When comparing outcomes of IMN with external fixation, IMN is associated with decreased malalignment and compared to closed treatment, IMN is associated with decreased union time and time to weight bearing. This is the treatment of choice for operative fixation. Treatment of choice when significant soft tissue compromise is present or in polytrauma cases where damage-control orthopedics is needed. The anterior compartment is composed of the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius.Ĭlosed-reduction and nonoperative treatment in a long leg cast is acceptable for fractures in less than 5 degrees of varus-valgus angulation, less than 10 degrees in anterior-posterior angulation, greater than 50% cortical apposition, less than 1-cm shortening and less than 10 to 20 degrees of flexion and less than 10 degrees of rotational malalignment after reduction. 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.

Broken tibia and fibula cast