Vicki Nguyen

Amber McCool

Summary of the Injury

The tibia (shinbone) fracture is the most common fracture long bone in
the body. The femur, humerus, tibia and fibula are included as the long bones in
the body. A tibia shaft fracture is a break along the length of the bone under the
knee and above the ankle (OrthoInfo). The tibia fracture can have many types
depending on the amount of force that was applied to fracture the bone.
Common types of the tibia fractures include; stable, displaced, transverse,
oblique, spiral, comminuted, open and closed fracture (OrthoInfo). The common
open and displaced shaft fractures usually involves the break of both the fibula
and tibia. Stable fractures are when the bone is broken and the ends of the
broken bone lines up. The displaced fractures occur when t​he bone snaps into
two or more parts and moves so that the two ends are not lined up straight(The
Free Dictionary). ​ A transverse fracture occurs when the bone breaks at a 90
degree angle to the long axis of the bone. Oblique fractures occur when the
break is curved or broken at an angle(Peconic Bay Medical Center).
 Most common tibial-fibula fractures occur when someone comes in
contact with high-energy collisions, falls, or sports injuries. High-energy
collisions involve motor vehicle accidents (Morrison, 2017). Sports injuries
include lower energy injuries in sports such as in soccer, skiing, football, etc.
They are caused by a twisting force and would most likely result in oblique
fractures (Morrison, 2017).
Of the two bones that are fractured in this injury, the tibia and fibula, the
tibia is the weight bearing bone. Fractures of the tibia generally are associated
with fibula fracture, because the force is transmitted along the interosseous
membrane to the fibula. The skin and subcutaneous tissue are very thin over the
anterior and medial tibia, and as a result, a significant number of fractures to the
lower leg are open fractures. Even in closed fractures, the thin, soft tissue can be
negatively affected without fully breaking through the skin. Fractures of the tibia
can involve the tibial plateau, tibial tubercle, tibial eminence, proximal tibia, tibial
shaft, and tibial plafond (Practice Essential, 2017) . The peroneal nerve that
crosses the fibular neck is susceptible to injury from a fibular neck fracture, the
pressure of a splint, or during surgical repair. This can result in foot drop and
sensation abnormalities.
Open tibia-fibula fractures are surgical emergencies, and an orthopedic
surgeon should be consulted immediately. In rare instances, a type I fracture can
be treated nonoperatively, but in most cases, the patient should be scheduled for
debridement and irrigation within 6 hours of the injury. Longer intervals have
been shown to increase infection rates (Konowalchuk, 2017). Situations in which
an open fracture should not be corrected on an emergency basis are rare. In some
cases, however, especially in the setting of polytrauma, definitive fracture
treatment may be delayed. Several reasons for surgical treatment of tibial shaft
fractures to be withheld are recognized, such as if the patient has had a more
serious injury in another area of his/her body. All patients require a thorough
preoperative evaluation and must be cleared for general anesthesia before any
operation, including treatment of tibial shaft fractures. In cases of acute trauma,
patients should be stabilized by the trauma team before fixation of a tibial shaft
fracture.
 Initially, all tibial shaft fractures should be stabilized with a long posterior
splint with the knee in 10-15° of flexion and the ankle flexed at 90°. Admission to
the hospital may also be necessary to control pain and to monitor closely for
compartment syndrome. According to Medscape, despite proper casting
techniques and adequate follow-up, not all nonoperatively treated tibial shaft
fractures heal successfully. In addition, 6 weeks without knee motion often results
in a stiff joint. As a result, early ambulation with weight-bearing as tolerated is
encouraged in order to combat joint stiffness.
There are multiple surgical options to treat a tibia-fibula fracture. One that
was commonly used in the past was plating, which involves using a large surgical
incision, reducing the fracture, placing a metal plate over the fracture, and fixing
the plate onto the bone with multiple screws. Because of the extensive soft-tissue
manipulation required, plating can be difficult for the surgeon, damaging to the
local vascular supply and makes the wound extremely susceptible to infection
(Konowalchuk, 2017). Intramedullary nailing and external fixation have replaced
fracture plating because they entail decreased technical difficulty, infection rates,
and damage to local soft tissues. External fixation, in which multiple pins are
attached to the external rods to maintain length and alignment, is a widely used
and very successful method of treating some types of tibial shaft fractures. It is
particularly useful for proximal tibial fractures that may be difficult to align
properly with intramedullary nailing. Intramedullary nailing with locking screws
has become the treatment of choice for most tibial shaft fractures. The
prevalence of nonunion and malunion is greatly decreased in comparison with the
other methods of fixation (Konowalchuk, 2017). Patients are also able to return to
low-impact activities much sooner than they can with the other treatments.
Amputation is uncommon but is sometimes indicated for severe tibial fractures,
especially those with extensive soft-tissue injury or those in patients with vascular
compromise such as diabetic patients.
Overall, an open tibia-fibula fracture must be stabilized and most likely the
patient will have to undergo surgery in order for this to happen. Once stabilized
the bones will heal naturally, doctors just have to be aware of the complications
that can come about with major surgeries such as this one and check for
infections so that the bones can heal properly.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
“Medical Expert Weighs in on Paul George's Future After 
Gruesome Leg Injury”  
Adi Joseph
USA Today Sports

In this news article written by Adi Joseph of the USA Today Sports News,
he wrote about the tragic injury that Paul George had sustained on August 1,
2014. Paul George is an American basketball player for the Oklahoma City
Thunders. George has been playing basketball professionally for 7 years and is a
shooting guard and small forward. In his game on August 1, 2014, he sustained
an injury when going to shoot in the hoop but due to the basket being closer
than NBA regulations had enforced, George suffered a tibia-fibula fracture. In
this Joseph interviewed Nick Grosso, a sports medicine surgeon and president of
The Centers for Advanced Orthopaedics. During the interview Joseph had asked
Dr. Grosso what would happen to the patient if a tibia-fibula fracture were to
occur. If a tibia-fibula fracture were to happen, the patient would be taken into
surgery within eight hours to avoid infection. After the patient has been cleared
of infection, the doctors would then insert a metal rod in the leg to keep it in
place. Once the rod is inserted the patient will take 6 to 10 weeks to heal and
will require an immense amount of rehab. Dr. Grosso stated that the healing
process of the bone didn’t worry him but instead the healing soft tissue around
it. In the article, Grosso cites that NFL players usually take up to their second
season of plays to return back to their normal playing.
“Doctors, athletes familiar with Paul George's injury 
believe he'll return” 
Michael Pointer
IndyStar

Indiana Pacers All-Star Paul George suffered a broken leg during a

basketball game and this article relays information of George’s future at the time
from a doctor’s perspective, one who was not present during the injury of Paul
George, but was present during the injury of Kevin Ware when he suffered a
gruesome leg injury in the NCAA Regional at Lucas Oil Stadium. This doctor is
named Patrick Kersey, and according to him, “First-aid workers in Las Vegas
handled the situation correctly. They were able to stabilize George quickly and
transport him to a nearby hospital.” He also believed that George would be able
to recover within 10-14 months, included 3-4 months of rehabilitation, where he
would begin putting weight on the leg and work with a physical therapist. The
article also gives multiple examples of other athletes who had suffered injuries
similar to Paul George’s and had these athletes give their insight based on what
they’ve been through. The article was helpful in determining the effect that the
injury might have on Paul George and indicating the future that he might face
during this time period.

 
 Glossary  
Compartment Syndrome:​ a painful, dangerous condition where there is pressure
buildup from internal bleeding or swelling
Contraindication: ​a condition or factor that serves as a reason to withhold a
certain medical treatment due to the harm that it would cause the patient.
Closed Fracture: ​a broken bone that does not penetrate the skin.
Displaced Fractures:​ occur when the broken pieces of bones are separated within
the leg.
Debridement:​ the removal of damaged tissue or foreign objects from a wound.
Delayed Union: ​Delayed unions affects the bone when it is unable to heal
complete. Usually delayed union occurs because it lacks stability, blood flow, or
even both. They are more likely to occur when the bone is broken in high-energy
collisions or motor vehicle accidents.
Fixation: ​refers to fixation of screws and/or plates, intramedullary bone nails
(femur, tibia, humerus) to enable or facilitate healing.
Gangrene: ​dead tissue that is caused by infection or lack of blood flow.
Interosseous membrane of the leg: ​extends between the interosseous crests of
the tibia and fibula, helps stabilize the Tib-Fib relationship and separates the
muscles on the front from those on the back of the leg.
Lateral malleolus:​ ​name given to the bone on the outside of the ankle joint​. 
Neurovascular Compromise: ​deterioration of blood vessels and nerves
Nonunion: ​a serious complication of a fracture and may occur when the fracture
moves too much, has a poor blood supply or gets infected.
Oblique​: Oblique fractures occur when there is a diagonal break on the bone.
Open Fracture: ​a fracture in which there is an open wound or break in the skin
near the site of the broken bone.
Osteomyelitis: ​infection of the bone
Peroneal nerve:​ ​supplies movement and sensation to the lower leg, foot and
toes.
Proximal tibia: ​upper portion of the bone where it widens to help form the knee
joint
Polytrauma: ​occurs when a person experiences injuries to multiple body parts
and organ systems often, but not always, as a result of blast-related events.
Popliteal Artery Injury: ​injury associated with major soft tissue damage
Stable fractures:​ when the bone is broken evenly and all broken bones line up.
Subcutaneous tissue: ​hypodermis
Tibial eminence:
Tibial plafond: ​Tibial plafond is a ​fracture of the distal part of the ​tibia​, involving
its articular surface at the ankle joint. It is caused mostly as a result of falls from a
height or motor vehicle accidents.
Tibial plateau: ​a break of the upper part of the tibia that involves the knee joint.
Tibial shaft:​ ​A ​tibial shaft​ fracture occurs along the length of the bone, below the
knee and above the ankle.
Tibial tubercle: ​an elevation at the top of the tibia where the ligament of the
patella attaches to it.
Transverse:​ this fracture is broken horizontally through the middle. When the
fibula is also broken the leg will become unstable.
Type 1 Fracture: ​transverse fracture through the growth plate.
Wound Irrigation: ​the steady flow of a solution across an open wound surface to
achieve wound hydration, to remove deeper debris, and to assist with the visual
examination.
 Works Cited:
Joseph, Adi. “Medical Expert Weighs in on Paul George's Future after Gruesome Leg Injury.”
USA Today​, Gannett Satellite Information Network, 6 Aug. 2014,
ftw.usatoday.com/2014/08/paul-george-surgeon.
Konowalchuk, Brian K. “Tibial Shaft Fractures Treatment & Management.” Tibial Shaft
Fractures Treatment & Management: Approach Considerations, Medical Therapy,
Surgical Therapy, Medscape, 19 July 2017,
emedicine.medscape.com/article/1249984-treatment.
Morrison, William. “Tibia Fracture: Treatment, Recovery, and More.” ​Healthline​, Healthline
Media, 2 Feb. 2017, ​www.healthline.com/health/tibia-fracture#causes​.
Wu, Brian. “Fibula Fracture: Symptoms, Treatment, and Recovery.” ​Medical News Today​,
MediLexicon International, ​www.medicalnewstoday.com/articles/315565.php​.
“Displaced Fracture.” ​The Free Dictionary​, Farlex,
medical-dictionary.thefreedictionary.com/displaced fracture.
“Our Knowledge of Orthopaedics. Your Best Health.” ​Tibia (Shinbone) Shaft Fractures​,
OrthoInfo, orthoinfo.aaos.org/en/diseases--conditions/tibia-shinbone-shaft-fractures/.
“Tibia and Fibula Fracture in the ED.” Practice Essentials, Epidemiology, 30 Nov. 2017,
emedicine.medscape.com/article/826304-overview.
“The Different Types of Bone Fractures.” ​Peconic Bay Medical Center​, 2 Nov. 2015,
www.pbmchealth.org/blog/different-types-bone-fractures/.

http://ftw.usatoday.com/2014/08/paul-george-surgeon