![]() The common peroneal nerve divides to form the superficial and deep peroneal nerves, providing innervation to the muscles in the lateral and anterior lower leg, respectively. In the popliteal space, branches of the tibial nerve provide innervation to the posterior compartment and to the popliteus muscle. The tibial nerve parallels the course of the posterior tibial artery and courses through the deep posterior compartment. The tibial and common peroneal nerves and their branches provide the key innervation to the muscles of the lower leg and foot. Anterior tibial artery as it branches off the popliteal artery and passes through a gap in the interosseous membrane.Popliteal artery injury before it branches into the anterior and posterior tibial arteries.Vascular compromise can arise more proximally from the following etiologies : Three of these, the anterior, posterior, and deep posterior compartments, all border the tibia and can be compromised by tibial injury. Fascial extensions and the interosseous membrane separate the muscles, nerves, and vessels of the lower leg into four distinct compartments ( figure 6). Proximally, this structure, reinforced by strong anterior and posterior ligaments, forms a synovial joint, the proximal tibiofibular articulation.Īnother fibrous structure, the crural fascia, surrounds the bones and muscles of the lower leg. The interosseous membrane is a strong fibrous structure that connects the tibia and fibula along the length of the two bones. However, injury to the tubercle does not pose a risk of growth disturbance. As the site of attachment for the patellar tendon, the tubercle is subject to tensile forces and thus, both inflammatory and avulsion injuries. The tibial tuberosity is another key landmark located on the anterior surface, one to two centimeters below the joint line and the inferior patellar pole. Injuries to pressure epiphyses and to growth plates can result in growth disturbances. The epiphysis of the proximal tibia is a pressure epiphysis and is subject to compressive forces. The physis, or growth plate, is the active zone of bone lengthening that links the epiphysis to the rest of the bone ( figure 5). The diaphysis, or long shaft of the bone, flares at either end of the bone metaphysis and terminates in the rounded end of the bone called the epiphysis. Separating the medial from the lateral tibial condyle is the tibial spine (intercondylar eminence), an important bony prominence that anchors the attachment of the anterior cruciate ligament (ACL). The thicker of the two articular surfaces is the medial tibial condyle, while the lateral tibial condyle is a relatively thinner and weaker portion of the joint. The proximal portion of the bone, the tibial plateau, forms the lower surface of the knee joint ( figure 4). Tibial tubercle avulsion occurs in older adolescents during active quadriceps contraction with forced flexion of the knee (eg, landing from a jump during basketball, hurdling, high jump or gymnastics or being tackled in American football or rugby).ĬLINICAL ANATOMY - The tibia is the major weight-bearing bone of the lower leg ( figure 2 and figure 3).These fractures are significantly more common in males than females. Physeal fractures are commonly seen in young adolescents (12 to 14 years of age) and are related to high energy mechanisms (eg, sports injuries, motor vehicle collisions) ( figure 1).Older children (10 to 12 years of age) are at risk for tibial spine avulsion from hyperextension and rotation injury (eg, most commonly a fall from a bicycle or motorbike).Jumping on a trampoline with other children is a common mechanism. Young children (three to nine years of age) are at risk for greenstick or complete metaphyseal fractures when valgus or varus stress is applied. ![]() Other patterns of injury correspond to the age of the child and the type of force : (See "Orthopedic aspects of child abuse".) In toddlers, metaphyseal corner or bucket handle fractures are highly associated with child abuse. (See "Tibial and fibular shaft fractures in children" and "Stress fractures of the tibia and fibula" and "Ankle fractures in children".)ĮPIDEMIOLOGY - Proximal tibial fractures are infrequent in children relative to diaphyseal and distal tibial fractures. Other pediatric fractures of the tibia or fibula are discussed separately. INTRODUCTION - The evaluation and management of proximal tibial fractures in children is reviewed here.
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