking intramedullary nails has introduced a new option.

Stress fracture of the tibia occurs in individuals who subject their extremities to repeated trauma. They can arise in otherwise healthy bone that is subjected to excessive loads (as in the marathon runner) or in abnormal bone that is subjected to minor loads (as in osteoporosis). These fractures may be anywhere along the tibial shaft and tend to be either transverse or oblique in orientation.

Fractures of the tibial spine or intercondylar eminence result from violent twisting, abduction-adduction injuries, or direct contact with the adjacent femoral condyle. Either the anterior tibial spine or, less commonly, the posterior tibial spine is affected, and rarely both are involved.

Boot-top Fractures And Skiing. You can break almost any bone of the body in a high-impact injury, but the bones most likely to break are the tibia and fibula in the leg - the so-called boot-top fracture. If the boot is rigidly fixed to the ski and the binding does not release, both bones will snap just above the boot-top if enough force is ...