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The lower leg is made up of two bones: the tibia and fibula. The tibia is the larger of the two bones. It supports most of your weight and is an important part of both the knee joint and ankle joint.

The tibia is the larger bone in your lower leg. Tibial shaft fractures occur along the length of the bone.

Tibia fractures vary greatly, depending on the force that causes the break:

• The pieces of bone may line up correctly (stable fracture) or they may be out of alignment (displaced fracture).
• The skin around the fracture may be intact (closed fracture) or the bone may puncture the skin (open fracture).
• Often, the fibula is broken as well.

Doctors describe fractures to each other using classification systems. Tibia fractures are classified depending on:

• The location of the fracture (the tibial shaft is divided into thirds: distal, middle, and proximal)
• The pattern of the fracture (for example, the bone can break in different directions, such as crosswise, lengthwise, or in the middle)
• Whether the skin and muscle over the bone is torn by the injury (open fracture)

The most common types of tibial shaft fractures include:

• Transverse fracture: In this type of fracture, the break is a straight horizontal line going across the tibial shaft.
• Oblique fracture: This type of fracture has an angled line across the shaft.

(Left) A transverse fracture has a horizontal line across the shaft. (Right) An oblique fracture has an angled line across the shaft.

• Spiral fracture: The fracture line encircles the shaft like the stripes on a candy cane. This type of fracture is caused by a twisting force.
• Comminuted fracture: In this type of fracture, the bone breaks into three or more pieces.
• Open fracture: If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates (reaches) down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications — especially infections — and take a longer time to heal.

(Left) A spiral fracture encircles the shaft.  (Middle) A comminuted fracture is broken into three or more pieces. (Right) An open fracture breaks through the skin. A transverse fracture pattern is shown here, but an open fracture can occur with any fracture pattern. 

Tibial shaft fractures are often caused by some type of high-energy collision, such as a motor vehicle or motorcycle crash. In cases like these, the bone can be broken into several pieces (comminuted fracture).

Sports injuries, such as a fall while skiing or a collision with another player during soccer, are lower-energy injuries that can cause tibial shaft fractures. These fractures are typically caused by a twisting force and result in an oblique or spiral fracture.

A tibial shaft fracture usually causes immediate, severe pain. Other symptoms may include:

• Inability to walk or bear weight on the leg
• Deformity or instability of the leg
• Bone "tenting" over the skin at the fracture site or bone protruding through a break in the skin
• Occasional loss of feeling in the foot

Medical History and Physical Examination

It is important that your doctor knows the specifics of how you hurt your leg. For example, if you were in a car accident, it would help your doctor to know:

• How fast you were going
• Whether you were the driver or the passenger
• Whether you were wearing your seatbelt
• Whether the airbags went off

This information will help your doctor determine how you were hurt and whether you may be hurt somewhere else.

It is also important for your doctor to know if you have any other health conditions like:

• Allergies
• Asthma
• Diabetes
• High blood pressure

Your doctor will also ask you if you use tobacco products or are taking any medications.

After discussing your injury and medical history, your doctor will perform a careful examination. They will assess your overall condition and then focus on your leg. Your doctor will look for:

• An obvious deformity of the tibia/leg (an unusual angle, twisting, or shortening of the leg)
• Breaks in the skin
• Bruises
• Swelling
• Bony pieces that may be pushing on the skin
• Instability (some patients may retain a degree of stability if the fibula is not broken or if the fracture is incomplete)

After the visual inspection, your doctor will feel along your tibia, leg, and foot looking for abnormalities. If you are awake and alert, your doctor will test for sensation and movement in your leg and foot.

Imaging Tests

Imaging tests will provide your doctor with more information about your injury.

X-rays. The most common way to evaluate a fracture is with X-rays, which provide clear images of dense structures like bones. X-rays can:

• Show whether the tibia is broken or intact
• Show the type of fracture and where it is located within the tibia
• Help identify the involvement of the knee or ankle joints 
• Show whether there is also a fibula fracture

X-ray shows an oblique (angled) fracture of the tibial shaft (red arrow). The patient’s fibula was also fractured during the injury (blue arrow).

Reproduced from Johnson TR, Steinbach LS (eds.): Essentials of Musculoskeletal Imaging. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2004, p. 504.

Computed tomography (CT) scans.  If your doctor still needs more information after reviewing your X-rays, they may order a CT scan.

A CT scan shows a cross-sectional image of your limb. It can provide your doctor with valuable information about the severity of the fracture or, in some cases, detect subtle fractures. For example, sometimes the fracture lines can be very thin and hard to see on an X-ray. A CT scan can help your doctor see the lines more clearly.

In planning your treatment, your doctor will consider several things, including:

• Your overall health
• The cause of your injury
• The severity of your injury
• The extent of soft tissue damage

Surgical Treatment

Surgery may be recommended for certain types of fractures, including:

• Open fractures with wounds that need monitoring
• Fractures that have not healed with nonsurgical treatment
• Fractures with many bone fragments for which the bones are out of position

Intramedullary nailing. Currently, the method most surgeons use for treating tibia fractures is intramedullary nailing. During this procedure, a specially designed metal rod (nail) is inserted inside the tibia. The nail passes across the fracture to keep it in position.

Screws are used to stabilize the nail at both ends (top and bottom). This keeps the nail and the bone in proper position during healing.

Intramedullary nailing provides strong, stable, full-length fixation.

Intramedullary nails are usually made of titanium. They come in various lengths and diameters to fit most tibia bones.

(Left) X-ray shows a tibial shaft fracture (red arrow) and a fibula fracture (blue arrow). (Right) The tibial shaft fracture has been treated with intramedullary nailing.

Intramedullary nailing is not ideal for fractures in children and adolescents because care must be taken to avoid crossing the bone's growth plates.

Plates and screws. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with screws and metal plates attached to the outer surface of the bone. 

Plates and screws are often used when intramedullary nailing may not be possible, such as for fractures that extend into either the knee or ankle joints.

(Left) X-ray shows a fibula fracture (blue arrow) and a tibial shaft fracture (red arrows) that extends into the ankle joint. (Right) Both fractures have been treated with plates and screws.

External fixation. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.

Most tibial shaft fractures take 4 to 6 months to heal completely. Some take even longer, especially if the fracture was open or broken into several pieces or if the patients uses tobacco products.

Complications from Tibial Shaft Fractures

Tibial shaft fractures can cause further injury and complications, including the following:

• The ends of broken bones are often sharp and can cut or tear surrounding muscles, nerves, or blood vessels.
• Acute compartment syndrome may develop. This is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. This is a surgical emergency. Unless the pressure is relieved quickly, permanent disability may result.  During the procedure, your surgeon makes incisions in your skin and the muscle coverings to relieve pressure.
• Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics.