What is a lower leg fracture?
A lower leg fracture is a term for a fracture or break to the two bones of the lower leg the Tibia and Fibula. The Tibia bone is the main bone that makes up the shin. The top portion of the tibia forms the lower portion of the knee joint and the lower end of the tibia forms the inside of the ankle joint. The Tibia is the main weight bearing bone of the lower limb and the fibula on the other hand is merely a supporting bone that sits on the outside of the Tibia. The Fibula is not involved in the knee joint as it is connected to the Tibia at a lower and further back level. The Fibula is a slight bone that broadens slightly as it extends down further than the end of the Tibia to form the outside of the ankle joint. There are three types of tibial fractures these include tibial plateau fractures, that occur just below the knee, tibial shaft fractures that occur in the shaft of the bone –the shin between the knee and the ankle and tibial plafond fractures that occur at the bottom of the tibia where it forms a portion of the ankle joint.
Why & when does a lower leg fracture happen?
Lower leg fractures are most common in the younger population and are normally the result of high impact trauma like car or motorcycle accidents including a pedestrian being hit by a car but also from contact sports. The injury is common in sports like football, normally as the result of a tackle that has ended in a direct blow to the shin or landing awkwardly with the foot twisted during or after the tackle. Minor injuries like mild falls and mild knocks to the shin can result in a lower leg fracture this typically only happens when there is an underlying bone weakening condition like osteoporosis. Lower leg fractures are classified into closed fractures where there is no injury to the skin of the lower limb and open fractures where there is an open wound as a result of the fracture. Due to the risk of damage to the surrounding arteries and nerves lower leg fractures are considered a medical emergency.
What to do if a lower leg Fracture is suspected after trauma?
If you suspect someone has sustained a lower leg fracture after any type of trauma then you must immediately call for medical help. As mentioned previously most people injured by high impact accidents may have sustained other injuries as well as the fracture making medical attention vital. It is important to make sure the individual is safe and comfortable without having to move the individual as any walking or weight bearing will be very painful. On arrival paramedics will stabilise the leg, normally on a stretcher before taking the patient to accident and emergency.
What does a lower leg fracture feel like?
A lower leg fracture from trauma causes a very intense immediate sharp pain around the fracture site this pain can radiate up into the knee and thigh and down into the ankle. The fracture is often accompanied by swelling and bruising and aggravated by most knee and foot movements this makes weight bearing and walking excruciating. The intense pain after a break will last for several hours which will be aggravated or prolonged by any treatment options like manipulation or traction. Post-surgery or after treatment when the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a lower leg Fracture be diagnosed?
Patients will be taken to A&E and a full examination will be done to rule out any additional injuries or complications like compartment syndrome or infection. Your doctor will order an X-ray of the lower leg to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally if the extent of the fracture isn’t fully visible on an X-ray then an MRI or a CT scan will be orderedas this will give a more detailed view of the fractured site. Doctors will also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the leg muscles, ligaments or joint capsule and not indeed from a fracture. The occurrence of a lower leg fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for a lower leg Fracture?
The treatment options and healing times for lower leg fractures varies depending on the position and severity of the fracture and also on the complications from any additional injuries like infection with open fractures. Most cases of lower leg fractures do not need surgery however it is occasionally necessary to surgically stabilise multiple fractures or complete breaks most likely in tibial plateau and tibial plafond fractures. Traction or manipulation may be used to correct the position of the fractured bone and a splint or a cast will be used to reinforce and stabilise the fracture until it is well healed. Patients will initially have to rest and avoid weight bearing and will be required to use Crutches whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. A lower leg fracture can take anything from 8 -12 weeks to heal if not longer for more severe breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen lower leg and thigh muscles to aid the healing process. It is vital that during the healing process the patient still tries to move a lot to reduce the risk of a DVT. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. The rehabilitation exercises as well as massage and some manipulative therapies can aid in recovering your ankle and knee flexibility.