Your doctor may recommend surgery for your fracture if it is:
- An open fracture with wounds that need monitoring
- Extremely unstable because of many bone fragments and large degrees of displacement
- Not healed with nonsurgical methods
The current most popular form of surgical treatment for tibial fractures is intramedullary nailing. During this procedure, a specially designed metal rod is inserted from the front of the knee down into the marrow canal of the tibia. The rod passes across the fracture to keep it in position.
Intramedullary nails come in various lengths and diameters to fit most tibia bones. The intramedullary nail is screwed to the bone at both ends. This keeps the nail and the bone in proper position during healing.
Intramedullary nailing allows for strong, stable, full-length fixation. The technique also makes it more likely that the position of the bone obtained at the time of surgery will be maintained when compared with casting or external fixation. Intramedullary nailing is not ideal for fractures in children and adolescents because care must be taken to avoid crossing the bone’s growth plates.
How long it takes to return to daily activities varies with different types of fractures. Some tibial shaft fractures heal within 4 months, yet many may take 6 months or longer to heal. This is particularly true with open fractures and fractures in patients who are less healthy.
- Early motion. Many doctors encourage leg motion early in the recovery period. For example, if a soft tissue injury is present with a fracture, the knee, ankle, foot, and toes may be mobilized early in order to prevent stiffness.
- Physical therapy. While you are wearing your cast or splint, you will likely lose muscle strength in the injured area. Exercises during the healing process and after your cast is removed are important. They will help you restore normal muscle strength, joint motion, and flexibility.
- Weightbearing. When you begin walking, you will most likely need to use crutches or a walker.
It is very important to follow your doctor’s instructions for putting weight on your injured leg to avoid problems. In some cases, doctors will allow patients to put as much weight as possible on the leg right after surgery. However, you should always follow the specific directions given by your surgeon.
Fracture pain usually stops long before the bone is solid enough to handle the stresses of everyday activities. If the bone is not healed and you put weight on it too soon, it could fail to heal. If that occurs, you may need a second surgical procedure, such as bone grafting or revision fixation.