Broken lower leg (fractured tibia or fibula) Waewae tāwhatiwhati o raro (kapiti, takakaha rānei)

One or both of the shinbone and calf bone can break. Because it takes a lot of force to break a long bone, it often happens with other injuries. Your injury might also involve the knee joint at the top of your bones or the ankle joint at the bottom.

Common causes of a broken lower leg bone are:

• high-energy collisions, such as a car or motorcycle crash
• sport injuries, such as a fall while skiing or running into another player during rugby

Weak bones, such as those in someone with osteoporosis, tend to break more easily.

Your lower leg bones can break in many different ways, and some breaks are worse than others. How bad a break it is depends on:

• how many pieces the bone breaks into
• whether the bones are stable or move around a lot
• whether the broken ends of the bone are still in the right place.

You may have broken your leg if:

• it is painful
• you are not able to walk or put weight on it
• it appears to be deformed or feels unstable
• you lose feeling in your foot
• you notice pieces of bone sticking up under your skin (tenting) or sticking out through your skin.

An open fracture is serious. An open fracture is when:

• bits of bone are sticking out through your skin
• a cut or gash goes all the way down to your broken bone.

Once your skin is broken, you are more likely to get an infection in your wound and bone.

If you think you may have broken your lower leg, it is important to see a healthcare provider. They will:

• ask about your injury
• examine your leg
• take x-rays to find out which bone is broken and what kind of break it is.

They may also take x-rays of above and below the sore area. This is to check if you have any other nearby injuries. Occasionally, you might have to have a CT scan. This can show a complex break more clearly.

There are several things you can do to help your broken lower leg bone heal, whether or not you are having surgery.

• If you smoke, stop smoking. Continuing to smoke will slow down how quickly you heal.
• Do not do any heavy lifting using your leg, as this will increase your pain and slow your recovery. You will probably need some time off work to let your leg recover.
• Take regular pain relief as recommended by your healthcare provider. Seek advice from them if you still have pain while taking the recommended pain relief. Do not take extra pain relief that has not been prescribed for you.
• The more swollen your leg is, the more painful it will be. To reduce swelling, keep it raised above the level of your heart whenever possible.
• Take care not to get the cast wet.
• Until the bone is fully healed, be very careful not to twist it. Twisting can make the bone rotate and heal incorrectly.

The way your broken lower leg will be treated depends on:

• what type of break it is and whether the bones have moved or are unstable (could move)
• whether a bone has broken through your skin (an open wound)
• how old you are
• your job, hobbies and activities
• whether you have other injuries as well
• how good your overall health is.

You will probably need surgery to put the broken bone back into the right place and hold it there until it heals. Occasionally, older people with less complex stable breaks (the bones do not move around) do not have surgery, but the broken bones are held in place in a cast while they heal.

If you are not having surgery

At first, your whole leg will be put into a cast (a long leg cast) to hold the bones in the right place and stop them from moving while they are healing. This cast usually starts at the base of your toes and goes up to the top of your thigh with your knee slightly bent.

You will have this cast for at least 6 weeks before it is either removed or changed to a shorter cast or brace that lets you start to move your leg gently.

When you start walking again, you will need to keep all weight off your leg and use crutches or a walker. Follow your healthcare provider's instructions, as putting any weight on your leg can mean you do not recover well. You will still have to take care of your leg once the cast comes off.

Using a pair of crutches

Sometimes, a break seems to be stable and is put in a cast, but as the swelling goes down, the broken bones move apart and need surgery to put them back into place. You will have regular x-rays while your leg is in a cast to make sure the bones stay in the right place while they are healing.

Surgery for a broken lower leg bone

If you need surgery, it will be done by a bone (orthopaedic) surgeon. What surgery you have will depend on what type of break you have. Your surgeon will talk to you about:

• what it involves
• the risks
• the benefits
• how you are likely to recover.

Your surgery will involve some metal (usually a rod called an intramedullary nail with locking screws, or a plate and screws) to line up your bones properly and support them while they heal. The screws may be held together with clamps and rods outside your skin to stabilise the break. This is called external fixation. It is usually a temporary measure until the swelling has gone down enough for surgery.

You will probably spend 2 to 3 nights in hospital. Your leg will be in a cast or backslab (a half-cast that wraps around the back of your leg) for up to 6 weeks. After that, the cast will either be removed or changed to a shorter cast or a brace so you can start gently moving your leg.

Depending on how unstable your break is, you may need to keep all weight off your leg and use crutches or a walker when you start walking again.

Using a pair of crutches

Follow your healthcare provider's instructions, as putting any weight on your leg can mean you do not recover well. You may even need another operation to fix problems caused by putting weight on your leg too soon. You will still have to take care of your leg once the cast comes off.

Recovery after surgery

You will most likely need at least 2 weeks off work after surgery. Exactly how much time you will need off depends on:

• how bad the break is
• what your job involves
• whether there are any light duties you can do.

For example, if you work at a desk, you may just need 10 to 14 days off work. But if you are on your feet all day, you may need 10 or more weeks off.

As you recover, you will have regular appointments with your surgeon and some x-rays to make sure your leg is healing well. You may also need some physiotherapy to strengthen your leg and get it moving again.

If you have clamps (external fixation), these will need to be removed once you have healed. If the metal inside you is causing pain or other problems, it will also need to be removed. Exactly when that happens depends on how bad your break was and how quickly your bones heal.