Broken fibula and tibia
Dr. med. Mira Seidel is a freelance writer for the medical team.
More about the experts All content is checked by medical journalists.Fibula and tibia fractures can result from direct or indirect violence on the lower leg. If both bones are broken at the same time, one speaks of a lower leg fracture. Swelling, pain, and a bruise in the affected area indicate the break. Find out more about the causes, symptoms and treatment of fibula and tibia fractures here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S82
Fractured fibula and tibial fracture: description
The lower leg consists of the shin bone (tibia) and the fibula (fibula). Both bones are connected to one another over their entire length by a connective tissue membrane - the interosseous membrane. If both bones are broken at the same time, doctors speak of a complete lower leg fracture. If one of the two bones remains intact, one speaks of an isolated fracture of the tibia (tibia fracture) or an isolated fracture of the fibula (fibula fracture).
A tibial fracture occurs most often near the ankle joint, as this is where the bone has the smallest diameter.
Since the lower leg is involved in both the knee and the ankle, a fracture of the lower leg can also affect both joints, which can happen especially in the case of a rotational trauma. A special form of ankle fracture is the Maisonneuve fracture: a high, isolated fracture of the fibula in which the ligament structures between the tibia and fibula (syndesmosis) and the connective tissue membrane around the two bones (membrana interossea) are injured. The inner ankle is also often broken.
AO classification
The fracture of the tibia and fibula is divided into different types of fracture, depending on the type and location of the fracture according to the AO classification (Working Group for Osteosynthesis Issues):
- Type A: only one bone fracture line, two bone fragments
- Type B: wedge-shaped bone fracture line, three bone fragments
- Type C: Debris fracture with three or more broken bones
Fractured fibula and broken tibia: symptoms
If the tibia and fibula fracture, the affected person usually complains of considerable pain. It is impossible for him to put weight on his leg or to bend his lower leg in the knee. Other typical symptoms are swelling and a bruise (hematoma) in the affected area. They are often accompanied by abrasions and soft tissue injuries.
A fractured tibia or fibula can be open or closed. In an open bone fracture, the skin and soft tissues are injured, so that the ends of the bone fracture become visible. An open tibial fracture occurs particularly often because the front edge of the tibia is only surrounded by a thin layer of soft tissue. There is always a high risk of wound infection because bacteria can easily penetrate through the open wound.
A closed tibia and fibula fracture or crush injuries can result in what is known as a compartment syndrome: the muscles, blood vessels and nerves in the fascia (compartments) can be squeezed off by blood or swelling. This causes a lot of pain. In the extreme case, the tissue can die.
Symptoms of an isolated fibula fracture are rare. The fracture can often be overlooked because the tibia is the load-bearing bone and patients can often walk normally despite the fractured fibula.
In the case of a Maisonneuve fracture, in which the fibula is high up and the inner ankle is broken, the symptoms usually only occur in the ankle.
Fractured fibula and tibial fracture: causes and risk factors
A fracture of the tibia and fibula results from direct or indirect trauma. If the lower leg is bent or rotated, indirect forces act on the leg. This can happen in a snowboard accident, for example: If the fixed foot is pulled in the opposite direction than the rest of the body, a lower leg fracture can result.
In the case of direct trauma, greater force is usually required. Such a break occurs in traffic accidents, for example when a pedestrian is hit by a car, or during sports, for example when a football player kicks the leg of a teammate. Often, this also results in soft tissue damage.
An isolated fibula fracture occurs when a force is applied directly to the outer lower leg or as an ankle trauma.
With multiple injuries, a tibia and fibula fracture often occurs as a chain injury. For example, the thigh, lower leg, and foot of the same leg are broken.
Fractured fibula and tibia: examinations and diagnosis
A doctor for orthopedics and trauma surgery is the right contact for the diagnosis and treatment of tibia and fibula fractures. He will first ask you exactly how the accident happened and your medical history (anamnesis). Questions from the doctor could include:
- Can you describe the exact course of the accident?
- Do you have pain?
- Can you put weight on the leg?
- Can you move your foot or bend your knee?
- Did you already have complaints such as pain and restricted mobility?
The doctor will then examine your leg carefully and also pay attention to possible accompanying injuries. When examining the lower leg, an audible and palpable crunch (crepitation) can be a sure indication of a lower leg fracture. The doctor also checks the peripheral pulses, the sensitivity of the foot and the motor function of the foot muscles.
Fractured fibula and tibia: imaging
For further diagnosis of a tibia and fibula fracture, the leg is X-rayed, from the side and from the front. During the recordings, care is taken to ensure that the adjacent joints (knee and ankle) are also recorded - they may also be injured.
If the pulse can no longer be felt or there is a visible circulatory disorder, a special ultrasound examination (Doppler sonography) is carried out immediately. If the examination does not reveal any clear findings, a vascular x-ray (angiography) can help.
Fractured fibula and tibial fracture: treatment
Depending on the type of fracture, a fibula fracture and tibia fracture are treated conservatively or surgically.
Tibia and fibula fractures: conservative treatment
Conservative treatment is usually sufficient for closed, simple fractures with few bone fragments. Fractures in children are also usually treated conservatively if the bone parts are not displaced or the bone is incompletely broken.
The leg is immobilized in a split cast until the swelling has subsided. The plaster of paris can then be circulated (closed). It must be worn for around two to four weeks. Then the patient is given a walking cast for four weeks or a Sarmiento cast, which can also be used to bend the knee.
If the leg is immobilized, there is a risk of thrombosis: a blood clot can form that clogs a blood vessel. Thrombosis prophylaxis (e.g. with anticoagulant drugs) is therefore very important.
Tibia and fibula fracture: surgery
The operation is always performed if there is an open fracture, a displaced fracture, a comminuted fracture, a fracture with vascular and nerve injuries or an impending or already existing compartment syndrome.
In the case of a fracture of the tibia, an intramedullary nail is inserted into the medulla of the long bone to stabilize it. Doctors call this operation intramedullary nail osteosynthesis. In the case of more complex fractures near joints, the fracture is often stabilized with a metal plate (plate osteosynthesis). You can read more about these surgical procedures in the article on osteosynthesis.
In the case of fragmentary or defect fractures with significant soft tissue damage, the lower leg is first stabilized from the outside with an external fixator. This is often done on multiple injuries (polytrauma) patients until final surgical treatment is possible.
In children, intramedullary nail osteosynthesis is usually not used because of the growth plates. Instead, the fracture is stabilized with an external fixator or a so-called elastic-stable intramedullary nailing.
Implanted material (such as plates, intramedullary nails) is surgically removed again later - after 12 months at the earliest.
Fracture and tibia fracture: disease course and prognosis
The duration and course of the healing process vary and depend largely on the accompanying soft tissue injuries. If the soft tissues are intact, the healing process is significantly better. In contrast, fractures with soft tissue injuries and defect fractures are often associated with complications.
Fractured fibula and tibia: complications
A number of complications can arise with a broken fibula and tibia. For example, vessels and nerves can also be damaged. If the bone heals delayed, a pseudoarthrosis can develop. If a fracture does not heal in the correct position, this can lead to an axis rotation error. Other possible complications of a fibula and tibia fracture include infections and wound healing disorders.
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