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Tibial/Fibular Shaft Fracture, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Fracture Description

Tibia 
  • 80% have associated fibular fractures

  • Open (24% are open) vs. closed

  • Extent of soft tissue damage

  • Gustilo–Anderson classification of open fractures:

    • Type I:

      • Woun...

Diagnosis

Signs and Symptoms

History

  • History of trauma

  • Pain is usually immediate, severe, and well localized to the fracture site.

Physical Exam

  • Visible or palpable deformity at the fracture site

  • Significan...

Treatment

Pre-Hospital

  • Look for associated injuries in high-energy mechanisms.

  • Assess for neurologic or vascular compromise.

  • Adequate immobilization is essential to prevent further injury.

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • Multiple trauma

  • High-energy mechanism

  • Soft tissue involvement

  • Risk for compartment syndrome

  • All open fractures

  • Displaced, angulated, transverse, shortened, comminuted...

Pearls and Pitfalls

  • High incidence of associated injuries in high-energy trauma:

    • Associated injuries commonly include:

      • Femoral fractures (“floating knee injury”)

      • Head trauma

      • Spine fractures

    • Deep venous thr...

Additional Reading

  • Browner  BD. Fractures of the tibial shaft. In: Skeletal Trauma. 4th ed. Philadelphia, PA: WB Saunders Co.; 2008.

  • Green  NE, Swiontkowski  MF. Fractures of the tibia and fibula. In...

Codes

ICD9

  • 823.20 Closed fracture of shaft of tibia alone

  • 823.22 Closed fracture of shaft of fibula with tibia

  • 823.32 Open fracture of shaft of fibula with tibia

  • 823.21 Closed fracture of shaft of fibula ...

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