What is Tibia Fractures Overview?
The section of your leg just below the knee, called the proximal tibia, is shaped like a triangle. It narrows down as it extends further into the lower leg. The tibia, or the shinbone, is a long bone that connects with a few other bones: the talus in your foot, the fibula which is the thin bone running alongside the tibia, and the lower part of your thighbone or femur.
There is a large network of blood vessels that supply blood to various muscle groups in the leg. For instance, the anterior tibial artery, which is a branch of the popliteal artery located behind the knee, runs between two muscles in the front of the leg and ends in the foot. Another branch, the posterior tibial artery, takes a deeper route into the leg, ending in the sole. There is also a peroneal artery that ends by supplying blood to the heel.
The leg has different compartments or groups of muscles, and these are supplied by different nerves. The tibial nerve runs deep to the muscle in the calf, sends branches to muscles in the back of the lower leg, and then runs down to the inner side of the ankle. The common peroneal nerve splits into two branches – the superficial peroneal nerve, which is located near the surface on the outside of the leg, and the deep peroneal nerve, which supplies the muscles in the front of the leg and provides sensation to the space between the first two toes. The saphenous nerve provides sensation to the inner part of the foot and leg.
There are four main muscle compartments in the lower leg: the deep posterior compartment which includes popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus; the superficial posterior compartment with the gastrocnemius (the main calf muscle), soleus, and plantaris; the lateral compartment containing peroneus longus and brevis; and, lastly, the anterior compartment with the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius.
What Causes Tibia Fractures Overview?
These breaks in the bone happen in two main ways – due to low-force incidents and high-force incidents. In low-force incidents, the fracture is usually caused by a twisting force or an indirect injury that causes spiral fractures or a break in the fibula (the smaller bone in your lower leg) at a different level. These breaks generally have minimal damage to the soft tissue surrounding the bone.
On the other hand, high-force incidents typically result from a direct hit to the bone. This can cause the bone to break in a wedge shape or in a short diagonal pattern, and it can result in the bone breaking into multiple pieces. High-force incidents can also be associated with injury to the surrounding soft tissue, a dangerous condition called compartment syndrome (where pressure within a muscle compartment builds up), bone loss, and injury to the bone on the same side of the body.
Risk Factors and Frequency for Tibia Fractures Overview
The tibial shaft, one of the longest bones in the body, commonly experiences fractures. These fractures are seen in about 4% of seniors.
Signs and Symptoms of Tibia Fractures Overview
Most people with a tibia (shinbone) fracture show similar symptoms and features when examined by a doctor. The main signs of this injury include not being able to put weight on the affected leg and visible deformity. Doctors always stay alert for a condition known as ‘compartment syndrome’, which is a dangerous increase in pressure within the muscle compartment. This is particularly a concern in patients who have experienced high-impact trauma.
Testing for Tibia Fractures Overview
When a doctor evaluates someone for possible issues with their limbs, the examination can be challenging due to pain. The doctor will examine the patient’s range of motion in their joints and check for any instability.
It’s important to assess the nervous system and blood circulation by checking the dorsalis pedis and posterior tibialis arteries, which help circulate blood to your feet. In addition, the doctor will be on the lookout for compartment syndrome, a dangerous condition where pressure builds up within your muscles. This could involve symptoms like severe pain that doesn’t go away, a tight or full feeling in your muscles, or numbness. Identifying these signs early is crucial to prevent further complications.
The doctor will also inspect your skin for any injuries, like cuts, bruises, or blisters. They might also touch your muscles to see if they feel too tight or hard. An imaging test, such as an x-ray or a CT scan, may be conducted to provide a clearer picture of what’s going on inside your body.
Doctors also use classification systems to assist in deciding how to treat your injury:
The Oestern and Tscherne classification is used for closed fractures and associated soft tissue injury:
- Grade 0: injuries with little damage to soft tissues caused by indirect impacts
- Grade 1: superficial skin scrapes or bruises, simple breaks
- Grade II: deep skin scrapes, bruising of muscles/skin, a sign of imminent compartment syndrome
- Grade III: extensive skin bruising, crushed skin or muscle, compartment syndrome, and tear of a major blood vessel or nerve
The Gustilo-Anderson classification is used specifically for open fractures of the tibia, the larger bone in the lower leg:
- Type I: minimal stripping of periosteum (a protective layer on the bone), clean wound less than 1 cm.
- Type II: mild to moderate periosteum stripping; wound larger than 1 cm.
- Type IIIA: major soft tissue injury, with a wound usually over 1 cm, but no need for a flap (a piece of tissue moved from one body part to another).
- Type IIIB: as in IIIA but with a need for a flap due to insufficient soft tissue coverage.
- Type IIIC: like IIIA and IIIB but with a damaged blood vessel needing repair.
Treatment Options for Tibia Fractures Overview
In simple terms, if you break your leg, there are various ways the doctor can treat it depending on the specifics of the break. Without needing surgery, a long leg cast can be used if the break is straight without much angling in any direction, if it’s mostly aligned, doesn’t shorten your leg by more than 1 cm, and doesn’t severely affect your leg movement.
In more serious cases, where the broken bone is misaligned or the surrounding tissue is significantly damaged, the doctor could recommend a surgical procedure. There are several types of surgical treatment:
– External Fixation: This involves placing metal screws or pins into the bone above and below the fracture. This approach is primarily used in cases of severe soft tissue injury or multiple injuries where urgent temporary stabilization is needed.
– Intramedullary Nailing (IMN): This is the most common surgical treatment for serious breaks. The surgeon inserts a metal rod into the bone to help it stay in place during healing. Studies show that compared to other methods, it leads to better realignment of the bone, quicker healing, and less time spent non-weight-bearing.
– Percutaneous Plating-Shaft: This strategy is used when the fracture is located in the distant part of the leg or the upper portion of the leg and is too far from the center for Intramedullary Nailing to be effective.
In some rare and severe cases, amputation might be recommended, even though it can be difficult for the patient to accept this approach. The severity of the injury, the extent of tissue damage, the duration of inadequate blood supply to the leg, and severe injuries to the same foot may indicate the need for amputation. However, it’s important to know that just because the sensation in the sole of the foot is lost, this doesn’t mean that amputation is absolutely necessary.
What else can Tibia Fractures Overview be?
Before using x-rays for diagnosis, doctors should consider other possibilities. These might include stress fractures, especially in people who are physically active, as well as potential bone bruises.
What to expect with Tibia Fractures Overview
If you break the upper part of your leg bone (the tibia), it tends not to heal as well compared to a break in the middle of the bone. This is because of the forces acting upon the upper part of the tibia and the limited amount of soft tissue surrounding the area. However, if it is treated and fixed properly, results are often positive. If the break in the tibia doesn’t require surgery and the bones stay aligned, there is a high success rate. But, this method can bear more risk if the fracture is slanted or ‘oblique.’
One of the key factors determining whether a limb might need to be amputated is the extent of damage to the soft tissue around the break. Research has shown that whether or not you need an amputation doesn’t significantly affect how well you’ll be able to function afterwards. It’s important to consult your doctor to understand what treatment is best for you.
Possible Complications When Diagnosed with Tibia Fractures Overview
Some of the possible complications of surgery involving plates inserted under the skin include increased instances of fractured bones not healing properly or taking longer to heal, along with wound separation. Additionally, longer plates can irritate a nerve near the surface of the shin bone. Abnormal healing that makes the affected bone grow at wrong angles is most common with fractures in the upper third of the bone.
If a fracture doesn’t heal (a relatively rare complication with surgery involving rods placed inside the bone), a common treatment is adjusting the rod to stimulate healing. This abnormal healing with rotations is most typically seen with fractures at the top and bottom thirds of the bone.
After this type of surgery, the most common issue is knee pain. This happens during the splitting of the kneecap tendon and the approach to the paratenon (a sheath of tissue around tendons). Compartment syndrome, a condition where increased pressure in a muscle compartment causes lack of blood flow, is another complication that can occur with both open and closed fractures.
- Increased instances of nonunion or delayed union
- Wound separation
- Nerve irritation
- Abnormal healing causing bones to grow at wrong angles
- Knee pain
- Compartment syndrome
Recovery from Tibia Fractures Overview
For individuals suffering from fractures in the main part of the shin bone (or tibial shaft), different treatment plans are necessary depending on the nature of the break. If the fracture does not require surgery, they should avoid putting weight on the leg for six weeks while using a long leg cast.
Those treated with a device that holds the bones in place externally, particularly for fractures that have made the length of the limb unstable, should also avoid bearing weight. This should last six weeks for fractures outside the joint areas and up to twelve weeks for fractures that involve joints.
For stable fractures, where the length isn’t affected, some doctors may allow patients to gradually put weight on the leg when they’re comfortable doing so. This often applies to shin bone fractures that go directly across (transverse) and are stable.
The same rules apply for surgically fixed fractures, whether it involves internal nails (IMN) or metal plates.
During recovery, it’s important to maintain active movement of the knee and ankle to help regain normal joint function.
Also, to prevent Deep Vein Thrombosis (a medical condition where blood clots form in your deep veins, often in your legs), doctors may give medication to patients who are unable to put weight on their fractured lower legs.