How is a shinbone fracture treated?
In planning your treatment, your doctor will consider several things, including:
- Your overall health
- The cause of your injury
- The severity of your injury
- The extent of soft tissue damage
Nonsurgical treatment may be recommended for patients who:
- Are poor candidates for surgery due to their overall health problems
- Are less active, so are better able to tolerate small degrees of angulation or differences in leg length
- Have closed fractures with minimal movement of the fracture ends
Initial treatment. Most injuries cause some swelling for the first few weeks. Your doctor may initially apply a splint to provide comfort and support. Unlike a full cast, a splint can be tightened or loosened to allow swelling to occur safely. Once the swelling goes down, your doctor will consider a range of treatment options.
Casting and bracing. Your doctor may immobilize the fracture in a cast for initial healing. After several weeks, the cast can be replaced with a functional brace made of plastic and fasteners. The brace will provide protection and support until healing is complete. The brace can be taken off for hygiene purposes and for physical therapy.
Surgery may be recommended for certain types of fractures, including:
- Open fractures with wounds that need monitoring
- Fractures that have not healed with nonsurgical treatment
- Fractures with many bone fragments and a large degree of displacement
Intramedullary nailing. Currently, the method most surgeons use for treating tibia fractures is intramedullary nailing. During this procedure, a specially designed metal rod is inserted into the canal of the tibia. The rod passes across the fracture to keep it in position.
The intramedullary nail is screwed to the bone at both ends. This keeps the nail and the bone in proper position during healing. Intramedullary nails are usually made of titanium. They come in various lengths and diameters to fit most tibia bones.
Intramedullary nailing is not ideal for fractures in children and adolescents because care must be taken to avoid crossing the bone's growth plates.
Plates and screws. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with screws and metal plates attached to the outer surface of the bone. Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend into either the knee or ankle joints.
External fixation. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.
How long will it take to recover from a shinbone fracture?
Most tibial shaft fractures take 4 to 6 months to heal completely. Some take even longer, especially if the fracture was open or broken into several pieces or if the patients uses tobacco products.
Many providers encourage leg motion early in the recovery period. It is very important to follow your doctor's instructions for putting weight on your injured leg to avoid problems.
In some cases, providers will allow patients to put as much as weight as possible on the leg right after surgery. However, you may not be able to put full weight on your leg until the fracture has started to heal. Be sure to follow your provider’s instructions carefully. When you begin walking, you will probably need to use crutches or a walker for support.
Because you will likely lose muscle strength in the injured area, exercises during the healing process are important. Physical therapy will help to restore normal muscle strength, joint motion, and flexibility. It can also help you manage your pain after surgery.
A physical therapist will most likely begin teaching you specific exercises while you are still in the hospital. The therapist will also help you learn how to use crutches or a walker.
What complications can be caused by a shinbone fracture?
Tibial shaft fractures can cause further injury and complications, including the following:
- The ends of broken bones are often sharp and can cut or tear surrounding muscles, nerves, or blood vessels.
- Acute compartment syndrome may develop. This is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. Unless the pressure is relieved quickly, permanent disability may result. This is a surgical emergency. During the procedure, your surgeon makes incisions in your skin and the muscle coverings to relieve pressure.
- Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics.
Complications from Surgery
In addition to the risks of surgery in general, such as blood loss and problems related to anesthesia, complications of surgery may include:
- Injury to nerves and blood vessels
- Blood clots (these may also occur without surgery)
- Malalignment or the inability to correctly position the broken fragments
- Delayed union or nonunion (when the fracture heals slower than usual or not at all)
- Angulation (with treatment by external fixation)