Tibial and fibular fractures

　　Tibial and fibular fractures are caused by direct and indirect violence. Direct violence is often seen in injuries caused by compression, collision, or striking, with fracture lines being transverse or comminuted. Sometimes both lower legs are fractured on the same plane, with severe soft tissue damage often leading to open fractures. Indirect violence is often seen in fractures caused by falling from a height, twisted injuries during running and jumping, or slipping, with fracture lines often being oblique or spiral, and the tibia and fibula not necessarily fractured on the same plane.

　　Tibial and fibular fractures are prone to delayed healing or non-healing, especially unstable fractures that are easy to dislocate. Local external fixation often fails, and the repositioning is not ideal due to the change in force lines, which can cause walking pain and traumatic arthritis.

　　In traumatic tibial and fibular fractures, it is common to have concurrent injuries to major blood vessels, as these injuries are often caused by significant violence, leading to severe conditions. They often also involve injuries to other parts of the body and internal organs. After tibial and fibular fractures with vascular injuries, the muscle-rich calf muscle group is easily affected due to the sensitivity of skeletal muscles to ischemia. It is generally believed that limb muscle tissue can undergo degeneration and necrosis after 6 to 8 hours of ischemia. If there is also damage to the soft tissue itself, the safe ischemic tolerance time is even shorter. Moreover, severe soft tissue injuries and postoperative wound infections can greatly increase the risk of amputation due to sepsis.

　　After tibial and fibular fractures, local pain, swelling, and significant deformity are common, showing angular and overlapping displacement. Attention should be paid to whether there is injury to the common peroneal nerve, anterior and posterior tibial arteries, and whether the tension in the anterior tibial and gastrocnemius muscle areas is increased. Often, the complications caused by the fracture are more serious than the consequences produced by the fracture itself.

　　Since the tibia and fibula are superficially located, the diagnosis is generally not difficult, and it is often possible to palpate the displaced bone ends locally in the area of pain and swelling. It is important to timely discover the injury of the anterior and posterior tibial arteries and the common peroneal nerve in conjunction with the fracture. During the examination, the palpation of the dorsalis pedis artery pulse, foot sensation, whether the ankle joint and great toe can be dorsiflexed, should be recorded as routine. For patients with severe local injuries such as crush injuries, open fractures, and those who have had a relatively long time of tourniquet application and tight bandaging, it is particularly important to observe whether there is progressive swelling in the injured limb, especially in areas rich in muscle. If there are signs such as skin tension, luster, coldness, blisters, hardening of muscles, palpation of the dorsalis pedis artery cannot be felt, limb color cyanosis or pallor, it is the manifestation of fascial compartment syndrome. Emergency treatment should be given in a timely manner.

　　It should be prevented that direct or indirect violence can reduce the incidence rate. If a fracture occurs, it should actively prevent different complications for different fracture sites, prevent ischemia, gangrene, and affect function.

　　After the patient's fracture, in order to recover the weight-bearing function of the lower leg as soon as possible, it is necessary to completely correct the angular deformity and rotational displacement of the fracture ends, as well as the shortening of the limb, to avoid affecting the weight-bearing function of the knee and ankle joints. After fixation, immediately guide them to perform the activities of ankle joint dorsiflexion and quadriceps muscle contraction exercises. For stable fractures, after two weeks of fixation, under the guidance of a doctor, they can perform leg lifting and knee flexion activities. After three weeks, under the continued fixation of the splint, they can walk on crutches without bearing weight. In the later stage, they can perform kneading and stretching exercises and pedaling activities.

　　The auxiliary examination methods for tibial and fibular fractures mostly adopt X-ray examination. The plain film shows localized bone fissure breakage on the tibia and fibula, discontinuity of bone cortex with grooves, increased bone density and thickened and hardened periosteum are basically present in all cases. The trabeculae are coarse and disorderly arranged, and incomplete fracture lines can be seen. In severe cases, there may be skeletal deformation and injury to the surrounding soft tissues.

　　It is necessary to perform vascular Doppler ultrasound examination in cases where there is a suspicion of arterial injury. Because Doppler ultrasound vascular examination is a non-invasive examination method that can be performed at the bedside, it is convenient and quick, and can clearly determine the blood flow speed and direction in various parts of the blood vessels. It can have a general understanding of the blood supply range of the limbs and the condition of vascular injury, which is of great significance for the timely formulation of emergency surgical plans.

　　DSA examination can be performed if the diagnosis of the patient is still unclear. However, the clinical application of DSA examination still has many limitations, such as being an invasive examination method, requiring repeated movement of patients, being inconvenient and dangerous for patients with multiple injuries, time-consuming, and possibly delaying the opportunity for treatment.

　　Patients with tibiofibular fractures should avoid blindly supplementing calcium. Calcium is an important raw material for bone formation. Some people think that supplementing more calcium after a fracture can accelerate the healing of the broken bone. However, scientific research has found that increasing the intake of calcium does not accelerate the healing of the broken bone, and for patients with fractures who have been bedridden for a long time, there is a potential risk of increased blood calcium and decreased blood phosphorus. This is due to the fact that the long-term bedridden condition, on the one hand, inhibits the absorption and utilization of calcium, and on the other hand, the reabsorption of calcium by the renal tubules increases.

　　Therefore, for patients with fractures, there is no lack of calcium in the body. As long as the functional exercise is strengthened and the activity is started as soon as possible according to the condition and the doctor's instructions, it can promote the absorption and utilization of calcium by the bone, accelerate the healing of the broken bone.

　　Stable tibiofibular fractures can consider conservative treatment, the specific situation is as follows:

　　1. Fractures without Displacement:It can be fixed with a cast or small splint.

　　2. Fractures with Displacement:Manual reduction, fixation with a cast or small splint. During the fixation period, attention should be paid to the tightness of the cast and splint, and X-ray examination should be performed regularly. If displacement is found, it should be adjusted at any time, or the cast should be refixed. It can be supported by crutches and bear partial weight after six to eight weeks.

　　3. Simple Fracture of the Tibia:Due to the support of the intact right fibula, there is usually no significant displacement. After being immobilized with a cast for six to eight weeks, it can be supported by crutches and bear partial weight.

　　4. Simple Fracture of the Fibula:If there is no injury to the superior and inferior tibiofibular syndesmosis, there is no need for special treatment. To reduce pain when walking on the ground, the leg is immobilized with a cast for three to four weeks.