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Leg Fractures

 

Tibia (Shinbone) Shaft Fracture

 

The lower leg is comprised of two long bones: the tibia (shinbone) and the fibula.  The tibia is the larger of the two and is responsible carrying the majority of your weight.  In general, a large force is required to fracture this large bone.  Therefore, we commonly see this type of injury with motor vehicle accidents, high impact or twisting sporting accidents.

 

If you have suffered a tibial shaft fracture, you will likely experience significant pain, inability to walk due to pain and instability and/or obvious deformity.  Occasionally, numbness or tingling in the foot will occur indicating some type of nerve damage or interruption of blood supply.  This type of injury should be evaluated immediately by a physician for proper immobilization and evaluation for nerve or blood supply damage.

 

There are several different types of tibial shaft fractures: stable, transverse, oblique, comminuted, spiral and open/displaced.  Stable fractures of the tibia are generally lined up perfectly with good bony contact.  Transverse fractures are perpendicular to the length of the bone and are typically very unstable, especially if the fibula is also fractured.  Oblique fractures are can be inherently unstable because the fracture line is at an angle.  These fractures have a tendency to move because of the angle, even if the fracture is initially stable.  Comminuted fractures have three or more bone fragments and are commonly a result of higher impact injuries such as car or motorcycle accidents.  These fractures are typically unstable due to the fact that there are several small pieces of bone involved.  Spiral fractures involve a fracture line that travels in a circle around the bone.  This type of fracture is usually seen with twisting injuries.  The stability of this fracture depends on how much force is experienced during the injury.  Finally, open and displaced fractures are the most unstable types of fractures in the lower leg.  This type of fracture typically results from high impact and can involve the fibula.  With these fractures the skin is broken and the bone can sometimes protrude through the skin.

 

Evaluation of the fracture will be done with an x-ray.  This will allow your doctor to determine the type and extent of the fracture.  Occasionally, a CT (computed tomography) scan will be recommended to further evaluate the damage.  Tibia shaft fractures can be treated either conservatively (non-operatively) or surgically.  The course of treatment will depend on the location, stability and severity of the fracture.  Additionally, your doctor will consider your health in general to determine if you are a suitable candidate for surgery.  Unstable fractures will likely require some type of internal fixation to stabilize the area.  This can consist of a rod down the inside of the tibial shaft or plates and screws on the outside of the bone.  Regardless of conservative versus surgical intervention, a period of immobilization and non-weight bearing is likely followed by transitioning to partial then full weight bearing.  Additionally, a period of rehabilitation is recommended for improving range of motion, restoring strength and proprioception (balance).

 

Any surgical procedure has possible risks and complications. Surgeons make every effort to minimize them. They include:

 

  • Nerve Damage
  • Infection
  • Stiffness
  • Blood Loss

 

 

Femur Fractures


The long bone in your upper leg is called the femur.  The femur is the largest bone in the body, therefore takes an extremely large force to fracture such as a motor vehicle accident or a fall from a large height.  This type of fracture is typically very obvious and can cause a significant amount of pain and debilitation.  Other symptoms include obvious deformity, swelling and bruising.  Often times the fractured leg will appear shorter than the other side due to the strong muscles of the leg pulling on the fractured end causing increased displacement.


A fractured femur is a serious injury and will require immediate medical attention.  As with any fracture, realigning the fragments is of utmost importance.  With a femur fracture, this will likely need to be done under anesthesia to allow the leg muscles to relax.  Additionally, some type of fixation is typically required, whether that is a long leg cast or internal fixation consisting of a rod or plates and screws.  Typically adults will require surgery to internally fixate the fracture, while children can sometimes have adequate healing with a cast.  Your doctor can discuss these different options with you and help choose what is right for you.