11/19/2023 0 Comments Spiral fracture distal fibulaUltrasound may show a hypoechoic hematoma along the tibial cortex or elevated periosteum indicative of a fracture, despite negative radiographs. Although operator dependent, extremity ultrasound has also been described as a possible imaging modality. Such fractures commonly occur in the distal half to third of the tibia. In this case, the lower leg should be immobilized and made non–weight bearing until repeat imaging is performed. Internal oblique views may also aid in identifying the fracture, although sometimes the fracture can only be visualized over a week after the injury, when bone resorption at the fracture site, periosteal reaction and callous have developed. These fractures are frequently not seen on lateral radiographs, and the appearance of the fracture on AP view can also be subtle and difficult to visualize. Spiral (toddler’s) fracture/oblique fractures often occur with minor trauma. Isolated fibula fracture s may also occur when there is a direct blow to the lateral lower leg however, prior to diagnosis, it is important to closely examine the distal tibial physis, as concomitant fractures to this location are frequently present. Radiographs may be normal or may show limited cortical changes or subperiosteal bone formation. Only 9% occur in children younger than 16 years old, 32% in adolescents aged 16 to 19 years old, and 59% in patients over 20 years old the proximal third of the tibia is the most often region affected. Stress fractures present as gradual onset of pain and limp and are much more common in older adolescents and young adults. Findings on radiographs may be subtle, especially on the AP view. Transverse fractures of the tibia/fibula result from a direct blow, and while they are frequently seen in sports injuries, they are also the most common type of long bone fracture associated with nonaccidental trauma.īowing fractures are caused by axial loading and may be subtle on radiographs.īuckle fractures occur when compressive forces lead to buckling of the cortex. ,Ī few unique types of pediatric tibia and fibula fractures are important to identify: Adolescent patients are more likely to have combined fractures of the tibia and fibula than other pediatric age groups. , Approximately 30% of cases of tibial fracture have an associated fibula fracture. Tibial shaft fractures are the third most common fracture in children-only fractures of the femur and forearm are more prevalent. Lateral view demonstrates a progressively healing right distal tibia fracture (arrow) noted in stable alignment. There is a nondisplaced spiral fracture of the distal tibia with an intact fibula, with visualized joints that are normal and no abnormal bone density the visualized portions of the knee and foot appear normal ( Figs. Two-view imaging of the right tibia and fibula was obtained. In instances where the fracture may involve the knee or ankle joint, MRI may be helpful to evaluate associated ligamentous or meniscal injuries. This modality is not indicated in the initial evaluation of tibia or fibula fractures. Tibia or fibular fractures that involve the knee (e.g., tibial plateau) or ankle joint may require use of non-contrast CT to evaluate the extent of the fracture. This modality is rarely indicated for midshaft fractures. These should incorporate the entire length of the lower leg and include both knee and ankle. Plain radiographs typically suffice when assessing acute tibial injuries in children and include anterior-posterior (AP) and lateral views. There is no back tenderness, crepitus, step-off, or deformity. He has normal range of motion at these joints. He has no pain, swelling, or tenderness to the ipsilateral hip, knee, ankle, or foot. His anterior tibial and posterior tibial pulses are intact. There is no abrasion, laceration, or ecchymoses. There is mild swelling to the anterior surface of the midshaft of the right tibia and fibula. His heart rate is 91 beats per minute, respiratory rate is 20 breaths per minute, and blood pressure is 118/62 mm Hg. His physical examination reveals an afebrile child who is complaining of right lower leg pain. There is no reported loss of consciousness he denies neck pain, back pain, hip pain, weakness, numbness, or other symptoms. He states he heard a “pop” and then began to experience pain and difficulty with ambulation secondary to the pain. A few hours prior to presentation, he was jumping up and down on a couch when he jumped off, landing on his right leg. A 7-year-old male is brought in for evaluation.
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