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Types

• Proximal Tibia Fracture: This fracture occurs at the upper end of the tibia, potentially affecting the knee joint through the growth plate.

• Tibial Shaft Fracture: This type of fracture occurs in the middle section of the tibia, which is the focus of this information sheet.

• Distal Tibia Fracture: This fracture happens at the lower end of the tibia and may impact the ankle joint through the growth plates.

• Stress Fracture: This type of fracture develops gradually due to overuse, sometimes requiring advanced imaging like an MRI for diagnosis.

• Open Fracture: Also known as a compound fracture, this type involves a break in the bone that causes it to protrude through the skin.

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Symptoms

Signs of a tibia fracture include a deformed, swollen, and painful leg. Children with this injury may have difficulty walking. Tibia fractures often result from low-energy trauma, such as sports injuries, but can also occur from high-energy trauma, like car accidents. While tibia fractures are usually isolated injuries, a thorough evaluation for additional injuries is essential in cases of high-energy impact. 

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In infants and young children who are not yet walking, non-accidental trauma (child abuse) should be considered, as the tibia is the second most commonly fractured long bone in such cases.

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Diagnosis & Treatment

Examination

The doctor will examine the skin and palpate (examine by touching) different areas of the leg to ensure the fracture does not extend to the growth plate, knee, or ankle. They will also check the muscles, nerves, and circulation in the foot.

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X-Rays and Tests

X-rays are typically used to confirm a tibia fracture, including images of the entire tibia and fibula. Additional imaging of the femur, knee, or ankle may be necessary to rule out other injuries. If the fracture is near a joint or growth plate, a CT scan may be ordered for a detailed view to guide treatment.

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Treatment

Treatment for tibia fractures depends on the fracture’s location, alignment, and the child’s age. 

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Most tibia fractures in children are treated with a cast or boot. Sometimes, sedation may be required to realign the bone before casting. Weekly follow-ups may be necessary to ensure proper alignment, and casting may last up to three months, depending on healing and the child’s age. The cast may be adjusted to aid in bone alignment during healing. Initially, weight-bearing may be restricted, but your doctor might allow partial weight-bearing or walking after several weeks if healing is progressing well.

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Surgery might be necessary for open fractures, misalignment that cannot be corrected with casting, or if the bones are healing improperly. Surgical options include using metal pins, flexible or rigid nails, or plates and screws to stabilize the bone. Post-surgery, a cast or splint may still be used. In severe cases with significant skin and muscle damage, an external fixator may be used to maintain bone alignment during recovery.

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Outcomes

Children generally recover from tibia fractures within a few months. After removing the cast, they may limp or turn their foot outward temporarily. Some angulation in the healed bone is acceptable and can straighten over time. Occasionally, long-term monitoring is required to ensure proper bone growth. Most children do not need physical therapy to regain leg function, but if implants were used, removal might be recommended later.

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For optimal care and outcomes, a pediatric orthopedic surgeon should manage tibia fractures in children to ensure proper alignment, minimize complications, and support a successful recovery.