Tibia Shaft Fracture

The tibia, or shinbone, is the most common fractured long bone in your body. The long bones include the femur, humerus, tibia, and fibula. A tibial shaft fracture occurs along the length of the bone, below the knee, and above the ankle. Because it typically takes a major force to break a long bone, other injuries often occur with these types of fractures.

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Types of Fractures

The tibia can break in several ways. The severity of the fracture usually depends on the amount of force that caused the break. The fibula is often broken as well. Common types of tibial fractures include:

  • Stable Fracture: This type of fracture is barely out of place. The broken ends of the bones basically line up correctly and are aligned. In a stable fracture, the bones usually stay in place during healing.
  • Displaced Fracture: When a bone breaks and is displaced, the broken ends are separated and do not line up. These types of fractures often require surgery to put the pieces back together.
  • Transverse Fracture: This type of fracture has a horizontal fracture line. This fracture can be unstable, especially if the fibula is also broken.
  • Oblique Fracture: This type of fracture has an angled pattern and is typically unstable. If an oblique fracture is initially stable or minimally displaced, over time it can become more out of place. This is especially true if the fibula is not broken.
  • Spiral Fracture: This type of fracture is caused by a twisting force. The result is a spiral-shaped fracture line about the bone, like a staircase. Spiral fractures can be displaced or stable, depending on how much force causes the fracture.
  • Comminuted Fracture: This type of fracture is very unstable. The bone shatters into three or more pieces.
  • Open Fracture: When broken bones break through the skin, they are called open or compound fractures. For example, when a pedestrian is struck by the bumper of a moving car, the broken tibia may protrude through a tear in the skin and other soft tissues. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications and take a longer time to heal.
  • Closed Fracture: With this injury, the broken bones do not break the skin. Although the skin is not broken, internal soft tissues can still be badly damaged. In extreme cases, excessive swelling may cut off blood supply and lead to muscle death, and in rare cases, amputation.

Cause

High-energy collisions, such as an automobile or motorcycle crash, are common causes of tibial shaft fractures. In cases like these, the bone can be broken into several pieces (comminuted fracture).

Sports injuries, such as a fall while skiing or running into another player during soccer, are lower-energy injuries that can cause tibial shaft fractures. These fractures are typically caused by a twisting force and result in an oblique or spiral type of fracture.

Symptoms

The most common symptoms of a tibial shaft fracture are:

  • Pain
  • Inability to walk or bear weight on the leg
  • Deformity or instability of the leg
  • Bone “tenting” the skin or protruding through a break in the skin
  • Occasional loss of feeling in the foot

Exam & Tests

It is important that your doctor knows the circumstances of your injury. For example, if you fell from a tree, how far did you fall? It is just as important for your doctor to know if you sustained any other injuries and if you have any other medical problems, such as diabetes. Your doctor also needs to know if you take any medications.

Other tests that may help your doctor confirm your fracture include:

  • X-RAYS: X-rays can show if the bone is broken and whether there is displacement (the gap between broken bones). They can also show how many pieces of bone there are. X-rays are also useful for identifying the involvement of the knee or ankle joint, and the presence of a fibula fracture.
  • COMPUTED TOMOGRAPHY (CT) SCAN: After reviewing your x-rays, your doctor may recommend a CT scan of your leg. This is often done if there is a question of the fracture extending into either the knee or ankle joint. A CT scan shows a cross-sectional image of your limb. It can provide your doctor with valuable information about the severity of the fracture.

Nonsurgical Treatment

Nonsurgical treatment may be recommended for patients who:

  • Are poor surgical candidates due to their overall health problems
  • Are less active, so are better able to tolerate small degrees of angulation or differences in leg length
  • Have closed fractures with only two major bone fragments and little displacement (gap)

INITIAL TREATMENT

Most injuries cause some swelling for the first few weeks. Your doctor may initially apply a splint to provide comfort and support. Unlike a full cast, a splint can be tightened or loosened and allows the swelling to occur safely. Once the swelling goes down, your doctor will consider a range of treatment options.

CAST AND FUNCTIONAL BRACE

One proven nonsurgical treatment method is to immobilize the fracture in a cast for initial healing. After weeks in the cast, it can be replaced with a functional brace made of plastic and fasteners. The brace will provide protection and support until healing is complete. The brace allows you to take it off for hygiene issues and for physical therapy.

Surgical Treatment

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

INTRAMEDULLARY NAILING

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.

RECOVERY

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.

Lowcountry Orthopaedics’ Sports Medicine Team

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