Tibial Shaft Fracture

with Rehab

The tibial shaft is the middle portion of the shinbone (tibia). A tibial shaft fracture is a partial or complete break in the middle portion of the shinbone. Fractures may occur anywhere along the shinbone, but this document does not discuss fractures that involve the knee or ankle joints.

SYMPTOMS

  • Severe pain at the fracture site, at the time of injury.

  • Tenderness, inflammation, and/or bruising (contusion) over the fracture site.

  • Inability to stand or walk on the injured leg.

  • Visible deformity, if the bone fragments are not properly aligned (displaced fracture).

  • Signs of vascular damage: numbness and coldness below the fracture site.

CAUSES

Tibial shaft fractures occur when a force is placed on the bone that is greater than it can withstand. The shinbone is a strong bone, so these injuries require a lot of force. Common causes of injury include:

  • Direct hit (trauma) to the shinbone.

  • Stress fracture (the bone is repetitively injured, a bit faster than it can heal).

  • Indirect trauma (i.e. twisting injuries, violent muscle contractions).

RISK INCREASES WITH:

  • Contact sports (i.e. football, rugby, lacrosse).

  • Motor sports.

  • Bone disease (i.e. osteoporosis, bone tumors).

  • Metabolism disorders, hormone problems, nutritional deficiency, or eating disorders (anorexia or bulimia).

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow adequate recovery time between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment (i.e. shin guards for soccer).

PROGNOSIS

If treated properly, tibial shaft fractures usually heal in 4 to 6 months. However, returning to sports may take up to 12 months.

RELATED COMPLICATIONS

  • Fracture fails to heal (nonunion).

  • Fracture heals in a poor position (malunion).

  • Bleeding within the leg that leads to the squeezing of nerves inside a closed space (compartment syndrome), causing injury to the nerves or vessels in the leg.

  • Shortening of the injured bones.

  • Shinbone growth stopping in children.

  • Infection, if the skin is broken over the fracture site (open fracture).

  • Longer healing time, if not properly treated or re-injured.

  • Risks of surgery: infection, bleeding, nerve damage, or damage to surrounding tissues.

TREATMENT

Treatment first involves the use of ice and medicine to reduce pain and inflammation. If the bone fragments are out of alignment (displaced fracture), immediate realignment of the bone (reduction) by a trained professional is required. Fractures that cannot be realigned by hand, or are open (bones poking through the skin), may require surgery to hold the fracture in place with screws, pins, and plates. Once the bone is aligned, the knee should be restrained to allow for healing. After restraint, it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Treatment does not seem to help, or the condition gets worse.

  • Any medicines produce negative side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the affected leg.

  • Discoloration under the toenails (blue or gray) of the affected leg.

  • Signs of infection (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Tibial Shaft Fracture

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending): Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening): Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

Repeat __________ times. Complete __________ times per day.

RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back, with both knees straight. (If this causes back discomfort, bend the knee of your healthy leg, placing your foot flat on the floor.)

  • Slowly slide your right / left heel back toward your buttocks, until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH - Knee Flexion, Supine

  • Lie on the floor with your right / left heel and foot lightly touching the wall (place both feet on the wall if you do not use a door frame).

  • Without using any effort, allow gravity to slide your foot down the wall slowly, until you feel a gentle stretch in the front of your right / left knee.

  • Hold this stretch for __________ seconds. Then return the leg to the starting position, using your healthy leg for help, if needed.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee, and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall, and the opposite leg flat on the ground through the door. To start, position your bottom farther away from the wall than the picture shows.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door and hold for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Knee Extension, Sitting

  • Sit with your right / left leg or heel propped on another chair, coffee table, or foot stool.

  • Allow your leg muscles to relax, letting gravity straighten out your knee.*

  • You should feel a stretch behind your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

*Your physician, physical therapist or athletic trainer may instruct you to place a __________ weight on your thigh, just above your kneecap, to deepen the stretch.

STRETCH - Knee Extension, Prone

  • Lie on your stomach on a firm surface, such as a bed or countertop. Place your right / left knee and leg just beyond the edge of the surface. You may wish to place a towel under the far end of your right / left thigh for comfort.

  • Relax your leg muscles and allow gravity to straighten your knee. Your caregiver may advise you to add an ankle weight, if more resistance is helpful for you.

  • You should feel a stretch in the back of your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this __________ times per day.

STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards, by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION- Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot and ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation so your littlest toes rise slightly toward the ceiling.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove your shoes and sit on a chair, preferably not on a carpeted surface.

  • Place your right / left foot on the floor, directly under your knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair, until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Gastrocsoleus

  • Sit with your right / left leg extended. Holding onto both ends of a belt or towel, loop it around the ball of your foot.

  • Keeping your right / left ankle and foot relaxed and your knee straight, pull your foot and ankle toward you using the belt.

  • You should feel a gentle stretch behind your calf or knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Tibial Shaft Fracture

These exercises may help you when beginning to recover from your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never get worse during these exercises. If this pain does get worse, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

STRENGTH - Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor, facing the fixed object. The band should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you, using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band or tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band across your opposite foot, away from the pole, slowly pull your little toe out and up. Make sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (i.e. table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Return to the starting position slowly, controlling the tension in the band.

Repeat __________ times. Complete this exercises __________ times per day.

STRENGTH - Towel Curls

  • Sit in a chair, on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel only by curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add ____________________ at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up toward your hip, or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat, or bed on which you are lying.

  • Hold the muscle as tight as you can, without increasing your pain, for __________ seconds.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your knee, so that the knee bends slightly.

  • Raise only your lower leg, by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/ 0.5 kilogram increments.

STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to make sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended, and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see your knee cap slide up, or see increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more, and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hamstring, Isometrics

  • Lie on your back, on a firm surface.

  • Bend your right / left knee approximately __________ degrees.

  • Dig your heel into the surface, as if you are trying to pull it toward your buttocks. Tighten the muscles in the back of your thighs to "dig" as hard as you can, without increasing any pain.

  • Hold this position for __________ seconds.

  • Release the tension gradually, and allow your muscle to completely relax for __________ seconds between each exercise.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hamstring, Curls

  • Lay on your stomach, with your legs extended. (If you lay on a bed, your feet may hang over the edge.)

  • Tighten the muscles in the back of your thigh to bend your right / left knee up to 90 degrees. Keep your hips flat on the bed or floor.

  • Hold this position for __________ seconds.

  • Slowly lower your leg back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in __________ increments.

STRENGTH - Hip Abductors, Straight Leg Raises

Be aware of your form throughout the entire exercise, so that you exercise the correct muscles. Poor form means that you are not strengthening the correct muscles.

  • Lie on your side so that your head, shoulders, knee and hip line up. You may bend your lower knee to help maintain your balance. Your right / left leg should be on top.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Lift your top leg up 4-6 inches, leading with your heel. Be sure that your foot does not drift forward or that your knee does not roll toward the ceiling.

  • Hold this position for __________ seconds. You should feel the muscles in your outer hip lifting (you may not notice this until your leg begins to tire).

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before starting the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Extensors, Bridge

  • Lie on your back, on a firm surface. Bend your knees and place your feet flat on the floor.

  • Tighten your buttocks muscles and lift your bottom off the floor, until your trunk is level with your thighs. You should feel the muscles in your buttocks and the back of your thighs working. If you do not feel these muscles, slide your feet 1-2 inches further away from your buttocks.

  • Hold this position for __________ seconds.

  • Slowly lower your hips to the starting position, and allow your buttock muscles to relax completely before starting the next repetition.

  • If this exercise is too easy, you may cross your arms over your chest.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Plantar-flexors, Standing

  • Stand with your feet shoulder width apart. Place your hands on a wall or table to steady yourself, using as little support as needed.

  • Keeping your weight evenly spread over the width of your feet, rise up on your toes.*

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If this is too easy, shift your weight toward your right / left leg until you feel challenged. Ultimately, you may be asked to do this exercise while standing on your right / left foot only.

STRENGTH – Quadriceps, Squats

  • Stand in a door frame, so that your feet and knees are in line with the frame.

  • Use your hands for balance, not support, on the frame.

  • Slowly lower your weight, bending at the hips and knees. Keep your lower legs (below the knee) upright, so that they are parallel with the door frame. Squat only within a range that does not increase your knee pain. Never let your hips drop below your knees.

  • Slowly return to upright, pushing with your legs, not pulling with your hands.

Repeat __________ times. Complete this exercise __________ times per day.