Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background:
Overview
what it is and why it matters"Knee and lower leg fracture" covers breaks in the bones at and just below the knee. The kneecap (patella) sits at the front of the knee. The top of the shin bone, called the tibial plateau, forms the lower half of the knee joint. Below that, the long shaft of the shin bone runs down toward the ankle. Just above the knee is the lower end of the thigh bone (the distal femur). A break in any of these is treated differently, so the first job is to find out which bone is hurt and how far the pieces have moved.
Some of these breaks heal in a cast or brace. Others need surgery to line the bone back up and hold it. What decides is straightforward: how far the pieces have shifted, whether the break runs into the knee joint surface, and whether the leg can still carry weight in good alignment. Your provider sorts that out with an exam and X-rays.
A few of these injuries are urgent. A bone that has come through the skin, a leg that looks crooked or cannot bear any weight, or a cold or numb foot all need to be seen the same day.
Breaks in this area
the bones at and below the kneeWhat It Feels Like
how the injury shows upMost knee and lower leg fractures cause sharp pain right away, fast swelling, and trouble putting weight on the leg. A kneecap fracture often makes it hard or impossible to straighten the knee or lift the leg while keeping it straight. A break into the knee joint, like a tibial plateau fracture, swells quickly. A shaft fracture can leave the leg looking bent or shortened. Bruising spreads over the hours that follow.
Some signs raise the urgency. Bone pushing on or through the skin, a leg that will not bear any weight or looks deformed, and a cold or numb foot all need to be seen the same day. Severe, tight, worsening pain and swelling in the calf after a shin fracture can mean pressure is building in the muscle (compartment syndrome), which is an emergency.
How We Make the Diagnosis
exam first, then the right picturesYour provider checks the whole leg: where it hurts, whether you can straighten and lift it, and whether the nerves and blood flow to the foot are normal. X-rays come next and show most fractures and how far the pieces have moved. When a break runs into the knee joint surface, as many tibial plateau and some distal femur fractures do, a CT scan is added to map the pieces before planning treatment.
How We Treat It
a cast or brace when the bone is stable, surgery when it is notThe plan depends on which bone is broken and how far it has shifted, but the idea is the same. Hold the bone in good position while it heals, keep the knee from stiffening, and check the alignment with repeat X-rays.
Bracing or casting
Stable breaks that are still lined up can heal in a cast or a hinged brace. A kneecap fracture that has not pulled apart, or a shin fracture in good position, often falls in this group.
Protected weight-bearing
Your surgeon sets how much weight the leg can take and when. Many of these fractures start with little or no weight on the leg and build up over weeks as the bone heals.
Early knee motion
The knee stiffens fast after an injury. Gentle, guided motion is started as soon as it is safe, on a timeline your surgeon sets, so the bone heals without leaving you with a stiff knee.
Repeat X-rays
X-rays at intervals confirm the position is holding. If the pieces shift, the plan can change toward surgery.
When Surgery Is Considered
the breaks that need fixingSurgery is offered when the bone will not heal in an alignment you can use. That includes kneecap fractures where the pieces have pulled apart or you cannot straighten the knee, breaks that step into the knee joint surface, shin shaft fractures that are out of line, and most distal femur fractures that have shifted. The goal is to line the bone up, hold it with a plate, screws, or a rod, and get the knee moving early.
If non-operative care is not enough, these procedures are offered by the OSI team for fractures in this area:
Frequently Asked
questions we hear in clinicWill I need surgery?
Not always. Stable breaks that are still lined up can heal in a cast or brace. Surgery is offered when the pieces have shifted, when the break runs into the knee joint surface, or when you cannot straighten the knee, as with a separated kneecap fracture.
How long until I can put weight on it?
Your surgeon sets that based on the bone and the repair. Many knee and lower leg fractures start with little or no weight on the leg and build up over several weeks as the bone heals and X-rays confirm it is holding.
Why start moving the knee so early?
The knee stiffens quickly after an injury or surgery. Gentle, guided motion started early, on a timeline your surgeon sets, helps the bone heal without leaving you with a stiff knee.
When is a leg fracture an emergency?
Bone pushing on or through the skin, a leg that will not bear any weight or looks deformed, a cold or numb foot, or severe and worsening tightness and swelling in the calf all need to be seen the same day.