Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.

by Alexis Thomson; Alexander Miles

Fig. 84.—Radiogram of Fracture of Head of Tibia and Upper Third of Fibula.

Fracture of the Upper End of the Tibia

Fig. 85.—Radiogram illustrating Schlatter's disease.

Fracture of the head of the tibia is a comparatively rare injury. It may result from a direct blow, such as the kick of a horse, or from indirect forms of violence, and the line of fracture may be transverse or oblique. Occasionally the distal fragment is impacted into the proximal and comminutes it. In oblique fracture a gliding displacement is liable to occur and cause bow- or knock-knee. Transverse fracture of the head of the fibula sometimes accompanies fracture of the head of the tibia, and there is always considerable effusion into the knee-joint. One or other of the condyles may be chipped off by forcible adduction or abduction at the knee.

The ordinary clinical features of fracture are well marked, and the diagnosis is easy. From some unexplained cause this fracture may take a long time, sometimes several months, to consolidate.

Separation of the upper epiphysis of the tibia, which includes the tongue-like process for the tubercle and the facet for the fibula, is also rare. It usually occurs between the ages of three and nine. The displacement of the epiphysis is almost always forward or lateral, and is accompanied by the usual signs of such lesions. The growth of the limb is sometimes arrested, and shortening and angular deformity may result.

Treatment.—After reduction under an anæsthetic these fractures are usually satisfactorily treated in a box splint ([Fig. 91]), carried sufficiently high to control the knee-joint. When the head of the tibia is comminuted or split obliquely, weight-extension—direct from the bone, the ice-tong callipers grasping the malleoli or the calcaneus—may be used. Massage and movement are employed from the outset.

Avulsion of the tuberosity of the tibia occasionally occurs in youths, from violent contraction of the quadriceps—as in jumping. The limb is at once rendered powerless; the osseous nodule can be felt, and on moving it crepitus is elicited.