Sports Medicine: Just the Facts

CHAPTER 64 • TIBIAL AND ANKLE FRACTURES 377

• Postoperative management
  
  
  1. Synovectomy: Immobilization for 10 days to
     allow wound healing, followed by 3 weeks in a
     short leg walking cast. After the cast is removed,
     range of motion exercises and weight bearing are
     begun as tolerated.
  
  
  2. Flexor digitorum longus transfer: Plantar splint
     for 10 days followed by short leg nonwalking
     cast for 4 weeks. Then the patient is progressed
     to short leg walking cast for another 4 weeks.
     After the casting period, physical therapy is
     begun with range of motion exercises followed
     by strengthening exercises for 3–4 months.
  
  
  
  


• Complications: The complications include infec-
  tion, deep venous thrombosis(DVT), wound dehis-
  cence, and adhesions. One third of patient
  undergoing tendon transfer will fail to have their
  arch corrected (Mann, 1993).

REFERENCES

Chang PS, Harris RM: Intramedullary nailing for chronic tibial
stress fractures. Am J Sports Med1996:24,688.
Green NE, Rogers RA, Lipscomb AB: Nonunion of stress
fractures of the tibia. Am J Sports Med1985:13, 171.
Mann RA: Flatfoot in adults, in Mann RA, Coughlin MJ (eds.),
Surgery of the Foot and Ankle, 6th ed, St. Louis, Mosby,
1993:757.
Mubarak SJ, Owne CA: Double incision fasciotomy of the lower
leg for decompression in compartment syndromes. J Bone
Joint Surg Am1977:59A, 184.
Trevino S, Baumhauer JF: Tendon injuries of the foot and ankle.
Clin Sports Med1992:11,727.
Wang CL, Wang TG, Hsu TC, et al: Ultrasonographic exami-
nation of the posterior tibial tendon. Foot Ankle Int1997:
18,34.

BIBLIOGRAPHY

Albertson KS, Dammann GG: The Leg, in O’Connor FG, Wilder RP
(eds.): The Textbook of Running Medicine, McGraw-Hill. 2001.
Andrish JT: The Leg, in DeLee JC, Drez D (eds.): Orthopaedic
Sports Medicine: Principles and Practice, Philadelphia, PA,
Saunders, 1994, p 1603.
Davey JR, Fowler PJ, Rorabeck CH: The tibialis posterior muscle
compartment: An unrecognized cause of exertional compart-
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Detmer DE, Sharpe K, Sufit RL, et al: Chronic compartment syn-
drome: Diagnosis, management and outcomes. Am J Sports
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Giladi M, Milgrom C, Simkin A, et al: Stress fractures:

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Ota Y, Senda M, Hashizume H, et al: Chronic compartment syn-

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64 TIBIAL AND ANKLE FRACTURES

Edward S Ashman, MD

Brian E Abell, BS, MS IV

TIBIAL FRACTURES

INTRODUCTION

• Fractures of the tibia and fibula are the most common
  long bone fractures with over 500,000 occurring
  annually. Tibial shaft fractures are more common in
  male athletes, particularly soccer players, with an
  average age of 31 years (Court-Brown and McBirnie,
  1995). Many, but not all of these fractures are high
  energy and are related to motor vehicle accidents or
  falls.


• The tibia is the most frequent site of stress fractures in
  the athletic population (Koval and Zuckerman, 2002).
  •Surgical emergencies related to tibial shaft fractures
  include compartment syndrome, open fracture, and
  neurovascular compromise.


• Common to all tibial fractures is a concern for soft
  tissue injury. For this reason it is extremely important
  to therapeutically ice, elevate, and immobilize the
  injured limb at initial examination.

PHYSICAL EXAMINATION

• The physician must always evaluate and document the
  neurovascular status of the patient with a suspected