A tibia fracture can be one of the most painful and horrific bone and joint injuries. Since the tibia (shin bone) bears much of the weight of your lower extremity, these fractures can dramatically affect patients’ lives for a long time. In this post, I offer information on these injuries and the treatment options, recovery and possible complications.
How do you suffer a tibia fracture?
Since the tibia is one of the largest bones in the body, a fracture usually requires tremendous force. Motor vehicle accidents are common culprits. Orthopaedic surgeons see them in contact sports, falls and gunshot wounds.
How does a doctor or orthopedic surgeon make the diagnosis?
Usually it is very obvious because the deformity is visible. Occasionally an open wound exists where the bone poked through the skin. X-rays are important to determine the exact location and severity of the fracture. If the fracture occurs near the knee (tibial plateau fracture) or ankle (tibial plafond or pilon fracture), then the doctor might order a CT scan.
What treatment options exist for a tibia fracture?
For a child or adolescent, nonsurgical treatment might be sufficient, especially if the fracture remains well aligned anatomically. If the fracture is open, or if it is significantly displaced, surgery can be necessary.
For adults, surgery is almost always needed. Orthopedic surgeons treat most midshaft fractures surgically, placing a metal rod down the shaft of the bone. More complex fractures, or fractures near the knee or ankle, might need plate and screw constructs or other forms of fixation. If the fracture is open, debridement and irrigation of the wound and bone is performed as well.
What is the typical postoperative recovery?
What a patient is allowed to do after surgery depends on the type of fracture and treatment. If the surgeon successfully treated the fracture with a tibial nail, he might allow the patient to bear weight early. Other fractures and surgical treatments might require patients to get around with limited weight bearing for weeks. The patient usually works with a physical therapist to regain knee and ankle motion and lower extremity strength. Healing of the bone can take 3 to 4 months or more.
What are some of the possible complications of a tibia fracture?
Open fractures, where the ends of the bones protrude through the skin, increase the risk for infection. Soon after such an injury, the orthopedic surgeon will thoroughly remove any foreign material and devitalized tissue and irrigate the wound.
Since significant trauma and force is involved in these leg fractures, compartment syndrome often occurs. The muscles in the leg can swell after the injury or during the early hours after surgery. The fascia that holds the muscles within the different compartments does not allow much muscle swelling. The pressure in these compartments increases and puts pressure on the nerves and blood vessels. If compartment syndrome develops, the surgeon will release the compartments in the operating room – a fasciotomy – soon after its development.
Occasionally tibia fractures do not heal appropriately. Open fractures, smoking, and other factors can increase the risk of nonunion.
Fortunately, patients who suffer tibia fractures can have good outcomes. While it can take many months, most patients eventually return to preinjury activities.
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