Fracture of Tibia & Fibula

Fracture of Tibia & Fibula 

 

Content:

1.    Definition.

2.    Types.

3.    Site of fracture.

4.    Cause.

5.    Mechanism.

6.    Pathophysiology.

7.    Complications.

8.    Treatment & Nursing intervention.

 

Definition:

 

The tibia or shinbone is the most commonly fractured long bone in the body. A tibia shaft fracture occurs along the length of the bone, below the knee and above the ankle. In many Tibia fractures, the smaller bone in the lower leg (fibula) is broken as well.

 

Types of Tibia & Fibula Fracture:

 

The most types of tibia shaft fracture include:

1.    Transverse fracture: It is the type of fracture, the break is a straight horizontal line going across the tibia shaft.

2.    Oblique fracture: It is the type of fracture, has an angle lined across the shaft.  

Site of Fracture:

 

1.    Condyle of the tibia.

2.    Neck of the fibula.

3.    Shaft of the tibia & fibula.

4.    Medial lateral malleolus or both.

5.    Medial or anterior margin of the lower end of the tibia.

6.    Posterior margin of the lower end of the tibia.  

Causes of Tibia Fibula Fracture:

 

1.    Direct trauma by direct hit.

2.    Indirect trauma:

•        Rod traffic accident.

•        Fall from height.

•        During play.

•        Twisting force.

 

Mechanism:

 

Mechanism of injury for tibia fibula fracture can be divided into 2 category:

Low energy injury such as ground level falls and athletic injury.

High level injury such as motor vehicle injuries, pedestrians struck by motor vehicle and gunshot wounds. 

Pathophysiology:

 

A lover leg fracture usually happens due to a “high energy” force from falls trauma or a direct below. This are often cause by motor vehicle crashes or by direct contract or sudden twisting in sports. Whenever there is a trauma to the leg, the impact spreads between the tibia and fibula. 

Complications:

 

1.    Mal union.

2.    Nonunion.

3.    Delayed union.

4.    Stiffness of the knee and ankle joint.

5.    Osteoarthritis.

6.    Infection.

7.    Shortening.

8.    Fat-embolism.

9.    Compartmental syndromes.

10.Re-fracture. 

Treatment & Nursing intervention:

 

A.    General:

1.    History of the trauma is to be taken.

2.    Examine of the patient thoroughly – Check and record TPR and BP.

3.    Skin examination if any external injury.

4.    X-ray to confirm diagnosis.

5.    I/V fluid is to be given if hemorrhage is present.

6.    Blood transfusion is to be given if excessive bleeding.

7.    Steroid is to be given if necessary.

8.    Surgical toileting is to be done in case of open fracture.

9.    Immobilize the affected limb by plaster cast.

10.Analgesic is to be given to relieve pain.

11.Sedative is to be given to relieve pain.

12.Antibiotic is to be given to prevent infection like –

·       Coxacillin, Ceftriaxone.

·       Immunization is to be done in case of external injury.

·       If the patient is not immunized then inj -TIG 250 IU I/M is to be given if not available then Inj ATS 1500 IU I/M is to be given after skin test.

·       Inj TT 1 ample I/M is to be given and another after one month.

·       If the patient is immunized only TT 1 ample I/M is to be given (buster dose).

B.    Specific :

1.    If displaced fracture then immobilize the affected part by plaster cast.

2.    If the fracture is displaced then close reduction is done under G/A and immobilize by plaster cast

3.    When Close reduction is failed then open reduction and external fixation under G/A by plate and Screw.