Treatment & Recovery of Tibial Shaft Fractures

Tibial fractures are common injuries of long-bone. The National Center for Health Statistics cites 492,000 tibial fractures per year in the United States. Open fractures usually occur from high velocity trauma (for example, automobile collision). Closed injuries may occur from sports-related trauma or falls.

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Treatment Options for Tibial Shaft Fractures

Tibial shaft fractures can be treated by many methods depending on the fracture type and alignment of the bone. The most common treatments are as follows:

• Casting: A cast is suitable for tibial shaft fractures that are not badly displaced and are well aligned. Patients should be in a cast that goes above the knee and below the ankle (a long leg cast). The benefit of casting is that these fractures tend to heal well, and casting avoids the potential risks of surgery such as infection. Patients with casts must be monitored to ensure adequate healing of the tibia and to make sure the bones maintain their alignment. The surgeons use orthopedic tools in the surgical procedure.

• Intramedullary (IM) Rodding: Intramedullary rodding is a procedure to place a metal rod down the center of the tibia to hold the bone alignment. A tibial rodding is a surgical procedure that lasts about an hour and a half and is often done under general anesthesia. Patients will have an incision over the knee joint, and small incisions above the ankle and below the knee. Moreover, some fractures may require an incision near the fracture to realign the bones. IM rods are secured within the bone by screws both below and above the fracture. The metal bone screws and the rod can be removed if they cause problems but can also be left in place for life. tibial rodding provides excellent alignment and fixation of the bones. The most concerning complication of surgery are an infection and the most common risk of surgery is knee pain. Infection of the rod may require removal of the rod to cure the infection.

• Plates and Screws: Plates and screws are less commonly used, but are helpful in some types of fractures, especially those closer to the ankle or knee joints. Most surgeons choose an IM rod for tibial shaft unless the fracture is too close to the joint to allow for placement of the IM rod. In these fractures close to the surface of joint, screws and a bone plate may be the ideal method of fixation.

• External fixator: An external fixator may also be helpful in some types of fracture. External fixators tend to be used in more serious fractures, especially open fractures with associated lacerations and soft-tissue damage. In these cases, the placement of plates or IM rods may not be possible due to soft-tissue injury. When there is significant soft-tissue injury, the external fixator may deliver excellent immobilization while allowing monitoring and treatment of the surrounding soft-tissue.

Recovery

Recovery following a tibial shaft fracture usually takes a minimum of 3 months or longer. The restrictions on your activity will depend on the option of treatment selected. People with external fixators, casts, and orthopedic plates, orthopaedic implants or (implantes ortopedicos) and screws are usually restricted from weightbearing for many months. One of the benefits of an intramedullary rod is the ability to place weight on the extremity at relatively earlier time. Even after the fracture has healed, it isn’t unusual for the joint mechanics to take quite a bit longer to recover. Regaining ankle and knee mobility, the strength of the lower extremity, and a normal gait usually takes 6-9 months. Moreover, people who sustain an open tibial fracture (compound fractures) usually take longer to recover.