Sports fans have witnessed several horrific tibia fractures. Louisville’s Kevin Ware and Indiana Pacers forward Paul George both suffered tibia fractures playing basketball. Both underwent surgery and returned to play. Arguably the most famous tibia fracture occurred with the injury of Washington Redskins quarterback Joe Theismann, who never returned to sports.
These injuries are devastating to professional and recreational athletes alike. In fact, whether athletes are likely to return to sports is one of the most common questions I receive.
Sports and broken leg injuries
It is an important one, as about one-quarter of all tibial shaft fractures occur in sports. A recent study published in Sports Health offers some insight that can help you discuss treatment options with your orthopedic surgeon should you break your leg playing football, soccer or basketball.
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Return to sports after a tibia fracture
Generally return to play requires a fracture to heal completely and in the proper position and alignment. The athlete must regain full motion, strength and function. This process applies whether or not a fracture requires surgery.
Typically displaced fractures (ones that don’t line up appropriately) require surgery, usually in the form of an intramedullary nail (a rod placed down the center of the bone with locking screws at the top and bottom of the rod). If the fracture is nondisplaced, it often requires a cast that extends up to the knee or above the knee.
Rates of return to sports
The authors of this paper compiled research studies on tibia fractures. They found some interesting trends:
• 91.5% of patients with tibial shaft fractures treated surgically returned to sports, although fewer (an average of 75% in different studies) returned to the same level of play.
• 66.7% treated nonsurgically returned to sports.
• Not only were return to sports rates lower for fractures treated without surgery, but the time required to return was much greater for nonsurgically-treated fractures.
• Surgery was associated with some complications, including knee pain after surgery, compartment syndrome, infection and blood clots.
• Displacement of the fracture can occur with nonoperative treatment.
It is important for any athlete with a tibial shaft fracture to have a thorough discussion of treatment options and the possibility of returning to sports. Surgery should be performed for displaced fractures, and it might increase the chance of returning to play and returning more quickly for nondisplaced fractures than cast treatment. If an athlete selects casting for a nondisplaced fracture, it should be followed closely to ensure that the fracture remains in proper position.
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Robertson GAJ and Wood AM. Return to Sport After Tibial Shaft Fractures: A Systematic Review. Sports Health. Published online August 18, 2015.