Six weeks ago I whacked my shin real hard into a trailer hitch just below the knee, there are two fracture lines which start together in the back of the tibia and go down diagonally toward the front, but do not go all the way through, both maybe 1.5 to 2 inches long, no surgery. The ER doctor said best case scenario six weeks to walk again, the OS was much more conservative, i think he said 8 to 10 weeks for walking. He said max 20 pounds of pressure, basically non weight berring for seven weeks until my next visit with him. I havent been very good about following this, at 5 weeks I could take quick steps on it without pain, at six weeks now I'm walking around with little to no pain, I still limp because I'm favoring it, but no pain. I'm 41, pretty good shape, I was running alot before this, a couple marathons in the last year. At this point in the proces doesnt it help to continue to use the leg and walk as much as possible assuming there is no pain? I'm thinking I dont need to go back to the OS for another Xray, as i appear to be on the fast track. But i dont want to do anything that is going to delay the process, espcially getting back to running. Am I moving too quickly with this?
We always say around here to follow the advice of your physician.
However, a few facts about bone healing. You are about over the danger period. With an incomplete fracture of a weight bearing bone, there is a point where the bone actually becomes very weak, but this is usually around 14 to 21 days. Up to this time the body has begun the remodeling process, which in the beginning entails resorbing bone around the fracture site. This is why some fractures do not even show up for a week or two after the injury, until the body was resorbed some of the bone around the fracture.
Then the body starts to lay down new bone (callus). So, in the next couple of weeks the bone gets back to its original strength. You are about at this time, maybe a little more. The fact that it does not hurt with weight bearing is a good sign.
At this time, actually putting stress across the fracture will help it heal. This is known as Wolff's Law: bone will respond to the stresses applied to it. This is why weight lifters and persons who do heavy manual labor have strong, stout bones. And the reverse, those who do not stress the bones (age, injury, space flight) will develop osteoporosis.
Again, you should always follow your surgeon's instructions. But, pain is a good guide. If you do not have any pain at the fracture site it is probably okay, but that is your judgment call. You do not want to displace the fracture and end up being in a cast longer or worse, have to have it operated on.
Low energy tibia fractures routinely take 10-13 weeks for union to occur. And that is just to get the bone to heal. Proximal ones, like yours, tend to heal a little faster than distal ones, due to the overlying soft tissues. But, once the bone is healed, then the soft tissues have to be rehabilitated.
It is not uncommon for it to take as much as a year to fully recover from a tibia fracture. That is not to say you will be laid up for that long, but that it may take that long till you know the final outcome.
So, again, pain is a great guide. If you have no pain at the fracture site, you are probably okay. If you have workout type of pain in the muscles, that's probably okay also, but if you have sharp, intense pain directly at the fracture site, back off.
Good luck. Hope everything is healing well.
Just for your reference:
TIME TO UNION FOR TIBIA FRACTURES:
- low energy fractures: 10-13 weeks;
- high energy fractures: 13-20 weeks;
- open fractures: 16-26 weeks
---- type 3B & 3C open fractures requires 30 to 50 weeks for consolidation;
- distal tibial fractures may be more prone to non union than proximal fractures due to absence of muscular soft tissue envelope;
- in the report by Anne Skoog et al., the authors studied 64 consecutive patients with a tibial shaft fracture; --->12 months after the injury, 44 percent had not regained full function of the injured leg, although all but two of the patients had returned to preinjury working status
---- references: “One-Year Outcome After Tibial Shaft Fractures: Results of a Prospective Fracture Registry” A Skoog. J Orthop Trauma 15(3):210-215, March/April 2001.