Fractures of the shaft of the tibia (situated between the knee and the ankle) usually result from high-energy injuries, such as motor vehicle accidents, collisions, falls during skiing, and when pedestrians are struck by a car. This type of fracture can be very serious, particularly if the skin, muscle, nerves, or blood vessels are damaged. Such damage can lead to compartment syndrome (see Fractures: Compartment Syndrome).
For closed fractures of the tibia, an above-the-knee cast is needed until healing is under way and is then changed to a below-the-knee cast. The total time the person needs to wear these casts is usually about 3 months, but healing can take much longer. Many of these closed fractures are treated surgically with metal rods or plates. After surgery, usually no cast is required, and rehabilitation can begin sooner. If the skin is severely damaged and bare bone is exposed, an external fixator (a frame of rods clamped to stainless steel pins that pass through the skin into the bone) is used.
Fractures of the shaft of the femur (the large bone above the knee) are serious injuries usually caused by falls from a height or high-speed motor vehicle accidents. Special traction equipment is needed for transport to the hospital. In adults, these fractures are treated with urgent surgery to align and fixate the fracture with metal rods or plates (a procedure known as open reduction and internal fixation, or ORIF). After surgery, most people begin to walk with crutches immediately.
Last full review/revision December 2008 by James R. Roberts, MD