It depends upon the fracture pattern. If the fracture is midshaft and transverse in nature, the patient can weight bear immediately. However, if the fracture is a spiral, long oblique, located near a joint then weight bearing is usually delayed. The spiral and long oblique fractures are inherently unstable. So, the intramedullary (IM) nail is just acting as an internal splint and cannot withstand the stresses of weight bearing.
So, again, it depends upon the fracture. But, weight bearing status is up to the surgeon. When the surgeon states that a patient can advance to weight bearing, then the patient should follow those instructions, and put only as much weight on the limb as the surgeon allows.
Weight bearing usually also depends upon the healing of the fracture. As more callus (new bone) is seen of the x-ray, the surgeon will be more likely to allow more weight bearing. The time it takes for a tibia to heal is noted in the following:
TIME TO UNION FOR TIBIAL SHAFT 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;
- “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.
- Wheeless Textbook of Orthopedics, Duke University.
The above is only for how long it takes for the bone to heal. It does not include the time it takes for rehabilitation.
Again, the use of crutches and the weight bearing status depends greatly on the fracture pattern and how the bone is healing. But, ultimately, it is up to the surgeon.
If there are any questions about a patient’s post-op activity level, the surgeon should be contacted.