Tibia and Fibula Fractures: Do You Need Bone Graft?

Q: Tibia and Fibula Fractures: Do You Need Bone Graft?

Hello： A comminuted fracture of the lower extremity generally requires three to six months before one can walk without assistive devices, but this varies from person to person. <br>Typically, regular follow-up appointments with X-rays are necessary, during which the physician wil

Tibiofibular fracture from a car accident?

I have a tibia and fibula fracture from a car accident.
The fracture is quite fragmented with a one-centimeter gap, and I have an internal fixation plate installed.
Do I need to use bone graft? The doctor said that the X-ray shows that the bone has not healed yet.
What is the purpose of bone grafting? Once the bone graft is done, how long will it take before I can walk? If the bone graft does not heal, can I still try to walk?

Da Ming, 40~49 year old female. Ask Date: 2023/02/25

Dr. Li Wenhong reply Orthopedics

Hello: A comminuted fracture of the lower extremity generally requires three to six months before one can walk without assistive devices, but this varies from person to person.
Typically, regular follow-up appointments with X-rays are necessary, during which the physician will advise on partial or full weight-bearing.
It is recommended that you discuss this with your doctor during your next visit.
The bone substitute you mentioned likely refers to artificial bone grafts.
If X-rays during follow-up show delayed healing or gaps in the bone, the physician may suggest a bone grafting procedure (using either your own bone or artificial bone substitutes) to promote fracture healing.
Using your own bone is preferable, but the surgery is longer, involves a second incision, and may be more painful.
Artificial bone substitutes come in various forms and may contain additives (such as growth factors), which typically require out-of-pocket expenses.
Please discuss the details with your attending physician.
If the fracture has not healed, it is advisable to use assistive devices for protection while walking (this should also be discussed with your attending physician).
Changhua Hospital, Orthopedics, Dr.
Li Wen-Hong.

Reply Date: 2023/02/25

More Info

When dealing with tibia and fibula fractures, especially in cases where there is significant fragmentation and a gap of about one centimeter, the treatment approach can vary based on the specifics of the injury and the healing process. In your situation, where internal fixation with a plate has been performed but the X-rays show that the bone has not yet healed, the question of whether to use bone grafting material (often referred to as "bone powder" or "bone graft") becomes pertinent.

Understanding Bone Grafting
Bone grafting is a surgical procedure that involves transplanting bone tissue to help repair and regenerate bone that is missing or not healing properly. The primary purposes of bone grafting in fracture cases include:
1. Promoting Healing: Bone grafts provide a scaffold for new bone growth and can stimulate the healing process, especially in cases where there is a gap or non-union (failure of the bone to heal).

2. Filling Gaps: In fractures with significant gaps, such as the one you described, bone grafts can fill the void and provide structural support.

3. Enhancing Stability: By providing additional material for the body to work with, bone grafts can enhance the stability of the fracture site, which is crucial for proper healing.

Timing and Recovery
If your doctor has indicated that the bone has not yet started to heal, the use of bone grafting may be recommended to facilitate the healing process. The timeline for recovery after a bone graft can vary significantly based on several factors, including the type of graft used (autograft, allograft, or synthetic), the patient's overall health, and adherence to post-operative care.

1. Walking After Bone Grafting: Generally, after a bone graft, you may need to wait several weeks to months before you can begin to put weight on the affected leg. This period allows the graft to integrate with the existing bone and for new bone to form. Your doctor will provide specific guidelines based on your individual healing progress.

2. Attempting to Walk: If the bone graft does not lead to healing and the fracture remains non-union, attempting to walk on the affected leg could lead to further complications, including malalignment or additional injury. It is crucial to follow your doctor's advice regarding weight-bearing activities.

Conclusion
In summary, if there is a significant gap in your fracture and the bone is not healing, bone grafting may be necessary to promote healing and restore function. The use of bone grafts can significantly enhance the chances of successful healing, but it is essential to follow your healthcare provider's recommendations regarding activity levels post-surgery. Always consult with your orthopedic surgeon to discuss the best course of action tailored to your specific situation, including the potential need for bone grafting and the timeline for returning to normal activities.

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