Overview

The tibia and fibula, often colloquially referred to as the shin and calf bone respectively, are the two bones that are found in your lower legs. The tibia and fibula may break or fracture if subjected to a force that is more than they can hold out against.

A fractured tibia and fibula is a grave injury and requires immediate medical attention. These fractures can heal  completely within a few months if you follow a proper treatment plan. Proper treatment requires surgery to repair the broken bone and physical therapy to regain normal leg movement.¹

Although it does not happen very often, you can fracture one of your tibia and fibula without affecting the other bone. As tibia and fibula are closer together, the more common type of fracture breaks both of these bones and is known as a combined tibia-fibula fracture.

What are the tibia and fibula?

The tibia and fibula are the two long bones that form your lower leg, starting from your knee to your ankle. The tibia is also called shin bone and is denser and longer than the fibula, which itself is also known as the calf bone.¹

Both of these bones are present alongside one another, where much of the body weight is supported by the tibia, while the tibia is supported by the fibula.

What are the signs and symptoms of tibia and fibula fractures?

You are more likely to have tibia-fibula fractures if you have the following symptoms:²

• Severe pain in the lower leg
• Inability to support weight, walk, or stand 
• Skin discoloration around the fracture
• Deformity

Seek immediate medical attention if you have any of the above-mentioned symptoms. 

What causes tibia and fibula fractures?

Tibia and fibula fractures are caused by serious injury or trauma. For example, when the leg is suddenly twisted which happens commonly in hockey, football, and basketball. Other causes include falls during skiing, ice-skating, or snowboarding and other sporting activities

These causes may include:²

• Falls
• Sports injuries
• Car accidents 

You are more likely to have your tibia and fibula fractured if you have osteoporosis. Osteoporosis is characterised by weak or fragile bones, making them more sensitive to sudden and unforeseen fractures. Osteoporosis usually does not have apparent symptoms and many individuals are not aware that they have this disease until it causes them to shatter a bone.

What are the types of tibia-fibula fractures?

The tibia and fibula are the most common long bones that people break or shatter. As it is rare for one of these bones to break without the other, tibia and fibula fractures most often happen at the same time.¹ You can have different types of tibia and fibula fractures depending upon the cause behind them. Common types of tibia-fibula fractures include:³

Proximal tibial fractures

Proximal tibial fractures occur in the proximal part of the tibia that is closer to the knee joint. This type is very rare and is also known as tibial plateau fracture. It is further divided into the following types.

Proximal tibial epiphyseal fracture:

These fractures are quite rare and are mostly found in children and adolescents. This type affects the uppermost section of the tibia (epiphysis) and results in detachment of the growth plate due to direct force to the knee (mostly happens due to car accidents). If not treated properly, these fractures may influence your future growth and give rise to deformities.⁴

Cozen’s Fracture:

This is also known as proximal tibial metaphyseal fracture and involves the neck of the tibia where it just starts to narrow down. This type of fracture can occur when force is applied to the side of the knee while the leg is outstretched. Knock knee is the most common complication associated with this type of fracture.

Tibial shaft fractures

This type of tibial fracture occurs in the middle portion of the tibia (diaphysis) and therefore is also known as diaphyseal tibial fracture. There are two major types of tibial shaft fracture.

Displaced fractures:

Displaced fractures are the ones where the broken bones do not remain aligned. It is further divided into two types where displaced comminuted fractures involve the bones being broken into multiple fragments. The other type is displaced noncomminuted fractures which are characterized by the bones being broken into no more than two pieces. Treatment does not require surgery and involves setting the bone along with a leg cast.

Nondisplaced:

This is the type of fracture where the broken bones remain in their original alignment. The initial symptom is most often a limp. The treatment of nondisplaced tibial shaft fractures is the restriction of movement and a leg cast.

Distal tibial fractures

These fractures occur at the distant or far end of the tibia closer to the ankle. Distal tibial metaphyseal fracture is one of the most common types of these fractures and is found in children. Distal tibial fractures are either transverse (across the bone) breaks or oblique (slanted) breaks in the tibia. These fractures also do not require surgery and heal well after setting the bone followed by applying a cast. 

Who is more likely to have tibia-fibula fractures?

Tibia and fibula fractures can occur any time you experience a serious accident, fall, or injury, they can happen to anyone. As there is no way to foresee an unexpected event, everyone has equal chances of having tibia and fibula fractures.

How are tibia and fibula fractures diagnosed?

Visit a healthcare provider in case you have the symptoms associated with these fractures. Tibia and fibula fractures are diagnosed with a physical exam as well as imaging tests, of which x-ray is the most commonly used diagnostic tool for tibia and fibula fractures.

X-ray testing is pain-free and involves using a small amount of radiation to generate images of your bones. Imaging tests other than x-ray include magnetic resonance imaging (MRI) and computed tomography (CT) scan. Although MRI for a tibia and fibula fracture is quite rare, it gives your healthcare provider a complete image of your bones and surrounding area including muscles, blood vessels, and ligaments. 

How are tibia and fibula fractures treated?

The goal of treating a fracture is to put the fractured bone back into its place, relieve the pain, repair the bone, and restore normal bone function. The choice of treatment option will depend upon several factors such as location and severity of the fracture. Following treatment approaches may be used alone or in combination for treating the fractures:⁵

Cast or splint

After the bone has been put in place or the fracture is mild and your bones did not move far away from their original position (displaced fracture), your healthcare provider will put your fractured bone in a cast or splint while it heals.

This procedure is also called immobilisation where the bone movement is restricted to allow it to heal properly. After the fracture is healed completely, your doctor may recommend physical therapy in order to regain your leg’s strength, function, and range of motion.

Closed reduction

Most tibia and fibula fractures require this nonsurgical procedure to set or realign your bones. During closed reduction, your healthcare provider will physically push and pull your body from the outside to position your broken bones into place.

As this procedure is painful, your provider gives you a local anesthetic (to numb the area around the fracture), sedative (for relaxing your body), or a general anesthetic (to cause you to sleep) to make the procedure painless. After the procedure is done, your doctor will put your leg in a cast or splint to give it time to heal.

Open reduction/Surgery

Surgery is done in case of a severe or more complicated fracture. You are given anesthesia beforehand. The following approaches are applied in the surgical treatment of a tibia and fibula fracture.

Internal fixation:

Your doctor will line up the broken bones and join them so they can heal properly. Internal fixation involves implanting metal pieces into your bone to align it in and hold it in place. Your doctor may advise you to restrict movement in your fractured leg to ensure complete healing. 

Your surgeon inserts one or a combination of the following items during internal fixation surgery:

• Plates and screws: Metal plates hold the broken bones together with the help of screws so they can realign (set) and heal right.
• Metal rods: Metal rods are lodged through the middle of your broken vertically (top to bottom).
• Pins and wires: In order to hold together the small pieces of broken bone, pins, and wires are inserted in combination with either plates or rods.

External fixation:

In external fixation, part of the structure that supports your bone is outside the body. Your surgeon punctures holes into the unfractured portion of your bone and then through these holes, inserts bolts that are connected to an outside brace. This procedure is usually temporary to secure your broken bone before carrying out internal fixation. 

Typically, your doctor also places a cast or splint after surgery to help the bone heal properly. 

Summary

Tibia and fibula fractures occur either due to a fall, accident, or serious trauma. Although an isolated tibia or fibula fracture may happen, it is quite rare and most often both the tibia and fibula are fractured together. You may feel pain or swelling in your lower leg in case you have a fractured tibia and fibula. Other symptoms may include deformity, inability to bear weight, and skin discoloration around the fracture. Although these fractures can be prevented by wearing protective gear in high-risk activities and managing osteoporosis if you have the condition, there is not an absolute way to prevent them. Treatment involves using casts and surgery.

FAQs

What are the causes of tibia and fibula fractures?

Tibia and fibula fractures may be caused by a number of factors including falls, traffic accidents, sports injuries, and direct blows to the leg.

What are the different types of tibia and fibula fractures?

Tibia and fibula fractures are classified based on the portion of bone affected (proximal, distal, and shaft fractures), the shape of the break line (transverse, oblique, spiral, segmented, comminuted fractures), and how the fracture happens (compound/open, stress, avulsion fracture).

How do I know I have a fractured tibia or fibula?

You are more likely to have a fractured tibia and fibula if you have symptoms like pain, swelling, difficulty bearing weight, deformity, or tenderness following a large trauma 

What is the recovery time for tibia and fibula fractures?

The recovery time of tibia and fibula fractures varies depending upon the severity and type of fracture. It can range from a few weeks to several months.

Can you walk on a fractured tibia or fibula?

The answer to this question depends on several factors such as the cause, type, and severity of fracture. The best choice is to consult your healthcare provider regarding your weight-bearing limitations during the healing process. Without a provider’s instructions, walking on a fractured tibia and fibula may lead to further complications, injury, and delayed healing.