Why is there a gap in the tibia even after surgery?

Question

Hi doctor,

I am 24 years old. It has been 13 months since surgery. I have a rod and 5 screws in my broken tibia. But there is still a gap in the tibia bone. The main purpose of asking this question is that I want to play professional cricket.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and I understand your concern.

Thanks for sharing the X-ray. I understand your concern, especially given your goal to return to professional-level cricket. Here is a detailed look at the situation based on the image and your history:

Implants: Intramedullary rod with five locking screws. There appears to be a visible gap at the fracture site, indicating incomplete bone union or delayed union. Some periosteal reaction is seen, but the bridging callus across the fracture appears inadequate. The alignment looks acceptable; no major angulation or rotation is evident. My main concern for you is delayed union or nonunion. A fracture that has not united after six to nine months is considered a delayed union; beyond nine months with no signs of healing is often considered a nonunion.
Load-bearing stress: High-impact activities like sprinting, bowling, and pivoting can lead to rod or screw fatigue or even re-fracture if the bone has not fully healed.

Based on the current X-ray and time since surgery, you cannot play cricket. You are at high risk for implant failure, re-fracture, chronic pain, or complications with high-impact activity.

What to do now:

1. See your orthopaedic surgeon: You may need a CT (computed tomography) scan to evaluate if any bridging bone is forming. Check for signs of infection, bone health, and implant stability.

2. Consider bone stimulation or bone grafting: Options include electrical or ultrasound bone stimulators, bone grafting, and biologicals like BMPs (bone morphogenetic proteins).

3. Lab work-up: Vitamin D, calcium, parathyroid hormone, and other nutritional deficiencies should be ruled out.

4. Physiotherapy: Continue non-impact strengthening exercises and maintain joint mobility.

When can you play again?

If bone healing improves with further management, and imaging confirms solid union, light training may begin three to six months after confirmed healing. Full return to cricket (batting, bowling, running) can be expected six to 12 months after bone union. In short, you have a delayed union of your tibial fracture. Avoid high-impact sports like cricket until bone healing is confirmed. Consult your orthopaedic surgeon for advanced imaging and possible intervention.

I hope this information will help you.

Thanks.