Of all the long bones in the body, which include the femur, humerus, tibia and fibula, the tibia, or shinbone, is the most commonly fractured. The fracture occurs along the bone between the knee and ankle as a result of significant force on the bone. The severity of the injury depends on the amount of force and type of fracture.
What is the tibia?
The tibia, commonly referred to as the shinbone, is the larger of the two bones that run the length of your shin between your knee and ankle. The fibula is the second and smaller of those two bones. The tibia can be felt when you run your hands along the front of your shin while the fibula sits slightly behind and on the outside the shinbone. Both the tibia and fibula are two “long bones” in your body. The other two are the femur, located between your hip and knee, and humerus, the long bone in the upper arm. The tibia is the most commonly fractured long bone.
What are the causes and types of tibial fractures?
All of the long bones tend to be very strong and take significant force to break them. A serious break or when the bone has broken into multiple pieces is generally caused by high-energy collisions such as an automobile, motorcycle, or bicycle crash. A tibia fracture can also be caused by sporting injuries — most often a fall or collision. The severity of force to the bone is generally a determining factor in the type of break to the tibia and resulting prognosis.
There are many ways in which the tibia can break, depending on the amount of force exerted on the bone. Fractures are considered to be stable or displaced depending on whether or not the bone lines up properly. A tibia fracture is considered displaced when the broken bone is not aligned and may require surgery. Common types of fractures in the tibia are:
Transverse Fracture: The fracture line in a transverse fracture is horizontal. It may still be stable but can result in instability, especially if the fibula is also broken.
Oblique Fractures: The fracture line in an oblique fracture is diagonal or at an angle. While these fractures can be initially stable, over time they can shift, resulting in displacement of the bones.
Spiral Fracture: This type of fracture results in a fracture line resembling a spiral staircase. These are often caused by a twisting force.
Comminuted Fracture: This fracture takes place when the bone shatters into multiple pieces. It is inherently very unstable.
Open Fracture: Also known as a compound fracture, this type of fracture occurs when the break to the tibia is so severe that the bone punctures the skin. It also results in torn soft tissues, such as muscles, ligaments, and skin.
What symptoms will I have from a broken tibia?
• Difficulty walking or putting weight on the hurt leg
• Instability or deformity of the injured leg
• Appearance of the bone protruding underneath the skin
• Bone protruding through the skin
• Possible loss of feeling in the foot of the affected leg
If any of these symptoms are apparent, you should seek medical help immediately. I treatment of a broken tibia is delayed, the injury can worsen and damage to the ligaments and tissues surrounding the area can also become further injured.
Diagnosis of a fractured tibia
One of the most important aspects of the diagnosis of a fractured tibia is the understanding of how the injury occurred. This will help the doctor ascertain how serious the break or fracture may be. Prior to focusing on the injured area, the doctor will take your medical history to determine if you have any other medical problems that could affect treatment.
Once your medical history is taken, the doctor will focus on the injury. He/she will do a visual inspection of the leg looking for any obvious deformities such as shortening of the leg, breaks in the skin or protruding bones under the skin, bruising and/or swelling in the lower leg, instability, and/or difficulty walking. The doctor will also feel along the leg, looking for abnormalities of the tibia. The doctor may ask a patient to move their toes and foot as a test of muscle strength.
If there is any uncertainty as to the severity of the injury, the doctor will most likely utilize the imaging techniques below. This will give the doctor a better idea of the type and size of the break and can help determine the corresponding treatment.
X-rays are a common procedure that will show the type of break in the bone, how many places the bone has broken, and if additional bones were also fractured. It will not show any injuries to surrounding tissue.
Computed tomography (CT) scans are another imaging process that shows a cross section of the limb. This technique will help the doctor to determine the severity of the injury and if other joints are also injured.
Treatment of a Broken Tibia
Non-surgical treatment of a broken tibia will be recommended if the patient’s overall health prevents them from having surgery (i.e a weak heart) or if the fracture is minor, involving little displacement and only two major bone fragments. Non-surgical treatments may include the following:
Splint: A splint is most often used at the onset of the injury or immediately following surgery. It is used to immobilize the leg and provide stability and support. The splint can be adjusted to allow for swelling. Once swelling is reduced, the doctor may look for a more substantial support or immobilization technique, such as casting.
Cast, boot, or brace: The most popular treatment of a fractured tibia is immobilization of the limb with a cast, boot, or brace. A cast is generally the initial treatment, and immobilizes the fracture allowing it to heal for a period of approximately 6 weeks. After this period, a brace or boot made of plastic will be used to provide protection and support until the healing process is complete.
Surgical Methods of Treatment
Non-surgical methods will not be sufficient to heal a fractured tibia if the fracture is open or the limb is extremely unstable because of significant displacement and many bone fragments. There are a number of surgical methods used to treat significant tibial fractures.
Intramedullary nailing: The most popular surgical treatment for tibial fractures, intramedullary nailing involves the insertion of a specially designed metal rod from the front of the knee down the canal of the tibia. The rod passes across the fracture to keep in in position and is screwed to the bone at both ends.
This procedure is very popular because it keeps the bone in proper position and allows for strong, stable fixation. However, it is not ideal for children and adolescents as growth plates can be damaged in the process.
Plates and screws: Insertion of plates and screws were once the surgery of choice but are now only used if nailing is not a viable option – generally, when the fracture extends into the knee or ankle joint. During this procedure, bone fragments are re-positioned to their normal alignment and are then held together with special screws and metal plates that attach to the outer surface of the bone.
External fixation: During this surgical procedure, metal pins and screws are placed into the bone above and below the fracture location. A bar located outside of the skin is attached to the pins and screws, stabilizing the frame and holding the bones in the proper position to facilitate healing. This is not a very popular type of surgery because of the patients are not fond of having the implants outside of the body.
As with any injury, it is very important to see a medical professional as soon as an injury has taken place. Complications can arise from an untreated broken tibia. These may include injury to adjacent muscles, nerves, and blood vessels, infection, excessive swelling.
What will my recovery entail?
Recovery time from a fractured tibia varies from person to person and is largely dependent on the severity of the break and type of treatment. A minor stress fracture to the tibia may only require a few weeks free of the activity that caused the fracture. Most fractures heal completely within 4 months. Others can take 6 months or longer to heal. The most important factors determining healing time are strictly following the doctor’s instructions and monitoring your ongoing recovery in order to avoid re-injury.
Immediately following surgery, depending on the level of swelling, you may be in a splint. Once swelling has subsided, a cast or boot may be used to support the healing bones. Your doctor may encourage some leg motion in the early recovery period to avoid stiffness. In addition, physical therapy may be prescribed while you are in your splint, cast or boot. Physical therapy will help to strengthen the surrounding muscles, prevent atrophy, and restore normal joint movement and flexibility.
A very common part of recovery from a fractured tibia is a period of time when you will not be able to bear weight on the injured limb. The period of time can last for a few weeks or up to several months, depending on the severity of your injury. A minor stress fracture may only require that you cease a certain activity for a short period of time, sometimes as little as a few weeks, but another injury may require a much longer period of non-weight bearing activity. It is very important to follow your doctor’s instructions carefully in order to have as quick a recovery period as possible.
While physicians commonly suggest traditional crutches, they can be very cumbersome to use and severely limit an active day-to-day lifestyle. A knee scooter is perceived to be easier to use, as it doesn’t require as much upper body strength or coordination to operate. However, it doesn’t function well if navigating stairs or small spaces are a part of your everyday routine. iWALK2.0, a hands-free crutch alternative, functions as an extension of the patient’s leg, and provides complete non-weight bearing mobility. Patients using iWALK2.0 find very few disruptions to their day-to-day lifestyle during their non-weight bearing period of recovery. To learn more about the iWALK2.0, click here.
While any broken bone is both painful and debilitating, a broken tibia can cause loss of mobility for a significant period of time. If you suspect that you have fractured one of the bones in your lower leg, it is very important to seek medical attention immediately. This will prevent further injury and will get you on the road to recovery quickly. Adhering to your doctor’s recovery regiment is the key to getting back to your normal day to day activities as quickly as possible. And, fortunately, advances in surgical procedures and medical devices such as iWALK2.0 will help you get back to an active lifestyle in as little time as possible!