LEG FRACTURE, TIBIA |
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General Information
DEFINITION--A complete or incomplete break in the tibia, one of the two large bones of the leg between the knee and ankle.
BODY PARTS INVOLVED
Tibia.
Knee or ankle joints.
Soft tissue around the fracture site, including nerves, tendons, ligaments and blood vessels.
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SIGNS & SYMPTOMS
Severe leg pain at the time of injury.
Swelling of soft tissue around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal leg contours.
Tenderness to the touch.
Numbness and coldness in the leg and foot beyond the fracture site if the blood supply is impaired.
CAUSES
Direct blow to the leg.
Weakening of the bone from repeated stress, resulting in a stress fracture that progresses to a complete fracture. This is especially common in joggers, marathon runners and walkers.
Indirect stress caused by twisting or violent muscle contraction.
RISK INCREASES WITH
Contact sports.
History of bone or joint disease.
Obesity.
Severe ankle sprain.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment, including good running shoes for running, and shin guards for participation in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Hospitalization (sometimes) for anesthesia and surgery to set the fracture.
Whirlpool, ultrasound, or massage after healing (to displace excess fluid from the knee and ankle).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the injured area, including the knee joint above and the ankle joint below.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Shortening of the injured bones.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Unstable or arthritic ankle or knee joint if the fracture is close to either.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated leg injury.
Problems caused by casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 8 weeks. Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible, but don't move the injured leg to do so.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will set (realign) the broken bones with surgery or, if possible, without. Surgery is seldom performed unless the skin at the injury site is broken. In tibial fractures, the segments are sometimes fixed together with screws or metal plates. Realignment should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary. A rigid cast is placed around the injured leg to immobilize the knee and ankle.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heat lamp or heating pads so heat can penetrate the cast.
After the cast is removed, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen for mild pain.
ACTIVITY
Learn to walk with crutches. See Appendix 3 (Safe Use of Crutches).
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Begin reconditioning the injured leg after clearance from your doctor.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a tibia fracture.
Any of the following occurs after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above or below the cast.
Blue or gray skin color beyond the cast, especially under the toenails.
Loss of feeling below the fracture site.
Nausea or vomiting.
Constipation.
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