Lower Extremity Fractures & Automobile Accidents

Lower extremity fractures are common complications of head-on and side-impact crashes. These fractures can include those as high as the knee in the upper tibia to foot fractures or even toe fractures. All of these fractures can be disabling, some for an extended period.

The mechanism of injury of these types of fractures is blunt force trauma to the lower leg. It includes pushing the foot into the front of the car or the back of the front seat and twisting the ankle. Depending on the position of the foot, the fracture can be higher and can include a tibial/fibular fracture of the midshaft to the upper tibial area.

Because the tibia is a weight-bearing bone in the body, walking is impossible after a fracture of this bone. Any attempt to walk would be considered extremely painful, if not impossible. The fibula is a stabilizing bone, so just a fracture of the fibula would be painful, but limited walking would be possible. The most common type of fibular fracture is the distal fibula, the outer bone of the ankle, and is essentially considered an ankle fracture.

Tibial and fibular fractures, or fractures of the foot, are identified by plain film X-rays. Tibial fractures are often open, meaning the bone protrudes through broken skin. This is because the tibia on the medial and anterior aspects is close to the skin, so a displaced fracture often goes right through.

Seat belts, airbags, and other lifesaving equipment have been found to reduce the incidence of injury. On the other hand, this doesn’t seem to be true for lower extremity fractures, which can come from front or lateral crashes even if restraints exist.

In one study, front-seat occupants were evaluated from police reports during five years from 1995-2000. Unrestrained occupants were compared to restrained and/or occupants with an airbag deployed. Those with airbags only had a higher risk of lower extremity fractures when compared to those who were restrained with a seat belt and an airbag or just a seat belt alone. The researchers recommended that automobiles be fitted with a knee accessory bolster to avoid “submarining,” sliding beneath the airbag and hitting the lower extremities with the dash or steering wheel.

Fibular fractures are often treated with casting, especially if they are distal fibular fractures or “ankle” fractures. They generally heal well without residual pain or deformity. Tibia fractures are different. Because they are the weight-bearing bones of the leg, if casting alone is done, there must be a prolonged period of non-weight bearing before it is healed. For this reason, tibial fractures are often treated surgically, such as by inserting a rod down into the two ends of the fractured bones. This promotes faster healing, quicker weight bearing, and an easier recovery.

The prognosis of tibial fibular fractures is excellent with the proper treatment. Open tib/fib fractures can yield infection and bleeding complications, which make recovery more complex.

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