I. Definition Fractures of the tibiofibular tuberosity are the most common of all fractures in the body, especially in children under 10 years of age. Single fractures of the tibial tuberosity are the most common, followed by double fractures of the tibiofibular tuberosity, and single fractures of the fibular tuberosity are the least common. The tibia is the main weight-bearing bone below the femur, and the fibula is the important bone attached to the calf muscles and carries 1/6 of the weight. The middle and lower 1/3 of the tibia is easily fractured. Fracture of the upper 1/3 of the tibia is easily displaced and can easily compress the N artery, causing severe ischemic necrosis of the lower leg. Fracture of the middle 1/3 of the tibia bruises and traps blood in the osteofascial compartment of the lower leg, increasing intraventricular pressure causing ischemic muscle contracture. The lower middle third of the tibia fracture dissects the trophoid artery, causing delayed fracture healing. Clinical manifestations: local pain and swelling, significant deformity, angulation and overlapping displacement. Attention should be paid to the presence of injury to the common peroneal nerve, anterior and posterior tibial arteries, and increased tension in the anterior tibial and gastrocnemius regions. Often the complications resulting from the fracture are more serious than the consequences of the fracture itself. Imaging: X-ray plain film shows fractures on the tibiofibula, discontinuity of the bone cortex with cut marks, increased bone density and thickening and sclerosis of the periosteum can be seen in basically all cases, coarse and disorganized bone trabeculae, and vague incomplete fracture lines are seen, and skeletal deformation and damage to the surrounding soft tissues are seen in severe cases. The diagnosis can be confirmed by combining clinical and X-ray manifestations, but fatigue tibiofibular fracture sometimes needs to be differentiated from osteoid osteoma and cyanotic fracture, local bone infection, early bone tumor, etc. The minimum standard of repositioning should reach 50% or more of the fracture alignment, and the angle of alignment should be no more than 5°~10° in either direction. Tube type plaster fixation for 6-8 weeks; adolescents need 10-12 weeks, in this case after 6-8 weeks it is changed to patellar ligament weight-bearing plaster tube or brace. 2.Surgical treatment: Applicable to most tibial fractures caused by high-energy trauma, mostly unstable, comminuted fractures and accompanied by varying degrees of soft tissue injury. Surgical modality selection: The surgical modality depends on the patient’s general condition and the degree of fracture displacement, comminution, localized soft tissue injury and whether there is co-infection. In order to prevent the fracture end from angling backward, the ankle joint can be fixed in plantar flexion position; for unstable fractures, it should be fixed at 45° of flexion to control rotation, and the flexion position can also prevent the child from re-displacement even after 2-3 weeks of early weight-bearing cast fixation, which is caused by loosening of fixation after soft tissue swelling subsides. The circulation, sensation and movement of the patient’s toes must be closely observed after resetting, and the patient should be reviewed regularly every week for the first three weeks after resetting. (1) Internal fixation with a gristle: the most traditional treatment for all ages, commonly used for epiphyseal fractures, not for diaphyseal fractures. The cast is opened and the pin is removed 3-4 weeks after surgery, beyond this time there is an increased chance of infection. (2) Elastic nail internal fixation: an internal fixation material designed for children, the preferred internal fixation for the surgical treatment of closed tibial fractures. Postoperatively, it is also fixed with a long-legged tubular cast to help maintain good alignment until there is sufficient bone scab. (3) Screw internal fixation: a type of fixation used in special cases, usually after a period of conservative treatment with displacement, applied only to oblique or spiral fractures in the diaphyseal area, non-tough fixation, requiring an auxiliary cast. (4) Plate internal fixation: commonly used for adult fractures, but should be used with caution in children. (5) External fixation brace treatment: commonly used for open fractures, there are many types of external fixation braces with similar principles, but be sure to choose the strongest possible fixation; pin tract care is critical and is a long-term job; external fixation in plaster after surgery, check the wound after 1 week, and also perform X-ray to observe whether the fracture block is displaced . The cast is fixed for about 4-6 weeks, and the cast is removed for non-weight-bearing joint exercises, with monthly radiographs, and weight-bearing walking after 3 months. 6-12 months for internal fixation removal.