Fractures of the fibula shaft account for approximately 9.45% of all fractures in the body. They are particularly common in children under 10 years old, with tibiofibular fractures being the most frequent, making up 5.1% of all fractures. Tibial fractures follow, accounting for 3.85% of all fractures, while fibular shaft fractures are the least common, representing only 0.59% of all fractures. Although treatment is relatively straightforward and often results in no significant functional impairment, improper management can lead to complications such as infection, delayed union, or nonunion. In severe cases, amputation may even be necessary. Therefore, tibiofibular shaft fractures should be treated with careful attention.

bubble_chart Etiology

(一) Direct violence

Fibula shaft fracture is commonly caused by blows from heavy objects, kicks, impact injuries, or wheel crush injuries, with the force mostly coming from the anterolateral side of the lower leg. The fracture line is often transverse or short oblique. Severe violence or traffic accident injuries often result in comminuted fractures. Since the anterior aspect of the tibia is located subcutaneously, there is a high likelihood of the fracture ends penetrating the skin, and the muscles are frequently contused.

(二) Indirect violence

Fractures caused by falls from heights, rotational sprains, or slips are characterized by oblique or spiral fracture lines. The fracture line of the fibula is usually higher than that of the tibia. In children, tibial and fibular fractures are generally caused by relatively minor forces, and due to the greater toughness of pediatric bone cortex, they may present as greenstick fractures.

Fracture of the tibia causes swelling and pain in the lower leg, possibly with deformity and abnormal mobility; X-ray examination helps diagnose the fracture and its type. This fracture requires attention to the extent and severity of tissue injury, as well as the possibility of nerve or vascular injury, upper tibial fracture, and fibular cervical fracture. Additionally, potential popliteal artery pulse disturbance and common peroneal nerve injury should be assessed.

bubble_chart Treatment Measures

The treatment method for tibial fracture of fibia should be selected based on the type of fracture and the extent of soft tissue injury, either external fixation or open reduction internal fixation.

Plaster fixation

For non-displaced or stable transverse fractures, short oblique fractures, etc., where the fracture surface remains stable without lateral displacement after reduction, manual reduction under anesthesia and long-leg plaster external fixation are performed. During plaster fixation, the knee joint should be maintained in approximately 15° of grade I flexion.

Bone traction

For unstable oblique, spiral, or grade I comminuted fractures, external fixation alone cannot maintain proper alignment. Under local anesthesia, calcaneal pin traction can be performed using a spiral traction frame for fixation.

Open reduction internal fixation

Tibial fracture of fibia generally has a longer bony healing period. Prolonged plaster external fixation inevitably affects the function of the knee and ankle joints. Currently, open reduction internal fixation is increasingly being adopted.

1. Screw internal fixation

For oblique or spiral fractures, screw internal fixation can be used. After open reduction, 1–2 screws are fixed at the fracture site to maintain alignment.

This method is suitable for oblique, transverse, or comminuted fractures. Since the skin and subcutaneous tissue on the anteromedial side of the tibia are relatively thin, the plate is best placed on the lateral side of the tibia, deep to the tibialis anterior muscle. Compression plate fixation ensures stability, accelerates fracture healing, and does not affect the knee or ankle joints.

3. Interlocking intramedullary nail fixation

The anatomical feature of the tibial shaft is its wide medullary cavity, with articular surfaces at both ends. Interlocking intramedullary nails can be inserted without restriction and control rotational forces. They effectively manage lateral, rotational, and angular displacement, eliminating the need for postoperative external fixation. Knee and ankle joint function remains unaffected, and the fracture healing period is significantly shortened. For multi-segment fractures, intramedullary nail fixation prevents angular deformities and yields favorable outcomes.

4. External fixation frame

For tibial fracture of fibia with severe skin injury, an external fixation frame provides reliable fracture stabilization and facilitates observation and management of soft tissue injuries. Another advantage is that knee and ankle joint movement is unaffected, and patients can even walk with the frame. Therefore, its use has increased in recent years.