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What to know about a tibia fracture
The shinbone or tibia is the long bone located in the lower leg between the knee and foot. Tibial fractures are common and usually caused by an injury or repetitive strain on the bone.
A fracture is another word for a break. In some cases, the only symptom of a small fracture is a pain in the shin while walking. In more severe cases, the tibia bone may protrude through the skin.
The recovery and healing time for tibial fractures differs and depends on the type and severity of the fracture. Fractures can be treated by a medical professional, and at-home exercises can speed up a person’s recovery.
This article looks in detail at types of tibial fractures, along with the symptoms, treatment, and recovery times for a fractured tibia.
What is a tibia fracture?
According to the American Academy of Orthopedic Surgeons, the tibia is the most common long bone in the body to fracture. A tibia fracture refers to any crack or breaks in the tibia bone.
The tibia is one of two bones that make up the lower leg, the other being the fibula. The tibia is the larger of these two bones.
The tibia plays a key role in body mechanics, as it is:
- the larger of the two lower leg bones
- responsible for supporting most of the body weight
- vital for proper knee and ankle joint mechanics
A fractured tibia often occurs with other kinds of tissue damage to the nearby muscles or ligaments. It should always be checked out by a medical professional.
Types of tibia fracture
Depending on the cause of the broken bone, the severity and type of fracture may vary. It may be a transverse fracture, meaning the crack is horizontal across the bone, or oblique, meaning the crack is at an angle.
Proximal fractures are those that affect the upper part of the tibia. Tibia shaft fractures occur below this area.
The tibia can have the following types of fracture:
- Stable fracture. A stable fracture involves a crack in the bone that leaves most of the bone intact and in its normal position. The broken parts of the tibia line up and maintain their correct position during the healing process. This is called a non-displaced fracture.
- Displaced fracture. With a displaced fracture, a crack in the bone moves part of the bone so that it is no longer aligned. Surgery is often needed to correct this type of fracture and realign the bones back together.
- Stress fracture. Stress fractures, also called hairline fractures, are common overuse injuries. These fractures are small, thin cracks in the bone.
- Spiral fracture. When a twisting movement causes a break, there may be a spiral-shaped fracture of the bone.
- Comminuted fracture. When the bone fractures into three or more pieces, this is called a comminuted fracture.
Below is a 3-D model of a stable fracture of the tibia.
This model is fully interactive and can be explored with your mouse pad or touchscreen.
When bones are broken, they can either stay under the skin or break through its surface. Open fractures are fractures where a broken bone breaks through the skin. With closed fractures, the bone does not break the skin, though there may still be internal tissue damage.
Cause of tibia fractures
Long bones in the body are resilient, but there are many ways that a person can sustain a tibia fracture. These include:
- traumatic injuries, such as motor vehicle accidents or falls
- sports that involve repeated impact to the shinbones, such as long-distance running
- injuries from contact sports such as American football
- osteoporosis, which makes the bones weaker than usual
Symptoms of tibia fracture
Symptoms of a fractured tibia may include:
- localized pain in one area of the tibia or several areas if there are multiple fractures
- lower leg swelling
- difficulty or inability to stand, walk, or bear weight
- leg deformity or uneven leg length
- bruising or discoloration around the shinbone
- sensation changes in the foot
- bone protruding through the skin
- a tent-like appearance where the skin is being pushed up by the bone
Diagnosis of tibia fracture
To diagnose a fractured tibia, a doctor will ask about a person’s medical history and how the injury happened. They will do an examination and order diagnostic tests to assess the extent of the injury and whether the bone is fractured. This is important for determining the best course of treatment.
Diagnostic tests may include:
- an X-ray to have an image of the tibia
- a computed tomography (CT) scan, also called a CAT scan, which is more powerful than an X-ray and gives a 3-D image of the bone
- a magnetic resonance imaging (MRI) scan for a detailed image of the muscles, ligaments, and bones around the tibia
An MRI scan is often used if the other scans have not been able to diagnose the problem.
Treatment of a tibia fracture depends on several factors, including a person’s overall health at the time of the injury, the cause and severity of the injury, and the presence or extent of damage to the soft tissues that surround the tibia.
In severe cases, surgery may be necessary to make sure the bone heals properly. A surgeon may place metal screws and plates on the bone to hold it in the right place, allowing it to heal with minimal long-term damage.
The surgeon may also use rods placed inside the tibia or pins placed through the bones above and below the fracture. They will attach these to a rigid frame called an external fixator to hold the bone in place.
Where surgery is not necessary or is not possible, for instance, due to a person’s health, a doctor may use the following treatments for a fractured tibia:
- A splint or cast to hold the bone in place, stop it from moving and allow it to heal. A splint can be removed easily and so it is a more flexible treatment option than surgical ones.
- A traction or functional brace, which is used in cases of less severe breaks to hold the bone in place while it heals.
In many cases, a person with a tibial fracture will require physical therapy and crutches or a walker to help them get back on their feet.
Recovery from a tibial fracture varies based on the severity of the fracture.
A person will often recover within 4 to 6 months. Recovery time may be longer for a complete break compared to a partial one and may take longer if a person has poor health for other reasons.
It may take longer than this time frame for a person to be able to return to their normal activities. People should always follow their doctor’s recommendations about returning to walking, exercising, and other physical activity after a leg fracture.
Certain exercises can help to take the pressure off the tibia bone, such as exercises that strengthen the hips, calves, and thighs. This protection may also prevent future injuries from happening.
Complications of a tibia fracture may include:
- complications from surgery or the need for further surgeries
- nerve, muscle, or blood vessel damage
- compartment syndrome, a serious condition which there is a reduction in blood supply to the leg due to swelling
- a bone infection called osteomyelitis
- development of a non-union where the bone does not heal
In many cases, a tibial fracture will be successfully managed without complication.
Fractures of the tibia or shinbone are common and can be caused by many types of situations. They can occur anywhere along the bone and include many variations in fracture type.
Fractures can be minor and take a short time to heal or more serious and require extensive surgery and healing times.
The long-term outlook for a tibia tib fib surgery is usually good but depends on the severity of the injury and other health-related factors. Doctors will be able to provide a person with a long-term outlook during the evaluation and healing process as their leg recovers.
Most children with fibular hemimelia (FIB-yoo-luhr heh-me-MEEL-yuh) have it in one leg, but some have it in both. Experts who treat bone problems have several options to help kids with a hemimelia.
What Are the Signs & Symptoms of Fibular Hemimelia?
Here are some of the things that parents might see when a baby is born with hemimelia:
- When all or some of the bone is missing in one leg, the leg is shorter than the other. Doctors call this a leg length discrepancy.
- Because the shinbone is short or missing, the ankle joint may not form as it should. The ankle and foot might look different from normal.
- The child's knee and lower leg might bend inward.
- The child's lower leg may bow out.
- The foot may not have all five toes.
A baby with hemimelia can have problems that parents won't see. Doctors can find these through physical exams and tests:
- The hip joint may be too shallow.
- Some of the ligaments (strong, flexible bands of tissue) that hold the knee together may be weak or missing.
What Causes Fibular Hemimelia?
Scientists and doctors don't know exactly why babies are born with fibular commbank bpay number. But they do know that nothing a mom does during pregnancy causes the problem. Parents can't stop it from happening, but they can help kids get the best care.
How Is Fibular Hemimelia Diagnosed?
Often, doctors know that a fibula is short or missing before a baby is born. That's because prenatal (before birth) ultrasound scans show the baby's bones as they form and grow.
If a mom didn't get a scan while pregnant, doctors will see the fibular hemimelia when the baby is born. They may order these tests to learn more:
- X-rays will show what the bones and joints look like.
- MRIs will let doctors see ligaments and other soft tissue in the foot and joints.
How Is Fibular Hemimelia Treated?
Treatment depends on how the child is affected. Some children with fibular hemimelia have very mild limb length difference and need very little treatment. Others have a large limb length difference and unstable joints.
When a child has fibular hemimelia, the leg may not grow as fast or as long as it should. Kids might have trouble standing or walking. Getting the right treatment is important.
Different experts work as a team to treat fibular hemimelia. The team is led by specialists (doctors and other health care providers who treat bone and muscle problems). They work with other specialists as needed. Your child's team also might include physical therapists and an .
The care team will come up with a plan to help your child stand, walk, and play like other kids. The plan is based on:
- how much bone is missing
- how much difference there is in the length of the legs
- how the problem might affect your child as he or she grows
- whether your child has foot or ankle problems
You might need to bring your child for a series of visits over several months before the care team decides on treatment. This gives the team time to understand how your child will grow and what the difference in leg length might be.
When there isn't a lot of difference in leg length, a child might wear a special shoe or shoe insert. But most kids need surgery.
What Surgeries Can Treat Fibular Hemimelia?
Doctors do different surgeries depending on a child's situation. Most kids get surgery to help their legs grow to the same length. Others need surgery to stand and walk. Some kids only need one surgery. Others have several surgeries during their growing years.
When kids have small differences in leg length, the care team might suggest a surgery called epiphysiodesis (eh-pih-fiz-ee-AH-deh-sis). For this surgery to work, kids must still be growing.
During the surgery, one or two of the growth plates in the longer leg are scraped or compressed with surgical plate and screws. A growth plate is an area at the end of the bone where new growth happens. The surgery slows or stops the longer leg from growing so the shorter leg can catch up.
Kids who get leg-lengthening surgery usually need a few operations over several years. The surgery can add about 8 inches (20 centimeters) to the shorter leg.
In this surgery, the orthopedic team places a lengthening device on the shorter leg. The device might be on the outside of the body or inside the bone.
Besides surgery to fix leg length differences, some kids need surgery to help them stand and walk. These surgeries repair bones, muscles, and joints that didn't form correctly because of the hemimelia.
Treatment for Severe Fibular Hemimelia
Sometimes orthopedic experts know that surgery won't help a child to stand or walk properly. A child might have one leg that is a lot shorter than the other or a foot problem that can't be fixed. For these kids, a offers the best chance to live an active life.
Doctors might amputate (do surgery to remove) part of the foot or leg so the child can wear a prosthesis. Orthotists then fit the child with a prosthetic lower leg.
New prosthetics let kids who have had an amputation run, climb, and jump like other kids. Most kids can play sports.
Kids who wear prosthetic legs need to see an orthotist at least once a year. The orthotist will adjust the prosthesis or make a new one as the child grows.
How Can Parents Help?
Helping children with fibular hemimelia reach their full potential takes many years. Kids need medical care until they are done growing. Because of this, doctors want parents to play a big role in treatment.
Here are things you can do:
- Talk to your child's care team about treatment and healing. Ask questions. Find out what each surgery is for and how to care for your child after them.
- Take your child to all medical visits. Some surgeries need to be done at the right time in the child's growth. Missing that time may mean kids can't get the surgery or it won't work as well.
- If your child is old enough, talk about treatments and what to expect. Include older kids in surgery decisions when you can. Doctors can often schedule a surgery so it doesn't interfere with an activity a child wants to do.
"What was exciting about our project was that all the mechanical analysis was done blinded to the clinical treatment of the patients, and the surgeon never saw any of our data," says Hannah Dailey, an assistant professor of mechanical engineering and mechanics at Lehigh University's P.C. Rossin School of Engineering and Applied Science. "When we put it all together, we were able to answer the question, 'Can the virtual mechanical test predict how long it will take the patient to heal?' We found that it could."
Dailey, who is also affiliated with Lehigh's Institute for Functional Materials and Devices (I-FMD), is the lead author of "Virtual Mechanical Testing Based On Low-Dose Computed Tomography Scans for Tibial Fracture." The paper appeared in the July 3 issue of the Journal of Bone and Joint Surgery.
Most people who break their tibia, or shin bone, proceed along a normal healing timeline. As the weeks go by, more and more new bone called callus forms along the fracture line. Callus starts out as a spongy material that over time hardens into bone that is just as strong -- or stronger -- than it was before the break. Patients typically come in for X-rays at regular intervals, and as long as the images reveal there's increasingly more callus in the region, all is well.
But some people don't heal normally. This failure to heal is called a nonunion, and it can be utterly debilitating.
"Musculoskeletal injuries are very, very painful," says Dailey. "And when a bone isn't healing properly, patients can be in pain for weeks or months."
Ideally, she says, surgeons would re-operate early on a patient with a nonunion. But differentiating between a true nonunion -- where no new bone is forming at all -- and a bone that is healing -- just very slowly -- is difficult. And that difference is critical. If it's the former, a second surgery is imperative. If it's the latter, it may be better for the patient to wait and avoid the risk and expense of another operation.
Pinpointing that crucial difference between who needs additional surgery and who does not is difficult because surgeons typically rely on X-rays to determine the extent of bone healing. X-rays, however, are two-dimensional, often fuzzy, and can reveal an incomplete picture.
"Our approach was, 'Can we measure healing in a structural way, and put a number on how healed a bone is?'" says Dailey. "Instead of using X-rays to determine, 'Yes, healed,' or 'No, not healed,' can we be more accurate? By using engineering tools, the answer was, yes. We could."
In this study, adults with tibial shaft fractures were prospectively recruited for observation following standard reamed intramedullary nailing, a procedure in which a titanium rod is inserted in the hollow space of the tibia and secured at the top and bottom with screws. The screws allow the patient to bear weight soon after surgery by keeping the upper bone fragment from collapsing onto the lower bone fragment.
Patient follow-up included radiographs and completion of patient-reported outcome measures, all performed at 6, 12, 18, and 24 weeks post-surgery. Low-dose computed tomography (CT) scans were done at 12 weeks. These scans provided a detailed, three-dimensional picture of what was going on inside each patient.
Using specialized, commercially available software on the scans, Dailey's PhD student and study co-author, Peter Schwarzenberg, built 3-D mechanical structural models that identified the regions of bone and new bone, or callus. Schwarzenberg then ran the models through finite element analysis software -- the same program used by civil engineers to simulate how much deformation happens to a bridge when a load (like cars or pedestrians) is applied to it. Schwarzenberg and Dailey wanted to do the same thing for bones -- apply a force and see how much the bone flexed. The less it flexed, the more healed it was.
Schwarzenberg used the finite element software to divide each bone model into tiny zones called tetrahedra that all have a mathematical relationship to each other. He and Dailey then simulated fixing the bottom of the bone so it couldn't move and putting a load on the top of the bone in the form of a one-degree rotational twist. The technique is called a virtual torsion test.
"So we know what's happening to the tetrahedra at the edges of the bone," says Schwarzenberg. "But finite element analysis allows you to calculate what is happening at the neighbors of those tetrahedra and then the neighbors of those tetrahedra, and it calculates all the way through until you've evaluated every piece inside the bone."
Those calculations revealed how much the bone flexed when it was twisted.
"You want to do one test you can apply to everybody, and a twist is a standard one," says Dailey. "It comes from the history of animal experimentation. We had a pretty good idea about what happens in the bones of animals at 12 weeks, but before we did this, nobody knew how much structural healing has taken place in humans at 12 weeks."
The pair then used the CT scans to digitally re-create a healthy version of each person's leg. Schwarzenberg performed the same virtual torsion test on that healthy model then measured the flex of the unbroken leg against the fractured leg. The resulting percentage helped them determine how stiff the broken bone was compared with the healthy bone. The stiffer a bone was early in the healing process, the quicker the patient could bear weight.
Schwarzenberg and Dailey found that their results from the virtual mechanical test significantly correlated with how long it took each patient to heal. It also clearly identified the single instance of a nonunion.
Dailey says the goal is to produce a diagnostic test that can help surgeons determine if an additional operation is necessary. It could also potentially help doctors determine when it's safe for patients to bear weight, and it could help measure the effectiveness of devices like bone growth stimulators that might be alternatives to surgery in some nonunion cases.
Dailey and her team acknowledge one flaw in their experimental design: how they're currently characterizing the callus.
"There's a lot of data for the mechanical properties of bone," says Schwarzenberg. "It's impossible to get cadaver bones with callus because callus disappears when a broken bone is fully healed. Bone is this organized, hard structure, and callus is almost like cartilage. It remodels into bone, but at the time points we're looking at, we don't expect the callus to have the same underlying structure as bone. We think we're making it too strong because we're using a model that was developed from bone."
Schwarzenberg is currently trying to fill that knowledge gap at the Tib fib surgery Research Unit at the University of Zurich, as part of the International Education's Graduate International Research Experiences program (IIE-GIRE). During his six-month fellowship, he is combining the virtual technique with an optimization algorithm to measure the mechanical properties of callus.
To be able to answer the question of whether a bone is healing and when it may be capable of bearing weight is revolutionary, says Dailey.
"These advanced modeling and simulation techniques are providing the opportunity to answer fundamental questions like, 'What are the mechanical properties of newly formed bone?' Questions that, believe it or not, haven't been addressed before. Because it's not like you can take a person, cut out a uniform piece of material, then put it in a machine and test it," she says. "That's impossible. But now we can do that in a virtual way."
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Materials provided by Lehigh University. Note: Content may be edited for style and length.
- Hannah Tib fib surgery. Dailey, Peter Schwarzenberg, Charles J. Daly, Sinéad A.M. Boran, Michael M. Maher, James A. Harty. Virtual Mechanical Testing Based on Low-Dose Computed Tomography Scans for Tibial Fracture. The Journal of Bone and Joint Surgery, 2019; 101 (13): 1193 DOI: 10.2106/JBJS.18.01139
Cite This Page:
Lehigh University. "Knowing when patients with tibial fractures can bear weight." ScienceDaily. ScienceDaily, 10 September 2019. <www.sciencedaily.com/releases/2019/09/190910134333.htm>.
Lehigh University. (2019, September 10). Knowing when patients with tibial fractures can bear weight. ScienceDaily. Retrieved December 4, 2021 from www.sciencedaily.com/releases/2019/09/190910134333.htm
Lehigh University. "Knowing when patients with tibial fractures can bear weight." ScienceDaily. www.sciencedaily.com/releases/2019/09/190910134333.htm (accessed December 4, 2021).
3 Common Types of Fibula Fractures
A fibula fracture occurs when there is an injury to the smaller of the two bones of the lower leg (the segment between the knee and ankle), the fibula.
The larger bone of the lower leg, the tibia, carries most of the body weight. The smaller bone, the fibula, is located on the outside of the leg.
The fibular bone starts just below the knee joint on the outside of the leg and extends all the way down to the ankle joint. The bone is a long, thin bone.
While the bone does little to support the weight of the body, it is a critical site of attachment for ligaments at both the knee and the ankle joint and is also connected to the tibia bone by a thick ligament called the syndesmosis.
While the fibula is an important bone, it is possible to excise some of the bone for surgical procedures where bone is needed elsewhere in the body. When these grafting procedures are performed, people are able to function very normally, despite missing a large part of the fibula bone.
Types of Fibula Fractures
There are a number of different types of injury to the fibula bone:
- Fibula fractures that result from injury to the ankle joint
- Fibula fractures that occur in conjunction with tibia fractures
- Stress fractures of the fibula
These are not the only types of injury that can occur to the fibula but account for the vast majority of injury to the fibula bone. By far the most common are injuries that occur when the ankle joint is damaged. Typically, the ankle buckles or is twisted and the fibula is damaged as part of the injury.
As mentioned, fibula fractures can occur in association with injuries to other bones, ligaments, and tendons around the knee and ankle.
The most common symptoms associated with the fibula fracture include:
- Pain directly over the fibula bone (outside of the leg)
- Swelling in the area of the fracture
- Bruising over the site of the injury
Diagnosis of a fibular fracture can typically be made with an X-ray image. Other imaging studies such as magnetic resonance imaging (MRI) or computerized tomography (CT) scan are typically not necessary, but there are some situations where a fibular fracture may not show up on a regular X-ray.
These situations include injuries such as stress fractures (described below). Your healthcare provider will examine the site of the injury, and also examine the knee and the ankle joints for associated injuries which may impact the treatment of the fibular fracture.
Signs You Might Have a Fracture and What to Do
Fibula fractures typically occur as part of an ankle injury. Whenever a fibula fracture is found, the ankle joint should also be examined for possible injury.
The most common type of fracture to occur to the fibula bone is an isolated injury to the end of the fibula bone at the level of the ankle joint. These injuries occur in a similar manner to a badly sprained ankle. Often the injury can be treated similarly to a badly sprained ankle.
Ankle-Level Fibula Fracture Without Other Ankle Injury
Isolated fibular fractures, when the tib fib surgery joint is unaffected, often can be treated with simple protection. Known as a lateral malleolus fracture, these injuries occur when the ankle twists or bends awkwardly and the inner (medial) side of the ankle is unaffected.
In these situations, a brace is sufficient to support the ankle. Crutches are often used for a few days or weeks to allow swelling and pain to subside. Once the pain has lessened, patients begin rehabilitation to resume mobility exercises, strengthening, and walking.
Fibula Fracture With Associated Ankle Injury
Fibula fractures that are associated with injury to the inner side of the ankle, the medial malleolus, or deltoid ligament, often require more aggressive treatment.
In these situations, called bimalleolar ankle fractures, surgery is usually necessary to stabilize the ankle joint. Without surgery, the ankle joint often heals in abnormal alignment, leading to the development of ankle arthritis.
Another type of injury that can occur with a fibular fracture is damage to the syndesmosis of the ankle. The syndesmosis is the group of ligaments that hold the two bones of the leg together, just above the ankle joint.
When the syndesmosis is damaged at the ankle, an injury that can occur along with a fibula fracture, surgery is often required to restore the alignment of the bones.
Fibular fractures with ankle injuries will usually require surgery to correct.
Fibula and Tibial Shaft Fractures
Severe injuries resulting from car crashes, sports injuries, or falls may lead to an injury of both the tibia and the fibula above the ankle joint. These injuries, often referred to as "tib-fib" fractures, typically require surgery to support the alignment of the leg.
When the tibia is surgically repaired, the fibula does not normally require a separate surgery to align this bone. In some tib-fib fractures, a long-leg cast (thigh to foot) will provide necessary support without requiring the surgery.
Stress Fractures of the Fibula
In some people, particularly long-distance runners or hikers, the fibula may be injured as a result of repetitive stress. This type of injury is known as a stress fracture. The pain of a stress fracture may begin gradually. Usually, the pain worsens with increasing levels of activity and is relieved by rest.
Stress Fracture: Causes, Treatment, Prevention
How a fibula fracture is treated depends on a number of factors, including where the fracture is located and if other injuries have occurred in association with the fracture.
Surgery may be recommended, but usually a splint or cast is given to help prevent movement and allow the bone to heal. If possible, your healthcare provider can realign your broken bones without open surgery as well.
While isolated fibula fractures usually heal quickly, some may involve more complex injuries that require further treatment. That's why it's critical for a medical professional familiar with the treatment of fibula fractures to evaluate your injury and ensure that appropriate treatment is recommended.
Because only a small amount of body weight is transmitted through the fibula (most weight is transmitted through the larger tibia bone) many types of fibula fractures can be tib fib surgery nonsurgically. However, as described, fibula fractures that occur in association with other fractures or ligament injuries often do require more invasive treatment.
How Does It Feel When a Broken Bone is Healing?
Surgery on the Fibula
The most common way to repair a fractured fibula bone is with a metal plate and screws. Typically a plate is applied to the outside of the bone, with several screws above the location of the fracture, and several screws below. Sometimes other techniques are used when repairing a fracture of the fibula, depending on its type and location.
When reviewing an operative report from the time of surgery, your surgeon will dictate the method in which they repaired the broken fibula, as well as any other treatment needed. The diagnosis of a fibula fracture is recorded as ICD-10 code S82. Any modifying codes can designate fracture side, mechanism, and other characteristics.
Common complications associated with surgery for treatment of a fibula fracture can be related to the incision and the underlying hardware. Because there is very little soft tissue between the skin and the bone, problems related to wound healing, infection, and painful hardware are common surgical complications.
Wound healing complications are most worrisome in people who have underlying conditions such as diabetes which may inhibit wound healing. Smokers are also at increased risk of wound complications.
Infection can occur after any surgical procedure, but is most common in people who have conditions that may impair immune defenses.
Lastly, pain associated with implanted hardware is not uncommon. Some people may choose to have surgical plates and screws removed after the fracture has healed.
Other types of complications, including slow healing and development of arthritis, are also possible depending on your type of injury.
Can Cigarettes Affect Your Bones?
A Word From Verywell
Have an open conversation with your healthcare provider about the best solution for your fracture. You may be nervous if more invasive treatments are required. Ask if they're truly the best option and confirm that alternatives would not be helpful. Remember that ultimately, the procedure is meant to heal your injured fibula.
Once healed, make sure to ask your healthcare provider for prevention and safety tips to reduce your risk of further injury, particularly if your injury resulted from an activity. It may be frustrating to wait until you're better to continue doing what you love, but it's well worth it.
In general, you can reduce your risk of a fibula fracture by working to maintain your bone mass. Some factors such as age and gender are out of your control, but others tib fib surgery as quitting smoking and practicing sports safety can help.
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