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Surgery Gets the Shaft
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Posted on: 11/30/1999
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The lower leg has two bones: the tibia and the fibula. The tibia is the larger bone, sometimes called the "shin bone." The shin portion is also called the tibial shaft. Fractures of the shaft often heal with an angle. In the past, these fractures were treated with a cast, but now surgery is used. Surgery results in less angulation.
Doctors at a large hospital in England studied 164 cases of tibial fracture from over 30 years ago. All had been treated with a cast. The doctors X-rayed all the patients and remeasured the angle of the healed bone. These findings were compared with patients' current status.
The long-term outcome after a tibial shaft fracture was good for most of the patients. There were mild symptoms of knee and ankle pain and arthritis. However, these were not caused by the previous fracture. In a small number of patients, fracture in the upper part of the tibia (closer to the knee) resulted in more wear and tear on the knee joint.
A 30-year study of the alignment of the tibia after fracture and treatment has been reported. Changing treatment from casting to surgery for tibial fractures may not have been needed. Patients from more than 30 years ago, who were treated with casting, didn't end up with more arthritis because of poor alignment after healing.
This information tells doctors two things. Tibial shaft fractures may not need to be treated with surgery. Casting may be all that is needed. And change in the angle of the tibia doesn't lead to arthritis. Arthritis appears to be caused by other factors after this injury.
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References:
S. A. Milner, FRCS (TR & Orth), et al. Long-Term Outcome After Tibial Shaft Fracture: Is Malunion Important? In Journal of Bone and Joint Surgery. June 2002. Vol. 84-A. No. 6. Pp. 971-980.
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