Tibial Head Fracture

What Is a Tibial Head Fracture?

The tibia (shinbone) is largely responsible for the stability of the lower leg and can fracture at various points but also in combination with the fibula or in isolation. A tibial head fracture occurs when the tibia is fractured near the knee joint. Tibial head fractures can be clinically classified into specific fracture types. The determining factors are the severity of the fracture on the one hand and whether the knee joint has been affected by the injury on the other. This classification is essential for choosing the right therapy.

What Are the Causes of a Tibial Head Fracture?

Traumatic events usually lead to fractures of the tibial head. Fractures in young patients, especially males, are often a result of traffic accidents or sports injuries. Older patients suffer such fractures more frequently as a result of falls. Here, women are affected to a greater extent than men.

Symptoms and Diagnosis

Patients with tibial plateau fractures primarily complain of severe pain that worsens with movement. In addition, swelling, bruising, and palpable or even visible deformities occur in the course of the fracture. Another fracture sign is crepitation, as the bone parts rubbing against each other can cause a creaking sound. Soft tissue damage, particularly to the knee joint, such as tears of ligamentous structures or menisci, is not uncommon and can additionally cause pain, restricted movement, or specific signs such as joint effusions. Ultimately, patients with such fractures generally present with an inability to walk or stand.

A tibial head fracture is usually diagnosed in the emergency department. First, a comprehensive medical history is taken to determine the exact history of the accident. This is followed by a physical examination of the knee joint and a check of the intact sensitivity, circulation, and motor function of the affected leg. Subsequently, an X-ray diagnosis of the knee joint is performed. In addition, a CT scan is initiated if the fracture requires surgery. Further imaging procedures depend on possible additional injuries such as soft tissue damage or circulatory problems and include ultrasound or MRI examinations or specimen collection.

How Is a Tibial Head Fracture Treated?

Basically, the fracture can be treated conservatively or surgically. The aim of each treatment is to reduce pain, restore functional mobility and load-bearing capacity, and achieve a correct axial and joint position while immobilizing the patient as briefly as possible.

Purely conservative treatments are carried out if individual patient factors speak against surgery, such as the general state of health, expected wound healing problems, or certain concomitant diseases.

On the other hand, the tibial head fracture may meet certain requirements for promising a good chance of healing even without surgery. Simple, stable fractures without the involvement of the knee joint and without significant soft tissue damage usually have a good chance of successful conservative treatment.

Initially, thrombosis prophylaxis is initiated, and both the upper and lower leg are immobilized with a split plaster splint so that no tissue damage occurs in the event of possible swelling. Only after a certain time window can the leg be plastered all over, or a special walking cast be applied. Thrombosis prophylaxis with medication is continued. As soon as the pain subsides, passive weight-bearing is initially possible, followed by active weight-bearing later on. In the course of physiotherapeutic treatment, the intensity of the load is continuously increased. Regular progress controls by means of X-ray examinations are important for a sensible adjustment of the load.

There are many indications for surgery. Emergency surgical treatment includes all open fractures, vascular and nerve injuries, and severe soft tissue injuries. In general, unstable fractures as well as fractures with joint involvement where joint steps are visible make surgery necessary.

There are numerous procedures that are used, depending on the type of fracture. Simple fractures are usually screw-retained and often can even be operated on minimally invasively. In addition to reduced tissue damage, this has the advantage that damaged ligaments or menisci can be repaired at the same time. In so-called impression fractures, parts of the bone are pressed in by external force. In this case, a special ram technique is used, whereby the depressed bone is virtually pushed up again from below, so that the normal bone edge is restored. Bone defects can then be filled with bone material taken directly from the iliac crest. For more complex fractures, plate systems are more commonly used, through which multiple fragments can be screwed together. In severe injuries with poor soft tissue conditions, the surgical healing process can be more protracted, as the fracture gaps are first stabilized using externally inserted fixation systems until a healthy soft tissue situation is created. Only then can the fracture be screw-retained.

Aftercare and Chances of Recovery

Typical aftercare following surgery is partial weight-bearing of the affected leg over a period of 6 weeks. Subsequently, X-ray follow-up checks determine the extent to which weight-bearing should be increased or adjusted. Early mobilization within the framework of physiotherapy is essential for successful therapy. Initially, the affected extremity is moved passively (for example, with special splints) and, in addition, static holding exercises can train the muscles. Later, walking exercises and lymphatic drainage are used, and active training is continuously increased according to progress monitoring.

With correct management, very good results can be achieved both conservatively and surgically.

Nevertheless, complications such as, among others, compartment syndrome, nerve damage, circulatory disorders, or infections may occur. Deformities, joint instability, loss of function, or osteoarthritis can also develop, especially with complex fractures or severe trauma.

Which Doctors and Clinics are Specialists in the Treatment of a Tibial Head Fracture?

Optimal care for tibial plateau fractures is provided by specialists in orthopedics and trauma surgery. For more serious fractures requiring surgery, these should be specialists with a surgical focus.

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on a doctor's experience.

We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in tibial plateau fracture and are awaiting your inquiry or request for treatment.

Sources

• https://www.amboss.com/de/wissen/Frakturen_des_Unterschenkels#Z5302150b71383ef24a310854fe384bb7