Intramedullary nail of tibial fracture - Broken shinbone

If you are considering surgery on your broken shin bone or have an operation planned, it is important to know all you can about it. This includes:

• why you need this operation

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making choices regarding broken shin treatment with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

Your shinbone is broken. A break is also called a fracture. There is no difference in severity between a fractured bone and a broken bone. Therefore your injury may be called a fractured tibia.

What is the tibia?

There are two bones in the lower leg.

The shinbone is called the tibia. The tibia goes from the knee to the ankle.

There is a thinner bone called the fibula that runs down the outside of the lower leg, next to the tibia.

What has gone wrong?

A fractured tibia usually follows an injury. Usually, the greater the force of the injury, the more serious the fracture. The broken ends of bone may be still in their correct place (undisplaced), or out of place (displaced).

The aims

The aims of the operation are to get the broken ends of the bone back into place (reduction) and to hold them in place while the fracture heals.

The benefits

The operation will stop your leg hurting. You can get out of bed the day after your operation. You will need crutches. You will not need a plaster cast.

Are there any alternatives?

Many tibial fractures can be treated by manipulation to reduce them and a plaster cast for 2 months or longer, to hold them in place. Manipulation means returning the bones to the correct position by pushing and pulling, without cutting the skin. The decision depends on the nature of the fracture.

In some cases, it is clearly better to treat the fracture surgically. For example, an unstable, displaced fracture, or one that has slipped out of position while in a cast will need holding with metalwork. In many cases, the choice between surgery and treatment in a plaster is evenly balanced. With surgery, you avoid having your leg in a cast for 3 months or more, your mobility following surgery is greater, the likelihood of the fracture healing is higher and your knee and ankle do not get stiff as they can do in a cast. Against this, you need to weigh the risk of infection in the metalwork. If your fracture cannot be held properly in a cast and you are not fit enough for surgery, we would treat you with bed rest and traction.

Traction means pulling on your tibia with a metal rod passed through the ankle area until the fracture has united. You would have to stay in bed for a minimum of 4 weeks and maybe as long as three months while your shinbone healed. You may suffer one of the serious complications that result from staying in bed for a long time. These complications include pressure sores, pneumonia and deep vein thrombosis (blood clots in the legs). If you have a lot of soft tissue injury or there is much loss of bone fixing the tibia with a special frame above and below the fracture (external fixation), may be better than an intramedullary nail.

What if you do nothing?

If you have no treatment at all, the fracture may never       heal, or may heal much shorter and out of alignment.

Who should have it done?

If your leg is broken and you are fit enough for surgery, you should have the fracture fixed.

Who should not have it done?

If you suffer from major medical problems, these should be sorted out before you have the operation. These problems include irregular heart rhythms and breathing problems.

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma

© Dumas Ltd 2006

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