What is Tibia Diaphyseal Fracture?
Fractures in the tibia, or shinbone, are quite common because its location just beneath the skin makes it more likely to be injured. The muscles around the lower leg are divided into four separate sections, each surrounded by a type of tissue called fascia. X-rays are crucial during the initial assessment of these types of fractures. If the lower leg gets injured or fractured, there might be a need to cut open the fascial tissue – a procedure called fasciotomy – to prevent complications like compartment syndrome, a painful condition caused by pressure buildup in the muscles.
Treatment methods vary depending on the extent of the fracture. If the bone fracture is small and the pieces have not moved out of place, non-surgical treatment can be used. However, when the fracture is severe, or the bone is protruding out of the skin, surgery is commonly recommended as the best treatment option.
What Causes Tibia Diaphyseal Fracture?
The tibia, one of the bones in your lower leg, can break due to falls, indoor activities, car accidents, sports, and other outdoor activities. Injuries caused specifically by car accidents and sports are more common in men.
Risk Factors and Frequency for Tibia Diaphyseal Fracture
Tibial shaft fractures, or breaks in the main bone of the lower leg, occur in about 16.9 out of every 100,000 people each year. They happen more frequently in men, with 21.5 cases per 100,000 people, compared to 12.3 cases per 100,000 women. Men typically experience these fractures at a younger age, particularly between the ages of 10 and 20. For women, the most common age range to have this fracture is 20 to 30.
- Tibial shaft fractures happen at a rate of 16.9 per 100,000 people each year.
- Incidence is higher in men, with 21.5 cases per 100,000 people.
- In women, the rate is 12.3 cases per 100,000 people.
- Men often experience these fractures between the ages of 10 and 20.
- Women commonly sustain this injury between the age of 20 and 30.
Signs and Symptoms of Tibia Diaphyseal Fracture
When a person experiences a tibial shaft fracture (a break in the large bone of the lower leg), it’s important to understand how the injury happened. This could be from a fall or a high-impact event like a car accident. If a person fainted (a condition known as syncope) before falling, they might need further medical examination. In the case of high-impact injuries, a full medical examination is necessary, and the Trauma Life Support protocol may be needed. Doctors also check the injured leg for any other injuries.
A key part of the examination involves checking the skin for any cuts that might be linked to the fracture site. This is significant as it could show if the fracture is open (the bone has punctured the skin).
Finally, a complete neurovascular exam is performed on the injured leg. This examines the nerves and blood vessels to ensure they have not been severely damaged by the fracture.
Testing for Tibia Diaphyseal Fracture
When it comes to suspected issues with a tibia (a significant bone in your lower leg), X-rays taken from the front (AP) and the side (lateral) are often recommended. To ensure a comprehensive understanding, the doctor may suggest taking additional X-rays of the joints above and below the tibia – the knee and ankle.
A CT scan, which gives more detailed images, is not usually required for fractures in the tibia. However, the doctor might request one in case the injury extends into the areas around the joints (tibial plafond or plateau).
Before any surgical procedure, patients usually need to undergo basic laboratory tests (like a Complete Blood Count, Basic Metabolic Panel, and a Prothrombin Time/International Normalized Ratio) and imaging tests (like a chest X-ray and EKG).
Elderly patients who have heart disease, or there is a possibility that they might have it, can benefit from a thorough check by a cardiologist before surgery.
When it gets down to categorizing tibial fractures, there’s a classification system called AO/OTA. Under this system, a tibia is referred to as ‘bone segment 4’, and the fractures are classified as A (simple), B (wedge), or C (complex). The system also includes subcategories based on the fracture’s location and if the fibula (the other bone in the lower leg) is also fractured. This system is mostly used for research purposes.
However, fractures can also be classified in simpler, descriptive terms. They could be closed (inside the skin) or open (break the skin), located at the top, middle, or bottom of the tibia, and categorized based on the pattern as – straight across (transverse), diagonal (oblique), twisted (spiral), or shattered into pieces (comminuted).
Treatment Options for Tibia Diaphyseal Fracture
The key to lowering the risk of infection is by giving antibiotics as quickly as possible. A debridement, which is a process to clean the wound, should be done right away at the patient’s bedside, followed by applying a temporary splint.
A broken bone is considered suitably aligned if the following conditions are met:
* It angles less than 5 degrees in either direction
* The overall tilt is under 10 degrees
* More than 50% of the bone’s thickness is in contact
* The length of the bone is shortened by less than 1 cm
* The bone is rotated less than 5-10 degrees
If a fracture meets these conditions, this is seen as acceptable alignment. For fractures with reasonable displacement, realigning the bone, or “reduction,” can be performed to achieve this acceptable alignment. Non-surgical methods are also considered, such as casting the entire length of the leg.
Various surgical treatments are available based on the type and severity of the break:
* An ‘intramedullary rod’ is the most common treatment for fractures in the main body of the tibia (the long part of the leg bone). This approach is usually taken for closed fractures and less severe open fractures.
* Another surgical option called ‘open reduction internal fixation’ is often used if the break extends into the surface of the joint or if it’s not suitable for ‘intramedullary fixation’
* Using an ‘external fixator’ is beneficial when there’s significant swelling or extensive tissue damage. This method involves attaching a framework outside the leg until it’s safe to proceed with internal fixation.
* All open injuries require cleaning and debridement.
‘Styker monitor’ is a device to measure the pressure inside a compartment of the leg, and is especially useful in patients under sedation. If there’s a concern for compartment syndrome, a procedure called ‘fasciotomy’ should be performed to relieve pressure and prevent further injury. Compartment syndrome is a dangerous condition that can occur when there’s increased pressure within a muscle compartment, which can impair blood flow.
What else can Tibia Diaphyseal Fracture be?
- Hematoma: This is a condition that can occur when the lower leg undergoes direct injury, resulting in swelling even if there’s no bone fracture.
- Compartment syndrome: This can lead to severe pain in the lower leg, caused by factors such as bone fracture, excessive use of the limb, or when a person has been lying down for a long period of time.
What to expect with Tibia Diaphyseal Fracture
After breaking their tibia, research shows that many patients initially experience a decrease in their physical functions. However, these functions typically improve gradually over 6 to 12 months. After five years, patients may still not have recovered fully to their original state.
At a 12 year follow-up after getting an intramedullary nail (a type of surgery that involves a metal rod inserted into the marrow cavity in the bone), it was shown that many patients still reported persistent knee pain (73%) and/or a feeling of their leg swelling (33%).
Possible Complications When Diagnosed with Tibia Diaphyseal Fracture
Compartment syndrome is a medical condition that often begins with severe pain that seems worse than expected, or pain that increases when the affected area is stretched. As the condition develops, other signs might appear, including notable swelling, pale skin, lack of pulse, and feelings of tingling or prickling in the skin(paresthesias). In kids, these symptoms might also present as anxiety, restlessness, and a higher need for painkillers.
For those with proximal tibia fractures, they are more prone to suffer from malunion. This condition is when a fracture heals incorrectly, causing a deformity known as “valgus and apex anterior”.
In some cases, a condition known as nonunion can occur. Nonunion is when a fracture fails to heal on its own and requires a surgical intervention, or if the healing process can’t be seen on a radiograph after six months.
Anterior knee pain is a common side effect experienced by many patients after an intramedullary nail is inserted into their body.
Recovery from Tibia Diaphyseal Fracture
It’s vital to consider the guidance provided regarding how much weight the injury can bear. Patients who receive non-surgical treatment, have their bones externally stabilized, or have complex fractures, are often asked to limit their weight-bearing activities. On the other hand, patients with simpler fractures that have been treated by fixing a supportive rod inside the bone can put weight on the injury as it tolerates.
Physical and occupational therapists play a crucial role in helping these patients recover.
Patients treated non-surgically with a cast need routine check-ups at the clinic to ensure that the bones are healing correctly and aren’t moving out of place. If the bones do shift during recovery, the cast might need adjustments. Alternatively, the bones may need to be realigned under anesthesia.