Leg > Lower Leg Fractures

What is a Lower Leg Fracture?

The two bones of the lower leg are the tibia and the fibula. The tibia, on the front inside portion of the lower leg, is the larger bone of the two, and it is a much more serious injury than a broken fibula. The smaller fibula, however, gets broken more often. Both lower leg bones are vulnerable to being broken because they are close to the surface and force directly impacts the bone. There is not a lot of protective soft tissue around them.

By far the most common cause of lower leg fractures is direct trauma, in which the lower leg is struck very hard, such as hitting the stanchion of a basketball goal or getting smashed with a hockey stick. The forces do not have to be tremendous. It is like breaking a stick – you do not have to hit it with a sledgehammer. If you know how to hit a stick in the right place or twist it the right way, you can break it. Rotational forces, in which there is a twisting-type motion can also break the bone. Football is by far the most likely sport to result in lower leg fractures, with skiing probably second. We also see these lower-leg fractures in baseball and basketball. In repetitive-motion sports, such as long-distance running, one can suffer a stress fracture.

If it is left untreated, a stress fracture can eventually develop into a complete break, but that is rare. An athlete would have to be pushing hard and ignoring what his body is saying for that progression to occur.

The method of treatment and the time to complete healing depend on where the bone was broken. Whether near the ankle, in the mid-portion, or close to the knee joint, each location has its own problems that are dealt with differently. Ideally, you want to avoid surgery on a tibial break. Doctors prefer to set it in place, brace it, and allow it to heal. Sometimes doctors are forced to operate, however. In this case, they use internal fixation of the fracture with a rod down the middle of the bone. The rod may be left in place permanently, or may be removed if there is a chance that the bone may be broken again, such as in the case of a professional athlete. The situation can become complicated if the tibia is refractured, because the broken rod can be difficult to remove. For the high-level athlete, the rod is often removed once healing is complete. Blood vessels and nerves surrounding lower-leg fractures can possibly be damaged. If a large blood vessel is compromised, the injury may be limb-threatening. The location of a nerve injury can play a major role in the functional outcome. Infection is a concern whenever the leg has to be opened up surgically, or if there is an open fracture. With an open fracture, the first step is to clean the wound as quickly and thoroughly as possible. Infections that are resistant to antibiotics are a concern.

The tibia is the main weight-bearing bone of the lower leg, so a tibial fracture is more serious than a broken fibula. There is not much tissue around the tibia, and therefore not as much blood supply to the bone. Consequently, it takes longer to heal. If the fracture requires internal fixation, the situation is generally more stable, and the patient can start weight-bearing rehabilitation faster. A tibial fracture in the mid-bone typically takes three to four months to heal. The greatest problem is that it takes a long time for an athlete to get back to playing. During recovery, the muscles of the leg may atrophy – shrink in size and become weaker – and weight-bearing exercises during rehab will be difficult. Compare this situation to an athlete with a broken arm – he can still run and bike. With a fractured lower leg, more strenuous muscular and aerobic training is delayed.

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A properly treated broken leg should be at no greater risk of being broken again than the same bone in the other leg. Usually, the healed bone is actually a little stronger than its counterpart because during the healing process, the body produces extra bone. The problem lies with the muscles around the healed bone. It takes the injured muscles a long time to catch up, so the protective mechanisms for that bone lag behind. An athlete who experiences no complications and who is motivated to work hard during rehabilitation can expect a full recovery and return to athletics.