Tibial Fractures in Children: Healing Time and Rehabilitation

Tibial fracture

Hello, Director.
My nephew, who is 3 years and 6 months old, suffered a tibial fracture in his left lower leg due to an accidental fall.
During the visit, he was only placed in a cast because both the ankle and knee joints are immobilized and cannot move freely.
Could you please advise how long it typically takes for a tibial fracture to heal and recover? Will rehabilitation be necessary? Is there a risk of stiffness in the ankle and knee joints? How long until the cast can be removed, and when can he start to get out of bed and bear weight? Thank you, Director.

Song, 20~29 year old female. Ask Date: 2006/07/07

Dr. Shi Guozheng reply Orthopedics

In children, tibial shaft fractures are typically treated conservatively with casting.
The immobilization period is approximately one month, during which time the fracture heals before the cast can be removed.
Most cases have a good prognosis, and there is usually no occurrence of joint stiffness.
After the cast is removed, soaking in warm water and performing some simple joint exercises can aid in recovery.
As long as the fracture has healed sufficiently to bear weight, the child can begin to put weight on the affected leg.

Reply Date: 2006/07/07

More Info

Tibial fractures in children, particularly in young children like your nephew who is just 3 years and 6 months old, can be concerning for both the child and the caregivers. Understanding the healing process, rehabilitation, and potential complications is crucial for ensuring a smooth recovery.

Healing Time for Tibial Fractures
In general, the healing time for tibial fractures in children is relatively quick compared to adults. Typically, children’s bones heal faster due to their higher metabolic rate and the presence of growth plates. For a tibial fracture, you can expect the healing process to take approximately 6 to 8 weeks. However, this can vary based on several factors, including the child's age, the type of fracture, and how well the fracture is stabilized.

Rehabilitation and Physical Activity
After the initial healing period, rehabilitation becomes essential. Although the fracture may have healed, the surrounding muscles and joints may become stiff due to immobilization. This is particularly true for the ankle and knee joints, which are often affected when a tibial fracture is treated with a cast that immobilizes both the ankle and knee.

1. Rehabilitation: Once the doctor determines that the bone has healed sufficiently (usually after about 6 weeks), rehabilitation exercises should begin. These may include gentle range-of-motion exercises to prevent stiffness in the knee and ankle joints. Physical therapy can be beneficial in helping the child regain strength and mobility.

2. Gradual Return to Activity: The child should be encouraged to gradually return to normal activities. Initially, this may involve walking with assistance or using crutches. Full weight-bearing activities can typically resume around 8 to 12 weeks post-injury, depending on the healing progress and the doctor's recommendations.

Concerns About Joint Stiffness
One of the concerns with immobilization is the potential for joint stiffness, particularly in the ankle and knee. To mitigate this risk:
- Gentle Movement: Encourage gentle movement of the joints that are not immobilized, as tolerated. This can help maintain some level of flexibility.

- Physical Therapy: Once the cast is removed, a physical therapist can provide a tailored rehabilitation program to address any stiffness and strengthen the muscles around the joints.

Cast Removal and Activity Resumption
The cast is usually kept on for about 4 to 6 weeks, depending on the fracture's stability and the doctor's assessment. After the cast is removed, the child may initially experience some discomfort or weakness in the leg. It’s essential to follow the doctor's advice regarding when to start putting weight on the leg and resuming normal activities.

Conclusion
In summary, your nephew's tibial fracture should heal within 6 to 8 weeks, but rehabilitation will be crucial to ensure that he regains full function in his leg. Joint stiffness can occur due to immobilization, but with proper rehabilitation and gradual return to activity, he should recover well. Always consult with the treating physician for personalized advice and follow-up care to monitor the healing process and adjust rehabilitation as needed.

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