Leg: Closed tibia shaft fracture, treated with cast (without surgery).

Adult female. Injury occurred after fall on ice.

There are several features of this fracture that make it amenable to cast treatment.

  1. The fracture of the tibia and fibula are at different levels. The effect of this is that at the tibia fracture, the fibula acts effectively as a splint, keeping the tibia better aligned.
  2. The alignment of the fracture in the splint is really good. Not perfect, but good.

Most importantly, the patient preferred nonsurgical treatment. Surgical treatment with an intramedullary nail would have been superior treatment in every respect, except for the possibility of a postoperative infection.

The patient was treated with splint immobilization. Most patients require general anesthesia for the manipulation and splinting of a tibia fracture. This was the case with this patient as well.

Glossary

  1. A cast is a hard 360-degree shell, almost cylindrical, placed around a broken bone.
  2. A splint is a hard support along a broken bone, but it does not surround the bone fully (not 360-degrees)
  3. A short leg splint or cast is one that stays below the knee.
  4. A long leg splint or cast is one that extends above the knee towards the hip.

The following xrays show the alignment of the fracture after manipulation. A long leg plaster splint was applied by myself.

At 2 weeks after initial splinting, she was reexamined. The fracture remained stable, and I then placed her in a short leg cast for another month.

Here are the xrays at 6 weeks after injury.

After the first 6 weeks, the leg was placed in a clam-shell, Sarmiento type brace. Patient was kept non-weight bearing, but at this point she could remove the splint for showering and hygiene.

The following are xrays at 10 weeks.

The following are xrays at 14 weeks after injury. At this point the patient was made 50% weight bearing.

The following are xrays at 18 weeks. Patient is pain free and remains pain free with full weight bearing.