Authors of section

Author

Alan Ruggles

Executive Editor

Jörg Auer

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Comminuted diaphyseal fractures

Fracture characteristics and causes

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.

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Etiology

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:

  1. Salter Harris Type II
  2. Tibial crest fractures
  3. Simple diaphyseal fractures
  4. Comminuted diaphyseal fractures
  5. Diaphyseal stress fractures
  6. Medial malleolus fractures
  7. Lateral malleolus fractures
  8. Distal physeal fractures
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Radiography

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.

Craniocaudal and lateromedial views
Craniolateral to caudomedial and craniomedial views

Clinicial signs

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.