Anatomy, Bony Pelvis and Lower Limb, Tibia

Article Author:
Matthew Bourne
Article Editor:
Patrick Murphy
Updated:
9/19/2018 1:52:19 AM
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Anatomy, Bony Pelvis and Lower Limb, Tibia

Introduction

The tibia is one of two bones that comprise the leg.[1] As the weight-bearing bone, it is significantly larger and stronger than its counterpart, the fibula. The tibia forms the knee joint proximally with the femur and forms the ankle joint distally with the fibula and talus. The tibia runs medial to the fibula from just below the knee joint to the ankle joint and is connected by the interosseous membrane.[2]

The proximal portion of the tibia consists of a medial and lateral condyle, which combine to form the inferior portion of the knee joint. Between the two condyles lies the intercondylar area, which is where the anterior collateral ligament, posterior collateral ligament, and menisci all have attachments.

The shaft of the tibia is triangular in cross-section with three borders and three surfaces. [3]The anterior border divides the medial and lateral surface, the medial border divides the medial and posterior surface, and the interosseous border divides the lateral and posterior surface. While the medial surface is mostly subcutaneous, the lateral surface abuts the anterior compartment of the leg, and the posterior surface abuts the posterior compartment.

The distal portion of the tibia is shaped like a box with a distal medial protuberance that makes up the medial malleolus.[4] The are five surfaces that make up the distal tibia.

  1. The inferior surface provides a smooth articulation with the talus.
  2. The anterior surface is covered by extensor tendons and provides an area for ankle joint capsule attachment.
  3. The posterior surface has a groove for the tibialis posterior muscle.
  4. The lateral surface has a fibular notch which serves as an attachment for the interosseous membrane.
  5. The medial surface is a large bony prominence that makes up the medial malleolus.

Structure and Function

As the second largest bone in the body, the tibia's main function in the leg is to bear weight. [5]It also serves as the origin or insertion site for 11 muscles; these allow for extension and flexion at the knee joint and dorsiflexion and plantarflexion at the ankle joint.

Embryology

The tibia has three ossification centers: one for the diaphysis and one for each epiphysis. It begins in the shaft at around the seventh week in utero. The proximal ossification center starts at birth and closes at age 16 in females and age 18 in males.[6] The distal ossification center starts at age one and closes at age 15 in females and age 17 in males.

Blood Supply and Lymphatics

The nutrient artery and periosteal vessels supply the blood to the tibia. The nutrient artery arises from the posterior tibial artery and enters the bone posteriorly distal to the soleal line. The periosteal vessels stem from the anterior tibial artery.[7]

Nerves

The nerves that supply the tibia are all branches of the main nerves that supply adjacent compartments.[8] In the posterior compartment of the leg, the tibial nerve gives off branches that supply the posterior aspect of the tibia, and in the anterior compartment of the leg, the deep fibular nerve gives off branches that supply the anterior aspect of the tibia.

Muscles

Muscles Inserting on the Tibia

  • Tensor fasciae latae inserts on the lateral tubercle of the tibia, which is known as the Gerdy tubercle
  • Quadriceps femoris inserts anteriorly on the tibial tuberosity
  • Sartorius, gracilis, and semitendinosus insert anteromedially on the pes anserinus
  • Horizontal head of semimembranosus muscle inserts on the medial condyle
  • Popliteus inserts on the soleal line of the posterior tibia

Muscles Originating at the Tibia

  • Tibialis anterior originates at the upper two-thirds of the lateral tibia
  • Extensor digitorum longus originates at the lateral condyle of the tibia
  • Soleus and flexor digitorum longus originate at the posterior aspect of the tibia on the soleal line

Physiologic Variants

One of the physiologic variants involving the tibia is a ball and socket ankle joint as opposed to the normal hinged ankle joint. In this variant, the distal tibia is concave and articulates with a rounded superior talus.[9]

Surgical Considerations

Management of Tibial Fractures

Tibial plateau fracture: These fractures present with knee pain and effusion. They classically occur after a car hits a pedestrian's fixed knee, which is known as a "bumper fracture." They are classified using the Schatzker classification and managed by using nonsurgical or surgical methods to achieve stable alignment.[10]

Tibial shaft fracture: Compared to most long bone fractures, tibial shaft fractures are more likely to be open because the medial surface is adjacent to the subcutaneous tissue. Open fractures usually occur from a motor vehicle accident while closed fractures usually occur from falls. Nonoperative treatment is chosen for low-energy fractures that are minimally displaced while operative treatment is indicated for high-energy fractures.[11]

Ankle fractures involving the distal tibia: These injuries generally present with ankle pain and swelling and an inability to bear weight. They are usually the result of severe inversion or eversion of the ankle joint. The Lauge-Hansen and Danis-Weber classifications are commonly used to determine the type of fracture. There are also several specific distal tibial fractures that have their own name. The Pilon fracture involves the distal tibia and its articular surface with the ankle joint, and the Tillaux fracture involves the anterolateral distal tibial epiphysis. Distal tibial fractures are most commonly treated with open reduction and internal fixation.[12],[13]

Clinical Significance

Medial Tibial Stress Syndrome

Medial tibial stress syndrome, also known as shin splints, presents as generalized, recurrent pain in the lower part of the tibia. While the exact mechanism is unknown, it is thought to be due to biomechanical imbalances that result in too much force on the tibia. It is most commonly seen in runners and aerobic dancers, who often overload their legs with a large amount of force. Medial tibial stress syndrome can be diagnosed by reproducing tenderness with palpation over a large area of the distal, medial tibia. Treatment generally involves rest and ice until the pain improves and then gradually reintroducing activity.[14]

Apophysitis of the Tibial Tubercle

Apophysitis of the tibial tubercle, also known as Osgood-Schlatter disease, presents as pain below the knee that increases with activity and is relieved by rest. It is due to overuse of the knee and excess physical stress on where the patellar tendon inserts on the tibia; this causes repeated tension on the epiphyseal plate of the proximal tibia.[3] It is most often seen in males between the ages of 10 and 15. Diagnosis is usually made clinically, and there can be a palpable bony prominence at the tibial tuberosity, which can persist even after the pain resolves. Treatment includes rest and ice to decrease inflammation and avoidance of high impact activities like jumping. Symptoms usually resolve when the epiphyseal plates close.[15]

Other Issues

One of the most serious complications of a tibial fracture is compartment syndrome, which can lead to necrosis of the leg if not treated with urgent surgery.[16]



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