The tibia, the larger of the two lower leg bones, can be broken in three areas: the tibial plateau, near the knee; the shaft; and tibial plafond, near the ankle. Fractures in each region have their own distinct concerns. Tibial plateau fractures are peri-articular (joint-adjacent) fractures, and thus may lead to post-traumatic arthritis. Shaft fractures are associated with acute compartment syndrome and, owing to their subcutaneous location, have greater difficulty healing. They are also associated with compartment syndrome. Tibial plafond fractures [covered in the ankle fracture chapter] are also peri-articular injuries, and they too can be complicated by post-traumatic arthritis.
Most tibial fractures are best managed with surgical fixation. Stabilizing the tibia non-operatively requires a long-leg cast, one that crosses the knee and ankle joints; surgical treatment thereby liberates the knee and ankle. Permitting motion of those joints helps avoid the stiffness that cast immobilization might otherwise induce.
The much smaller lower leg bone, the fibula, is usually fractured when the tibia is broken. The injury pattern is commonly called a “tib-fib” fracture. Unlike the case of a “both bones” fracture of the forearm, where both the radius and ulna must be treated to restore rotation function, specific treatment of the fibular shaft is usually not required. That is because the fibula supports only approximately 10% of the bodyweight and the tibial shaft can adapt to greater loads if needed. Fibular fractures are problematic usually only to the extent they involve the knee or ankle joints, or a fracture fragment injures the nearby common peroneal nerve.
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