How is a broken upper tibia treated?
A proximal tibia fracture can be treated nonsurgically or surgically. There are benefits and risks associated with both forms of treatment.
Whether to have surgery is a combined decision made by the patient, the family, and the provider. The preferred treatment is accordingly based on the type of injury and the general needs of the patient.
When planning treatment, your provider will consider several things, including your expectations, lifestyle, and medical condition.
In an active individual, restoring the joint through surgery is often appropriate because this will maximize the joint's stability and motion, and minimize the risk of arthritis.
In other individuals, however, surgery may be of limited benefit. Medical concerns or pre- existing limb problems might make it unlikely that the individual will benefit from surgery. In such cases, surgical treatment may only expose these individuals to its risks (anesthesia and infection, for example).
Open fractures. If the skin is broken and there is an open wound, the underlying fracture may be exposed to bacteria that might cause infection. Early surgical treatment will cleanse the fracture surfaces and soft tissues to lessen the risk of infection.
External fixation. If the soft tissues (skin and muscle) around your fracture are badly damaged, or if it will take time before you can tolerate a longer surgery because of health reasons, your provider may apply a temporary external fixator. In this type of operation, metal pins or screws are placed into the middle of the femur (thighbone) and tibia (shinbone). The pins and screws are attached to a bar outside the skin. This device holds the bones in the proper position until you are ready for surgery.
Compartment syndrome. In a small number of injuries, soft-tissue swelling in the calf may be so severe that it threatens blood supply to the muscles and nerves in the leg and foot. This is called compartment syndrome and may require emergency surgery. During the procedure, called a fasciotomy, vertical incisions are made to release the skin and muscle coverings. These incisions are often left open and then stitched closed days or weeks later as the soft tissues recover and swelling resolves. In some cases, a skin graft is required to help cover the incision and promote healing.
Nonsurgical treatment may include casting and bracing, in addition to restrictions on motion and weight bearing. Your provider will most likely schedule additional x-rays during your recovery to monitor whether the bones are healing well while in the cast. Knee motion and weight-bearing activities begin as the injury and method of treatment allow.
There are a few different methods that a surgeon may use to obtain alignment of the broken bone fragments and keep them in place while they heal.
Internal fixation. During this type of procedure, the bone fragments are first repositioned (reduced) into their normal position. They are held together with special devices, such as an intramedullary rod or plates and screws.
In cases in which the upper one fourth of the tibia is broken, but the joint is not injured, a rod or plate may be used to stabilize the fracture. A rod is placed in the hollow medullary cavity in the center of the bone. A plate is placed on the outside surface of the bone.
Plates and screws are commonly used for fractures that enter the joint. If the fracture enters the joint and pushes the bone down, lifting the bone fragments may be required to restore joint function. Lifting these fragments, however, creates a hole in the cancellous bone of the region. This hole must be filled with material to keep the bone from collapsing. This material can be a bone graft from the patient or from a bone bank. Synthetic or naturally occurring products which stimulate bone healing can also be used.
External fixators. In some cases, the condition of the soft tissue is so poor that the use of a plate or rod might threaten it further. An external fixator (described under Emergency
Care above) may be considered as final treatment. The external fixator is removed when the injury has healed.
What is the recovery process like after breaking the upper tibia?
Your provider will decide when it is best to begin moving your knee in order to prevent stiffness. This depends on how well the soft tissues (skin and muscle) are recovering and how secure the fracture is after having been fixed.
Early motion sometimes starts with passive exercise: a physical therapist will gently move your knee for you, or your knee may be placed in a continuous passive motion machine that cradles and moves your leg.
If your bone was fractured in many pieces or your bone is weak, it may take longer to heal, and it may be a longer time before your provider recommends motion activities.
To avoid problems, it is very important to follow your provider's instructions for putting weight on your injured leg.
Whether your fracture is treated with surgery or not, your provider will most likely discourage full weight bearing until some healing has occurred. This may require as much as 3 months or more of healing before full weight bearing can be done safely. During this time, you will need crutches or a walker to move around. You may also wear a knee brace for additional support.
Your provider will regularly schedule x-rays to see how well your fracture is healing. If treated with a brace or cast, these regular x-rays show your provider if the bone is changing position. Once your provider determines that your fracture is not at risk for changing position, you may start putting more weight on your leg. Even though you can put weight on your leg, you may still need crutches or a walker at times.
When you are allowed to put weight on your leg, it is very normal to feel weak, unsteady, and stiff. Even though this is expected, be sure to share your concerns with your provider and physical therapist. A rehabilitation plan will be designed to help your regain as much function as possible.
Your physical therapist is like a coach guiding you through your rehabilitation. Your commitment to physical therapy and making healthy choices can make a big difference in how well you recover. For example, if you are a smoker, your doctor or therapist may recommend that you quit. Some providers believe that smoking may prevent bone from healing. Your providers or therapist may be able to recommend professional services to help you quit smoking.