Types of tibia fractures
The fracture is classified by level, direction of the line, number of fragments and joint involvement. Diaphyseal fractures of the middle third are most common; they are transverse, oblique, helical and comminuted. Separately, there are fractures of the tibial plateau at the knee and the ankle area at the ankle - they are intra-articular and require particularly accurate comparison of fragments. The condition of the skin is also important: with an open fracture, the wound communicates with the bone, the risk of infection increases sharply, and help should be provided in the first hours.
- Diaphyseal fracture of the tibia
- Isolated fibula fracture
- Fracture of both leg bones
- Intra-articular plateau and malleolus fractures
- Open and closed fracture
- Stress fracture in runners and military personnel
Symptoms and first aid
Immediately after the injury, sharp pain occurs, the inability to lean on the leg, and rapidly increasing swelling. The shin may be deformed, and a crunching sound can be heard when moving. With an isolated fracture of the fibula, a person sometimes continues to walk, which delays seeing a doctor. Before help arrives, the leg must be immobilized with a splint or improvised objects, grabbing the knee and ankle joints, applying cold and placing the limb in an elevated position. You cannot remove shoes, set fragments, or set bone into a wound.
- Sharp pain and inability to step on your foot
- Swelling and bruising, deformation of the lower leg
- Pathological mobility and crunching
- Numbness of the foot due to nerve damage
- First aid: splint, cold, elevated position, anesthesia
- Cover the open wound with a clean cloth, do not rinse
Diagnostics
An X-ray of the lower leg must be performed with the knee and ankle joints included: a fracture of one bone is often accompanied by damage to the ligaments or dislocation at another level. CT is necessary for intra-articular and comminuted fractures; it helps to plan surgery and the location of fixators. MRI is used in cases of suspected ligament rupture and stress fracture, which is not visible on a regular image in the first weeks. A mandatory part of the examination is checking the pulse in the foot and sensitivity, as well as monitoring muscle tension for early detection of compartment syndrome.
- X-ray of the lower leg in two projections with joint coverage
- CT scan for intra-articular and comminuted fractures
- MRI for suspected stress fracture and ligament damage
- Ultrasound of blood vessels in case of blood flow disturbances
- Assessment of pulse, sensitivity and muscle tension
Treatment: cast or surgery
Nondisplaced fractures and isolated fibula fractures can be treated with a cast or orthosis with follow-up films. In case of displacement, splintered nature, intra-articular fracture and open injury, osteosynthesis is preferable. The gold standard for the tibial diaphysis is an intramedullary pin with locking: it allows earlier movement and dosed loading. Plates are used for fractures closer to the joints, external fixation devices are used for open fractures and severe damage to soft tissue. An open fracture requires urgent surgical debridement and antibiotics.
- Plaster or orthosis for a stable non-displaced fracture
- Intramedullary nail for diaphyseal fracture
- Bone plate for periarticular fractures
- External fixation device for open and comminuted fractures
- Urgent wound treatment and antibiotics for an open fracture
- Prevention of thrombosis as prescribed by a doctor
Rehabilitation and load periods
The healing of the tibia takes longer than that of many other bones: usually 3–4 months, and with open and comminuted fractures up to six months or more. Walking on crutches without support on the leg begins early, and the doctor allows partial and full load based on control images, focusing on the formation of callus. Rehabilitation includes movements in the knee and ankle joints, exercises for the thigh and lower leg muscles, balance and gait training. Smoking significantly slows down fusion, so quitting it during treatment is a real measure that affects the result.
- Early movements of fingers and adjacent joints
- Walking on crutches without support until a doctor's permission
- Gradual increase in load based on images
- Exercise therapy for the muscles of the thigh, lower leg and foot
- Balance training and gait restoration
- Quitting smoking during the fusion period
- Skin and wound monitoring