Bramlage, in, 2012 Preoperative ConsiderationsUsually, diaphyseal fractures of the adult tibia are high-energy, catastrophic injuries accompanied by extensive comminution and skin penetration. 9 For these reasons, attempts at repair are seldom practical, because of the very poor prognosis. However, tibial fractures in foals usually have less comminution and have a better chance of remaining closed, and repair has a greater chance of success.Because traction on the distal limb does not reduce a tibial fracture—in fact, it causes overriding because of the reciprocal apparatus—hanging the limb in tension is not helpful. Placing the injured tibia down with the horse in lateral recumbency impedes surgical manipulation of the diaphyseal fracture and necessitates a medial surgical approach, where little soft tissue covers the bone and implant. Therefore, the horse is best positioned in dorsal recumbency with minimal traction on the limb or in lateral recumbency with the injured tibia uppermost.Approaches to the tibia for diaphyseal fracture repair must take the anatomy into consideration.

The cranial tibial artery is located on the cranial lateral aspect of the tibia. The lateral outpouching (sulcus muscularis) of the lateral femorotibial joint compartment extends distad, surrounding the long digital extensor tendon on the proximolateral aspect of the tibia. The tenuous soft tissue on the medial aspect of the tibia must be protected and the closely attached digital extensor tendons distally near the tarsocrural joint must be avoided.Three surgical approaches are available: the medial approach directly over the tibia without muscle cover, the lateral approach between the long digital extensor and the cranial tibial muscles, and the cranial approach, in which the incision is made over the cranial tibial muscle. 9 The cranial approach over the muscle is the most versatile.Deep dissection is extended slightly mediad allowing the muscle and soft tissue to be retracted as one unit laterad, permitting a cranial approach to the proximal tibial shaft. The cranial approach eliminates the necessity of dealing with any blood vessels, because all the vasculature is elevated with the cranial tibial muscle. Some surgeons prefer to place the implants on the surface of the periosteum. If this approach is elected, the vessels need to be protected if extra-periosteal dissection is used.

Implants can be placed on the medial and lateral aspects of the bone through this incision, eliminating the need for two incisions, as are required with the medial and lateral approaches. The biomechanics of weight bearing of the tibia dictate that two plates be used and that one plate is best placed craniolaterally on the tension surface of the bone, spiraling distad to the cranial tibia ( Figure 98-7, C and D). 10Broad-spectrum antimicrobial agents and anti-inflammatory medications are administered preoperatively. The tibia ( Figure 7.23) is the larger and medial bone of the crus, or middle segment of the hind limb. Its proximal surface bears lateral and medial condyles that articulate with the femur. Just distal to the lateral condyle, on the lateral surface and facing distally, is the small, nearly oval facet for the head of the fibula (see later). On the posterior surface of the tibia, between the condyles, is the popliteal notch.

A small muscle, the popliteus, lies in the notch and is a flexor of the knee joint. The tibial tuberosity, for insertion of the patellar ligament, lies anteriorly. The tibial crest continues distally from the tuberosity along the shaft. Bones of the left crus of the cat; tibia and fibula in (a) anterior and (b) posterior views.The distal end of the tibia has two articular surfaces. The large surface on the distal surface, the cochlea tibiae, is for the astragalus, the tarsal bone with which the pes articulates with the hind limb. Note how this facet consists of two sulci separated by a median ridge. This structure restricts motion at the ankle almost entirely to a fore and aft direction, producing flexion and extension.

Tibia, also called shin, inner and larger of the two bones of the lower leg in vertebrates—the other is the fibula. In humans the tibia forms the.

If available, manipulate the tibia and pes to observe this. The small, nearly triangular fibular facet, for articulation with the fibula, faces posterolaterally and is contiguous with the lateral part of the cochlea tibiae. The medial malleolus is the distal extension of the tibia’s medial surface.

It forms the medial protrusion of the ankle. Robert Lewis Maynard, Noel Downes, in, 2019 The Tibia and FibulaThe tibia is equivalent to the radius of the forelimb, and is the weight bearing member of the second segment of the hindlimb. In the rat, the fibula is much reduced compared with man fusing with the tibia in its lower part, but breaking free in its most distal part to provide the lateral malleolus of the ankle joint.

Hunt (1924) described the combination of tibia and fibula as resembling an archer’s bow with the fibula providing the bowstring.The articular surface at the proximal end of the tibia comprises two concave or dished areas: the upper surfaces of the medial and lateral condyles, and between them the intercondylar groove or fossa. The menisci are anchored anteriorly and posteriorly to the tibial surface in the groove. The tibia bears an anterior crest that separates its lateral and medial surfaces. The proximal anterior surface of the tibia is prominent, forming the tibial tuberosity, to which is attached the patellar ligament. The proximal end of the fibula articulates with the tibia at a facet beneath the overhang of the lateral tibial condyle.

The joint is synovial in man, which according to Flower (1885) is typical of mammals. Hunt (1924) says nothing of this articulation but states, ‘The slender fibula expands dorsally, where it is attached by a ligament to the external condyle of the tibia’. Flower points out that the fibula ‘often ankyloses fuses with the tibia at one or both ends’.In man, the distal ends of the tibia and fibula form a mortice that grips the talus and forms the ankle joint. The tibia carries the weight of the body and the fibula provides only the lateral side of the mortice.

Neither Greene (1935), Hebel and Stromberg (1976) nor Hunt (1924) provide any details of the ankle joint in the rat, but Hunt described the distal end of the tibia as containing a pair of longitudinal groves, which presumably fit the ridges at the sides of the articular surface of the talus. De Araujo et al. (2012) provide some information, they used the rat for comparison with caviomorph rodents, and Vickerton et al. (2014) provide illustrations that show the distal end of the fibula resting on what appears to be a lateral extension of the talus. In this study, Finite Element Analysis, used to identify regions of strain in the tibia-fibula, showed the joint between the medial aspect of the lateral malleolus (of the fibula) and the lateral aspect of the talus appeared to be a region of considerable strain.

Montavon, in, 2009 39.1 Surgical anatomyThe tibia is a straight bone with a triangular shape in the proximal third and a round to oval shape in the distal two-thirds. The fibula is very thin in cats and does not contribute to weight-bearing, but it is important for stifle and tarsal joint stability because it serves as the attachment site for the lateral collateral ligaments of both joints. The distal fibula has a ligamentous connection to the tibia, the inferior tibiofibular ligament. This ligament is important for stability of the tarsal joint, because the medial and lateral malleolus are not only the sites of origin of the tarsal collateral ligaments but also serve as a medial and lateral restraint for the trochlea of the talus ( Chapter 40). The synovial joint between the lower ends of the tibia and fibula and the talus is the ankle joint ( Figs 6.70–6.75). Plantar flexion and dorsiflexion of the foot are the main movements in this joint.

The deep socket formed by the tibia and fibula with the medial and lateral malleoli gripping the sides of the talus along with the ligaments and the muscles crossing the joint stabilise the ankle joint. The lower end of the tibia and fibula forming the socket for the talus is held together by the tibiofibular syndesmosis, injury to which makes the ankle joint very unstable. Lateral aspect of the ankle OsteologyThe lower ends of the tibia and fibula along with the two malleoli form the tibiofibular mortise into which the talus is received. The medial surface of the lateral malleolus articulates with the lateral surface of the talus, the inferior surface of tibia with the superior articular surface (trochlear surface) of the talus, and the lateral surface of the medial malleolus with the medial surface of the talus ( Figs 6.70–6.73). The posterior border of the tibia, often known as the posterior malleolus, also contributes to the tibiofibular mortise which grip the talus.

The joint is most stable in dorsiflexion when the broad end of the trochlear surface ( Fig. 6.74) fills the tibiofibular mortise. Capsule and ligamentsThe fibrous capsule is thin in front and behind but is reinforced on either side by ligaments.The medial ligament or the deltoid ligament is a strong ligament on the medial aspect of the joint. Its narrow proximal part is attached to the medial malleolus, whereas distally it fans out to be attached to the calcaneus, talus and navicular. Clinical box 6.11Ankle injuriesA wide variety of fractures can occur at the ankle often associated with ligament injuries.

Fracture of the medial malleolus, lateral malleolus and posterior malleolus can occur. Ligaments often injured are the deltoid ligament, the anterior talofibular ligament, the calcaneofibular ligament and the interosseous (inferior) talofibular ligament.

Commonest injury is a sprained ankle where the anterior talofibular and/or the calcaneofibular ligament are partially torn. It is caused by a sudden inversion of the foot while it is in plantar flexion.More serious injuries at the ankle are sustained by a forceful inversion of the foot associated with external rotation of the talus. As the talus rotates laterally the lateral malleolus is fractured. This should still leave a stable ankle. However if the force is more violent the rotation of the talus can fracture the posterior and medial malleoli and tear the deltoid ligament. In a very severe external rotation injury the inferior tibiofibular joint is disrupted, making the tibia and fibula separate from each other. This will make the ankle very unstable.

MovementsDorsiflexion and plantar flexion are the main movements. In the upright position with the foot at right angles to the leg the plantar flexion is about 20° and dorsiflexion about 10°. The range of passive movements is markedly more than these. The axis of movements is not horizontal but one which slopes from the lateral malleolus downwards and medially towards the medial malleolus, contributing to slight eversion of the foot during dorsiflexion and inversion during plantar flexion. A.The tibial plateau is the proximal tibial surface on which the femur rests. It is divided into two articular sections, one for each femoral condyle.

In life there are fibrocartilagenous rings around the periphery of these articular facets, the medial and lateral menisci. B.The medial condyle is the medial part of the tibial plateau. Its femoral articulation is oval, with the long axis oriented anteroposteriorly. Its lateral edge is straight. C.The lateral condyle is the lateral part of the tibial plateau. Its femoral articulation is smaller and rounder than the medial articulation.

D.The intercondylar eminence is the raised area on the proximal tibial surface between articular facets. E.The medial intercondylar tubercle forms the medial part of the intercondylar eminence. F.The lateral intercondylar tubercle forms the lateral part of the intercondylar eminence. The anterior and posterior cruciate ligaments and the anterior and posterior extremities of the menisci insert into the nonarticular areas between the condyles, which are just anterior and posterior to the medial and lateral intercondylar tubercles, respectively. G.The superior fibular articular facet is located on the posteroinferior edge of the lateral condyle. H.The tibial tuberosity is the rugose area on the anterior surface of the proximal tibia.

Its superior part is smoothest and widest. The patellar ligament of the quadriceps femoris muscle, a major lower leg extensor at the knee, inserts here. I.The tibial shaft is the fairly straight segment of the tibia between the expanded proximal and distal ends. J.The soleal ( popliteal) line crosses the proximal half of the posterior tibial surface from superolateral to inferomedial. The line demarcates the inferior boundary of the popliteus muscle insertion. This muscle is a flexor and medial rotator of the tibia and originates from the popliteal groove on the lateral femoral condyle.

The line itself gives rise to the popliteus fascia and soleus muscle, a plantarflexor of the foot at the ankle. K.The nutrient foramen is just inferolateral to the popliteal line. It is a large foramen that exits the bone proximally. L.The anterior surface (anterior crest) of the shaft forms the anterior edge of the “shin.” m.The medial surface of the shaft forms the medial edge of the “shin” of the lower leg. This subcutaneous border is the widest tibial shaft surface.

N.The interosseous surface of the shaft is lateral, opposite the fibula. It is the most concave of the three tibial surfaces. O.The interosseous crest is the lateral crest of the shaft, which faces the fibula. It is the attachment area for the interosseous membrane, a sheet of tissue that functions to bind the tibia and fibula together and to compartmentalize lower leg muscles into anterior and posterior groups, just as its serial homolog does in the forearm. P.The medial malleolus is the projection on the medial side of the distal tibia that forms the subcutaneous medial knob at the ankle. Its lateral surface is articular, for the talar body.

Q.The fibular notch is the distolateral corner of the tibia. It is a triangular nonarticular area for the thick, short interosseous tibiofibular ligament. This ligament binds the distal tibia and fibula together as a unit at this syndesmosis. The proximal ankle, or talocrural, joint is formed by the tightly bound distal tibia and fibula, which articulate with the superior, medial, and lateral talar surfaces. R.The inferior fibular articular surface is a thin articular surface for the fibula, which faces laterally at the base of the fibular notch.

S.The malleolar groove on the posterior aspect of the medial malleolus transmits the tendons of the tibialis posterior and flexor digitorum longus muscles, plantarflexors. 15.3.2 Growth ( Figure 15.7)The tibia ossifies from three centers: one for the shaft and one for each end of the bone. Separate centers for the tibial tuberosity sometimes occur. 15.3.3 Possible Confusion.For an intact tibia, the tibial tuberosity is proximal and anterior.

The medial malleolus is on the distal end and is medial.For the proximal tibia, the tibial tuberosity is anterolateral, the fibular articulation is placed posterolaterally, and the lateral femoral articular surface is smaller, rounder, and set laterally. The intercondylar eminence is set posteriorly, and the axis of the nonarticular strip on the plateau runs from anterolateral to posteromedial. This strip is wider anteriorly than posteriorly. The intercondylar eminence has a more concave medial border and a more evenly sloping lateral border.For fragments of shaft, the entire shaft tapers distally, and the interosseous crest is lateral and posterior. The medial surface is the widest and faces anteriorly.

The nutrient foramen is posterior and exits proximally. The cortex is thickest at midshaft.For the distal end, the malleolus is medial and its distal-most projection is anterior. Grooves for the plantarflexor tendons are posterior. The fibular notch is lateral, and the interosseous crest runs toward its anterior surface. The margin of the articular surface for the superior talus is grooved on the anterior surface but not the posterior surface.

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The distal tibia and fibula are connected to each other via the inferior tibiofibular ligament ( Fig. Both the medial and lateral malleolus enclose the trochlea tali and thus prevent mediolateral displacement. The malleoli are also the insertion sites for the collateral ligaments. In contrast to dogs, cats only have short collateral ligaments (2). The medial and lateral collateral ligaments each consist of straight and oblique branches ( Fig. The oblique tibiotalar part of the ligament on the medial side and the talofibular part on the lateral side are hidden below the malleoli, and are difficult to access surgically. Important ligaments of the tarsocrural joint.( A) The tibiofibular ligament complex is responsible for the tight connection between the distal tibia and fibula.( B) The short medial collateral ligament consists of a straight tibiocentral and an oblique tibiotalar part.

The tibiotalar part is partially hidden under the malleolus.( C) The short lateral collateral ligament has a calcaneofibular part, and a talofibular part. The calcaneofibular part of the lateral collateral ligament has an oblique and a straight branch.The tarsus is composed of seven tarsal bones. The articulations between the bones are known as the tarsocrural, talocentral, calcaneoquartal, centrodistal and the tarsometatarsal joints. The distal tibia, the distal fibula, and the talus contribute to the tarsocrural joint. Axial force transmission is through the distal tibia and the talus.An intertarsal joint is the articulation between adjacent tarsal bones, some of which have specific names. For ease of description, although not technically correct, the talocentral and calcaneoquartal joints are often referred to as the proximal intertarsal joint.

The joints between the small tarsal bones are generally considered joints with low mobility, but some functional motion is present, especially in the talocentral, calcaneoquartal, and talocalcaneal joint. The centrodistal and tarsometatarsal joints are tighter joints, with less motion.Numerous short ligaments span the small bones of the tarsus. For functional reasons they can be divided into short dorsal and plantar ligaments, and short medial and lateral ligaments. The plantar ligaments are located on the tension side of the limb and are therefore subject to large tensile forces. A long ligament is present at the plantar side of the tarsus extending from the distal end of the calcaneus to both the fourth tarsal bone and the base of the fourth metatarsal bone. Jacqueline R.

Davidson, Sharon Kerwin, in, 2014 Tibial and Fibular FracturesFractures of the tibia and fibula are common in the dog. Depending on the fracture type and configuration, they may be treated with closed reduction and external coaptation, or open reduction with internal or external fixation. Nonsteroidal antiinflammatory drugs, cryotherapy, and PROM are used to decrease pain and inflammation and maintain ROM for the first 2 to 3 weeks. Massage may be performed initially to help resolve edema. Active weight-bearing exercises are then initiated. The rate and progression of activity are dictated by the severity of the fracture and stability of repair.

Because relatively little soft tissue covers the medial surface of the tibia, open fractures are quite common. In these cases, wound management and bandaging also may be necessary.

Osteomyelitis tends to occur in the tibia more commonly than other bones and is probably related to the high incidence of open fractures. Aquatic therapy is contraindicated in patients with open wounds.

What are the other Names for this Condition? (Also known as/Synonyms). Posterior Tibial Tendon Dysfunction. Tibial Nerve NeuropathyWhat is Tibial Nerve Dysfunction? (Definition/Background Information).

Tibial Nerve Dysfunction is damage to the tibial nerve which is responsible for sensation and movement in the calf and foot. The condition is more likely to occur in adults over 40 years of age. It is caused by sustaining a heavy impact to the posterior tibial tendon or through overuse (such as occurring through sports participation).

The predisposing factors for Tibial Nerve Dysfunction may include high-impact sports, climbing stairs, and running. Individuals with hypertension and those who are diabetic are also at risk. The signs and symptoms of Tibial Nerve Dysfunction may include pain on the inside of the foot or ankle, pain that gets worse during activity and spreading to the outside of the ankle. Complications of Tibial Nerve Dysfunction may include inability to walk due to pain, partial to complete loss of feeling in the foot, and mild to severe foot deformity. Tibial Nerve Dysfunction is treated symptomatically for pain and swelling of the feet. In some cases, a surgery may be required. The prognosis of Tibial Nerve Dysfunction may vary, but is good with early diagnosis and treatment.

The condition may be prevented by reducing the risk of blunt force injury that occur from falling or high impact sports and through the use of suitable protective sports gearWho gets Tibial Nerve Dysfunction? (Age and Sex Distribution).

Tibial Nerve Dysfunction is more likely to occur in adults over the age of 40 years. Females are more likely to be affected than males.

All races and ethnic groups can be affected and no preference is seenWhat are the Risk Factors for Tibial Nerve Dysfunction? (Predisposing Factors)The risk factors for Tibial Nerve Dysfunction may include:. Walking and running.

High impact sports. Climbing stairs. Hiking. Obesity. Diabetics. Individuals with hypertension are also at risk for Tibial Nerve DysfunctionIt is important to note that having a risk factor does not mean that one will get the condition.

A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Tibial Nerve Dysfunction? (Etiology)Tibial Nerve Dysfunction may be caused by sustaining a high impact force to the feet. Overuse of the posterior tibial tendon may also cause the condition, which may be due to activities such as:. Walking and running. High impact sports. Climbing stairs.

HikingWhat are the Signs and Symptoms of Tibial Nerve Dysfunction?Tibial Nerve Dysfunction usually affects only one foot, but both feet may be involved. (accessed on )(accessed on )(accessed on )(accessed on )(accessed on )(accessed on ).

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