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Upper Tibia (Shinbone) Fracture

Upper Shinbone Anantomy

(Left) The proximal tibia is the upper portion of the bone, closest to the knee. (Right) Ligaments connect the femur to the tibia and fibula (kneecap not shown).

A fracture, or break, in the shinbone just below the knee is called a proximal tibia fracture. The proximal tibia is the upper portion of the bone where it widens to help form the knee joint.

In addition to the broken bone, soft tissues (skin, muscle, nerves, blood vessels, and ligaments) may be injured at the time of the fracture. Both the broken bone and any soft- tissue injuries must be treated together. In many cases, surgery is required to restore strength, motion, and stability to the leg, and reduce the risk for arthritis.

The knee is the largest weight-bearing joint of the body. Three bones meet to form the knee joint: the femur (thighbone), tibia (shinbone), and patella (kneecap). Ligaments and tendons act like strong ropes to hold the bones together. They also work as restraints — allowing some types of knee movements, and not others. In addition, the way the ends of the bones are shaped help to keep the knee properly aligned.

What are the different types of upper shinbone fractures?

There are several types of upper shinbone fractures. The bone can break straight across (transverse fracture) or into many pieces (comminuted fracture)

Shinbone Fracture

Examples of different types of proximal tibia fractures.

Sometimes these fractures extend into the knee joint and separate the surface of the bone into a few (or many) parts. These types of fractures are called intra-articular or tibial plateau fractures.

The top surface of the tibia (the tibial plateau) is made of cancellous bone, which has a "honeycombed" appearance and is softer than the thicker bone lower in the tibia.

Fractures that involve the tibial plateau occur when a force drives the lower end of the thighbone (femur) into the soft bone of the tibial plateau, similar to a die punch. The impact often causes the cancellous bone to compress and remain sunken, as if it were a piece of Styrofoam that has been stepped on.

This damage to the surface of the bone may result in improper limb alignment, and over time may contribute to arthritis, instability, and loss of motion.

Proximal tibia fractures can be closed — meaning the skin is intact — or open. An open fracture is when a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for problems like infection, and take a longer time to heal.

What causes upper tibia fractures?

A fracture of the upper tibia can occur from stress (minor breaks from unusual excessive activity) or from already compromised bone (as in cancer or infection). Most, however, are the result of trauma (injury).

Young people experience these fractures often as a result of a high-energy injury, such as a fall from considerable height, sports-related trauma, and motor vehicle accidents.

Older persons with poorer quality bone often require only low-energy injury (fall from a standing position) to create these fractures.

What are symptoms of an upper tibia fracture?

Symptoms include:

  • Pain that is worse when weight is placed on the affected leg
  • Swelling around the knee and limited bending of the joint
  • Deformity — The knee may look "out of place"
  • Pale, cool foot — A pale appearance or cool feeling to the foot may suggest that the blood supply is in some way impaired.
  • Numbness around the foot — Numbness, or "pins and needles," around the foot raises concern about nerve injury or excessive swelling within the leg.

If you have these symptoms after an injury, go to the nearest hospital emergency room for an evaluation.