Surgery for a Shinbone (Tibia) Fracture (Plates, Screws, or Flexible Nails)

What this surgery is

The tibia (shinbone) is the main bone of the lower leg. When it is broken and unstable or out of place, surgery can line it up and hold it while it heals. In children this is commonly done with flexible (elastic) nails inside the bone, or with a plate and screws (ORIF). Sometimes the leg is protected afterward in a long-leg cast that is later changed to a shorter cast or boot.

Why it was done

A tibia that is too bent, rotated, or out of place will not heal in a position that lets your child walk and run normally. Surgery restores alignment for a straight, strong heal.

Activity & weight-bearing

• Follow your surgeon's weight-bearing instructions exactly — they will tell you how much weight, if any, is allowed on the leg.
• Use the crutches, walker, or wheelchair you were given until you are told otherwise.
• Keep the leg elevated above the heart for the first 2–3 days and use ice over (not directly on) the cast or dressing.

Caring for the cast and incision

• Keep the cast clean and dry; keep any incision clean and covered as instructed.
• Wiggle the toes often to reduce swelling and stiffness.
• Nothing inside the cast; no powder or lotion at the edges.

Pain control

• Acetaminophen and ibuprofen, used as directed, control most discomfort.
• Give any prescribed pain medicine exactly as directed; elevation also helps.

Call our office right away if you notice

• Fingers/toes that are cold, pale, gray, or blue, or that your child cannot move or wiggle
• Numbness, tingling, or burning that does not get better after raising the limb
• Pain that keeps getting worse and is not controlled by the prescribed medicine and elevation
• Fever of 100.4°F (38°C) or higher, or shaking chills
• Swelling that does not go down with rest and elevation
• Calf pain or tightness, or severe pain that seems out of proportion and is not relieved by medicine and elevation
• Redness, spreading warmth, swelling, or pus-like or foul drainage from an incision
• A cast that becomes wet, cracked, soft, too loose, or too tight

Call 911 right away if your child has

• Trouble breathing or shortness of breath
• Chest pain
• A pale, gray, or bluish color to the lips or face that does not improve

Follow-up

Most tibia fractures heal in about 6–12 weeks, though full return to sports may take longer. Your surgeon will follow healing with X-rays and guide weight-bearing and return to activity. If flexible nails were used, they may be removed in a small later surgery once healed.

Learn more

For pictures and a family-friendly overview, see the OrthoKids resource linked on this page (OrthoKids: Tibia fractures / Internal fixation). It is provided by pediatric orthopaedic surgeons.