Fractures of the Proximal Tibia

The tibia or shinbone is a major bone of the leg, which connects the knee to the ankle. A proximal tibial fracture is a break in the upper part of the shinbone. Proximal tibial fractures are caused by stress or trauma, or can occur in a bone compromised by diseases such as cancer or infection.

The symptoms of tibial fractures include pain during weight-bearing movements, tenseness, limitation of movement and deformity around the knee. In some individuals, impairment of blood supply secondary to the fracture may result in a pale or cool foot. Patients may also experience numbness or feeling of ‘pins and needles’ in the foot as a result of associated nerve injury.

Proximal tibial fractures may or may not involve the knee joint. Fractures that enter the knee joint may cause joint imperfections, irregular joint surfaces and improper alignment of the legs. This can lead to joint instability, arthritis and loss of motion. The fractures can result in injury to the surrounding soft tissues including the skin, muscles, nerves, blood vessels or ligaments.

The diagnosis of tibial fractures is based on your medical history, including the history of any previous injuries, complete physical examination and imaging studies. Your physician will evaluate the soft tissue around the joint to identify any signs of nerve or blood vessel injury. Multiple X-rays and other imaging studies, such as CT and MRI scans, may be ordered to identify the location and severity of the fracture.

The management of the fracture is based on its severity, medical condition of the patient and the patient’s lifestyle.

Non-surgical treatment comprises of immobilizing the fractured site with the help of casts or braces to prevent weight-bearing and help in the healing process. X-rays are taken at regular intervals to assess the healing process. Movement and weight-bearing are initiated gradually, depending on the nature of the injury and the condition of the patient.

Surgical treatment is considered to maintain the alignment of the fractured bone. External or internal fixators may be used to align the fractured bone segments. If the fracture does not involve the knee joint, rods and plates can be used to stabilize the fracture. For a fracture involving the knee joint, a bone graft may be required to prevent the knee joint from collapsing. An external fixator is used when the surrounding soft tissue is severely damaged, as the use of plate and screw may be harmful.

As the tibial fracture usually involves the weight-bearing joint, it may cause long-term problems such as loss of knee motion or instability, and long-term arthritis. Hence, a rehabilitation program is initiated along with the treatment, which comprises of instructions on weight-bearing, knee movements and the use of external devices such as braces.