The tibia is a larger bone on the inside, and the fibula is a smaller bone on the outside. make up about 17% of all lower extremity fractures, account for 4% of all fractures seen in the Medicare population, older patients - falls, lower energy mechanisms, proximal 1/3 tibia fractures account for 5-10% of tibial shaft fractures, low energy (fall from standing, twisting, etc), spiral fracture pattern with fibula fracture at a different level, high association of posterior malleolus fractures with spiral distal tibia fractures, more likely to be associated with a lower degree of soft tissue injury, high energy fx (MVA, fall from height, athletics, etc), leads to wedge or short oblique fracture that may have significant comminution with fibula fracture at same level, more likely to be associated with severe soft tissue injury, must rule out extension into tibial plateau on plain films or CT scan, high risk for valgus/procurvatum deformity, higher rates of ankle injury seen with distal 1/3 tibia fracture and spiral fracture pattern, posterior malleolus most common associated ankle injury which, in some cases, may affect syndesmotic stability, extension into or adjacent to tibial plafond may require separate/additional fixation and are managed differently than tibial shaft fractures, severity of muscle injury has highest impact on eventual need for amputation, more common in diaphyseal tibial shaft fractures than proximal or distal tibia fractures, 8.1% risk in diaphyseal fractures, compared to proximal (1.6%) and distal (1.4%) fractures, can occur even in the setting of an open fracture, all four compartments must be examined. Diaphyseal tibial fractures are the most common long bone fracture. Posterior tibiofibular ligament rupture or avulsion of posterior malleolus, Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol, Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw, Question SessionAnkle Fractures & Replantation. At Another Johns Hopkins Member Hospital: Tibia fractures are the most common lower extremity fractures in children. Patients with tibia fractures, syndesmosis injuries, or ankle fractures should be referred to an orthopaedic surgeon. Correlation of interosseous membrane tears to the level of the fibular fracture.

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