Overview of Tibia Fractures

The tibia is the major bone of the lower leg, commonly referred to as the shin bone. Tibia fractures can occur from many types of injuries and come in different shapes and sizes. Each fracture must be treated with individual factors taken into account. 

In general, tibia fractures can be separated into three categories based on the location of the fracture. It should be noted that all open, or compound, fractures must be treated with special care. Open fractures occur when the fractured bone is open through the skin. These fractures are at especially high risk of developing an infection and generally require surgical treatment in all cases.

• Tibial shaft fractures: Tibial shaft fractures, which occur between the knee and ankle joints, are the most common type of tibia fracture. Some tibial shaft fractures can be treated in a long leg cast. However, some fractures have too much displacement or angulation and may require surgery to realign and secure the bones.
• Tibial plateau fractures: Tibial plateau fractures occur just below the knee joint. These fractures require consideration of the knee joint and its cartilage surface. Tibial plateau fractures can lead to a chance of developing knee arthritis.
• Tibial plafond fractures: Tibial plafond, or pilon, fractures occur at the bottom of the shin bone around the ankle joint. These fractures also require special consideration because of the ankle cartilage surface. Tibial plafond fractures are also concerning because of potential damage to surrounding soft tissues.

Signs

Tibia fractures are most often the result of high-energy injuries, such as automobile collisions, sports injuries, or falls from a height. There are also less common causes of tibia fractures, including overuse stress fractures and insufficiency fractures resulting from bone thinning (osteoporosis). When a tibia fracture has occurred, the signs might include:

• Tenderness directly over the shin bone
• Deformity of the leg
• Swelling and bruising around the injured bone
• Inability to put weight on the leg

If you have a suspicion that you, or someone you are helping to care for, has a tibia fracture, it is important to seek immediate medical care. While this can be done at an orthopedist's office, it is typical for an individual with a suspected tibia fracture to be seen in an emergency department.

X-rays are the most helpful test to diagnose a tibia fracture, and often the only test needed, even when surgery is being considered for treatment. Other tests can be helpful, including MRIs and CT scans. When the fracture involves the area surrounding the ankle or knee joint, a CT scan can help your surgeon plan how to best reconstruct the important surface of the joint. MRIs are most often used if there is a question regarding the diagnosis of a fracture, such as a stress fracture of the tibia.

Treatment

Your healthcare provider considers the following factors when determining the treatment of a tibia fracture:

• Location of the fracture
• Displacement of the fracture
• Alignment of the fracture
• Associated injuries
• Soft tissue condition around the fracture
• Patient general health

Not every tibia fracture requires surgery, and many can be managed with immobilization and limitations in weight-bearing activity. In many of these cases, a cast is used for treatment. In other situations, the fracture alignment or stability may be such that surgery will help to ensure more proper healing of the bone. 

Surgical treatment options can vary and may include pins, plates, screws, and rods. Again, the exact method to repair a tibia fracture is highly dependent on the specific circumstances of the injury. Surgery may be performed in an emergency setting soon after the injury, or in other cases, it may be delayed until swelling and soft-tissue injuries have begun to heal. 

Recovery timelines are also highly variable and depend on the specific circumstances of the fracture and treatment provided. In general, tibia fractures will take a minimum of three months for healing, and many can take much longer for a full recovery.