Trauma X-ray - Lower limb
Tibia and fibula

Key points

  • Tibial fractures usually result from high force trauma
  • Stress fractures of the tibia result from repeated low force trauma
  • 'Toddler's fracture' = Tibial spiral fracture in a toddler
  • Tibial stress fractures and toddler's fractures may not be visible on the initial X-ray - follow up may be necessary

High force impact is required to fracture the tibia. Injuries are often obvious both clinically and radiologically, but a careful check should be made for undisplaced fractures.

Occasionally a history of chronic tibial pain is due to a stress fracture. Stress injuries are due to repeated low force trauma to a normal bone - unlike a pathological fracture which is the result of minor injury to an abnormal bone.

Standard views

Anterior-Posterior (AP) and Lateral. Several images may be required to ensure at least 2 views covering the whole length of both bones.

Tibial and fibular fracture

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Tibial and fibular fracture

  • Comminuted fractures of the tibial and fibular shafts with medial displacement and posterior angulation
  • X-rays of the distal end of the bones (not shown) did not reveal further injury

Tibial stress fracture

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Tibial stress fracture

  • Periosteal stress reaction are signs of stress injury (often not present on the initial X-ray)
  • History of chronic pain worsened by activity

Toddler's fracture

A toddler's fracture is a spiral tibial fracture seen in young children. This fracture is associated with a twisting injury, and may present with refusal to weight-bear. Often there is little or no displacement and the fracture line is very subtle. Some toddler's fractures are not visible on the initial X-rays but cause a periosteal stress reaction which becomes visible on follow up.

Toddler's fracture

Hover on/off image to show/hide findings

Tap on/off image to show/hide findings

Click image to align with top of page

Toddler's fracture

  • Fine spiral line through the tibial shaft
  • This toddler presented with refusal to weight-bear