Tibia/Fibula Shaft Fracture
A broken leg (tibia/fibula fracture) is a break or crack in one of the bones in your leg. Common causes include falls, motor vehicle accidents and sports injuries.
Treatment of a broken leg depends on the location and severity of the injury. A severely broken leg may require surgery to implant devices into the broken bone to maintain proper alignment during healing. Other injuries may be treated with a cast or splint. In all cases, prompt diagnosis and treatment of a broken leg is critical to complete healing.
There are several types of proximal tibia fractures. The bone can break straight across (transverse fracture) or into many pieces (comminuted fracture).
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.
TIBIA/FIBULA SHAFT ANATOMY
A broken thighbone (femur) — the strongest bone in your body — usually is obvious because it takes so much force to break. But fractures of your shinbone (tibia) — the major weight-bearing bone in your lower leg — and the bone that runs alongside your tibia below your knee (fibula) may be more subtle.
Signs and symptoms of a broken leg may include:
Severe pain, which may worsen with movement
Obvious deformity or shortening of the affected leg
Inability to walk
Toddlers or young children who break a leg may simply stop walking, even if they can’t explain why. Unexplained crying may be a symptom of a toddler who has a fracture.
There are a number of ways you can break a leg, including:
A simple fall can fracture one or both of the lower leg bones. However, the thighbone is unlikely to be broken without more significant trauma.
MOTOR VEHICLE ACCIDENTS.
All three leg bones can break during a motor vehicle accident. Fractures can occur when your knees become jammed against the dashboard during a collision.
Hyperextending your leg during contact sports can cause a broken leg. So can a direct blow — such as from a hockey stick or an opponent’s body.
In children, a broken leg may be the result of child abuse, especially when such an injury occurs before the child can walk.
Stress fractures are tiny cracks that develop in the weight-bearing bones of your body, including your shinbone. Stress fractures are usually caused by repetitive force or overuse, such as running long distances. But they can also occur with normal use of a bone that’s been weakened by a condition such as osteoporosis.
Treatment of a broken leg will vary, depending on the type and location of the break. Stress fractures may require only rest and immobilization. Fractures are classified into one or more of the following categories:
OPEN (COMPOUND) FRACTURE.
In this type of fracture, the skin is pierced by the broken bone. This is a serious condition that requires immediate, aggressive treatment to decrease your chance of an infection.
In closed fractures, the surrounding skin remains intact.
This term means that the bone is cracked, but it isn’t separated into two parts.
In complete fractures, the bone has snapped into two or more parts.
In this type of fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign the bones properly.
In this type of fracture, the bone cracks but doesn’t break all the way through — like when you try to break a green stick of wood. Most broken bones in children are greenstick fractures, because a child’s bones are softer and more flexible than those of an adult.
SETTING THE LEG
Initial treatment for a broken leg usually begins in an emergency room or urgent care clinic. Here, doctors typically evaluate your injury and immobilize your leg with a splint. If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Some fractures are splinted for a day to allow swelling to subside before they are casted.
Restricting the movement of a broken bone in your leg is critical to proper healing. To do this, you may need a splint or a cast. And you may need to use crutches or a cane to keep weight off the affected leg for six to eight weeks or longer.
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a combination of the two. If you’re experiencing severe pain, your doctor might prescribe stronger pain medications.
After your cast or splint is removed, you’ll likely need rehabilitation exercises or physical therapy to reduce stiffness and restore movement in the injured leg. Because you haven’t moved your leg for a while, you may even have stiffness and weakened muscles in uninjured areas. Rehabilitation can help, but it may take up to several months — or even longer — for complete healing of severe injuries.
Immobilization heals most broken bones. However, you may need surgery to implant internal fixation devices, such as plates, rods or screws, to maintain proper position of your bones during healing. These internal fixation devices may be necessary if you have the following injuries:
An unstable or displaced fracture
Loose bone fragments that could enter a joint
Damage to the surrounding ligaments
Fractures that extend into a joint
A fracture that is the result of a crushing accident
A fracture in particular areas of your leg, such as your thighbone
For some injuries, your doctor may also recommend an external fixation device — a frame outside your leg attached to the bone with pins. This device provides stability during the healing process and is usually removed after about six to eight weeks. There’s a risk of infection around the surgical pins connected to the external fixation device.
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