Release notes for tibial shaft fractures
Third edition
Publication of third edition (October 23, 2025)
The content was authored by Markku Nousiainen (CA) and Andrew Oppy (AU). J. Spence Reid (US) was the author of the Ring fixator content. Markku Nousiainen was the editor.
Table of contents
The third edition of the tibial shaft module includes a detailed description of the following fracture types and their management.
Simple spiral fractures:
- Nonoperative treatment (casting)
- Modular external fixation
- Uniplanar external fixation
- Ring fixation
- Intramedullary nailing
- ORIF - Lag screws through protection plate
- ORIF - Lag screws outside protection plate
Simple oblique fractures:
- Nonoperative treatment (casting)
- Modular external fixation
- Uniplanar external fixation
- Ring fixation
- Intramedullary nailing
- MIO - Compression plating
- ORIF - Lag screws through protection plate
- ORIF - Lag screws outside protection plate
- ORIF - Compression plate with lag screw
Simple transverse fractures:
- Nonoperative treatment (casting)
- Modular external fixation
- Uniplanar external fixation
- Ring fixation
- Intramedullary nailing
- MIO - Compression plating
- ORIF - Compression plating
Wedge fractures with an intact wedge:
- Nonoperative treatment (casting)
- Modular external fixation
- Uniplanar external fixation
- Ring fixation
- Intramedullary nailing
- MIO - Bridge plating
- ORIF - Lag screws with protection plate
- ORIF - Compression plating
Wedge fractures with a fragmented wedge:
- Nonoperative treatment (casting)
- Modular external fixation
- Uniplanar external fixation
- Ring fixation
- Intramedullary nailing
- MIO - Bridge plating
Intact segmental multifragmentary fractures:
- Nonoperative treatment (casting)
- Modular external fixation
- Uniplanar external fixation
- Ring fixation
- Intramedullary nailing
- MIO - Compression plating
- Bridge plating
- ORIF - Compression plating
- ORIF - Lag screws with protection plate
Fragmentary segmental multifragmentary fractures:
- Modular external fixation
- Uniplanar external fixation
- Ring fixation
- Intramedullary nailing
- Bridge plating
Additional material
The following additional material is available for this module.
Approaches:
- Approach to the anteromedial surface of the tibial shaft
- Approach to the anterolateral surface of the tibial shaft
- Minimally invasive medial approach to the tibial shaft
- Minimally invasive lateral approach to the tibial shaft
- Semi-extended suprapatellar approach for intramedullary nailing of the tibial shaft
- Medial parapatellar approach for intramedullary nailing of the tibial shaft
- Semi-extended lateral parapatellar approach for intramedullary nailing of the tibial shaft
- Infrapatellar approach for intramedullary nailing of the tibial shaft
- Safe zones in the tibia for pin insertion
- Safe zones in the tibia for wire and Schanz screw insertion
- Approach to the posteromedial surface of the tibial shaft
- Approach to the posterolateral surface of the tibial shaft
Patient preparations:
- Supine position
- Prone position
- Flexed knee position for intramedullary nailing
- Semi-extended knee position for intramedullary nailing
- Supine position for ring fixator
Basic techniques:
- Fracture management with limited resources
- Nailing without image intensification
- Casting/splinting of lower limb
- Infrapatellar intramedullary nailing
- Lateral parapatellar intramedullary nailing
- Medial parapatellar intramedullary nailing
- Suprapatellar intramedullary nailing
Further reading:
- Bacteriology
- Delayed presentation of infection
- Infection
- Prevention of infection
- Principles of management of open fractures
- Recurrent osteomyelitis
- References
