TIBIA FRACTURES – BROKEN LEGS

Types of Tibia-Fibula Fractures in Children

Not all tibia-fibula fractures are created equal. Children’s bones are constantly growing and changing, so certain types of fractures tend to show up more frequently at particular ages.

Here are a few of the more common patterns:

• Cozen’s Fractures: These usually affect children under 6 years old and often happen at the top part of the tibia. A typical scenario is a little one coming down a slide or while sledding, accidentally twisting their knee or pinning a leg beneath their body. The sideways force bends the knee just enough to cause a crack near the growth plate.
• Toddler Fractures: Seen in kids under 4, these subtle breaks run through the middle portion of the tibia. They’re often the result of a simple stumble or a twist while playing—think “toddler meets coffee table leg.” Toddler fractures can be sneaky, sometimes barely visible on X-rays, but can cause a child to limp or refuse to bear weight.
• Tibial Tubercle Fractures: As kids hit adolescence and those growth plates are working overtime, the upper shinbone where the quadriceps tendon attaches can become a weak spot. A powerful contraction—like trying to jump high for a basketball dunk or launching into a gymnastics flip—can cause this bumpy area to break away from the bone.

Understanding which fracture your child has is key, as treatment and recovery time can differ depending on the type and location of the break.

Causes of Tibia Fractures

Repetitive stress or overtraining for sports is the most common cause of stress fractures of the tibia. It may also link to bone weakness caused by osteoporosis. Stress fractures are more common in women. Overuse is the most obvious cause of a tibial stress fracture; however, there are a number of other factors that can increase the risk of sustaining a tibial stress fracture:

Training

Sudden changes in a running surface, such as moving from grass to a lot of track or road running, can increase the chances of a stress fracture.

Foot Biomechanics

Overpronation or supination puts extra strain on the tibia bone. Overpronation and rolling in of the foot, flattening the arch, has the effect of rotating the shin bone inwards. As a result, the bone is subjected to increased torsion or twisting stresses.

Acute Causes: Trauma and Sudden Impact

Not all tibia fractures are the result of overuse. Tibia-fibula fractures can also occur suddenly due to trauma or a hard blow to the leg—anything that puts too much force on the bone. Common causes include:

• Direct Impact or Falls: A fall or a forceful blow, such as a collision during contact sports, can break the tibia and often the fibula at once.
• Twisting Injuries: Sudden twisting of the leg, especially if the foot is planted and the body rotates (as seen in football, hockey, and basketball), can cause the bone to snap.
• Sporting Accidents: Activities like ice skating, skiing, or snowboarding, where the foot remains secured in a boot, can lead to fractures just above the boot line during a fall.
• Playground Mishaps: Falls from trampolines or playground structures are also frequent culprits, especially in children.

Both repetitive stress and sudden trauma can lead to tibial fractures.  Understanding these causes helps to avoid fractures and when they occur, parents can seek and early treatment.

Tibia Fracture Symptoms

Tibial stress fracture symptoms include those that are similar to shin splints (medial tibial stress syndrome):

• Pain on the inside of the shin, usually in the lower third of the shin.
• Symptoms frequently appear after long-distance running.
• When you press upon that area, your child’s leg will feel tender and sore.
• Swelling around the fracture site.
• If your child has a stress fracture, you may notice a particularly tender spot at the stress fracture’s exact location.

A broken tibia or fibula can also cause:

• Pain or swelling in the lower leg that may occurs suddenly and severe.
• Inability to stand or walk — this is less likely if only the fibula is broken.
• Limited range of motion in the knee or ankle area.
• Bruising or discoloration of the skin around the break.

These symptoms can overlap, so it’s important to look for changes in how your child walks or stands, as well as any new swelling or bruising. If you notice any of these signs, especially after a fall or sports injury, it’s a good idea to have your child evaluated by a healthcare provider.

Diagnosing Tibia Fractures

Before conducting a physical examination, your doctor will go over your child’s medical history and symptoms. The doctor will also examine the leg and order X-rays and possibly other scans to help with the diagnosis:

• X-rays: High electromagnetic energy beams make an image of the broken bones. An X-ray is the primary and painless diagnostic tool for a tibia fracture, using small amounts of radiation to produce images of the bones and surrounding soft tissue. X-rays are not just used to confirm the initial break—they are also valuable after the doctor has corrected the position of the bones, allowing confirmation that the bones are properly aligned. At follow-up appointments, additional X-rays help monitor whether the bones are healing correctly. When the X-ray does not disclose a fracture, the doctor must consider stress fractures and may order additional tests.

Other imaging tests can provide more information about possible damage to muscles, ligaments, or blood vessels around the bone, or reveal fractures not visible on a standard X-ray:

• Bone scan: This refers to an imaging technique that involves injecting a radioactive drug into the bone to detect any damage or disease.
• CT scan: Using X-rays from various angles, detailed images of the tibia are obtained. A CT (computed tomography) scan can help diagnose complex fractures, offering cross-sectional images and highlighting subtle bone injuries.
• MRI Scan: An imaging study that produces detailed images of the tibia by using a large magnetic field and radio waves. MRI is particularly useful for assessing injuries to muscles, ligaments, or blood vessels that may not show up on X-rays or CT scans.

These diagnostic tools allow your doctor to fully assess the extent of the injury and develop the most effective treatment plan for your child’s recovery.

Treatment Differences: Tibia vs. Fibula Fractures

The management of a broken tibia compared to a broken fibula in children often reflects the different roles these bones play in the lower leg.

• Tibia Fractures:
  Because the tibia is the main weight-bearing bone in the lower leg, a fracture here generally requires more substantial support and immobilization. Most children with a tibia fracture will start off in a long leg cast, which keeps the knee and ankle immobilized for about six weeks. Once healing progresses, the child may transition to a shorter cast, and finally to a supportive walking boot as they regain mobility.
• Fibula Fractures:
  The fibula, being a smaller bone that is not heavily involved in bearing weight, typically requires a less intensive treatment. Children with fibula fractures usually need only a short leg cast. Often, as healing advances, doctors may recommend moving to a walking boot to allow for more movement and a quicker return to normal activities.

In summary, tibia fractures require longer and more extensive immobilization due to their crucial role in supporting body weight, while fibula fractures can often be managed with shorter periods of immobilization and an earlier switch to a boot as soon as the bone is stable. Your child’s doctor will tailor the plan to best suit the specific injury and your child’s individual needs.

Tibia Stress Fracture Treatment

The treatment approach for a fractured tibia depends on several factors, including the type and location of the fracture, the child’s age, and overall health. In some cases, a doctor will treat tibia fracture non-surgically with casting or bracing to allow the bones to heal naturally. In more complex or displaced fractures, doctors will perform surgery to realign and stabilize the bones. The doctor will assess the specific details of the fracture and provide a personalized treatment plan.

For less severe fractures, casting or bracing typically provides enough support for the bone to heal properly. However, if the fracture is more complicated or if the bones are significantly out of alignment, doctors will recommend surgery. In older children and adolescents, a surgeon might use a different procedure depending on the child’s needs. For particularly severe fractures, there are other procedures as outlined below. Ultimately, doctors will tailor the chosen treatment to your child’s age, the type of fracture, and how best to ensure proper healing and return to activity.

All physical activity must stop during stress fracture treatment. Crutches or even a walking boot can helprelieve tibial stress, particularly during daily activities such as walking. X-rays, MRIs, or a bone scan may help determine the extent of the stress fracture. Depending on the severity of the stress fracture, a full recovery can occur. Once completely symptom-free, a gradual return to sports and activity is recommended.

The following non-surgical steps can help in healing:

Rest

Your child should rest for 8 weeks if you suspect and the doctor diagnoses a stress fracture. All running and weight-bearing activities should stop. This allows your child’s injury to start healing. If pain-free, substitute swimming or cycling or use the opportunity to work on upper-body strength in the gym. Running in the water with a buoyancy aid or belt is also an excellent substitute for road running. A doctor will examine the leg and decide when it is safe to return to training.

If the injury is more significant, such as a broken tibia or tibia-fibula, your child may need to wear a cast or boot for six to twelve weeks. Typically, this starts with a long leg cast for the first six weeks, then a short leg cast, and finally a boot, depending on your doctor’s recommendation. This staged approach helps to protect the healing bone while gradually restoring mobility.

Throughout recovery, it’s important to follow your doctor’s guidance closely, limit high-impact activities, and focus on activities that do not stress the injured leg. This strategy promotes healing and reduces the risk of re-injury.

Stress fractures do not appear on an X-ray at first. However, after 2 or 3 weeks, you may notice some signs. As a result, it is critical to perform another x-ray after a period of rest.

Taping

A simple shin-taping technique can help reduce shin strain. It works by supporting and pulling the muscles of the lower leg toward the bone. As a result, the rotation of the tibia is reduced. However, if your child has a suspected tibial stress fracture, your child should not run or play.

Exercises

When returning to weight-bearing exercise, it is important to stretch and strengthen calf muscles. They may have tightened and become in poor condition after a period of rest. This increases the likelihood of suffering additional shin pain as a result of medial tibial stress syndrome (shin splints).

Training errors

Analyze your child’s activities to see if or how they contributed to your child’s injury. Do you need to replace your child’s shoes? Running shoes last about 500 miles or 6 months before needing replacement.

Foot biomechanics

Gait analysis to detect any biomechanical issues with the foot that may have heightened the risk of injury. Parents can resove foot problems such as overpronation with orthotic inserts worn in shoes.

Massage

A Sports massage for the calf muscles at the back of the lower leg can relax them.  This can stop muscle spasms, tight knots, lumps, or bumps. This can make the calfs more efficient at absorbing running forces when normal training resumes. If these methods prove ineffective, your doctor will advise you to use:

Splints

Made of plastic and fiberglass, splints are used to immobilize the joint.

Casting

The cast acts as a protective shell and its made of fiber or plaster that has been molded to protect the broken bones.

Braces

Braces are made of plaster or fiber and serve as a protective shield to align the damaged bone. The recovery time from a tibial stress fracture depends on the severity of the fracture. A person will usually recover in 4 to 6 months. Recovery time for a complete break can take longer than for a partial break. Also, it may take longer if a person is in poor health for other reasons. It may take longer than this time frame for a person to resume normal activities.

Following a leg fracture, people should always follow their doctor’s recommendations for returning to walking, exercising, and other physical activity. Exercises that strengthen the hips, calves, and thighs, for example, can help to relieve pressure on the tibia bone. This protection may also help to prevent future injuries.

How long it takes to heal also depends on how quickly the injury is treated and the complexity of the break. For most tibia-fibula fractures, recovery typically takes about three to six months. Adhering to rest and avoiding putting too much weight on the injured leg are essential for a full recovery. In some cases, with complex breaks, your doctor may recommend additional time before your child returns to physical activity.

Being patient with the healing process and gradually reintroducing activity, starting with low-impact exercises and stretching, can help restore strength and mobility while minimizing the risk of re-injury.

Surgery

If rest and conservative treatment do not appear to work, doctors may consider surgical intervention.

Surgery for a broken tibia in children or adolescents is typically required when the fracture is severe, displaced, or unstable, or involves the growth plate, to ensure proper healing and alignment. Here’s a concise overview of what it usually entails:

Pre-Surgery Assessment:

• Doctors perform X-rays, CT scans, or MRIs to evaluate fracture type, displacement, and growth plate involvement.
• General anesthesia is planned, considering the patient’s health and age.

Surgical Procedures: Open Reduction and Internal Fixation (ORIF):

• Surgeons make an incision to realign (reduce) the bone fragments. A reduction is a common, non-surgical procedure used when a broken bone has shifted out of its proper alignment. In the case of tibia-fibula fractures, the doctor gently moves the bones back into their correct position—usually right in the emergency room. This process helps the bone heal straight and reduces the risk of long-term problems. Medications are often given to help your child relax and stay comfortable during the procedure. Not every fracture needs a reduction, but if the bones are noticeably out of place, this step is essential before casting or bracing can be effective.
• Metal hardware, like plates, screws, or rods, stabilizes the bone.
• Intramedullary nailing (inserting a rod inside the bone canal) is common for shaft fractures.

External Fixation:

• Pins or screws are inserted into the bone, connected to an external frame, for complex or open fractures.

Growth Plate Considerations:

• If the growth plate is involved, surgeons use specialized pins or screws to minimize growth disruption.

Procedure Details:

• Surgery lasts 1–3 hours, depending on fracture complexity.
• Incisions are closed with stitches or staples.
• A cast or splint is often applied post-surgery to protect the repair.

Post-Surgery Care:

• Hospital stay is typically 1–2 days, longer for complex cases.
• Pain is managed with medications.
• Physical therapy starts after initial healing (4–8 weeks) to restore strength and mobility.
• Surgeons may remove hardware after 6–12 months, if it causes irritation or growth issues.

Recovery Timeline:

• Weight-bearing is restricted for 6–12 weeks, often with crutches.
• Full recovery takes 3–6 months, depending on age, fracture severity, and activity level.
• Follow-up X-rays monitor healing and growth plate health.

Complications, like infection or growth disturbances, are rare but monitored closely, especially in children due to active growth plates. Pediatric orthopedic surgeons tailor the approach to minimize long-term issues.

Risk Factor for Breaking a Tibia

Stress fractures are much more common in athletes who compete in high-impact sports including gymnastics, basketball, tennis, dance, and athletics.

Enhanced activity

People who abruptly go from a sedentary lifestyle to an active training program or who quickly increase the intensity, duration, or frequency of training sessions are more likely to get stress fractures.

Foot problems

Stress fractures are more common in people who have flat feet or high, rigid arches. Worn footwear adds to the problem.

Bone weakening

Osteoporosis, for example, can weaken bones and make stress fractures more likely.

Prior stress fractures

Your child is more prone to have further stress fractures if he or she has already had one or more.

How Medical City Children’s Orthopedic and Spine Specialists Care For Tibia Fractures

The board-certified pediatric orthopedic surgeons and fellowship-trained physicians at Medical City Children’s Orthopedic and Spine Specialists treat children, adolescents, and young adults who have fractures of all complexities. Our expertise gives room for the accurate diagnosis of problems that relate to the growing musculoskeletal system. We will develop optimal care plans that will ensure that your child’s specific condition is catered for.

Finally, we offer personalized treatment and urgent pediatric care services at all of our five locations — Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX.  If you notice any symptoms of a stress fracture in your child, don’t hesitate to contact us to avoid complications.

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Footnote:

American Academy of Orthopaedic Surgeons: Tibia Fracture