I was involved in a football accident during the weekend and have unfortunately fractured my tibia on my left leg. At the moment I am on crutches and trying to elevate my leg as much as I can! My fracture did not require surgery as it was called an almost "perfect" break. The fracture is not displaced, it currently sits in the correct alignment. Im in a full leg cast which is Surpsingly comfortable. I am a healthy fit and active 19 year old male. Quick question... How long can I expect to start work again? And what's the minimum time (if possible) I can get my cast off?
Unfortunately, tibia fractures can take a while to heal. The usual time that it takes for a low energy fracture such as yours to unite is 10-13 weeks. This is just the time for the bone to heal, it does not include the time needed for rehabilitation.
So, the usual treatment course is to keep the patient in a long leg cast till there is some sign of callus formation (new bone). This is usually around 8 weeks or so. If the surgeon feels that there is enough callus formation to hold the fracture from rotation, the long leg cast can be changed to a PTB (patellar tendon bearing) cast, which is below the knee. This allows the patient to start working on regaining knee range of motion.
If the fracture pattern is that of a transverse fracture, weight bearing can usually be started at this time also. But, if the fracture is a spiral or oblique, weight bearing has to be delayed till there is enough callus to prevent the fragments from displacing (sliding on each other) when weight is applied. This will be up to the surgeon to determine.
Once the fracture has united, then the patient can be removed from immobilization and rehabilitation can be started. This is where the hard work starts. Motion in the knee and ankle has to be regained. The muscles in the calf and thigh will have atrophied significantly, and will have to be rebuilt. So, it can take a couple months or more of hard work in the gym to get back to “regular” activities. Athletics and heavy manual labor may take a while longer.
As to work, it depends upon what you do. If you have a desk job, you can go to work with your cast on. But, if you are in construction or something similar, you have a few months before you can get back to that.
There is not a whole lot that you can do to speed mother nature up, in terms of healing the injury. You can slow it down though. Do not smoke. Smoking is the single most detrimental things there is to fracture healing. You should eat a proper diet, with extra protein (for the building blocks the body needs to rebuild tissue), calcium, vitamin D, and magnesium. Most of the time you can get these in your diet and from the sun (vitamin D), but if you desire you can take supplements.
Once the surgeon allows you to weight bear, that can stimulate the body to heal the fracture a little faster. Placing stress across a fracture can make the body lay down more callus (Wolff’s Law - bone will respond to the stresses applied to it). But, you do not want to apply stress till the surgeon states that it is okay, because you do not want to displace the fracture.
The above is the usual time lines. Every patient heals at his/her own rate. Since your fracture is a low energy one, with no displacement of the fragments, it may heal a little faster. But, the tibia is notorious for slow healing, mainly because of its poor blood supply.
So, again, do not smoke. Eat a good diet. Follow your surgeon’s instructions.
If you have any questions or concerns, ask your surgeon. He/she has seen your injury films and may be able to give you are more accurate time line for his/her treatment plan and healing of the injury.
(PS - you noted that the cast is surprisingly comfortable. It is supposed to be that way. In fact, the best analgesic for a fracture is not strong medicine, but immobilization. If the fracture fragments are kept from moving there is very little discomfort. This is the main reason to splint a fracture as soon as possible. When there is no movement, the nerve endings in the periosteum (the soft tissue sheath that covers the bones) are not stimulated, thus no pain. So, a cast should always be comfortable. If it is not, the surgeon should be notified as soon as possible, as that may signify a problem. Just FYI).
I have just rescently broke my tibia about 2 weeks ago now and been put in a full leg cast,
I'm still finding the pain very bad but bairable is this ok and normal even being in the cast??
It seems to be every time I'm moving or upright?
You would still be expected to have at least a little discomfort just two weeks after a tibial shaft fracture.
Every patient has a different tolerance of pain. Most patients, if they are immobilized in a well molded, well padded cast, have very little pain. In fact, in this setting as two weeks, most patients do not need any pain medication and are very comfortable. That is not to say that these patients do not occasionally have some throbbing if they let the leg hang down for too long.
Every patient and every fracture is unique. But, again, by two weeks, the fracture should not really be very painful at all.
If you are having pretty significant pain, you should try to find out what seems to be causing it. If there is too much swelling of the soft tissue, that could put a lot of pressure on the soft tissues and nerves. This can cause numbness, tingling, and pain. Usually, elevation of the foot and wriggling the toes will decrease the swelling and thus the pain.
If the pain seems to be caused by the cast, such as around the edges, or where it has been molded around prominent areas, it may be rubbing causing sores under the cast. This usually occurs when the cast is too loose.
Sometimes, when the cast is too loose, the bones can shift, causing malalignment and discomfort as the fracture fragments rub over each other.
About this time, (between 2 and 3 weeks after injury) your fracture should be getting “sticky”. This is the point where the body has begun to lay down a matrix called osteoid. Osteoid is the soft tissue material that will eventually become bone. It sticks the fracture fragments together, somewhat like glue. Then, the body will lay calcium down inside the osteoid, making it into callus (new bone formation). Thus, when the osteoid glues the bones together, it is called the fracture becoming “sticky”.
At this point, the fracture fragments should not move around a lot anymore. Usually, once the fracture becomes sticky, there is no longer any discomfort of significance anymore.
There will be some aching and throbbing once in a while, if you have been up and about more than normal; if there has been a big change in the swelling around the limb.
Also, joints do not like to be immobilized for a long time. Sometimes, the joints will go through periods of aching and throbbing, for no real apparent reason. But, it does occur. Usually, some elevation and wriggling of the toes is about all that needs to be done.
Of course, building up your muscles in the upper extremities and the uninjured leg will help with rehabilitation. Cardio training is also very important. There are upper extremity stationary bicycles, where you “peddle” with your arms. This is great for building up the heart and lungs. You can do one legged stationary biking. There are a lot of exercises you can do, even in a long leg cast. You may have to be a little creative.
But, the stronger you are, the easier it is to rehab a tibia fracture.
However, if you feel that you are having more pain than you think you should be having, then you should contact your surgeon for an evaluation. It takes a tibia fracture a long time to heal. So, it is important to be in as comfortable of a cast as possible.
I came accroos to this health forums just by chance. However I've read very interesting and useful information. Yet again, I can't find an answer to the question I am looking for. My son is 8 yeas old. 2 weeks ago he broke his tibia in sking accident. Very badly, very rudely fracture has happened as the bones were displaced. He got immediate medical help. Unfortunality he had to go trough a surgery and 2 metal implants were installed to keep the bone united Sorry!(Well I am not sure how to express it correctly in English particulary these medical terms I am not familiar with)Sorry, if I sound weird. Now he is in a full cast and it is difficult to move using crutches. My question is. How long does it take for recovery if it is a kid? I know, the human body is unique and is different for each individual but I am so, concerned as he has to be absent from school and God knows for how long? During these two weeks he had antibiotics after the surgery, his diet is stricytly kept by very "strong" food including carrots, salmon; lots of yogurt and cheese; nuts; almonds, 3 times a day fresh juices from different fruits. I prod him to move his toes, also to have different breathing exercises and to move his arms up and down. Is there estimated time for recovery taking into consideration this picture and the fact that the kid is just 8? Thank you in advance. I am looking forward for your experienced advice.
Children heal much faster than adults. It is not uncommon for a youngster to heal a tibia fracture in about 6 weeks or so.
Usually, in children with open growth plates, flexibile nails (such a Enders nails or Rush pins) of used to hold the fracture stable. But, there are many different type of hardware used. And, what exact type was used is not important.
The cast is used to supplement the interal fixation.
Most eight year olds will start to use the crutches pretty well, once the pain starts to subside at the fracture site. Which, at two weeks, he should start to see a great decrease in discomfort.
Of course, children will look to adults (particularly parents) on how to react to injuries. So, it is important to encourge his moving the toes and gettin up on crutches.
Again, children heal a lot faster than adults. As long as they get proper nutrition (extra protein, calcium, vitamin D, magnesium), they cannot usually be kept down. They usually lay down new bone very quickly, and thus heal the fracture very fast.
Most children will heal a tibia fracture in about six weeks. But, everyone heals at their own rate, so there may be some that heal a little faster and some a little slower.
sorry about your sons break but as kid heal much quicker than adults it shhould only be about 5-6 weeks in plaster
me myself had one of theese breaks not long ago and afterwards i had to go for physio for 4 weeks so as he is young it will all heal very quickly so wish you all the best kind reagars
Thank you for your wise and cheerful reply! Thank you for writing me promptly. I feel much better now and kind of reliefed a bit.You gave me a very optimistic and a nice hope. I have never been in this situation and feel very perplexed and concerned. Haven't slept for couple of nights because of too much thinking. It is not that bad if it takes 6 weeks as the first two already have gone. I cross fingers that your forecast is very close to the reality. I try to supply his body with the vitamins you mentioned but only in their natural form- I mean that I provide these vitamins with his food. I do not give pills. I am afraid to do so particulary try to be very careful with Ca. I bumped into some article where was written that Ca in pills can be tricky for kids as their bonds grow at this age. What I've noticed is that Internet is full with info about so many issues. However when it comes to the orthopaedics for children there is incuficient information. That's why I am happy I found this forum. It is so useful to read advices and to find out about the experiences of others. Thank you for the nice wishes.
It does not matter how one gets the needed nutrients, as long as they get them.
Protein is obtained from the diet, such as lean meats, fish, etc.
Calcium is usually obtained from the dairy products, such as milk, cheese, ice cream, etc.
Vitamin D is actually best obtained from the sun. About 15-30 minutes of the sun shinning on the face and arms, will give a person their needed amount of daily vitamin D. Vitamin D is not found naturally in foods, in very high amounts at all. Many foods are now fortified with vitamin D, especially milk and bread.
Magnesium is found in your grains (wheat, rice, flax, oats), in nuts and seeds (brazil nuts, sunflower seeds, almonds, cashews soybeans), in molasses, and cocoa powder (dark chocolate).
So, it is possible for a youngster to get the needed requirements. Basically, it is most important to just eat a good well balanced diet and also get some sunshine.
Your son should be encouraged to wriggle his toes as much as possible, as that will help to prevent the tendons from scarring down. By moving the toes, it also helps to pump the venous blood and edema back up the limb into the body.
He should be encouraged to get up on his crutches and do some physical activity. Lying around decreases cardiac conditioning and makes muscles weak (atrophy). He may be weak and uncomfortable at first, but with time he will get better at using the crutches. Kids are much better at it than adults.
Again, kids heal a lot faster than adults. Thus, it is not uncommon to see an eight year old heal a tibia fracture in about six weeks. But, every one heals at their own rate. It also depends upon how badly the soft tissues around the fracture were injured, because they have to heal also.
So, hopefully, around six weeks, he should have abundant callus formation around the fracture. If he does, the surgeon may decide to switch him to a short leg cast, just till he gets used to walking again. Once the fracture callus is fully consolidated, the immobilization can be removed.
As to the internal fixation, usually it is removed in children, once the fracture is healed. But, that is something to discuss with his surgeon.
I think that i've read every post on this forum just to get an idea of how long it will take to recover from this break; i'm a very active person and i'm just becoming increasingly frustrated with the time its taking me to heal.
I'll explain how the break happened quickly. I was messing around with friends and ended up running at full pace into a concrete bench, pitch black at the time so I didn't see it. Anyway long story short, I was carried to hospital where the surgeon decided that the best course of action was to put my leg in a cast with no pins or nails etc. The reason for this is because I am on quite an active course at university and the surgeon thought that I would be in a lot of pain when moving if he inserted a pin. I was told I could weight bare instantly as the break was stable, this however was difficult for the first few weeks due to the pain which is more or less non existent now. I asked how long it would take before I would be up and walking without crutches, casts etc, and he told me 3 months. He said because I was very active before the break (e.g. run the 100m in around 11 sec) then I should heal relatively quickly.
At this point 7 weeks after the break i've had two casts; 1. this was a large heavy cast which sat just below the knee all the way to my toes (the surgeon explained the cast was "old school"). 2. this was replaced about 4 weeks in with a fibreglass cast and again sat just below the knee and extended to my toes, the cast was much lighter. At the 4 week stage the surgeon said the break had moved slightly but that I had nothing to worry about, the technique employed was to bend the cast a bit so that the alignment of the break was better. At that point the surgeon said he could see a small amount of soft callus formation and that the recovery was on track.
I am due to go for my appointment in 3 days however I am slightly concerned, I can still feel the bone moving a bit after 7 weeks, is this normal? its not moving as much as before but I thought it would be more or less rigid by now. I am taking all the right supplements, centrum and extra vit D due to my heritage as prescribed by the surgeon, eating a balanced diet, resting a lot (didn't move at all basically for about 6 weeks after the break). There is no pain lifting it, when I have been out for a long time however due to having to go back to university; around the break is a little sore but not excruciating. I thought the exercise was good as the surgeon said exercise increases bone growth formation (wolffe's law as you point out). I rarely feel the bone moving after I wake up, its just initially when I take my foot of the bed first thing in the morning; thats how I know its still not where I want it to be, why is this? this is what depresses me really, theres a part of me that want to wake up and just not feel that initial bend. I'm able to move my toes, I can feel the calk flex in the cast and thats what frustrating. Also over the last week and a half, i've felt the leg tingling, light-throbbing, heating up slightly where the break is located; I assume this is the healing process?
I think i just want to know the duration i'm going to be out for, does it seem likely all will be well at the 3 month stage? The surgeon said on the next visit if all is well, he will put me in the plastic moon boot; at which point possible light physio work can begin, is this likely? I just need to be on my feet again, you don't appreciate how great walking is until you can't do it of your own free will. Writing from the UK; Thanks I hope your reply is good news.
You are lucky, in that your casts have all been below the knee. The usual treatment for a fractured tibia is to immobilize the joints above and below the site of the fracture, which means a long leg, bent knee, cast (from the toes to the groin).
So, your fracture pattern and fracture, must be a stable one. It is very rare to treat a tibial shaft fracture in just a below the knee cast. Without including the knee joint in the cast, there is no rotational stability to the immobilization.
So, again, you are very lucky to have just a below the knee cast. With your description of how you fractured your tibia, it would be considered a low energy fracture. In very low energy fractures, the periosteum (a soft tissue sleeve which goes around the bone, supplying the nerves and blood vessels to the bone) may remain intact. Thus, it can help to keep the bone aligned.
Usually, the time to union for a low energy tibial shaft fracture is about 10-13 weeks. This is just the time for the bone to unite. It does not include the time needed for rehabilitation of the limb. Muscles atrophy very quickly and the ankle can become very stiff when immobilized for any period of time.
It is very unusual for the bone fragments to be moving around after about a month. But, the tibia can be a very slow healing bone (poor blood supply), so it may be possible that you do not have a lot of solid callus formation yet around the fracture at just 7 weeks. You should have significant amount of osteoid around the fracture. Osteoid is the soft tissue matrix of bone. It is the first substance laid down around a fracture site, it sort of “glues” the bone together at first. Thus, if there has not been a lot of calcium put into the osteoid, to form callus (new bone formation), it is possible that the bones are still moving a little.
Weight bearing is a very good thing for the healing of fractures. By applying stress across the fracture site, the body will respond by laying down callus. This is known as Wolff’s Law - bone will respond to the stresses applied to it.
This is why persons who do a lot of weight lifting or manual labor will have strong stout bones. Likewise, persons who do not do a lot of lifting or manual labor will develop osteoporosis (age, injury, space flight). This is one of the concerns of prolonged space flights. Without stress on the bones, the astronauts will develop very severe osteoporosis. Sorry, got off onto a tangent.
So, hopefully, at your next appointment, your x-ray will show good callus formation at the fracture site. If so, you may be able to switch to a fracture brace (AirCast, CamWalker, moon boot, etc). But, if you still have significant movement of the fracture fragments, you may have to remain in the cast for a bit longer. It is usually determined by, if you still have a lot of discomfort at the fracture site, or there is gross motion to physical stressing of the fracture, then continued immobilization is warranted.
If you are placed in a fracture brace, you may then be able to begin range of motion of your ankle. But, again, if there is still motion at the fracture site, you may have to wait a little while longer.
You asked about the feelings around the fracture site, yes that is probably due to the healing. The first stage of fracture healing is called the inflammatory stage. Without inflammation, the fracture would not heal.
Thus, again, you have been lucky to be able to be treated in only a below knee cast for a tibial shaft fracture. At 7 weeks, you are still not quite to the point where a tibial shaft fracture, low energy, would be united yet. That normally takes anywhere from 10 to 13 weeks to occur (3 months).
Good luck. Hopefully, you will be able to go to a fracture brace at your next appointment. That would allow you to begin range of motion of your ankle, which is going to be very stiff after being immobilized. You calf muscles are going to be very atrophied. It will take quite a bit of time and effort to get the muscle bulk and strength back again.
As you can see its been quite some time since my last post. Thank you for your advice, it gave me a lot of belief at quite a difficult time mentally. On the plus side i'm walking, still got a bit of a limp; but I assume this is normal after not using the leg for so long.
My surgeon has moved me on to physio now, so i'm doing my exercises and progressing well I think. This is along with what i'm studying which is quite a dynamic course; static stetches, yoga, light aerobics etc. No running or jumping just yet.
I just wanted to know, I do sometimes get pain in the leg where the break occurred, and sometimes a little further up; is this normal? I've been told by my doctor that i have a 5 degree displacement but that it should straighten up, is this often true? When I start doing more dynamic exercise will it help to straighten the bone out? Will this injury dog me for the rest of my life, its frustrating because I'm quite a dynamic person and its starting to get on my nerves.
Does the pain indicate to the body that it needs to keep strengthening the bone. I think I just want to know how long the body will take to get the bone back to how strong it was; baring in mind i'm 24yo.
Sorry to ask so many question, I know I should be grateful to be walking; but i'm close to losing my mind. Just want to be back to normal.
First, glad that you are doing pretty well, after a significant injury.
As to the bone "straightening". Well, it will a little, but not completely. The body will lay callus down and sort of smooth the outside of the bone a little, but you will always have some offset.
Adults are not like children, in terms of bone healing. In growing children, you can actually leave fractures angulated quite a bit, and with growth, they will actually completely straighten up the bone. But, since adults are no longer growing, the potential remodeling capacity is very limited.
The thing with tibia fractures, the bone being offset a little is actually very well tolerated, as long as the overall alignment of the tibia is okay. It is when the fracture remains angulated, so much that the knee and/or ankle joints are no longer horizontal, that the patient may have some problems.
Also, remember that you did not just break the tibia. All of the soft tissue around area of the fracture was also damaged. All this soft tissue has to heal, and it does so with scar. So, it is very common for patients to have aches and pains around the fracture site. As long as the pain is not a really sharp, intense pain directly on the bone, it is probably okay.
Also, remember, it often takes as much as a year to 18 months to fully recover from a tibia fracture. So, it may still be a while before you know your final outcome. Many patients with tibia fractures return to their pre-injury activity level, and lead very active lives.
I am afraid of blood, that's why i don't want to do operation and we don't have money to do so. the doctor advice that i have do operation and needed three metal to put in my leg, can someone check on my picture and tell me if i can recover without operation? my leg now have cast. thanks.
I have been in a leg brace due to a crack on my left leg (tibia), I have been in it for about going on 5 weeks now, and am using crutches, I get pain now and then but bareable. I also smke but no more then 10 a day.ive occasionally takin the brace off to shower and jst to look at it sometimes. It seems to be still swollen. When I do gt pain its around the joint where the knee cap joint is? I have my first appointment since been to the hospital in about a week and a half. Is this normal? And willmy leg go back to its normal shpe after recovery? Im not sure.how serious the injury is so could smeone help me out and give sme advice? and how long does it take to heal? Also I was told not to put weight on it. It gets real frustrating arrgh haha
First off I can't stress the importance of not smoking during the recovery period!!!! I myself smoked, and have touched only a few during 3.5 months post op. Your bones are nourished by blood. Smoking elevates the levels of nicotine in your blood causing the blood to constrict. So with the blood vessels constricted in diameter; means decreased levels of nutrients. Decreased levels of nutrition, means a negative impact on healing!
If you want to heal quickly and effectively, you will need to work on not smoking, taking extra vitamin D, and calcium. I have had an amazing healing of my bones, because I have taken lots of vitamin D, and calcium as-well as not smoking. I know it’s hard, but it’s soooo worth it. I still have a long ways to go because of how bad my accident was and the breaks of my tibia and fibula, but if I didn’t take care of myself, I believe I wouldn’t be where I’m at today!!!
As mentioned I’m out close to 4 months now, with two huge breaks in my tibia, and a big break in my fibula. This was considered high energy breaks; due to the nature of the crash, and I still get lots of swelling, discoloration, etc. I do wish you luck, and hope your doctor’s appointment goes well!?
I fractured my Tib and fib 36 weeks ago. I had surgery (fix plate on Fib) and MIPPO plate on Tib within 24 hours of fracture. My Tib was in 4 pieces. I knew it was going to take an age to heat but my latets x ray and CT scan at 35 weeks show a huge gap still at the front of my tibia. My surgeon suggested a bone graft but my pain management consultant (dmanaging nerve pain from damage to nerves) has put a stop to it. I am so so frustrated. I'm a healthy and fit Mum. I don't smoke, don't drink and compete in triathlon, ski, train blah blah blah. Anyone got any words of advice, reassurance as I really need to see the light at the end of the tunnel.