Rehabilitation

What happens as I recover?

The bones of the shin are fairly typical in terms of healing (see A Patient's Guide to Adult Fractures for more details on the healing process). The normal healing times are six weeks to achieve 50 percent of eventual strength, three months to reach 80 percent of eventual strength, and 18 months to complete the process of consolidation and remodeling of the fracture. If this is the only injury this time scale usually suggests change to weight bearing with some protection (e.g., walking cast) at six weeks; unrestricted weight bearing and gradual return to sports or heavy working activities at three months; and consideration of hardware removal after 18 months.

Initially many patients need the help of a physical therapist to learn to use crutches safely and confidently. Until full weight-bearing is allowed there is less need for a formal PT program as exercises should be confined to keeping the joints and muscles mobile. At the stage of recovering strength, endurance, and sports function it may be valuable to have physical therapy supervision once more.

There is no "typical" fracture of the tibia and recovery depends to a large extent on the severity of the original injury. Clearly the outcome expected from a stable closed spiral fracture will be different from the result after the leg has been mangled in machinery. The first object of treatment is to save the patient's life - preventing any of the complications of the injury from having a fatal effect. The second is to heal the fracture and the third is to restore function to the pre-injury level. Fortunately, the occasions where it is necessary to resort to amputation to accomplish the first of these aims are rare. However, obtaining normal function and even obtaining healing is not 100 percent certain with these injuries. The consequences of treatment failure and complications of this injury will be discussed in the next section.