What are the complications of tibial fractures?

What complications may result from a diaphyseal tibial fracture?

1. Compartment syndrome: When the lower leg is fractured or soft tissue such as muscles are injured, hematoma and reactive edema occur, which increases the pressure in the fascial space and can cause blood circulation disorders and form fascial compartment syndrome, among which the incidence of anterior tibial compartment syndrome is the highest.

2. The anterior tibial space is located in the anterior and lateral part of the lower leg, the tibialis anterior muscle, the extensor muscles, the toe extensors, the third peroneus muscle, the common peroneal nerve and the anterior tibial movement, and the vein is located in it. When the anterior tibial space syndrome occurs, the anterior and lateral part of the lower leg is hardened, tenderness is obvious, and the pain is aggravated when the toes are passively stretched and flexed. The pain is related to the degree of pressure on the peroneal nerve.

3. The sensation between the first and second toes may be decreased, followed by paralysis of the extensor muscles, toe extensors, and tibialis anterior muscles. The dorsalis pedis artery can be palpated early because the peroneal artery has a communicating branch connecting the anterior tibial artery.

4. In addition to the anterior tibial fascia space, syndromes may also occur in the three posterior tibial spaces, among which the incidence of deep posterior tibial space syndrome is higher than that of superficial posterior tibial space and external space. It is characterized by posterior space pain, metatarsal numbness, weakened toe flexion force, aggravated passive toe pain, increased tension in the distal internal fascia of the triceps surae, and obvious tenderness. If the symptoms continue to develop and are not treated in time, ischemic contracture of the space muscles may occur, forming claw feet. The posterior incision of the calf, starting from the soleus muscle, longitudinally cuts the deep fascia, and cuts the muscle adventitia if necessary to achieve the purpose of decompression.

5. Tibial anterior compartment syndrome is caused by continuous increase in compartment pressure, vascular spasm, increased tissue osmotic pressure, and tissue ischemia and hypoxia. In particular, closed tibial fractures with obvious soft tissue contusion may cause compartment syndrome. The fracture should be repositioned as soon as possible, and 20% mannitol should be dripped intravenously to improve microcirculation, reduce edema, and be closely observed.