The shin bone is called the tibia, which spans from your knee joint to your ankle joint.
Your tibia can break (fracture) from many different types of injuries, and can come in different shapes, sizes and locations.
How a fracture of the tibia is treated depends on numerous factors, including:
- the exact location of the fracture
- how far your fractured bone has moved out of place
- other injuries you might have
- the condition of the skin and muscle around your fracture
- your general health
Tibia fractures can be categorized according to the location of the fracture:
- Tibial Plateau Fractures: These fractures occur below your knee joint and disrupts the smooth gliding surface of your knee joint. This can lead to permanent cartilage damage and lead to osteoarthritis of the knee.
- Tibial Shaft Fractures: These fractures occur between the knee and ankle joints and are a common location for fractures of the tibia. These fractures are often treated with an operation which involves securing it with a metal rod called an intramedullary nail.
- Tibial Plafond Fractures: These fractures occur at the bottom of the shin bone around the ankle joint. These fractures disrupt the smooth gliding surface of your ankle joint. This can lead to permanent cartilage damage and lead to osteoarthritis of the ankle.
Symptoms
Symptoms can include any of the following:
- Pain on weight bearing
- Leg swelling
- Leg weakness
- Tenseness around the knee or leg with limited bending
- Deformity around the knee
- Pale and cool foot
- Numbness around the foot
Causes
The most common cause is due to direct trauma. Other causes are from stress and from already compromised bone (eg cancer or infection).
Fractured tibias are especially high in young people due to high-energy injuries like sports-related trauma and motor vehicle accidents.
In contrast, older people often only need low-energy injuries to get these fractures due to their low bone density. Even just a fall from standing can result in a fracture.
Risk Factors
You can be at increased risk of any fracture due to:
- Osteoporosis
- Overactive thyroid
- Physical inactivity (poor bone strength)
- Gender – Females after menopause have a rapid decline in bone density
- Age – As you age your bone density decreases
Investigations
Imaging of the limb using x-rays is the main investigation used in the suspicion of tibial fracture. The knee and ankle also are imaged as they are also commonly involved. CT or MRI scans may also be done to determine if there is associated soft-tissue injury. A bone scan can also be done if there is concern for an underlying bone condition which may have contributed to you having a fracture.
Complications
Tibial fractures usually take a long time to heal so you may be monitored quite regularly with x-rays to make sure healing is occurring as it should.
The type of complications you may experience depends on the type of fracture and what treatment you may have received. Some complications include:
- Arthritis due to mal-alignment
- Knee or ankle pain
- Unequal leg length
- Infection
- Rotational deformity
- Compartment syndrome-This is when your leg gets very painful and swollen, and as your leg is a fixed compartment the pressure in your leg can only increase. If you feel this is happening you need to go to the hospital immediately
- Vascular injuries (injuries to your arteries or veins)
Treatment
When treating a tibial fracture, the following factors must be considered:
- Location of the fracture
- Displacement of the fracture
- Alignment of the fracture
- Associated injuries
- Soft-tissue condition around the fracture
- Patient general health
- If there is an open wound
Non-surgical
This includes no weight-bearing. Also an external device is usually applied, either a plaster cast or a brace. Also simple pain medications like NSAIDs can be used.
Surgical
Sometimes conservative treatment is inadequate and in these situations surgery is opted for. To stabilise the joint either internal or external fixation can be done. Internal fixation involves rods and plates being put inside the leg and involves opening the leg up. External fixation is used when the soft tissue injury is too great and the use of a rod or plate may make it worse.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Depending on the severity of the break, your family doctor or the emergency room physician may recommend that you or your child be examined by an orthopaedic surgeon.
Bring along information about yourself
It can be a great help for your doctor if you bring along the following information about yourself
- A list of your medications, including the name and dosage.
- Information about your medical problems and past treatment
- Previous investigation results, such as xrays and blood tests.
Prepare a list of questions for your doctor
You may want to write a list that includes:
- Detailed descriptions of the symptoms and the precipitating event
- Information about past medical problems
- All the medications and dietary supplements you or your child takes
- Questions you want to ask the doctor
What to expect from your doctor
During the physical exam, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound. He or she will probably want to see X-rays of the injury.
Prevention
Up until the age of 30 is when bone mass building occurs. Thus healthy lifestyle choices during this time leads to a higher peak bone mass and a lower chance of osteoporosis later on. Bone density can be optimised by maintaining adequate levels of calcium and Vitamin D in your diet. Regular resistance training strengthens your bone greatly.
F.A.Q. | Frequently Asked Questions
Can I swim after a tibial fracture?
During recovery this is very much encouraged as in water there is less stress placed on the muscles, and so you can exercise better. But make sure there are lifeguards or someone else there with you while you are swimming.