Have you been diagnosed with a tibial fracture, and you have so many questions about treatment and recovery. Are you worried, wondering when you will be able to walk again?
Based on my experience as a diagnostic radiographer and on the scientific studies on the subject, I have written this article for you.
Happy reading!😀
Last updated: April 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links.
Basics
The tibia is one of two bones that make up the lower leg, the other being the fibula. The tibia is the larger of these two bones and it plays a major a key role in the body mechanics as it is:
⚫The larger of the two lower leg bones
⚫Responsible for supporting most of the body weight.
⚫Vital for proper knee and ankle joint mechanics.
▶️What are types of tibia fracture and causes.
⭐Stable or a non-displaced fracture- involves a crack in the bone that leaves most of the bone intact and in its normal position.
⭐Displaced fracture. With a displaced fracture, a crack in the bone moves part of the bone so that it is no longer aligned. Surgery is often needed to correct this type of fracture and realign the bones back together.
⭐Stress or hairline fractures are common. They are small, thin cracks in the bone.
⭐Spiral fracture. When a twisting movement causes a break, there may be a spiral-shaped fracture of the bone.
⭐Comminute fracture. When the bone fractures into three or more pieces.
Image of a tibia fracture
So, when you go to the doctors, they will tell you what kind of fracture you have after taking some imaging.
▶️How painful is a tibia fracture?
I cannot lie to you that you will not feel pain when you break your leg. Because every fracture is painful depending on the mechanism of injury.
A tibial fracture usually causes immediate, severe pain and pain can only be judged by an individual.
if the cause of your fracture is through the following causes you will feel pain immediately after you have had an injury. It could be mild or intense depending on how bad the break is.
Causes
♦️If your injury is caused by a traumatic event, such as motor vehicle accidents or falls.
♦️Sports that involve repeated impact to the shin bones, such as long-distance running
♦️Injuries from contact sports such as football
♦️Osteoporosis, which makes the bones weaker than usual.
Most patients I see who come in for x-ray are usually in mild pain because they are given painkillers before sending them to x-ray.
When you have had a tibia fracture the first symptoms you might experience will be.
♦️Localised pain in one area of the tibia or several areas if there are multiple fractures.
♦️Lower leg swelling
♦️Difficulty or inability to stand, walk, or bear weight.
♦️Leg deformity or uneven leg length
♦️Bruising or discoloration around the shinbone
♦️Sensation changes in the foot
♦️Bone protruding through the skin
♦️A tent-like appearance where the skin is being pushed up by the bone.
Caution! You may have a few of these symptoms or not but that does not mean you have not broken a bone. Remember we are different in how we experience pain and symptoms.
I have seen patients come in with a few of these symptoms but only to realise they have a severe fracture and they do not seem to be in pain.
▶️Diagnosis of tibia fractures
When you go to the doctor you will be examined and x-rays will be ordered to find out what type of fracture to help determine the treatment options.
X-rays will be the first line of investigation, usually if your bone is broken it will be obvious on x-ray images.
You will only be sent to computer tomography (CT) scan if the doctor wants to see more 3-D images for surgical planning.
A magnetic resonance imaging (MRI) scan for a detailed image of the muscles, ligaments, and bones around the tibia could also be requested.
An MRI scan is often used if the other scans have not been able to diagnose the problem.
▶️Can a broken tibia heal without surgery?
Treatment options for a tibial fracture will depend on the type and severity of injury you have got, your general health at the time of injury and the extent of damage to the soft tissues surrounding the tibia.
To answer your question. Yes, it is true a tibial fracture can heal without surgery.
Surgery will only come in depending on how bad your break is.
Treatment options:
Non -surgery options
In the case where you fracture is stable/ minimally displaced or where you have any medical reasons that cannot allow surgery, the orthopaedic doctor may use the following treatments methods for a fractured tibia:
A splint or cast to hold the bone in place, to stop it from moving and allow it to heal will be applied.
A splint can be removed easily and so it is a more flexible treatment option than surgical ones.
A walking boot or functional brace, which is used in cases of less severe breaks to hold the bone in place while it heals.
In many cases, a person with a tibial fracture will require physical therapy and crutches or a walker to help them get back on their feet.
Why Surgery is necessary for a tibia fracture:
Surgery may be recommended for certain types of fractures, including:
- If your fracture is open with wounds that need monitoring.
- If your fracture has not healed with nonsurgical treatment.
- If your fracture has many bone fragments and a large degree of displacement
In such cases Intramedullary nailing which I have seen surgeons use to treat tribal fractures.
During this procedure, a specially designed metal rod is inserted into the canal of the tibia. The rod passes across the fracture to keep it in position.
The intramedullary nail is screwed to the bone at both ends. This keeps the nail and the bone in proper position during healing.
An example of intramedullary nail screwed surgery post image
▶️Possible complications of a tibia fracture may include:
Sometimes you may have complications from surgery, but this is very rare since caution is usually taken during the whole procedure.
I have been in theatre x-raying fractured tribal operations and maximum sterile preparation is at the highest standard to help prevent things like infection.
However, in some cases it is possible to have.
⏺️Complications from surgery or the need for further surgeries
⏺️Nerve, muscle, or blood vessel damage
⏺️Compartment syndrome, a serious condition in 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.
▶️How long does it take to recover from a fractured tibia?
Recovery from a tibial fracture varies based on the severity of the fracture. And it is different for everyone. The scientific studies available about the healing time are very scarce.
I consulted specialists in the physiotherapy sector at my workplace, and these are the timelines I was given based on the patients they see.
| Phase | Day of fracture |
| When you start feeling less pain | Between 1 to 2 weeks |
| Bone strengthening | Between 6 to 8 weeks |
| Swelling to subsides | It could take weeks/ months |
| When to walk with crutches | Immediately. |
| Walking without crutches | Between 4 to 3 months |
| Returning to work | It will depend on your sick leave period (if you work for the NHS here in the UK, up to six months at full pay and six months at half pay, depending on your length of service. |
| Able to drive again | 4 to 12 weeks, caution if you leave the UK. You must tell DVLA if you’ll be unable to drive for more than 3 months because of a broken limb. You can be fined up to £1,000 if you don’t tell DVLA about a medical condition that affects your driving. You may be prosecuted if you’re involved in an accident as a result. |
| Running again /sports | 3 months to 1 year for a surgical tibial and 6 months to several years of a simple fracture |
| Full leg muscle function. | Between 4 to 1 year. |
Recovery time may be longer for a complete break compared to a partial one and may take longer if a person has other health problems.
It may take longer than the time frame given in this article for a person to be able to return to their normal activities. Always follow your doctor’s recommendations about returning to walking, exercising, and other physical activity after a leg fracture.
Certain exercises can help to take the pressure off the tibia bone, such as exercises that strengthen the hips, calves, and thighs.
This protection may also prevent future injuries from happening.
There is limited evidence supporting early commencement of weight-bearing and the use of a removable type of immobilisation to allow exercise during the immobilisation period after surgical fixation.
Because of the potential increased risk of adverse events, the patient’s ability to comply with the use of a removable type of immobilisation to enable controlled exercise is essential. (Lin,2012)
Now I have had patients ask these questions when they come to x-ray.
▶️When can you walk after treatment with a broken tibia?
Yes, you can walk again after a tibia fracture, it does not matter what kind of treatment you go through, but you will have to adapt your way of walking, in the first few days you will need crutches or a walking aid to help relieve weight on your injured leg.
Consulting experts in physical therapy: They encourage simple weight bearing to be restricted to 10% of body weight.
🚶By this I mean start walking without weight bearing on the affected leg.
🚶Then you can progress by putting some touch weight on but let it be partial weight-bearing.
🚶Lastly you can try walking with partial weight on the affected leg.
Even at this stage you can still use crutches for weeks until you feel you can walk without them.
Walking normally again without crutches usually takes between one to 3 months after the fracture. But remember this varies from person to person.
Some people experience minimal pain when they resume walking and others may have significant pain.
So, walking should be gradual based on how you feel. Take it easy, do not push yourself too hard.
▶️How do you sleep with a broken tibia?
Sleeping on your back is recommended, and the leg should be elevated. If you have an adjustable bed, this is easy, but you can also elevate the lower leg on pillows, a bolster, or a cushion.
If that doesn’t work, slowly adjust yourself to a side position if possible. Sleep in the middle of the bed to prevent any chance of falling off in the middle of the night.
This is what I wanted to tell you about tibia fracture. I hope I have answered some of your questions, I wish you a quick recovery.🙋
Below are some of the articles I have relied on for this article.
📚Sources:
Mechrefe AP, Koh EY, Trafton PG, DiGiovanni CW. Tibial malunion. Foot Ankle Clin. 2006 Mar;11(1):19-33, vii. doi: 10.1016/j.fcl.2005.12.004. PMID: 16564451.
Yim GH, Pikturnaite J, Harry L, Clement R, Pope-Jones S, Emam A, Marsden N. Enhanced recovery for acute open lower limb fracture ‘fix and flap’. Injury. 2024 Feb;55(2):111234. doi: 10.1016/j.injury.2023.111234. Epub 2023 Nov 23. PMID: 38029681.
Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop. 2011 May;35(5):737-42. doi: 10.1007/s00264-010-1052-2. Epub 2010 Jun 2. PMID: 20517695; PMCID: PMC3080491.
Lin CW, Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev. 2012 Nov 14;11:CD005595. doi: 10.1002/14651858.CD005595.pub3. PMID: 23152232.