Tibia (Shinbone) Shaft Fractures

About

A tibial shaft fracture is an injury that occurs to the tibia, which is one of the long bones of the leg.

The femur, humerus, and the fibula are the long bones of the lower limb. The femur is the bone of the thigh, while the tibia and fibular are bones of the leg. The tibia is the larger bone, bears most of your weight and is linked to the joints of both the knee and the ankle. It is also called the shinbone. The fibula is a thinner bone on the outer aspect of the tibia.

It takes a lot of force to fracture a tibia shaft, therefore, it is quite common to find other injuries along with a shinbone fracture.

The force that causes the fracture decides the severity of fractures. Usually the impact is so severe that the fibula is also broken when the tibia is fractured.

There are different types of tibial fractures. Common types include:

a) Stable fracture: In this type of fracture, the broken ends of the tibia are well aligned and hardly out of place.

b) Displaced fracture: Here, the bone breaks and the broken ends get displaced. These types of fractures can only be rectified through surgery.

c) Transverse fracture: This type of fracture may be unstable and is characterized by a horizontal fracture line.

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d) Oblique fracture: This type of fracture is unstable and is characterized by an angled pattern.

e) Spiral fracture: In this type of fracture, the bones may be displaced or stable depending on the force. The fracture is a spiral-shaped line and resembles a staircase along the length of the tibia.

f) Comminuted fracture: This is a very unstable fracture, with bones breaking into three or more pieces.

g) Open fracture: When broken bones of the shin break through the skin, they are known as open or compound fractures. These types of fractures pose more damage to the surrounding muscles, tendons, and ligaments. They could lead to complications and take longer to heal.

h) Closed fracture: In this type of fracture, the broken bones do not pierce through the skin. In some cases, this can cause excessive swelling and even stop the blood supply, bringing about the need for an amputation.

Tibia fractures are of several types and each individual factors must be considered while treating the patient.

Tibial shaft fractures occur commonly after car accidents, falls, sports injuries, and other activities. High- power automobile collisions, which are common reasons of tibial shaft fractures, are capable of breaking the tibia into several pieces.

Sports injuries, such as skiing accidents, or colliding with another player during a contact sport are lower-energy injuries that could result in tibial shaft fractures. Treatment for these fractures is carried out depending on the type of fracture and bone alignment.

Tibia Shaft Fracture Symptoms

The most common symptoms of tibial shaft fracture include:

• Pain

• Inability to walk
• Difficulty in bearing weight on the leg
• Deformity or instability of the leg
• Bone protruding through the skin in case of open fractures
• Numbness / loss of sensation in the foot(occasional)

Complications

A tibial shaft fracture can cause further complications. These include -

• Cut or tear in the adjacent muscles, nerves, or blood vessels.
• Excessive Swelling leading to compartment syndrome, where the blood supply to the leg is cut off, requiring emergency surgery.
• Open fractures can result in deep bone infections or osteomyelitis

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Tibia Shaft Fracture - Diagnosis

Tibial shaft fractures are diagnosed based on:

History of the patient which includes the type of injury. The doctor will also question on any other medical condition, such as diabetes that the patient may be suffering and inquire about any medication that the patient might be taking.

Physical examination which includes checking for:

• Obvious deformity
• Skin breaks
• Bony protrusions under the skin
• Swelling
• Bruising
• Instability
• Sensations
• Muscle strength

Tests like X-rays, and imaging studies such as CT scan, will be recommended. X-rays help to confirm the fracture and also to find out if knee or ankle joints are also involved in the fracture.

After seeing the X-ray, if the doctor suspects knee or ankle joint involvement in the fracture, a CT scan will be advised to get a cross-sectional image of your limb.

Tibia Shaft Fracture Treatment

The doctor considers several factors while planning treatment of tibial fracture. They include -

• Reason for your injury
• Severity of injury
• Extent of damage to soft tissue
• Overall health

A. Nonsurgical Treatment

Nonsurgical treatment may be recommended for the following patients:

• Those with closed fractures and with little displacement
• Those who are less active and hence in a better position to tolerate small degrees of angulation or differences in the length of a leg
• Those with overall health problems

Most people who suffer fractures display swelling for the first few weeks. Hence, the first step may be to apply a splint for comfort and support. Once the swelling subsides, a range of treatment options may be considered.

Another effective nonsurgical treatment method is to immobilize the affected leg using a cast for a few weeks, as part of the initial healing process. After this period, the cast may be replaced with a functional brace, for support, until healing is complete. The brace may be taken off, if necessary, while taking bath or during physical therapy.

B. Surgical Treatment

Surgery is recommended for the following reasons -

• Fracture that does not heal with non surgical methods
• An open fracture
• Fracture with many bone fragments and large degrees of displacement

Surgical methods:

a) Intramedullary nailing is the most popular form of surgical treatment for tibial fractures. Here a specially designed metal rod is inserted into the marrow canal of the tibial bone from the front. The rod passes across the fracture and helps to keep it in position.

The intramedullary nails come in sizes and lengths to suit most tibia bones. They are screwed to the bone at both ends to keep them in place during healing. This method is not suitable for children or adolescents as there is a risk of damaging the bone’s growth plates.

b) Plates and screws are used to treat fractures in which intramedullary nailing is not a good choice of treatment, such as fractures that extend into the knee or ankle joints. Here, the bone fragments are first repositioned into their normal alignment and, then, are held together with metal plates and special screws fixed to the outer surface of the bone.

c) External fixation. Here, metal pins or screws are fixed to a bar outside the skin, above and below the site of tibial fracture. The bar is a frame that stabilizes the bones and holds them in the proper position to enable healing. Although effective, implants fixed outside the body are not very popular, both with the patients and the doctors who treat them.

Surgical complications include:

• Mal alignment
• Infections
• Nerve and vascular injury
• Blood clots
• Nonunion in which bones fail to heal
• Angulation

Please Note

• Early motion involving the movement of knee, ankle, foot, and toes will be encouraged in the initial stages of recovery, to avoid stiffness.
• Physical therapy after the cast or splint is removed will help to restore normal muscle strength, joint motion, and flexibility.
• Walking with the help of walker or crutches can be done once healing is restored.

It is advised that you follow the doctor’s advice before putting weight on your fractured leg. Open fractures are more prone to infections and therefore take time to heal. In some cases, they may also require secondary surgery.