Tibial Shaft Fracture before and after repair

Tibial Fractures

Tibial fractures are one of the most common fractures in adults.  Most are due to high energy trauma such as motorcycle accidents although some can occur during sporting events. Most patients are admitted to the hospital.  Injuries are a spectrum ranging from low energy closed fractures to high energy open fractures. For fractures with minimal soft tissue injury and fracture displacement, cast treatment can be attempted.  In adults, however, most tibial shaft fractures are treated with surgical repair.  In severe cases with damage to the soft tissue envelope, I recommend placing an external fixation device across the fracture to allow the soft tissue envelope to “cool off”.  Surgical repair typically involves placement of an intramedullary nail into the hollow portion of the bone. Screws are placed at the top and bottom of the nail to stabilize the fracture and prevent rotation or shortening.  Surgery usually takes roughly 1 hour, although more complex fractures can take longer.  Most patients stay 1-2 days in the hospital. I keep most patients on crutches for the first 4-6 weeks after surgery. Pool therapy is very useful during this time as it allows for some motion without putting stress on the surgical repair. The biggest risk after surgery is blood clots in the veins of the legs and pelvis and I treat all patients with a medication called low molecular weight heparin for the first two weeks after surgery. After 6 weeks I allow patients to begin putting full weight on their leg and start more aggressive physical therapy. Full recovery for most tibia fractures takes 6-8 months; however, some fractures develop a condition called non union and require further surgery.