Juan Wang, Guang Yang, and Xiao Chen

A total of 417 patients with 423 fractures of the tibia/fibula were investigated in the China National Fracture Study (CNFS). The fractures accounted for 23.65% of all patients with fractures and 23.08% of all types of fractures. The population-weighted incidence rate of humeral fractures was 76 per 100,000 population.

The epidemiologic features of tibial/fibular fractures in the CNFS are as follows:

• More males than females

• More right-side injuries than left-side injuries

• The highest risk age group is 15–64 years

• Ankle fracture is the most common tibial/fibular fracture

• Injuries occurred most commonly via slips, trips, or falls

A total of 66,758 patients with 68,878 fractures of the tibia/fibula were treated in 83 hospitals of China over a 2-year period from 2010 to 2011. All cases were reviewed and statistically studied; the fractures accounted for 16.09% of all patients with fractures and 15.95% of all types of fractures, respectively. Among these 66,758 patients, 8,144 were children with 8,264 fractures, and 58,614 were adults with 60,614 fractures.

Epidemiologic features of tibial/fibular fractures are as follows:

• More males than females

• More left-side than right-side injuries

• The high-risk age group is 41–45 years. The most affected male age group is 41–45 years, while females aged 56–60 years have the highest risk.

• The malleolar injury is the most common tibial/fibular fracture.

Tibial/Fibular Fractures by Sex

Segment Distribution of Tibial/Fibular Fractures in Adults by AO Classification

The upper end of the tibia is large, and expands laterally into two ridges, the medial and lateral condyles. The medial and lateral tibial plateaus are the articular surfaces of the medial and lateral tibial condyles. These plateaus articulate with the medial and lateral femoral condyles, respectively. The tibial plateau is not perpendicular to the longitudinal axis of the tibial shaft, but slopes posteriorly at ~10 degrees. The bone comprising the tibial plateau is cancellous, as opposed to the thicker cortical bone of the tibial shaft. As a result, knee fractures often occur at the tibial plateau. The lateral plateau is smaller and higher than the medial plateau; thus, it decentralizes the shear load, which makes the lateral plateau more prone to fractures than the medial plateau. The outer portion of each plateau is covered by a semilunar fibrocartilaginous meniscus.

A total of 10,944 adult fractures of the proximal tibia/fibula were treated in 83 hospitals of China over a 2-year period from 2010 to 2011. All cases were reviewed and statistically studied; the fractures accounted for 18.06% of all tibial/fibular fractures in adults. The epidemiologic features are as follows:

• More males than females

• The high-risk age group is 41–45 years. The most affected male age group is 41–45 years, while females between 56 and 60 years have the highest risk.

• The most common fracture type among segment 41 fractures is type 41-A, the same fracture type for both males and females.

• The most common fracture group among segment 41 fractures is group 41-A1, the same fracture group for both males and females.

The most common mechanism of injury involves axial loading and/or valgus or varus force, such as from a fall or automobile accident. The severity of the fracture is associated with the magnitude and duration of the force. The axial compression load resulting from a fall from a significant height can cause depression, splitting, or even comminuted fractures of the tibial plateau. Depression or avulsion of the lateral plateau is the most common trauma that results from valgus/varus or hyperflexion/hyperextension forces, which also can cause avulsion of the tibial attachment of the anterior/posterior cruciate ligaments.

Patients with proximal tibial/fibular fractures may present with a knee effusion, pain, and stiffness, with a partial or limited range of motion. In severe fractures, a varus or valgus deformity of the affected limb may be present. If the injury resulted from high-energy trauma, a hypertonic blister, or compartment syndrome, rupture of ligaments, and disruption of the neurovascular supply may accompany the fractures. The neurovascular status of the extremity and the surrounding soft tissue must be carefully evaluated.

Intra-articular fractures of the proximal tibia/fibula are always associated with unstable fragments. If the fracture involves the articular surface, surgical intervention must be considered, using the principles of anatomic reduction, large-volume bone grafting, rigid fixation, and early postoperative nonweight-bearing active mobilization, which can minimize joint adhesion and joint stiffness. Depending on the fracture-healing stage, partial weight-bearing mobilization and exercise can be initiated under the supervision of an experienced therapist. Conservative methods such as casting or traction are inadequate in the treatment of such types of fractures, and should be applied cautiously even to treat fractures with minimal or no displacement.

Avulsion fractures of the fibular head are frequently associated with injuries of the lateral collateral ligament, and can be treated by casting, utilization of a joint, spanning external fixator, or internal fixation depending on the amount of fracture displacement and severity of ligamentous damage. The available internal fixators include a mini hook plate and Kirschner wire (K-wire), combined with a tension band wire. Tibial tuberosity fractures can be treated with lag screws, tension band wires, tension band wires combined with K-wires, or a mini hook plate, depending on the size of the fragments and amount of displacement. A few factors influence the treatment choice of either conservative or surgical intervention for fractures of the tibial spine, including the patient’s age, size of the fragment, and amount of displacement. Surgical treatment usually can be done by arthroscopic reduction and fixation by screws or K-wires.

A total of 15,000 adult tibial diaphyseal fractures were treated in 83 hospitals of China over a 2-year period from 2010 to 2011. All cases were reviewed and statistically studied; the fractures accounted for 24.75% of all tibial/fibular fractures in adults. Their epidemiologic features are as follows:

• More males than females

• The highest-risk age group is 41–45 years. The most affected age group of both males and females is 41–45 years.

• The most common fracture type among segment 42 fractures is type 42-A, the same fracture type for both males and females.

• The most common fracture group among segment 42 fractures is group 42-A1; group 42-B2 in males and group 42-A1 in females.