The tibia, or the shinbone, is the larger of the two bones that exist between the knee and the ankle. The tibia is one of the most critical areas in the human body for load bearing – yet it’s also the most commonly fractured long bone. Tibial fractures can occur in high-speed traumas, such as sports and vehicle accidents. Patients with tibial fractures can suffer improper limb alignment, arthritis, loss of motion, and chronic instability. There are several types of tibial fractures, depending on the type of trauma to the shinbone.
Common Causes of Tibial Fractures
Tibia fractures can be low- or high-energy breaks in the shinbone. Low-energy fractures can result from age-related bone changes, such as osteoporosis. High-energy fractures result from traumatic accidents with high-velocity impacts. This can include car accidents, sports injuries, and crush injuries. The most common causes of tibial fractures are falls from significant heights. Although physicians initially referred to tibial fractures as “fender fractures,” only about 25% of tibial fractures result from automobile bumpers striking pedestrians.
Other causes of tibial fractures are stress-related and occur over time with repetitive motions. For example, runners can experience tibial fractures, or shin splints, with excessive motion. Military personnel can experience stress fractures from carrying heavy packs over long distances, as well as wearing heavy boots. Doing too much too soon can result in a tibial fracture in any age group.
Tibial Plateau Fracture
The human leg has four fascial compartments. In a traumatic injury situation, the compartmental anatomy of the leg is important when there is internal bleeding. When a fracture in the tibia extends to the knee joint, it can separate the surface of the shinbone into many different parts. These fractures are tibial plateau fractures, or intra-articular fractures. When a strong force drives the femur, or the lower part of the thighbone, into the tibial plateau’s softer bone, it often results in a tibial fracture. Tibial plateau fractures affect the joint of the knee, consequently altering motion and stability.
There are three main areas of the tibial plateau – the medial, lateral, and central tibial. The medial tibial plateau is nearest the center of the body, while the lateral plateau is farthest away. The central tibial plateau is between the medial and lateral plateaus. A tibial plateau fracture can occur in any of the three areas. These fractures can also lead to soft-tissue injury and knee injuries such as meniscal and ligamentous issues.
Signs of a tibial plateau fracture include swelling of the knee, inability to bear weight on the affected leg, and a deformed-looking knee. Deformity may occur due to the tibia’s displacement or fragmentation within the leg. A patient with a tibial plateau fracture may also notice bruising and a doughy-feeling knee joint due to blood in the soft tissues.
Tibial Stress Fracture
As one of the major load-bearing bones in the body, the tibia is susceptible to fractures due to too much stress. Stress fractures produce many microfractures the bone does not have enough time to repair. Over time, a stress fracture occurs. Physicians treat stress fractures by modifying the patient’s activity. In some cases, patients may need crutches or analgesics for pain relief. Patients can resume normal activity once a stress fracture has completely healed.
The prognosis for most tibial fractures is positive, and patients typically only need to modify activity and rest until the fracture heals on its own. Some cases may need a pneumatic compression device to speed recovery. Patients prone to stress fractures should consider using shock-absorbing orthotics or special footwear to reduce the stress placed on the tibia during regular activities.