![]() ![]() ![]() The neurovascular exam is very important to assess the dorsalis pedis and posterior tibialis arteries. EvaluationĮvaluating the range of motion and stability are often difficult due to pain. A high index of suspicion should be maintained for elevated compartment pressures, especially in the higher impact trauma patient. Patients with this injury present with the inability to bear weight and deformity. Patient presentation and physical exam are the same for most tibia fractures. In general, the tibial shaft fractures are the most common long bone fractures and seen in 4% of the senior population. High-energy mechanism injury is usually a result of direct trauma causing wedge or short oblique fractures and significant comminution and can be associated with soft-tissue injury, compartment syndrome, bone loss, and ipsilateral-skeletal injury. With a low-energy injury, these are a result of a torsional force, indirect trauma resulting in spiral fractures, and/or a fibular fracture at a different level with a minimal soft-tissue injury. These fractures occur in a bimodal pattern involving both low-energy and high-energy mechanisms. The anterior compartment is composed of the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius. Lateral compartment is composed of the peroneus longus and brevis. The muscles of the superficial posterior compartment include the gastrocnemius, soleus, and plantaris. The muscles of the deep compartment include popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus. The saphenous nerve innervates the medial aspect of the foot and leg. The deep peroneal nerve, on the other hand, supplies the musculature of the anterior compartment and is sensory to the first web space. The superficial peroneal nerve is seen along the border between the lateral and anterior compartments and supplies the peroneus longus and brevis. The common peroneal nerve divides into the superficial and deep peroneal nerves. The muscular branches of this nerve innervate muscles in the superficial and deep posterior compartments. The tibial nerve passes deep to the soleus, traveling down to the posterior aspect of the medial malleolus. ![]() It is important to understand the nerves and the compartments these nerves supply. The peroneal artery terminates as the calcaneal arteries. The posterior tibial artery is a continuation of the popliteal artery coursing in the deep compartment of the leg terminating as the medial and lateral plantar arteries. ![]() The vascular anatomy is extensive and dependent on the compartment of muscles it supplies. The anterior tibial artery is the first branch of the popliteal artery, passes between the 2 heads of the tibialis anterior and Extensor hallucis longus (EHL) terminating as the dorsalis pedis. The tibia shaft is a long bone that articulates with the talus, fibula and the distal femur. The proximal tibia is triangular in shape with a vast metaphyseal region narrowing distally.
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