What to Expect with a Fractured Tibia

A tibia fracture is a broken bone in the lower leg. The tibia, or shinbone, is the larger of the two lower leg bones. The other bone, the fibula, sits to the outside of the tibia to support it. Seek prompt medical care for symptoms that could indicate a tibia fracture. You should find medical treatment even if you are not sure whether the bone is broken.

This article will describe the types of tibia fractures, common causes, and treatment.

The tibia bears most of your weight and is a main component of both the knee and ankle joints. It can break anywhere along the bone. A shinbone fracture is another name for a broken tibia.

The most common type of tibia fracture is a shaft fracture. This break occurs on the length of the bone between the knee and ankle. In many cases, the fibula breaks along with the tibia.

Of the long bones in the body, the shinbone is the most commonly fractured one.  

Like other broken bones, a tibia fracture causes sudden, severe pain. The break can cause a physical abnormality in the leg as well as leg instability, which prevents you from bearing weight on it.

Basic treatment includes casting and bracing to immobilize the bone while it heals. Surgery may be necessary when the break is complex or severe.

Doctors classify tibia fractures in several ways. The type of fracture can influence your treatment options.

The location of a tibia fracture is one way to describe the type fracture:

• Distal: This fracture happens at the lower end of the tibia at the ankle.
• Proximal: This fracture occurs at the upper end of the bone at the knee joint.
• Shaft: This is the most common type of tibia fracture. It occurs somewhere along the length of bone between the knee and ankle.

The pattern is another way to classify the type of tibia fracture. Tibial shaft fractures can be:

• Oblique: This is an angled break across the bone.
• Spiral: This is a break that circles the bone like a candy cane’s stripes due to twisting of the bone.
• Transverse: This is break that goes straight across the bone.

The way the pieces of bone line up and the integrity of the skin and muscle are another way to define the type of tibia fracture:

• Stable fracture: The two broken ends of the bone are close together and aligned. The fracture will likely not become displaced. Another name for this is a nondisplaced fracture. It usually only requires a cast or splint.
• Displaced fracture: The two ends of the bone are out of place and not aligned. This requires putting the bones back in place in a process called reduction. Then, doctors immobilize the bones or fix them in place for healing.
• Comminuted fracture: The bone has shattered into three or more pieces. Surgery to reassemble them is the usual treatment.
• Open or compound fracture: The bone has punctured the skin or a wound is open down to the bone. The damage includes surrounding tissues, such as muscles, tendons, and ligaments. Due to the risk of infection, emergency surgery is necessary. 

The specific symptoms of a broken shinbone and their severity will vary with the type of fracture. Symptoms also depend on whether the fracture involves joint structures, such as ligaments or tendons.

The American Academy of Orthopaedic Surgeons lists common symptoms of a tibia fracture, including:

• physical abnormality of the leg, ankle, or knee, such as an abnormal lump, tenting of the skin, or unnatural bend
• inability to bear weight or walk on the leg
• pain, which can be sudden and range from moderate to severe
• pale, numb, or cool foot
• pins-and-needles sensation in the foot
• popping, snapping, or grinding sound during the injury
• swelling or bruising

It is a medical emergency anytime you break a bone. Compound fractures can lead to infection very quickly. If sepsis occurs, this can be life threatening.

Seek immediate medical care for a broken bone, a piece of bone sticking out through the skin, or a deep wound or trauma with open skin down to the bone.

Getting care right away offers the best chance of the bone healing successfully without complications. 

This is an X-ray image of a tibia fracture.

It takes a major force to break the tibia. Most tibia fractures are the result of a high energy impact. This includes motor vehicle accidents, sports injuries, and falls from heights.

In some cases, low energy impacts, such as falling from a standing position, can break the shinbone. This is more likely in people with weak bones or diseases of the bone. 

The tibia is also the most common bone to develop stress fractures. These fractures involve the strong outer layer of bone but are not complete fractures. Stress fractures develop with repetitive force on the bone, such as what would happen with frequent running or jumping.

A stress fracture is not the same as a shin splint, which is inflammation of the thin membrane covering the bone. A true stress fracture is painful with everyday activities, while a shin splint may only hurt with the activity that caused it.

Several factors increase the risk of breaking a leg bone, including the tibia. Risk factors include:

• activities involving repetitive motions or forces, such as running, ballet dancing, tennis, or marching in a band
• contact sports, such as football, hockey, or soccer
• motor vehicle accidents
• osteoporosis or bone cancer, which weaken and compromise the bone

It is not always possible to prevent broken bones because they are usually from sudden accidents. However, you may be able to lower your risk of a tibia fracture when you do not have an injury by:

• doing weight-bearing activities on a regular basis to strengthen your bones
• getting enough calcium and vitamin D to build and maintain strong bones
• wearing protective equipment during sports and other activities

If you have risk factors for osteoporosis, talk with your doctor. A screening test may be necessary to assess your risk. Finding and treating a problem early can help prevent future fractures and other complications.

To diagnose a shinbone fracture, your doctor will take a medical history, perform an exam, and order an X-ray to see the bone and whether there is a fracture.

During the exam, your doctor will inspect your leg for any physical abnormalities, swelling, bruises, or other signs of trauma. Your doctor may also feel your leg and foot to test for sensation, stability, and movement.  

Depending on the results of your exam and X-ray, your doctor may order additional imaging tests to learn more about the fracture. This usually involves a CT scan or an MRI scan.

Questions your doctor may ask include:

• How did you injure your leg?
• On a scale of 1–10 with 10 being the worst pain ever, how severe is your pain?
• Does movement make the pain worse?
• Does anything make the pain feel better?
• Can you bear weight on your leg or walk on it?
• Can you move your leg and foot?
• Are you having any symptoms in your foot, such as numbness?
• What other medical conditions do you have?
• Do you smoke?
• What medications do you take?

The goals of treating a tibia fracture are to put the pieces of bones back in place and stabilize them while they heal. In many cases, this involves a splint or a cast. However, surgery may be necessary if the break is severe or if there is extensive soft tissue damage. 

If the bone pieces are out of alignment, doctors need to put them back into place before continuing with treatment. This process of realignment is called reduction, and it is performed under anesthesia.

A closed reduction accomplishes realignment without a skin incision to access the fracture. An open reduction involves a skin incision to access the fracture and repair the injury.

Broken tibia treatments may include:

• Cast immobilization: This is the most common treatment. Your doctor may opt for a splint before casting in order to let any swelling subside. You may need to wear a brace after the cast comes off until healing is complete.
• Internal fixation: This is the process of fixing or holding the bone pieces in place. With internal fixations, doctors use screws, pins, or plates on the bone to set the pieces. One of the more common methods for a shaft fracture in adults is an intramedullary nail. This is a rod that runs through the canal inside the tibia to keep it straight. It is generally not an option for children, whose growth plates are still open.
• External fixation: This also sets the bone pieces in place with pins or screws. However, the surgeon will attach a metal bar on the outside of the skin to keep the bones set properly.

Medications may also be necessary to aid in a tibia fracture recovery. This includes pain relievers and antibiotics if the break is a compound fracture. Your doctor may prescribe a blood thinner as well, which can reduce your chance of blood clots.

You may also need assistive devices, such as a walker or crutches, during recovery.

The timeline for complete recovery from a tibia fracture varies with the type and severity of the fracture.

Tibia fractures can take 4–6 months to heal completely, according to the American Academy of Orthopedic Surgeons (AAOS). The National Health Service (NHS) indicates minor fractures may heal in 6–8 weeks.

Your doctor may encourage you to move and bear weight on the affected leg early in your recovery. Early movement usually involves passive motion, either with a machine or a physical therapist. This can help prevent stiffness and make rehabilitation easier. Physical therapy will restore strength, motion, and flexibility in your leg and joints.

With treatment and stabilization of a tibia fracture, the outlook is usually good.

Complications are infrequent, but they can occur, including:

• blood clots
• changes in gait, such as limping or difficulty walking
• infection
• arthritis, more so for proximal tibia fractures near the knee
• malunion, which is when the bone pieces heal in an incorrect position
• nonunion, which is when the bone will not heal
• pain or other symptoms from the stabilizing hardware
• compartment syndrome, which is a surgical emergency

These complications may require surgery or other interventions to correct them. 

A tibia fracture is a broken shinbone. Symptoms include pain, an inability to walk, a popping sound at the time of the injury, and physical abnormalities of the leg. Anyone with a possible bone fracture requires immediate medical care.

Treatment options include splints, casts, and surgery. Surgery is more often necessary for open or comminuted fractures. Recovery time varies, but an estimate is 4–6 months for complete healing.