OVERVIEW

When most people hear about a “broken leg”, they immediately think of a tibial fracture (usually accompanied by a fibula fracture), and for good reason, as it is the most common injury, mainly due to the position of the bone, which is exposed to direct injuries, and which is almost “naked”, muscle-wise. Epidemiological data show that 15% of all pediatric fractures are found in the tibia, while a large-scale study in 2017 showed that 16.9 fractures correspond to 100,000 people aged 20 to 50 years.
A simple fall or a car accident (especially when the knees hit the dashboard) are the most common ways for a tibia injury (which is a sports injury) to occur. It can also be a fatigue fracture, that is to say, a small crack in the bone, usually caused from overuse and repetitive activity.
By looking through the literature, high-risk groups include younger men and older women. Epidemiological data link them to osteoporosis, diabetes, and rheumatoid arthritis.

WHICH ARE THE SYMPTOMS?

The main symptoms are pain that becomes more acute upon loading, while the leg swings in all directions, inability to walk, swelling, bruising, tenderness to palpation, and deformation. If the fracture is due to a severe injury (e.g. a car accident) it is usually a comminuted one (the skin splits open and the broken bone is sticking out), and hospital care is required.
Fractures due to rotational injury are called spiral fractures - in these cases, the leg looks stable, without axial deformation, but the tibia is swollen due to the hematoma. In many cases, patients with no “worrying” symptoms delay the visit to an orthopedist, but this can have a time-consuming effect and can cause complications.

WHICH IS THE BEST TREATMENT?

The tibial fracture requires immediate immobilization (fixation) with a splint. Once the edema has receded, an evaluation of the conservative treatment option is performed, either with a splint or with a cast, that can then be replaced by a brace.
In the case of surgical treatment, open fractures are immobilized by an external osteosynthesis system, and closed ones are immobilized by intramedullary rods. In addition, cases where conservative treatment has failed are treated surgically.
If a fibula fracture does not coexist, the orthopedist creates a fracture before commencing treatment, to prevent the formation of a pseudoarthrosis.
Full recovery time varies from 4 to 6 months. However, this period may become much longer in patients with open or comminuted fractures. The patient is usually encouraged to be mobilized as soon as possible, in combination with a physiotherapy program, which aims to restore muscle strength, movement, and joint flexibility.