Tibia and Fibula Fractures
By Louis Corpora, PTA
Tibia and Fibula Fractures
The tibia and fibula are the two long bones of the lower leg. The tibia is the bone located on the inside of the lower leg and the fibula is the bone located on the outside of the lower leg. Unlike the fibula, the tibia transmits most of the body weight during standing, walking, running, etc. These bones make up the bottom half of the knee joint and the top half of the ankle joint.
Two main categories of fractures are open and closed, open fractures occur when the bone penetrates through the skin or if a wound is formed and the bone is visible. Closed fractures occur when the bone breaks but the skin remains intact. There are several types of fractures:
–Transverse: fracture line is horizontal
–Oblique: fracture line is an angled
–Spiral: a fracture that resembles a spiral encircling the bone like stripes on a candy cane
–Comminuted: fracture breaking into 3 or more pieces
Causes of tibia and fibula fractures
Of the two bones, the tibia is more commonly fractured. Several causes can attribute to tibia and fibula fractures. Some include trauma from a high fall, contact sports, or vehicle accidents. Others are due to non-contact forces on the ankle such as severe inversion (foot rolling in). Elderly individuals with osteoporosis can easily suffer fractures with falls or other mishaps.
Those with tibia and fibula fractures have severe pain at the location of the injury. Often there is a deformity present in the limb or a wound where the bone protrudes through the skin. If the fibula is only fractured, depending on severity, walking may be tolerable but likely very painful if it’s at the ankle level. With a tibial fracture, it’s highly unlikely the individual will be able to bear weight. Other symptoms include extreme tenderness, swelling, numbness due to artery or nerve damage, and bruising.
To confirm a fracture of the tibia and fibula, and X-ray is the first line of diagnostics and is usually sufficient enough to diagnose a fracture. Sometimes, stress fractures may not show up on an X-ray and another form of imaging would be warranted. A CT scan will give a more in-depth image of the bone, and an MRI will show the integrity of the ligaments, muscles, or any other soft tissue structures involved in the injury.
Treatment – Surgery vs. Non-Surgery
When a fracture is stable, casting may be recommended. Usually, spiral and transverse fractures are stable enough for a cast. Oblique fractures are typically unstable and can shorten.
All open fractures will require surgery. Common surgeries consist of the following:
–Open Reduction and Internal Fixation (ORIF): consist of moving the broken bone fragments back into the original position which is held in place by a metal plate held by screws.
– Closed Reduction: the bone is realigned without making an incision at the site of injury.
–Intramedullary nailing: a rod is placed into the medullary cavity of the bone with nails screwed to the 2 ends of the bone to stabilize the fracture.
–External Fixation: bone fragments are held in alignment and supported outside of the leg via pins or screws. This procedure is indicated for more severe and unstable fractures.
-Malalignment of bones
After surgery, physical therapy will begin as soon as the surgeon decides. Depending on the fracture or phase of the healing process, a patient will either be non-weight bearing, partially weight bearing/toe touch weight bearing, or full weight bearing depending on what the surgeon thinks. It’s important to know that each surgeon’s protocol is individualized to his or her own restrictions based on healing phase, or surgery performed.
During the physical therapy evaluation, the physical therapist will likely find the following musculoskeletal impairments in the patient:
-decreased ROM and strength in the ankle or foot
-decreased ability to put weight into the affected limb
Throughout the course of physical therapy, ankle mobility, strength, and balance improve, swelling decreases, and the patient is eventually able to fully weight bear and walk normally. Full recovery of a tibia/fibula fracture takes between 3 and 6 months and the patient returns to their normal activities of daily living.