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Tibia

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Overview

The tibia, or the shin bone, is a long bone articulating superiorly with the inferior articulating surfaces of the femur, and with the talus inferiorly. The tibia hangs down the medial surface of the talus and forms the medial malleolus. It is the second largest bone in the body after the femur and its size results from the heavy weight distribution that is required of it. The tibia is a long bone, which means it has a hard outer surface known as compact bone, with a mesh-like interior called cancellous bone, designed to take pressure from multiple angles. It is also useful to note that the cancellous bone contains bone marrow that produces red blood cells.

Bones and ligaments of lower leg
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Bones, ligaments and joints of the knee and the lower leg.

Interaction with the fibula

There is a special articulation with the fibula bone that runs parallel to the tibia. Compared to the tibia, the fibula is the same length but thinner. This suggests a difference in the weight bearing demands of the two bones. Some sources say there is a 10% weight bearing responsibility placed on the tibia, other sources say there is no weight bearing pressure on the fibula.

The two articulations of the tibia and fibula are the superior and inferior tibiofibular joints:

The superior tibiofibular joint is a synovial plane joint, with the transverse joint line spanning the lateral tibial condyle and the medial fibular head. The capsule is thickened anteriorly and posteriorly and joins with the anterior ligament (passing obliquely from the fibular head to the tibial condyle), relating closely to the tendon of biceps femoris. The posterior ligament is thicker and oblique, projecting between the posterior fibular head and lateral tibial condyle.

The inferior tibiofibular joint is a syndesmosis joint, just above the ankle region. This joint lies between the medial distal end of the fibula and the concave fibular notch region of the tibia. The distal end of the joint has a 4 mm separation from a prolongation of the ankle joint. There is no fibrous capsule surrounding this joint but there is a flat band of ligament named the anterior tibiofibular ligament which descends laterally between the two leg bones. The posterior tibiofibular ligament is stronger than the anterior, running in a similar fashion to its anterior counterpart but having a distal band named the inferior transverse ligament. Finally, the interosseous ligament is a continuous ligament with the leg bones, possessing many short, strong bands. This is the strongest support for the two bones. All these ligaments are important stability factors.

Landmarks

At the proximal end of the tibia lie the tibial condyles. The tibial condyles carry the body weight transmitted by the femur. To ease the pressure, there are pads of fibrocartilage known as menisci attached to these condyles. The condyles swing down posteriorly to allow for flexion and are palpable anteriorly. The menisci divide the intercondylar areas into anterior and posterior sections, resembling an hourglass shape. The anterior section has an attachment site for the menisci (via the meniscofemoral and transverse ligaments) and the anterior cruciate ligament, with the posterior section doing a similar job but attaching to the posterior cruciate ligament.

The tibial tuberosity is a big landmark on the tibia as it provides an attachment surface for the quadriceps muscles, via the quadriceps tendon. This is prone to inflammation (see Osgood-Schlatter disease in the pathology section) due to the tension exerted. The tuberosity is located anterior to where to condylar surfaces meet. There is also a bursa, the infrapatellar bursa that separates the tibial tuberosity from the skin.

Muscle and menisci attachment

The menisci of the knee are attached to the medial and lateral condyles of the proximal tibia by the meniscotibial (coronary) ligaments. The quadriceps tendon attaches to the superior part of the tibial tuberosity. The medial and lateral tibial condyles provide attachment to the semimembranosus and biceps femoris muscles respectively, with the third hamstring muscle, the semitendinosus, attaching just anteriorly to the medial condyle attachment point. The tendons of the semitendinosus muscle group together with the tendons of the gracilis and sartorius muscles to form the pes anserinus.

The tibialis anterior muscle originates proximal two-thirds along the lateral surface of the tibia, with the extensor digitorum longus originating behind the tibialis anterior, along the midline. Posteriorly, the soleal line houses the soleus, with the popliteus, originating just proximal to the region, in a roughly triangular area. Finally the tibialis posterior and flexor digitorum longus originate just distal to the soleal line.

Pathology

Tibia and associated fibula fractures can be quite different to other long bone fractures. If an oblique force is applied, there is usually less soft tissue damage if the resulting fracture is a clean tibial and fibular break on the same level. The usually unharmed interosseous membrane and fascia are useful in providing blood to the area, therefore decreasing the healing time required for the injury. If the fractures of both bones are on different levels there is usually more soft tissue damage, especially at the interosseous membrane. Around 75% of tibia fractures have an associated fibula fracture. A fracture of the tibia alone can cause complications as, although the fibula is not a weight-bearing bone, the tibia can succumb to various angular deformities.

Osgood-Schlatter disease is a painful inflammation of the patellar ligament at the tibial tuberosity. It is rare to find this in anyone over the age of 16. It usually occurs in young, tall males who play a lot of anterior-dominant sport, which places considerable strain on the quadriceps muscles. In its most severe form, the bone can be pulled from the tibial tuberosity after a powerful, quick movement. The effects of Osgood-Schlatter disease can last up until full growth or, with careful rehabilitation, they can disappear within a few months.

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Show references

References:

  • Sandstring, S. (ed.) (2008) Grey’s Anatomy, 40th edition, London: Churchill Livingstone, Chapter 83 Leg, (page 1412-1416)
  • Types of Bones in the Human Body. Copyright TeachPE.Com. http://www.teachpe.com/anatomy/types_of_bones.php.
  • Sandstring, S. (ed.) (2008) Grey’s Anatomy, 40th edition, London: Churchill Livingstone, Chapter 82 Knee, (page 1395)
  • Sandstring, S. (ed.) (2008) Grey’s Anatomy, 40th edition, London: Churchill Livingstone, Chapter 84 Ankle and Foot, (page 1444)
  • Sarmiento, A, Latta, L (1995). Functional Fracture Bracing: Tibia, Humerus and Ulna. California : Springer. 39-40.
  • Dr Kenny, T. (2011): Osgood-Schlatter Disease. (accessed 09/11/2014).

Author and Layout:

  • Ed Madeley
  • Catarina Chaves

Illustrators:         

  • Lower leg bones - anterior and posterior views - Liene Znotina 
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