Dr. Richard Cunningham of Vail-Summit Orthopaedics & Neurosurgery (VSON) is a leading expert in orthopedic trauma, treating skiers and athletes who suffer lower leg injuries on the slopes. One of the most common and serious ski-related injuries is a tib fib fracture—a break in the tibia and fibula, the two bones of the lower leg. Understanding what causes this injury, recognizing the symptoms, and exploring treatment options can help patients navigate the injury recovery process with confidence.

What Is a Tib/Fib Fracture?

A tib fib fracture occurs when both the tibia (shinbone) and fibula (the smaller bone next to it) break due to high energy trauma. This injury is particularly common among skiers because of the forces involved in falls, collisions, and twisting movements. A broken lower leg can range from a simple, clean break to a more severe, complex, multi-part fracture, and at times fractures can be “open” where the bones have broken through the skin.

Dr. Cunningham explains, “Skiing places significant torsional stresses on the lower leg, and a bad fall or awkward landing can result in a tib-fib fracture. Appropriate treatment is crucial for optimal healing and a full return to activity.”

What Causes a Tib/Fib Fracture in Skiers?

Skiing-related tib-fib fractures often result from:

• Twisting Injuries: When a skier catches an edge or lands awkwardly after a jump, the rotational force can exceed the bone’s strength, causing a fracture of the lower leg.
• Direct Impact: Collisions with other skiers, trees, or obstacles can generate enough force to break both the tibia and fibula.
• Ski Bindings Not Releasing: If ski bindings fail to release properly, the lower leg can be subjected to extreme torque, increasing the risk of a tib fib fracture.

Dr. Cunningham stresses the importance of proper equipment and correctly adjusted bindings, to help reduce the likelihood of injury.

Symptoms of a Broken Tib/Fib

The symptoms of a broken lower leg can vary depending on the severity of the fracture but commonly include:

• Immediate, severe pain in the lower leg
• An inability to bear weight
• Swelling and bruising around the injury site
• Deformity or an obvious misalignment of the leg
• Numbness or tingling in the foot, which could indicate nerve involvement

If you suspect a tib-fib fracture, it becomes immediately apparent that you need to seek immediate medical attention. Prompt treatment is critical to preventing complications and ensuring a smooth recovery after a tib-fib fracture.

Treatment Options for Tib/Fib Fractures

The treatment approach for a tib fib fracture depends on the type and severity of the break. Common treatment methods include:

Non-Surgical Treatment

If you fracture just your fibula and not your tibia, you may be able to treat this non-surgically by wearing a cast boot and using crutches. However, there is a high incidence of syndesmotic injury or injury to the ligaments that join the tibia and the fibula. If there is an associated syndesmotic injury in addition to a fibula fracture, then surgery is required for the best outcome.

Surgical Treatment

The vast majority of tib-fib fractures are best treated with surgery. In the old days, patients would be put in a cast, and patients would heal with a limb length inquality or with angular or rotational deformity. Surgery is usually always necessary as then the broken tibia can be properly aligned so that it and the adjoining fibula can heal out to length and without rotational or angular deformity. Common surgical interventions include:

• Intramedullary Nailing: This is used for fractures in the mid portion of the tibia. A metal rod is inserted down into the center of the tibia. Screws are placed through the bone and then through the rod at the top and the bottom to prevent the fracture from rotating. This surgery can be done with several very small incisions so as not to further injure the already traumatized soft tissues at the fracture site. In simple fracture patterns, the patient can even start weight bearing immediately.
• Plates and Screws: These may be used to hold the bones in proper alignment. Orthopedists tend to use plates and screws for fractures at the top end or the bottom end of the tibia where the fracture involves the knee or ankle joint. The surgeon opens the fractures (makes an incision in the skin and dissects down to the fracture), reduces the fracture (puts the pieces back together) and then fixates the fracture (places a plate that spans the fracture and inserts screws through the plate and into the bone) in order to hold all the fragments in the proper position.
• External Fixation: In some cases, an external frame is used temporarily to stabilize the fracture. This is usually used for very complex and/or open fractures. With this, small pins are inserted through the skin and into the bone and the pins are connected to a frame that spans the fracture. Some call it an “erector set.” This Ex-Fix is used to temporarily stabilize severe fractures, often for just 7-10 days until the swelling comes down. Following it’s removal, the fracture then undergoes definitive fixation with one of the methods mentioned above.

“Surgical intervention significantly improves the outcomes of tib-fib fractures by allowing for proper alignment and stability so the fracture can heal uneventfully,” Dr. Cunningham notes.

Recovery and Rehabilitation

A full broken tib fib recovery can take several months, depending on the severity of the injury and the treatment approach. Key aspects of recovery include:

• Weight-Bearing Progression: Initially, patients need crutches or a walker, with gradual weight-bearing as healing progresses.
• Physical Therapy: Rehabilitation focuses on restoring range of motion to the knee and ankle followed by strengthening.
• Return to Activity: Most skiers can expect to return to the slopes within 6-12 months, depending on the extent of the fracture and recovery progress.

Expert Orthopedic Care for Ski Injuries

Suffering a tib-fib fracture can be a challenging experience, but with expert care and a dedicated rehabilitation plan, a full recovery is possible. Dr. Cunningham and his team at Vail-Summit Orthopaedics & Neurosurgery provide comprehensive treatment and personalized recovery plans to help patients regain their full function and return to their active lifestyles.

If you’ve experienced a broken lower leg or need guidance on tib-fib fracture recovery, schedule a consultation with Dr. Cunningham to explore the best treatment options for your injury.