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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. |
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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. |
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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. |
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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.
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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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