Shinbone Fractures

A broken or fractured shinbone (tibia) is the most common long-bone injury. Several types of fractures can occur, ranging from the hairline stress fractures common in runners to severe open fractures (where the skin is broken) resulting from motor vehicle crashes.

Toddler's fracture

A toddler (one to three years of age) can fracture the shinbone when he or she trips over a toy or falls down a stair while learning to walk. These fractures usually do not break the skin, and the bone stays fairly well-aligned. There will be acute pain and possibly some swelling. The toddler may refuse to get up and walk again. The area of the fracture may be very tender.

It may be difficult to see this type of fracture on an X-ray, and your physician may request a bone scan to verify the diagnosis. These fractures heal quickly and can be treated with only a short leg weightbearing cast.

Growth plate fractures

Growth plate fractures are more common in older children and adolescents. These injuries occur near the ends of the bones at the ankle or knee. Bones do not grow from the center out, but from these growth plate areas. A fracture can disrupt the bone's development, leading to unequal limb length.

Growth plate fractures need to be identified early and watched carefully until the child reaches skeletal maturity to ensure that there is no shortening of the limb. The orthopaedic surgeon may need to use internal fixation devices, such as screws or nails, to stabilize the bone.

Stress fractures

Stress fractures are overuse injuries that occur when fatigued muscles can no longer absorb shock and transfer the load to the bone. More than 50 percent of all stress fractures occur in the lower leg. Stress fractures can develop gradually, with swelling and pain during activity.

The most important treatment for stress fractures is rest. It takes six to eight weeks for most stress fractures to heal. During that time, the individual should not participate in the activity that caused the fracture, but can participate in other pain-free activities.

Closed fractures

In a closed fracture, the skin is not broken. Closed fractures may be classified in several different ways, depending on the force of the injury, the stability of the bone, and the type and location of the break. The mechanism of the injury, such as a direct blow to the bone or an indirect twisting injury, can also cause soft-tissue damage.

Many stable closed fractures can be aligned without surgery, immobilized in a cast, and later supported by a fracture brace until healing is complete. However, if there is severe soft-tissue injury or if the fracture is grossly unstable, the orthopaedic surgeon may not be able to manipulate the bone into alignment and surgical treatment may be necessary. Surgical treatment may also be needed if the bone is fragmented into three or more pieces.

Open fractures

Because the shinbone is so close to the skin surface, a high-energy direct force may push the bone through the skin, resulting in an open fracture. All open fractures have an increased risk of infection and require surgical exploration and treatment. Open fractures are also often associated with trauma elsewhere in the body.

The use of small-diameter, interlocking nails to stabilize the fracture can result in less deformity, improved limb function, and shorter healing times. External fixators, such as a frame constructed around the leg, may also be used for the more severe, contaminated fractures, although these generally have higher rates of infection, poor alignment, or nonunion. In severe cases, amputation may be necessary.

Complications

Tibial fractures typically take a long time to heal. So that the bone can heal properly, you may need to use crutches and avoid placing any weight on the leg for several weeks. Periodic X-rays may be needed to ensure that the bone remains aligned and is healing properly. Closed fractures may take 5 to 6 months to heal; severe open fractures may take 9 months or more.

The type of complication encountered depends on the type of fracture and the treatment provided. Knee or ankle pain, unequal leg length, malalignment that leads to arthritis, nonunion, infection, rotational deformity, compartment syndrome, and vascular injuries are among the possible complications. Orthopaedic surgeons are continuing to research ways to reduce complications and to identify fractures at risk for delayed healing or nonunion.

March 2001