Page 129 - ASOP Orthopedic Casting Manual

3.3.1 Fracture Type(s) for Short Leg

Cast

Shor t leg c asts LSLCsM are widely used in or thopedic practice for immobilizing fractures of the distal tibia, fibula,
ankle, and foot. These fractures often occur due to trauma, falls, or spor ts-related injur ies and require precise
diagnosis and management to ensure proper he aling. This section explores distal tibia fractures, isolated fibular
fractures, ankle fractures, metatarsal fractures, and Lisfranc injur ies, detailing their clinic al anatomy,
epidemiology, mechanism of injur y, clinic al character istics, diagnostic process, differential diagnoses, and
tre atment considerations.

Distal Tibia Fractures
✓ Clinic al Relevant Anatomy: The tibia, or shinbone, is the pr imar y weight-be ar ing bone of the lower leg and
plays a crucial role in lower ex tremit y biomechanics. The distal tibial metaphysis transitions from the dense
cor tic al bone of the shaft to the more porous c ancellous bone ne ar the ankle joint, making it more susceptible
to fractures. The medial malleolus, which ex tends from the distal tibia, for ms a cr itic al stabilizing component
of the ankle joint. Additionally, the poster ior tibial ar ter y and ner ve p ass closely along the poster ior aspect of
the tibia, making vascular and neurologic al compromise a concer n in tibial fractures LMoore et al., 2020M.
✓ Epidemiology / Etiology / Mechanism of Injur y: Distal tibial fractures compr ise approximately 7]10% of all tibial
fractures, with a bimodal age distr ibution. Younger individuals commonly sustain these fractures through
high-energy trauma, such as motor vehicle accidents, spor ts injur ies, or falls from height. In contrast, older
adul ts often exper ience low-energy fragilit y fractures due to osteoporosis and falls LCour t-Brown et al., 2021M.
The mechanism of injur y var ies but often involves axial lo ading, torsional forces, or direct imp act. High-energy
fractures are frequently comminuted or intra-ar ticular, while low-energy fractures tend to be simple
transverse or oblique fractures.
✓ Clinic al Character istics / Presentation: Patients with distal tibial fractures t ypic ally present with signific ant
loc alized p ain, swelling, and bruising over the lower leg and ankle. Depending on the sever it y, they may have
an obvious defor mit y in displaced fractures or minimal swelling in hair line fractures. Weight-be ar ing is often
p ainful or impossible, and p atients may repor t numbness or tingling if neurovascular structures are affected.
Comp ar tment syndrome is a rare but cr itic al complic ation in high-imp act fractures, requir ing immediate
assessment.
✓ Fracture Diagnosis Process: Assess for tender ness along the tibia, p ar ticular ly ne ar the medial malleolus;
Evaluate skin integr it y to rule out open fractures; Per for m a neurovascular examination, checking for c apillar y
refill, dorsalis pedis and poster ior tibial pulses, and sensation in the foot.
✓ Imaging Studies: L1M X-ray LAP, lateral, oblique views) is the first-line imaging modalit y to confir m the fracture
p atter n; L2M CT sc an may be necessar y for complex fractures with suspected intra-ar ticular ex tension.
✓ Differential Diagnosis / Associated Injur ies: Ankle sprains (c an mimic p ain at the distal tibia); Stress fractures

(p ar ticular ly in athletes with chronic lower leg p ain); Talus fractures (c an coexist with distal tibial fractures);
Maisonneuve fractures (high fibular fractures associated with syndesmosis injur ies)
✓ Tre atment / Management Considerations: For nondisplaced fractures, an SLC is applied for 6^8 weeks, with
non-weight-be ar ing status for the first few weeks, followed by progressive weight-be ar ing. If the fracture is
displaced, closed reduction is per for med before c asting. Surgic al fixation (intramedullar y nailing or plating) is
considered for unstable fractures, open fractures, or those involving the ar ticular sur face LBucholz et al.,
2021M.