Broken Tibia/Fibula (Shin bone/Calf)

  • Overview

    Pediatric tibia/fibula fractures

    Boston Children's Hospital can provide expert diagnosis, treatment and care for fractured tibias/fibulas in children.

    What is a fractured tibia/fibula?

    The tibia and fibula are two bones in the lower leg. The tibia forms the shin and the fibula forms the calf. Although the tibia and fibula can break (fracture) independently from each other, it is more common for the two bones to break together (this is called a combined tibia/fibula fracture) because they are so close together, especially around the knee and ankle joints. When one bone is injured, it usually affects the other bone too.

    The symptoms of a fractured tibia/fibula are serious and need immediate medical attention. With the proper treatment, fractured tibias/fibulas in children can heal completely.

    Broken tibia/fibula: Reviewed by Travis H. Matheney, MD, MLA
    © Boston Children’s Hospital, 2012

    Boston Children's Hospital
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  • In-Depth

    What are the tibia and fibula bones?

    The tibia and fibula are the two long bones in the lower leg. They are closely linked at the knee and ankle, but they are two separate bones.


    • The tibia is the bone that forms the shin and is the larger of the two lower-leg bones.
    • The top of the tibia connects to the knee joint and the bottom of the tibia connects to the ankle joint.
    • Although this bone carries all the body’s weight, it needs support from the fibula.


    • The fibula forms the calf bone. It is the smaller bone of the two lower-leg bones and runs parallel to the tibia. 
    • The top end of the fibula is located below the knee joint, but is not part of the joint itself. The lower end of the fibula forms the outer part of the ankle joint (it can usually be seen as the bony lump on the outside of the ankle).
    • The fibula doesn’t carry much weight, but instead acts as a stabilizer for the tibia.

    Learn more about the different types of fractures in children.


    What causes a tibia/fibula fracture in children?

    Fractures happen when there’s more force applied to the bone than it can withstand.

    • A lower-leg fracture usually happens due to a “high-energy” force from falls, trauma or a direct blow. These are often caused by motor vehicle crashes or by direct contact or sudden twisting in sports.
    • Whenever there is a trauma to the leg, the impact spreads between the tibia and fibula. Because both bones absorb the blow, the impact usually results in a combined tibia /fibula fracture. 
    • A stress (hairline) fracture may also occur in the fibula, although it is far less common than stress fractures to the tibia, which is a weight-bearing bone. Stress fractures in the tibia/fibula are likely to be caused by repetitive motion, as in running, ballet, baseball and basketball.

    Certain risk factors may also increase a child’s chances of getting a broken tibia/fibula.

    Signs and symptoms

    What are the symptoms of a tibia/fibula fracture in children?

    Generally, a tibia/fibula fracture is associated with:

    • Pain or swelling in the lower leg area
    • An obvious deformity or uneven leg lengths
    • Inability to stand or walk (more likely with tibia; less likely if only the fibula is broken)
    • Limited range of motion in the knee or ankle area
    • Bruising or discoloration (may indicate damage to blood vessels)
  • Tests

    How are tibia/fibula fractures in children diagnosed?

    To make a broken tibia/fibula diagnosis, your child’s doctor will physically examine the injured area to check for swelling and tenderness. Imaging tests take pictures of the fracture and can reveal damage to muscles or blood vessels.


    An x-ray of the lower leg is the main diagnostic tool for a tibia/fibula fracture. It is a painless test that uses small amounts of radiation to produce images of the child’s bones (including the tibia and fibula) and soft tissue.

    After the doctor puts the pieces of the broken bone in the right position, an x-ray of the tibia/fibula can also help determine whether the bones are in proper alignment and whether they are healing correctly.

    Other diagnostic tools include:

    • Magnetic resonance imaging(MRI): a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
    • Computed tomography scan (CT, CAT scan): a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.
    • Bone scan: a noninvasive imaging technique that uses a radioactive substance to visualize the bones. The image is different from a plain x-ray or CT in that it shows bone metabolism and cell activity in the bones. It is also useful for detecting stress fractures and toddler’s fractures, which can be hard to see on an x-ray.
  • The treatments for broken tibia/fibula in children depend on the location, complexity and severity of your child's break—as well as age and overall health.

    What is the treatment for pediatric tibia/fibula fractures?

    Fractures of the fibula are usually placed in a lower leg and ankle cast for six to eight weeks to immobilize the bone.

    • Your child may also be advised not to bear any weight on the leg so the bone can heal properly; crutches may be provided in this case.
    • Surgery may be needed to put broken bones back into place.
    • In severe or complicated fractures, a surgeon may insert metal rods or pins into the bone (internal fixation) or outside the body (external fixation) to hold bone fragments in place to allow for alignment and to help the bone heal.
    • For children who are older than 5 but don't yet have mature “adult” bones, the surgeon can perform a minimally invasive technique in which flexible nails are inserted into the bone through small incisions in the skin. These flexible nails realign the bone and hold it in place, while still allowing growth and natural remodeling. This allows the child to begin walking right away.
    • In adolescence through adulthood, a rigid nail may be inserted. This also allows the patient to walk immediately.
    • Both flexible and rigid nails can either remain in place permanently or be removed.
    • Physical therapy may be needed to strengthen the leg, restore gait and range of motion and help it return to full function after treatment and/or casting.

    How long after treatment will it take for my child to heal?

    Every situation is different, and children heal relatively fast. In general, recovery for a tibia/fibula fracture takes about three to six months while stress fractures usually take six to eight weeks.

    The healing time can be quicker by taking the right steps. Rest is crucial, and it's important to make sure that your child doesn't overstress (overload) the site of the fracture until the bone's strength is fully restored, which can take up to a year. A cast for the tibia/fibula fracture also helps to speed healing. Overall, a tibia and fibula fracture can definitely be handled through proper care, casts and medicines.

  • Research & Innovation

    Orthopedic basic science laboratories

    Some of the leading musculoskeletal researchers in the nation are working in the basic science laboratories at Boston Children's Hospital.  

    The orthopedic labs include:

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