Comminuted tibial diaphyseal fractures are more common in foals than adults. In foals, surgical repair may be possible. Comminuted fractures of the tibia in adult horses typically occur from high energy trauma and are generally unsuited for internal fixation. Additionally, some comminuted fractures involve the proximal or distal extend of the tibia to such a degree that internal fixation is not possible. The cause of tibial fractures is typically direct trauma or falls although complete fractures secondary to tibial stress fractures can occur but are rare.
Tibial fractures usually develop as a result of trauma, such as kicks or falls. The exception to this are tibial stress fractures, which are an accumulation of cyclic loading and bone fatigue.
Fracture types overview
The most common types of tibial fractures are:
Salter Harris Type II
Tibial crest fractures
Simple diaphyseal fractures
Comminuted diaphyseal fractures
Diaphyseal stress fractures
Medial malleolus fractures
Lateral malleolus fractures
Distal physeal fractures
Radiography provides the most meaningful information as to location and configuration of the fracture(s). In most cases 4 views at 45 degree intervals provide adequate information for an exact diagnosis. For the evaluation of the proximal tibia typically a lateromedial and a caudocranial projection each is enough. Nuclear scintigraphy is useful in the identification of tibial stress fractures, which may be radiographically inapparent.
Clinical signs of comminuted diaphyseal fractures are obvious with limb instability and associated swelling. Many fractures are type I open, but more significant soft-tissue injury can also occur.