A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. It typically takes a major force to cause this type of broken leg. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures.

1. Tibia (Shinbone) Shaft
Fractures

2. Introduction:
• The tibia, or shinbone, is the most commonly fractured long
bone in the body. A tibial shaft fracture occurs along the length
of the bone, below the knee and above the ankle.
• It typically takes a major force to cause this type of broken leg.
Motor vehicle collisions, for example, are a common cause of
tibial shaft fractures. In many tibia fractures, the smaller bone in
the lower leg (fibula) is broken as well.

3. Anatomy:
• The lower leg is made up of two bones: the tibia and fibula. The
tibia is the larger of the two bones. It supports most of your weight
and is an important part of both the knee joint and ankle joint.

4. Types of Tibial Shaft Fractures:
• Tibia fractures vary greatly, depending on the force that causes the
break.
• The pieces of bone may line up correctly (stable fracture) or be out
of alignment (displaced fracture). The skin around the fracture may
be intact (closed fracture) or the bone may puncture the skin (open
fracture).
• In many tibia fractures, the fibula is broken as well.
• Doctors describe fractures to each other using classification
systems. Tibia fractures are classified depending on:
• The location of the fracture (the tibial shaft is divided into thirds:
distal, middle, and proximal)
• The pattern of the fracture (for example, the bone can break in
different directions, such as crosswise, lengthwise, or in the middle)

5. • Whether the skin and muscle over the bone is torn by the injury
(open fracture)
• The most common types of tibial shaft fractures include:
• Transverse fracture: In this type of fracture, the break is a straight
horizontal line going across the tibial shaft.
• Oblique fracture: This type of fracture has an angled line across the
shaft.
• Spiral fracture: The fracture line encircles the shaft like the stripes on
a candy cane. This type of fracture is caused by a twisting force.
• Comminuted fracture: In this type of fracture, the bone breaks into
three or more pieces.

6. • Open fracture: If a bone breaks in such a way that bone
fragments stick out through the skin or a wound penetrates
down to the broken bone, the fracture is called an open or
compound fracture. Open fractures often involve much more
damage to the surrounding muscles, tendons, and ligaments.
They have a higher risk for complications—especially
infections—and take a longer time to heal.

8. Cause:
• Tibial shaft fractures are often caused by some type of high-
energy collision, such as a motor vehicle or motorcycle crash. In
cases like these, the bone can be broken into several pieces
(comminuted fracture).
• Sports injuries, such as a fall while skiing or a collision with
another player during soccer, are lower-energy injuries that can
cause tibial shaft fractures. These fractures are typically caused
by a twisting force and result in an oblique or spiral fracture.

9. Symptoms:
• A tibial shaft fracture usually causes immediate, severe pain.
Other symptoms may include:
• Inability to walk or bear weight on the leg
• Deformity or instability of the leg
• Bone "tenting" over the skin at the fracture site or bone
protruding through a break in the skin
• Occasional loss of feeling in the foot

10. Doctor Examination
Medical History and Physical Examination
• It is important that your doctor know the specifics of how you
hurt your leg. For example, if you were in a car accident, it
would help your doctor to know how fast you were going,
whether you were the driver or the passenger, whether you
were wearing your seatbelt, and if the airbags went off. This
information will help your doctor determine how you were hurt
and whether you may be hurt somewhere else.
• It is also important for your doctor to know if you have any other
health conditions like high blood pressure, diabetes, asthma, or
allergies. Your doctor will also ask you if you use tobacco
products or are taking any medications.

11. • After discussing your injury and medical history, your doctor will perform a careful
examination. He or she will assess your overall condition and then focus on your
leg. Your doctor will look for:
• An obvious deformity of the tibia/leg (an unusual angle, twisting, or shortening of
the leg)
• Breaks in the skin
• Bruises
• Swelling
• Bony pieces that may be pushing on the skin
• Instability (some patients may retain a degree of stability if the fibula is not broken
or if the fracture is incomplete)
• After the visual inspection, your doctor will feel along your tibia, leg, and foot
looking for abnormalities. If you are awake and alert, your doctor will test for
sensation and movement in your leg and foot.

12. Physical examination which includes checking for:
• Obvious deformity
• Skin breaks
• Bony protrusions under the skin
• Swelling
• Bruising
• Instability
• Sensations
• Muscle strength

13. •Oestern and Tscherne Classification of Closed Fracture Soft Tissue Injury
•Grade 0
•Injuries from indirect forces with negligible soft-
tissue damage
•Grade I •Superficial contusion/abrasion, simple fractures
•Grade II
•Deep abrasions, muscle/skin contusion, direct
trauma, impending compartment syndrome
•Grade III
•Excessive skin contusion, crushed skin or
destruction of muscle, subcutaneous degloving,
acute compartment syndrome, and rupture of
major blood vessel or nerve

14. •Gustilo-Anderson Classification of Open Tibia Fractures
•Type I •Limited periosteal stripping, clean wound < 1 cm •
•Type II
•Minimal periosteal stripping, wound >1 cm in length without extensive soft-tissue injury
damage
•
•Type IIIA
•Significant soft tissue injury (often evidenced by a segmental fracture or comminution),
significant periosteal stripping, wound usually >5cm in length, no flap required.
•

15. Imaging Tests
• X-rays. The most common way to evaluate a fracture is with x-rays, which
provide clear images of bones. X-rays can show whether the tibia is broken or
intact. They can also show the type of fracture and where it is located within the
tibia. X-rays are also useful for identifying the involvement of the knee or ankle
joints and the presence of a fibula fracture.
• an X-ray to have an image of the tibia
• Radiographs
• recommended views
• full-length AP and lateral views of the affected tibia
• AP, lateral and oblique views of ipsilateral knee and ankle
• repeat radiographs recommended after splinting or fracture manipulation
• a computed tomography (CT) scan, also called a CAT scan, which is more
powerful than an X-ray and gives a 3-D image of the bone
• a magnetic resonance imaging (MRI) scan for a detailed image of the muscles,
ligaments, and bones around the tibia

17. Tibia Shaft Fracture Treatment:
• The doctor considers several factors while planning treatment of tibial fracture.
They include -
• Reason for your injury
• Severity of injury
• Extent of damage to soft tissue
• Overall health

18. Nonsurgical Treatment:
• Nonsurgical treatment may be recommended for the following patients:
• Those with closed fractures and with little displacement
• Those who are less active and hence in a better position to tolerate small degrees of
angulation or differences in the length of a leg
• Those with overall health problems
• Most people who suffer fractures display swelling for the first few weeks. Hence, the
first step may be to apply a splint for comfort and support. Once the swelling
subsides, a range of treatment options may be considered.

19. Another effective nonsurgical treatment method is to immobilize the affected leg using a cast for a few weeks, as part of
the initial healing process. After this period, the cast may be replaced with a functional brace, for support, until healing is
complete. The brace may be taken off, if necessary, while taking bath or during physical therapy.

20. • Surgical Treatment
• Surgery is recommended for the following reasons -
• Fracture that does not heal with non surgical methods
• An open fracture
• Fracture with many bone fragments and large degrees of displacement

21. . Intramedullary nailing is the most popular form of surgical treatment for tibial
fractures. Here a specially designed metal rod is inserted into the marrow canal
of the tibial bone from the front. The rod passes across the fracture and helps to
keep it in position.
• The intramedullary nails come in sizes and lengths to suit most tibia bones.
They are screwed to the bone at both ends to keep them in place during
healing. This method is not suitable for children or adolescents as there is a
risk of damaging the bone’s growth plates.

22. • Plates and screws are used to treat fractures in which intramedullary nailing
is not a good choice of treatment, such as fractures that extend into the knee
or ankle joints. Here, the bone fragments are first repositioned into their
normal alignment and, then, are held together with metal plates and special
screws fixed to the outer surface of the bone.
• External fixation. Here, metal pins or screws are fixed to a bar outside the
skin, above and below the site of tibial fracture. The bar is a frame that
stabilizes the bones and holds them in the proper position to enable healing.
Although effective, implants fixed outside the body are not very popular, both
with the patients and the doctors who treat them.

23. Complications:
• Complications of a tibia fracture may include:
• complications from surgery or the need for further surgeries
• nerve, muscle, or blood vessel damage
• compartment syndrome, a serious condition which there is a
reduction in blood supply to the leg due to swelling
• a bone infection called osteomyelitis
• development of a non-union where the bone does not heal
• In many cases, a tibial fracture will be successfully managed
without complication.

24. • Mal alignment
• Infections
• Nerve and vascular injury
• Blood clots
• Nonunion in which bones fail to heal
• Angulation