Tibial Fractures

The tibia is considered the weight-bearing bone of the body. It is paired with the thinner fibula as the two main bony structures making up the lower leg. Often the two bones are fractured at the same time, in which it is called a tib/fib fracture.

The tibia is also known as the “shin bone”. Fractures of the shin bone come in different sizes, locations, and shapes, depending on the forces involved in the injury.

The following things determine the type of treatment a tibial fracture gets:

• How displaced a fracture is
• The location of the fracture
• The patient’s health
• Alignment of injuries
• Soft tissue damage near the injured bone

Tibia fractures can be open/compound or closed fractures. Open fractures can occur when segments of the bony ends of the fracture are connected in some way to the outside of the skin. The bony fragment can be visible through the lacerated skin.

Fractures of the tibia can also be labeled by location:

• Tibial shaft fractures occur at the level of the long bone and aren’t near the knee or the ankle. They are often treated with a cast or with an intramedullary rod.
• Tibial plateau fractures occur just below the level of the knee joint. The fracture will often lead to osteoarthritis of the knee even if the fracture heals well.
• Tibial plafond fracture is a fracture of the bottom of the tibia near the ankle joint. It needs to be treated especially due to its proximity to the joint surfaces.

In this article, we will be concerned primarily with tibial shaft fractures.

Fractures of the tibia are the most common types of fractured bones involving the longer bones of the body with an incidence of 2 fractures per 1000 people. The average age of those who suffer from a tibial shaft fracture is about 37 years of age with the highest incidence found in teen males.

The common cause of a fractured tibia is high energy collisions, such as being in a high-speed automobile or motorcycle accident. ATV accidents can fracture the tibial shaft. Sports like skiing, football, and soccer can lead to tibial shaft fracture. It is usually a direct blow to the tibia that causes the fracture; however, axial loads such as falling on one’s feet can also fracture the leg at the level of the tibial shaft. Falls from a significant height and gunshot wounds to the leg can fracture the shaft of the tibia.

The symptoms of a tibia fracture are not much different from other long bone fractures. They include:

• Severe pain in the leg
• Deformity of the tibia
• An open skin wound in open fractures
• Swelling of the tibia
• Inability to walk on the leg
• Loss of pulses below the level of the fracture
• Numbness or tingling distal to the level of the fracture

Most tibial fractures can be easily uncovered using plain film x-ray. An anterior-posterior and a lateral plain film are all that is necessary. In cases where a fracture is suspected but not seen on plain film x-ray or in cases where the soft tissue needs to be evaluated, a CT scan or MRI scan of the bones in the lower leg can be done. The MRI scan is the best scan for looking at soft tissue.

Tibial shaft fractures are common following falls from a great height, sports accidents, and automobile accidents. It can be treated in several different ways, depending on the circumstances of the fracture.

The tibial fracture can be cast using normal casting material or functional brace made for tibia fracture recovery. They can be used for fractures that are minimally displaced and not angulated. The cast must extend from the foot to above the knee covering the entire fracture site. Casting avoids the chances of infection during surgery and the outcome is usually good. Patients who have casts must have regular x-rays to make sure there is ongoing healing of the affected leg. These bones must maintain alignment throughout the healing process.

The tibial fracture can often be repaired using an intramedullary rod. It involves placing a rod through the bone marrow cavity of both ends of the fracture under general anesthesia and in surgery. The rod is secured in place by screwing in two screws above and below the rod. They can be removed if there are problems or can remain in the marrow cavity forever. There are usually several incision following the surgical procedure: at least one at the level of the knee and one or more at the level of the ankle.

There is a risk of infection with this type of surgery and ongoing knee pain is common. If there is an infection, the rod may have to be removed and the leg ultimately cast.

Plates and screws can hold together the bony fragments; however, this procedure is done less and less because the intramedullary rod works so much better. They tend to be used more often when the fracture is close to the upper or lower part of the tibia. If the fracture is close to the joint, it can’t be successfully treated using an intramedullary rod. Plates and screws have the risk of infection similar to the intramedullary rod.

In some cases, an external fixator is used to hold the fracture elements together for the duration of the healing process. This is especially used for severe fractures of tibia, including open fractures with a great deal of soft tissue swelling and injury. The external fixator is a good way to be able to monitor open wounds while the bones are healing and can minimize severe infections of open wounds.

Tibial shaft fractures can have a range of complications, including:

• Persistent deformity
• Neural deficit below the level of the fracture
• Vascular injury at the level of the fracture
• Persistent pain in the affected area
• Persistent limp
• Infection in the bone in open fracture or following surgery

I'm Ed Smith, if you or a loved one has suffered a traumatic injury to the tibia or another bone as a result of someone else's negligence, please give me a call today for a free consultation. You can contact me online or reach me at 916-921-6400 or 800-404-5400 for free and friendly advice.

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