The radiographs demonstrate an oblique fracture of the distal third of the tibia shaft with a proximal fibula fracture. The coronal and sagittal alignments are within acceptable limits. The oblique fracture is at risk of shortening, especially with a concomitant fibular fracture.
Acceptable alignment for non-operative treatment of tibia fractures is defined as:
<5 degrees varus-valgus angulation,
<10 degrees anterior/posterior angulation
>50% cortical apposition
<1 cm shortening
< 10 degrees rotational alignment
Sarmiento et al reviews fracture bracing for the treatment of long bones. With reference to tibial fractures, bracing is best for transverse fractures. Shortening is difficult to control in oblique fractures. However, shortening is usually less than 15 mm and does not result in functional limitations. He reports union in 97% of tibial fractures treated with bracing.
One year follow-up radiographs are provided in Illustrations A and B. The patient presented in this question went on to functional healing.
Court-Brown CM. Fractures of the tibia and fibula. In: Rockwood and Green's Fractures in Adults, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:2079-2146.
Sarmiento A, Latta LL. Functional fracture bracing. J Am Acad Orthop Surg. 1999 Jan;7(1):66-75.
PMID:9916190 (Link to Abstract)