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lower leg bone

Fractures of the bones of the lower leg (the tibia and fibula)

Fractures of the tibia usually are the result of a direct blow to the leg.  They can be thought of as either stable (usually the smaller bone of the leg, the fibula, is not broken)

or unstable (both the tibia and the fibula are broken).  Because the bones are so close to  the skin, it is not uncommon for these fractures to be “open”, meaning that they communicate with the skin.  Any open fracture of the tibia will require surgery to clean up the wound, and protect the bone from developing an infection.

Most fractures of the tibia in children can be treated casting alone.  For unstable fractures, the cast should extend above the knee so that both alignment and rotation can be controlled.

Other treatment options are available if the alignment cannot be maintained, including the use of an intramedullary nail, plating, or external fixation.

Toddler’s Fractures

These are fractures of the tibia that occur in toddlers who are within 1-2 years of beginning to walk.  The fracture itself is a short oblique break in the tibia, and the fibula is usually not broken.  These fractures happen after seemingly minor twisting falls.  The fracture is usually suspected when the child refuses to walk on the leg.  X-rays may show the fracture, but it is sometimes necessary to get oblique angled x-rays of the leg to see the  fracture line. Rarely, these fractures are discovered by bone scan after the initial x-rays failed to show a fracture yet the child still refuses to walk.

oblique fracture of the distal tibia in a toddler

This is an x-ray of a toddler’s fracture. The two arrows indicate where one of the bones of the leg (the tibia) is broken. This can be a difficult fracture to see, because in this case the bones have not moved very far from their correct position. However, if you look closely, you can see a crack in the bone between the arrows. This type of a fracture usually does very well without an operation. A cast that goes from the knee down to the foot is usually applied, and the child is allowed to walk on the leg right away. The cast needs to stay on for four weeks, and once it is removed, the child can go back to being themselves.

External fixation of tibia fractures.

Unfortunately, some tibia fractures are very difficult to treat. Fractures where the bone is sticking out through the skin (called compound or open fractures) or fractures where there are lots of little peices (called comminuted fractures) can be a real challenge to get to heal. This often made even more difficult because the skin that is on top of the fracture bone can be severely damaged by the injury. In these situations, an external fixator can be used to treat the fracture. This is a series of pictures of a particularly bad tibia fracture that was treated with an external fixator. Two pins are placed above the are of the frature, and two pins are placed below the area of the fracture.

initial film of a tibia fracture treated with an external fixator     initial film of a tibia fracture treated with an external fixator

 

 

 

external fixator applied to the tibia at the time of injury

 

A close up picture shows how many broken pieces of bone there are, and the staples have been used to close the cuts in the skin where the bone came through.

healing tibia fracture after external fixator removal  healing tibia fracture after external fixator removal

After eight weeks, the external fixator was removed, but the fracture hasn’t healed completely yet. There are still areas where the bone has grown together, and the holes where the pins were placed through the bone are still visible. Six weeks later, the fracture is still healing slowly, but there is a significant risk that the bone could break again if it was placed under too much stress. These fractures can be very difficult for the patient, family, and doctor to treat and they require a lot of patience and time to heal correctly. Sometimes multiple surgeries are needed in order to clean out the areas where the bone is not healing in order to stimulate the growth of more bone, or if an infection occurs, multiple surgeries can also be required to treat the infection.

healed tibia fracture after external fixator removal  After eight weeks, the external fixator was removed, but the fracture hasn't healed completely yet. There are still areas where the bone has grown together, and the holes where the pins were placed through the bone are still visible. Six weeks later, the fracture is still healing slowly, but there is a significant risk that the bone could break again if it was placed under too much stress. These fractures can be very difficult for the patient, family, and doctor to treat and they require a lot of patience and time to heal correctly. Sometimes multiple surgeries are needed in order to clean out the areas where the bone is not healing in order to stimulate the growth of more bone, or if an infection occurs, multiple surgeries can also be required to treat the infection.

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  1. Different types of fractures that occur in children | Child hoold fractures menu says:

    [...] lower leg bone (tibia) [...]

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