Tibial Shaft Fracture

Options For Treatment of a Broken Shin Bone

broken leg casted
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The tibia is the large shin bone located between the knee and the ankle. This part of the body is called (in medical terms) the leg, and together with the foot and thigh, form the lower extremity (the leg is actually only the segment between the knee and ankle, even though many people refer to the lower extremity as the 'leg'). There are two bones of the leg, the tibia and the fibula.

The tibia is the larger bone that people often refer to as the shin bone.

Most of the the body weight is supported by the tibia. The fibula is a smaller bone located on the outside of the leg, and does not support much body weight, although it does serve important functions at the knee and ankle joint and is the attachment of muscles and ligaments.

Fractures of the Tibia

Tibial shaft fractures are significant injuries that generally occur after falls, car accidents, sports injuries, and other high-energy activities. The shaft of the tibia is the central portion of the bone, not the flared ends of the bone located just below the knee or above the ankle. The medical name for the shaft of the tibia is the diaphysis of the bone. The shaft of the tibia is a hollow tube, although it does have a slightly triangular shape with the tibia crest being the prominent ridge at the front of the shin. The top of the tibia is called the tibial plateau, and the bottom of the bone is called the tibial plafond.

Inside the hollow center of the bone is the bone marrow canal. The outer part of the bone is thick and rigid; this is called the cortex of the bone and provides the strength of the tibia. As mentioned, fractures of this part of the tibia generally are high-energy injuries that only occur after significant events.

There are circumstances where the bone can be abnormally weakened, and fractures can occur with less significant injuries. These are called pathologic fractures, and occur when the bone is weakened by osteoporosis, tumor, infection, or other conditions.

Signs of Tibial Shaft Fractures

Tibial shaft fractures typically occur with significant traumatic injuries. Common signs of these fractures include:

  • Pain over the shin
  • Deformity of the leg
  • Swelling and bruising around the shin
  • Inability to place weight on the leg

Tibial shaft fractures should be evaluated in an emergency room setting. While the injury may seem obvious, it is important to assess the entire extremity to not only evaluate the tibia, but also for associated injuries to the extremity. People who sustain these injuries should also have a full body assessment, as there can be other injuries that occur that may not be obvious because of the pain in the leg.

Most all tibia fractures can be fully evaluated with x-ray tests. A stress fracture of the bone may not show up on an x-ray, and these injuries may only be evident on tests such as MRI or bone scan. However, the usual way to assess is with an x-ray to start.

Treatment Options for Tibial Shaft Fractures

A tibial shaft fracture can be treated by several methods depending on the type of fracture and alignment of the bone.

The most common treatments include:

  • Casting: A cast is appropriate for tibial shaft fractures that are not badly displaced and are well aligned. Patients need to be in a cast that goes above the knee and below the ankle (a long leg cast). The advantage of casting is that these fractures tend to heal well and casting avoids the potential risks of surgery such as infection. Patients with casts must be monitored to ensure adequate healing of the tibia and to ensure the bones maintain their alignment.
  • Intrameduallary (IM) Rodding: Intrameduallary rodding is a procedure to place a medal rod down the center of the tibia to hold the alignment of the bone. A tibial rodding is a surgical procedure that lasts about an hour and half and is usually done under general anesthesia. Patients will have an incision over the knee joint, and small incisions below the knee and above the ankle. In addition, some fractures may require an incision near the fracture to realign the bones.  IM rods are secured within the bone by screws both above and below the fracture. The metal screws and the rod can be removed if they cause problems, but can also be left in place for life. Tibial rodding provides excellent fixation and alignment of the bones. The most common risk of surgery is knee pain, and the most concerning complication is infection. Infection of the rod may require removal of the rod in order to cure the infection.
  • Plates and Screws: Plates and screws are less commonly used, but are helpful in some fracture types, especially those closer to the knee or ankle joints (see information on tibial plateau and tibial plafond fractures). Most surgeons choose an IM rod for tibial shaft fractures unless the fracture is too close to the joint to allow for placement of the IM rod. In these fractures close to the joint surface, a plate and screws may be the ideal method of fixation.
  • External Fixator: An external fixator may also be helpful in some particular fracture types. External fixators tend to be used in more severe fractures, especially open fractures with associated lacerations and soft-tissue damage. In these cases, the placement of IM rods or plates may not be possible because of soft-tissue injury. When there is significant soft-tissue injury, the external fixator may provide excellent immobilization while allowing monitoring and treatment of the surrounding soft-tissues.

A Word From Verywell

Tibia fractures are generally very serious injuries. The tibia is a large, strong bone that supports the entire weight of our body. Most often these injuries are the result of a serious trauma. For that reason, tibia fractures may require invasive treatment to ensure the function of the bone returns to normal. Without proper treatment, there are possible long term complications that may limit normal function of the extremity. People who have long term problems after a tibia shaft fracture may have difficulty walking normally.

Sources:

Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S. "Open tibial shaft fractures: I. Evaluation and initial wound management" J Am Acad Orthop Surg. 2010 Jan;18(1):10-9.

Mashru RP, Herman MJ, Pizzutillo PD. "Tibial shaft fractures in children and adolescents" J Am Acad Orthop Surg. 2005 Sep;13(5):345-52.

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