Issuu

health watch: dr. nirav k. pandya

Tibia fractures: Career ending or bump in the road? With the fall sports season just around the corner, physicians will see a natural increase in the number of patients entering their offices. Many athletes and their parents are prepared for the normal sprains and strains of the upcoming sports season, but are naturally nervous about more serious injuries. With the recent injury to the lower leg of the Indiana Pacers’ Paul George during national team training — which brought back memories of Kevin Ware’s NCAA tournament injury from last year — broken shin bones and their impact on an athlete’s immediate and long-term participation have garnered interest. From an anatomic standpoint, the shin is made up of the tibia (the larger bone) and the fibula (the smaller bone). The tibia is particularly susceptible to being fractured during sports due to the fact there is very minimal tissue covering it. In addition, it bears the brunt of both direct and indirect force during athletic activity. These injuries are not only very common in sports such as soccer and football in which direct contact is made with the bone, but also during sports such as basketball in which an awkward landing can lead to a break. If you or someone you know has broken their tibia, the prognosis for such an injury varies largely based on several factors. First, a fracture in which the bone breaks through the skin (i.e. compound/open injury) is treated much differently than one in which the skin is unscathed (closed injury). Open fractures are emergencies and must be cleaned out quickly in the operating room in order to decrease the chance of infection. These types of injuries generally have a higher complication rate, take a longer time to heal, and have a much more guarded prognosis. Second, tibia fractures can either be due to repetitive stress (i.e. endurance athletes) or acute trauma (i.e. a blow during a soccer game). Acute injuries are more likely to require surgery than those due to repetitive stress. Finally, the fracture pattern (i.e. how many pieces the bone has been broken into, how far apart the pieces are, proximity of the fracture to the joint) determines treatment. For minor fractures, this could be as simple as several weeks in a cast. For more serious injuries, this could mean treatment with a form of surgery in which a solid (for athletes who are done growing) or flexible (for athletes who are still growing) metal rod is inserted into the bone to align it and allow healing. The good news is that most tibia fractures are straightforward injuries that occur away from the joint. Thus, the major factor determining a return to sports is not if, but when, healing is complete. Once the bone heals, most athletes will be able to return at or near the same level once they regain their strength and functional abilities. A carefully designed physical therapy plan is essential. As a result, although initially disheartening, a tibia fracture does not necessarily mean the end of career, but rather a bump in the road. ✪ Dr. Nirav K. Pandya is a orthopedic surgeon specializing in pediatric sports injuries at the Children’s Hospital in Oakland. He sees patients and operates in Oakland and our facility at Walnut Creek.

At right, a radiograph of a metal rod placed in the tibia of a soccer player who suffered a fracture while playing. The fracture has nearly healed. 44

SportStars™

August 21, 2014

Subscribe to the Digital Weekly at SportStarsOnline.com