Therapy for fracture of the tibia



In order to assess a fracture of the bone shaft, it is first extremely important to understand how the trauma occurred in order to be able to assess the injury mechanism and the acting forces.

The force generated in a traffic accident involving motorized vehicles is a hundred times greater than in a simple fall.

Although X-rays can look virtually the same, the soft tissue injuries associated with them vary widely.
Most displaced fractures can be easily seen with the naked eye Palpation is only necessary if no fracture is obvious.
Important in the clinical examination is the search for nerve and vascular injuries.

Some fractures, including displaced fractures at the top of the shin (near the knee joint), suggest major vascular injuries.
An arterial lesion is an orthopedic emergency and must be treated promptly, along with proper stabilization of the hernia.
The compartment syndrome requires urgent intervention.
This syndrome can occur at any time in the first days after the trauma; it is more common in strongly displaced fractures, but also in simple and open fractures, even after intramedullary nailing.

X-ray examination for tibial fracture

The most important diagnostic procedure is X-ray examination.
X-rays are usually taken in two planes perpendicular to each other (front/back and side); Oblique images are helpful for the representation of the bone areas near the joint (metaphysis).

CT and magnetic resonance imaging are not performed to assess acute shaft injuries, but can be useful for planning reconstructive surgery in the case of complex, unconsolidated fractures.

Forms of therapy for tibial fracture

In general, there are two treatment options for shin fracture:

1. Conservative

First plaster, then orthosis.
Functional strengthening.

2. Operational

The methods of operation include plating, intramedullary nailing and external fixator.

Gypsum for tibial fracture

For a long time, the most common method of treating shin fractures was the use of plaster casts. It was applied regardless of soft tissue injuries, shape and stability of the fracture.
The first days of conservative treatment of shin shaft fractures initially provide for a pull in the longitudinal axis, after which a plaster cast is applied to immobilize the leg.
For proper immobilization of the shin, the cast must include both knee and ankle joints.
The cast should not be worn for more than 8-12 weeks to avoid stiffness of the ankle joint, and then replace with a bandage.

X-rays must be repeated at regular intervals (15 days, 1 month, 2 months) to monitor bone position.
After 4-8 weeks or as soon as signs of consolidation become noticeable, the long plaster cast reaching above the knee is removed and replaced by an orthosis.


The initial displacement of bone fragments, the extent of fragmentation and the condition of the fibula have a great influence on the treatment results and recovery times.

Complications of gypsum

The joint stiffness, especially of the ankle joint, is certainly the main problem when plastering shin fractures. It can occur when a shin fracture is immobilized by a long cast over the entire treatment period.
Passive mobilization performed by an experienced physiotherapist is strongly recommended so that normal range of motion can be regained in the shortest possible time.
If the pain allows, active exercises should be performed to regain functionality and strength.

Surgical treatment for tibial fracture

The surgical procedures for the treatment of shin fractures are: external fixation, intramedullary nailing and plating.

External fixation and plating of the fracture by conventional plates and screws might not work on a fragile bone.
Internal fixations give a bone suffering from osteoporosis more support.

The insertion of intramedullary nails allows early loading of the injured leg and is preferable to fixation by plates and screws, because there is a risk of failure if the healing process takes a long time.
In the case of joint or joint fractures, intramedullary nailing is usually not suitable, they require direct reposition and absolute stability in order to maintain the anatomical conditions of the articular bones.
Bone quality is of paramount importance.
Severe osteoporosis reduces the grip of screws and bolts.

Treatment of pathological fractures must be carefully thought out and weighed. In patients with a short life expectancy, mobility and pain relief are probably more important than a perfect fracture setup.
The use of an auxiliary technique, such as the use of bone cement, could be an alternative, although it can delay bone healing.

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