Injuries to the Leg,
Ankle and Foot
BY
DR BHARGAV U PATEL
M.P.T (SPORTS SCIENCES)
FRACTURES OF SHAFTS OF TIBIA AND FIBULA
RELEVANT ANATOMY
•The tibia is the major weight bearing bone of the leg.
•It is connected to the less important bone, the fibula,
through the proximal and distal tibiofibular joints.
•Like fractures of forearm bones, these bones frequently
fracture together, and are referred to as ‘fracture both
bones of leg’.
The following are some of the characteristics of these bones.
MECHANISM
•The tibia and fibula may be fractured by a direct or indirect injury.
•Direct injury:
•Road traffic accidents are the commonest cause of these fractures, mostly due
•to direct violence.
•Frequently the object causing the fracture lacerates the skin over it, resulting in an open fracture.
•Indirect injury:
•A bending or torsional force on the tibia may result in an oblique or spiral fracture respectively.
•The sharp edge of the fracture fragment may pierce the skin from within, resulting in an open fracture.
•PATHOANATOMY
•The fracture may be closed or open and may have various patterns.
•It may occur at different levels (upper, middle or lower-third). Occasionally, it may
•be a single bone fracture i.e., only the tibia or fibula is fractured.
•Displacements may be sideways, angulatory or rotational.
•Occasionally, the fracture may remain undisplaced.
CLINICAL FEATURES
The patient is brought to the hospital
with a history of injury to the leg
followed by the classic features of a
fracture i.e., pain, swelling, deformity
etc.
•There may be a wound communicating with
the underlying bone.
•RADIOLOGICAL FEATURES
•The diagnosis is usually confirmed by X-ray
examination.
•Evaluation of the anatomical configuration
of the fracture on X-ray helps in reduction.
•TREATMENT
For the purpose of treatment, fractures of the tibia and fibula may be divided into two types:
•Closed or Open.
•The trend is changing, from primarily conservative treatment to operative treatment, in
care of open tibial fractures.
•More and more open fractures in grade I and II are being fixed internally.
•In a number of other cases, a delayed operation (ORIF) is done once the wound is taken
care of.
The Lauge-Hansen classification of ankle injuries is most widely used It is based on the mechanism of injury
•CLINICAL FEATURES
There is history of a twisting injury to the ankle followed by pain
and swelling.
Often the patient is able to describe exactly the way the ankle
got twisted.
On examination, the ankle is found to be swollen.
Swelling and tenderness may be localized to the area of injury
(bone or ligament).
Crepitus may be noticed if there is a fracture.
The ankle may be lying deformed (adducted or abducted, with
or without rotation)
•RADIOLOGICAL EXAMINATION
Antero-posterior and lateral X-rays of the
ankle are sufficient in most cases.
While examining an X-ray, it is important
to make note of the following features:
Fracture line of the medial and lateral malleoli should be
studied in order to evaluate the type of ankle injury (Lauge-
Hansen classification).
Small avulsion fractures from the malleoli are sometimes
missed. These often have attached to them the whole ligament.
Tibio-fibular syndesmosis:
All ankle injuries where the fibular fracture is above the
mortice, the syndesmosis is bound to have been disrupted.
In injuries where the fibular fracture is at the level of the
syndesmosis, one must carefully look for any lateral subluxation
of the talus; if it is so, width of the joint space between the
medial malleolus and the talus will be more than the space
between the weight bearing surfaces of tibia and talus.
• Posterior subluxation of the talus should be
looked for, on the lateral X-ray.
• Soft tissue swelling on the medial or lateral
side in the absence of a fracture, must arouse
suspicion of a ligament injury. This should be
confirmed or ruled out after thorough clinical
examination and stress X-rays. MRI may help.
