A tibial shaft fracture is a fracture of one of the bones of your lower leg. Your lower leg has two bones in it, the tibia and fibula. The tibia serves as the primary support of your leg. Your fibula adds stability to your knee and ankle joints. Your tibia is the big bone between your knee and ankle. The shaft is the middle of that bone. Tibial shaft fractures are often, but not always, associated with fractures of the fibula.
Your lower leg is surrounded by groups of muscles that are in separate spaces, or compartments. These are groups of muscles that do the same movement. The muscles in the front of your leg are smaller than the ones in the back, and you can feel the bone right under the skin. The bigger muscles in the back of your leg make up most of the muscles in your leg. Since there is not much muscle around some parts of your tibia, the bone can poke through your skin when it breaks, which is called an "open" or "compound" fracture.
Mechanism and Epidemiology
Tibial shaft fractures can result from a wide variety of mechanisms, including twisting injuries (frequently seen in sports related fractures) or direct trauma (a motor vehicle collision or a motorcycle crash). These injuries are some of the most common fractures that require surgical treatment in adults.
Tibial shaft fractures are painful and may even prevent you from moving your leg or putting any weight on it. These injuries most often need to be evaluated in an emergency room. The fractured bones typically need to be lined up (reduced) and immobilized in a splint in order to provide some pain relief. X-rays will be taken of your knee, leg, and ankle. A CT scan may also be obtained to provide further details of your injury. Individuals with tibial shaft fractures are often admitted to the hospital for observation, pain control, and surgical treatment.
In rare instances the injury may cause a significant amount of swelling of your leg. This can become dangerous and require an emergency operation. For this reason, treating doctors will often watch you closely before and after surgery to be certain no problem has arisen. If this happens, you will likely require several operations. Large incisions or cuts are made in your leg to release swelling and pressure that endangers your muscles. Either these cuts will be closed later or a skin graft may be needed to cover them.
This fracture generally requires an operation. Surgery increases your chance of healing and allows you to begin rehabilitation sooner. Common this injury is placement of a “rod” or “nail” in the hollow center or canal of your tibia. The surgeon may choose to use a plate if the fracture extends towards either the knee or ankle joint. Surgery stabilizes your broken bone fracture and lets it heal. You will receive antibiotics prior to surgery, so it is important to tell your surgeon about any known allergies.
Following surgery, you may start weight-bearing (walking) immediately or you may require a period of non-weight bearing (use of crutches or walker). This depends on the severity of your fracture and its location. You may work with physical therapy in and out of the hospital to rebuild your strength and regain function, but this is not always necessary. You may be given a blood thinner after surgery to prevent blood clots. The choice of a blood thinner will depend on your fracture type and your other medical conditions. Blood thinners and early movement are useful for decreasing your chance of getting a blood clot. You will get several medications to help decrease, but not eliminate your pain. You will typically return to see your surgeon in the first few weeks after surgery. It is important to follow the instructions provided by your treating surgeon.
After surgery, you may require an assistive device such as walker or crutches for a period of time. Physical therapy is not usually needed to get back to a normal walking motion, but may be required for muscle strengthening, stretching, and endurance training.
Complications after tibial shaft fractures are infrequent but can occur. These include blood clots, infections, difficulty walking, or a limp. Long-term risks include the bone not healing (nonunion), not healing in the correct position (malunion), and bothersome (symptomatic) hardware. All of these complications may require another operation, hospital stay, antibiotics, or other intervention. Sometimes some or all of the hardware needs to be removed.
Lucas S. Marchand, MD
Edited by the OTA Patient Education Committee and Justin Haller, MD (section lead)
All x-rays and pictures taken from the personal collection of Dr. Marchand and Christopher Domes, MD