The tibia and fibula are the two bones in your lower leg. The larger bone is the tibia, which supports most of a person's weight. It is also an important part of the ankle and knee joints. A fractured or broken tibia is usually along the length of the bone and in between the knee and above the ankle. Even though the tibia carries most of the body's weight, it still needs the support of the fibula.
These two bones are commonly fractured together since they are very near each other, particularly around the ankle joint and knee joint. However, there are also cases in which these bones break independently. The symptoms of a combined tibia/fibula fracture require immediate medical attention and proper treatment. Early intervention and appropriate treatment can help in the complete healing of the fracture.
A broken tibia generally causes an immediate and severe lower leg pain. Other symptoms that are associated with a broken tibia may include:
- Inability to walk, stand, or bear the weight on the injured leg
- Leg deformity or uneven length of the legs
- Swelling and pain in the lower leg
- Skin discoloration or bruising (may indicate blood vessel damage)
- Foot numbness
- Limited motion in the ankle or knee area
- A protruding bone through the broken skin
A broken tibia happens when more force is applied to the bone than it can handle. Some examples are a direct blow or trauma and high-energy injuries or force from falls, which are usually caused by vehicular accidents, sudden twisting in sports, or by direct contact. Impact usually spreads between the tibia and fibula whenever there is trauma to the leg.
Stress fractures or small cracks in bones are also often caused by overuse or repetitive motions from playing basketball or baseball, running, and ballet.
The doctor will initially examine the injured area to look for swelling and tenderness. To help reveal muscle or blood vessel damage, imaging tests may be required.
The main diagnostic tool for a broken tibia/fibula is an X-ray of the lower leg. This painless imaging test uses small amounts of radiation to create images of the tibia and fibula, including soft tissues.
Other diagnostic imaging tests include:
Treatment for a broken tibia is determined by the severity of the injury and the place or location where the injury has taken place. In certain cases, surgery is the best option. However, not all cases require surgery.
1. Nonsurgical Treatment
Nonsurgical treatments may be advised to people with the following criteria:
- Closed fractures
- Less active people
- Poor candidates for surgery due to certain medical problems
a. Initial Treatment
Within the first few weeks, swelling is commonly experienced. Your healthcare provider may initially apply a splint for support and comfort. A splint can also be easily adjusted to accommodate the swelling, unlike a full cast. Your doctor will provide other treatment options when the swelling subsides.
b. Casting and Bracing
For initial healing, your healthcare provider may also immobilize the fracture by using a cast. A functional brace that is made of plastic and fasteners will then replace the cast after several weeks. The brace will help provide support and protection until complete healing is achieved.
2. Surgical Treatment
Certain types of fractures may require surgery, and they include:
- Unhealed fractures with nonsurgical treatment
- Open fractures with wounds that require monitoring
- Fractures with numerous bone fragments, including a large degree of displacement
a. Intramedullary Nailing
Intramedullary nailing is currently the most used method of surgeons when it comes to treating tibia fractures. This procedure involves the insertion of a special metal rod into the tibial canal. This metal rod helps the fracture to remain in position.
The intramedullary (IM) nail is screwed at both ends of the bone to help keep the bone and nail in the correct position during the healing process. Intramedullary nails are usually available in different diameters and lengths to properly fit the bones. They are also often made of titanium.
However, intramedullary nailing is not suitable for children and adolescent fractures since it requires extra care to avoid crossing their bone's growth plates.
b. Plates and Screws
This operation initially involves the repositioning of bone fragments into proper alignment. Next, screws and metal plates are attached to the outer bone surface to hold them together. When intramedullary nailing is impossible, metal plates and screws are often used.
c. External Fixation
External fixation involves the placing of metal pins or screws into the bone above and below the fracture. These metal pins and screws are usually attached to a metal bar outside of the skin, stabilizing the bones in correct position while healing.
Aside from the general risks of surgery, complications may also arise, which include:
- Blood clots
- Blood vessel and nerve injuries
- Slower healing of fractures
- Failure to properly position broken fragments
- Angulation by external fixation
Most fractures are completely healed after 4-6 months. However, recovery can be longer for some people, particularly if they have an open fracture or if they use tobacco products.
- Pain Management - Pain is a natural part of the healing process, especially after an injury or surgery. However, pain can be reduced by taking certain medications, such as acetaminophen, topical pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, gabapentinoids, and opioids.
- Weightbearing - There are many healthcare providers who encourage leg motion during the early recovery period. To avoid complications and other problems, it is very important to follow your healthcare provider's instructions when it comes to putting weight on the affected leg. For support, the use of a walker or crutches may be needed when you start walking.
- Physical Therapy - Exercises are quite important during the healing process because you are more likely to have poor muscle strength on the injured leg. Aside from pain management after surgery, physical therapy can help you regain normal muscle strength, flexibility, and joint motion. Specific exercises are usually taught by a physical therapist during your stay at the hospital. A physical therapist will also help you on how to properly use a walker or crutches.