Which physical findings are characteristic of tibia and fibula fracture?

Updated: Nov 30, 2017
  • Author: Jeffrey G Norvell, MD, MBA, RDMS; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Tibial plateau fractures often present with a knee effusion. Tenderness will be present along the medial or lateral tibial plateau. Approximately 20% of tibial plateau fractures are associated with ligamentous injuries. See the images below.

Tibial plateau fractures. Line drawings of Schatzk Tibial plateau fractures. Line drawings of Schatzker types I, II, and III tibial plateau fractures. Type I consists of a wedge fracture of the lateral tibial plateau, produced by low-force injuries. Type II combines the wedge fracture of the lateral plateau with depression of the lateral plateau. Type III fractures are classified as those with depression of the lateral plateau but no associated wedge fracture.
Tibial plateau fractures. Line drawings of Schatzk Tibial plateau fractures. Line drawings of Schatzker types IV, V, and VI tibial plateau fractures. Type IV is similar to type I fracture, except that it involves the medial tibial plateau as opposed to the lateral plateau. Greater force is required to produce this type of injury. Type V fractures are termed bicondylar and demonstrate wedge fractures of both the medial and lateral tibial plateaus. Finally, type VI fractures consist of a type V fracture along with a fracture of the underlying diaphysis and/or metaphysis.

Tibial tubercle fracture will have tenderness over the anterior tibia approximately 3 cm distal to the articular surface. In more severe tibial tubercle fractures, full extension of the knee is not possible. The patella may be high riding.

Tibial eminence fracture may present with a knee effusion and pain and may represent an avulsion of the tibial attachment of the anterior cruciate ligament.

Tibial shaft fractures are the most common long bone fracture and usually involve the fibula as well. Tibial fractures present with localized pain, swelling, and deformity.

Maisonneuve fractures involve a fracture of the proximal fibula in association with a fractured medial malleolus (or injured deltoid ligament) and diastasis of the distal tibiofibular syndesmosis. Patients present with proximal fibular pain in addition to medial ankle pain. This is an unstable ankle injury.

Tibial plafond fractures will have tenderness along the distal tibial and may have severely decreased range of motion in the ankle.


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