A large amount of force is required to produce fractures of both the tibia and fibula. Fractures of the diaphysis of the tibia are frequently associated with fibular fractures and are usually open. Consideration of popliteal artery involvement for proximal tibial fractures is important as is monitoring for compartment syndrome.

A	Lateral, AP, and oblique radiographs of the tibia and fibula. These reveal mildly displaced spiral fractures of both the tibia and fibula.
B	AP radiograph of the tibia and fibula in a different patient. This demonstrates comminuted and mildly displaced fractures of the distal fibula and tibia.
C	Lateral radiograph of the foot. This also demonstrates the fractures of the distal fibula and tibia.
D	Lateral radiograph of the tibia and fibula. Notice the dense band of sclerosis at the fracture site. This appearance is due to nonunion of the fracture fragments.

Links to online textbooks:

• Wheeless' Orthopedics: menu of tibial fractures

Links to online cases:

• Akhtar Khan
• Mueller Foundation
• Doctoronnet.com

References:

• Agnew SG, Freeland AE: Closed unstable fractures of the tibial and fibular shafts at the same level Orthopedics. 1991 Aug;14(8):911-2.           [See related articles]
• Oni OO: Fractures of the tibia and fibula in adults Clin Orthop. 1987 Mar;(216):310-1.           [See related articles]
• Bostman OM: Spiral fractures of the shaft of the tibia. Initial displacement and stability of reduction J Bone Joint Surg Br. 1986 May;68(3):462-6.           [See related articles]