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Tibial Shaft Fractures in Combat Sports

1.0 Background

1.1 Tibial Fractures

The tibia bone, also known as the shinbone, extends vertically from the knee to the ankle on the anterior side of the lower leg, and in alignment with the coronal and sagittal planes. It is the second largest bone in the human body and is classified as a long bone[1]. Long bones are longer than they are wide and have an elongated middle shaft, which has a thick layer of compact bone and two ends containing spongy bone. Figure 1 represents the diagram of the tibial shaft and ends[2]. The three common tibial shaft patterns (transverse, oblique, and spiral) can be seen in Figure 2. Transverse fractures are characterized by a breakage perpendicular to the tibial shaft, an oblique fracture is characterized by an angled breakage across the tibial shaft, and a spiral fracture is characterized by a breakage pattern around the shaft, which are mainly caused by torsional forces[3]. Furthermore, fractures where the bone is broken into more than 3 pieces are comminuted and are often a result of two or more fracture patterns. Fractures can also be classified as open, if the bone has broken through the surrounding skin, or closed, if the surrounding skin is intact[3].

Fig. 1. Diagram of the tibial shaft and ends
Fig. 2. Tibial fracture patterns

A research study conducted by the University of Western Ontario and McMaster University found that there are several long-term effects of tibial fractures[4]. The study looked at 164 individuals who had a tibial shaft fracture 30-43 years prior to the study. Disregarding participants with additional surrounding injuries (knee, ankle, or knee and ankle), around 15% reported at least moderate levels of knee pain, 6% reported at least moderate levels of ankle pain, and 13% reported at least moderate levels of disability. This study concluded that many factors affect the long-term outcomes of tibial shaft fractures; however, generally, the recovery over the 35-year period is good, and most patients do not experience associated pain. However, mild osteoarthritis can be common due to the cumulative effects of the initial fracture[4].

Tibial fractures have an incidence rate of 51.7 per 100,000 persons per year and account for 17% of all lower extremity fractures [5][6]. Males, particularly those aged 10-30, displayed a higher incidence of tibial fractures than females, who were seen to have an increasing incidence with age[7]. This demographic follows a bimodal distribution model relating age and energy mechanism, which overlaps with the competitive age range and gender of most combat athletes[8].

1.2 Injuries in Combat Sports

Famously, in December 2013, in the Ultimate Fighting Championship (UFC), Anderson Silva threw a low kick towards his opponent's knee. The hard, low kick caused his left tibia to be fractured. This injury to Silva prevented him from fighting for over a year[9]. UFC is one of the biggest promotions in mixed martial arts (MMA). With its increased popularity over the years, there are a lot of athletes joining UFC or similar promotions for their careers. Moreover, other combat sports such as Muay Thai are gaining popularity. Thus, there is an increased need to understand how the mechanisms involved in tibial shaft fractures work and how to reduce their occurrence.

A nine-year longitudinal study found that the most common mechanisms of injury include defensive kicks (receiving a kick), contributing to 44% of the reported injuries, and offensive kicks (delivering a kick), contributing to 35% of the reported injuries[10]. In combat sports such as MMA, the lower limbs are commonly used; therefore, it makes sense that kicks, either defensive or offensive, are a common injury mechanism[10]. Lower limbs, when grouped together, have an injury occurrence of 54%, which is higher than that of the grouped head and neck, which is around 23%. However, when isolating the lower leg where the tibia sits, this was done by subtracting all other lower limb components, including the thigh, knee, ankle, and toes, from the total lower limb occurrence, there is an injury occurrence of 6%. This suggests that while tibial shaft injuries are relatively uncommon, they are clinically significant consequences in combat sports because they originate from a region that is frequently subjected to high-energy loading from kicks, even though they make up a smaller percentage of all lower-limb trauma.  

High-energy tibial fractures in combat injury include traumas caused by defensive or offensive kicks[11]. These direct-impact, high-energy tibial fractures include primarily shear loading of the tibia and could result from any impact, including a punch, jab, or kick of high enough force. Low-energy tibial fractures in combat sports consist of torsional forces acting secondary to the tibia, likely through the thigh, resulting in spiral fractures[11].

In this review, we will focus on kicks, one of the high-energy mechanisms in combat sports that lead to tibial transverse, oblique, and comminuted fractures as a result of trauma to the tibia (defensive kick).

2.0 Injury Biomechanics

2.1 Tibia Fracture Tolerances

Tibia fractures, specifically those due to bending and shear loads, have been measured in various studies using a three-point bending apparatus[12]. When looking at tibial fracture tolerances, this experimental design consists of a mechanism that fixes the two ends of the bone, allowing an impactor to apply a transverse load to the bone. The magnitude of the force and moments resulting from this impact can be measured, and the reaction of the material can be observed. These metrics can be used to establish the injury tolerances for tibial fractures, which can be used to inform the potential threshold of injury in combat sports. Through a review of three experimental studies, we were able to establish the injury thresholds for force and moment measurements as a result of impact to the tibia.

2.1.1 Force Injury Criteria

Various studies have been performed to examine the magnitude of force resulting in fracture of the human tibia bone under transverse loading. One experiment looked at injury tolerance in synthetic (n=6) and cadaver (n=6) tibias. According to Cameron et al., loads were applied to each specimen by a pneumatic impactor, striking at a velocity of 30km/h. This impact force resulted in anterior-posterior bending, causing fractures in cadaveric tibias at a mean force of 4889N. Looking specifically at the cadaveric trials, due to their superior biofidelity, a 10% risk of injury was associated with an impact force of 3386N[12]. The experimental set-up for the study conducted by Cameron et al. used a 3-point bending apparatus, which can be seen in Figure 3. A similar study done by Rabl et al. was performed using human tibial specimens (n=32), impacted using a servo-hydraulic testing machine. This generated loading limits of 2475N to 12206N, with a mean fracture force of 5787N, which is comparable to findings from the previous study[13]. Taking the average of the mean forces from both studies gives an overall mean fracture force of 5338N for the cadaveric tibia. This mean value can be inferred from the means of the two studies due to their similarity in experimental setup and loading conditions. Using the value from the first study, it can be inferred that a force applied to the tibia in the transverse direction, exceeding 3386N, will have a >10% chance of resulting in a tibial fracture.

Fig. 3. Experimental set-up for cadaveric study on tibial response to loading under three point-bending

2.1.2 Moment Injury Criteria

Along with examining force, impactor studies have also been used to establish the bending thresholds in tibial impacts. Nyquist et al. conducted a study that looked at unembalmed human tibias (n=42), loaded in the transverse direction, under 3 different criteria: loaded in the anterior-posterior direction only, loaded in the lateral-medial direction only, and loaded in both the anterior-posterior and lateral-medial directions[14]. This experimental setup utilized a 32kg impactor with a 25mm cylindrical surface. Looking at the threshold bending moments, it was found that the threshold for midshaft tibial fractures was a moment of 280Nm for females and 320Nm for males[14]. These would therefore be similar to the maximum moments tolerated from frontal or lateral impact to the tibia in combat sports.

2.2 Combat Sports Kicking Mechanisms

In combat sports like Taekwondo, Muay Thai, kickboxing, MMA, and UFC, kicking strikes are fundamental in sparring. Specifically in UFC, kicks to the shin are often used as a strategic play to weaken the opponent’s balance and stability. These strikes typically target the opponent’s shins or knees[15]. In this review, we looked at various studies on the forces of these types of kicks used in combat sports like Taekwondo. Taekwondo consists of more traditional and fundamental techniques used in today’s modern combat sports like UFC[16]. Therefore, these studies focus on the power generated from some of the most common and powerful Taekwondo kicks: the round kick and the side kick. The round kick, also known as a turning or roundhouse kick, is rooted in the rotation of the hips while the leg extends towards the opponent, while the side kick is more of a linear extension of the leg and foot[17] (Figure 4).

Fig. 4. Mechanisms of Taekwondo round and side kicks[18]

In one study by Falco et. al, both novice and elite Taekwondo athletes were assessed for the impact forces of their roundhouse kicks[19]. After warming up, each athlete kicked a freestanding boxing mannequin that was equipped with a force platform with five piezoresistant pressure sensors. The target height was adjusted to the athlete’s abdomen height, with each athlete kicking from 3 different distances away from the target. Out of 31 athletes, ranging from 16 to 31 years, the novice group had an overall impact force mean of 1477.9N, while the expert group had an overall impact force mean of 1994.03N[19].

In two other studies by Buśko et. al and Górski and Orysiak, the impact forces of the round kick were measured from small sample sizes of Olympic Taekwondo athletes[20][21]. In these studies, the focus on Olympic-level athletes performing roundhouse kicks provides a clear representation of high-performance competition striking. In the first study, by Buśko et. al, the researchers used a punching bag embedded with an accelerometer and split the sample size of 28 into 14 male and 14 female athletes[20]. The resulting round kick forces ranged from 965.3N to 2072.3N, with male and female combined. In the study conducted by Górski and Orysiak, a dynamometric punching bag embedded with an accelerometer was also used to measure the kick forces, for which the mean came to be 2733N[21].

A study conducted by O’sullivan et. al investigated the impact forces between two different target heights of a round kick[22]. Since leg kicks are much lower to the ground, there is a shorter distance for the attacker’s leg to reach, as well as less effort needed to deliver the kick, compared to reaching head height. Their study set up consisted of a PVC pipe with screwed in accelerometers being placed inside a sand bag, as well as a 7 camera system and two force platforms. These force plates were used to calibrate the accelerometers by dropping the bag onto the platform. This study by O’Sullivan et. al concluded that the round kicks at a lower target to the trunk were of greater force than those delivered to the head height[22]. Given this, the impact force values from the lower height kicks had an average of 6400N from five Taekwondo athletes with over 10 years of experience, collected via motion capture and accelerometer equipment[22]. Therefore, while the <2000N values reported by Falco et al. are mean impact forces across multiple kick types and ability levels, the much higher value of 6400N reflects peak forces from experienced athletes performing trunk-level roundhouse kicks under a specific testing setup. As a result, these numbers describe different kicking conditions and are not directly contradictory; rather, they highlight how kick type, target height, and athlete expertise can greatly influence measured impact forces.

3.0 Discussion

3.1 Correlation of Injury Tolerances and Kicking Forces

The peak martial arts round kicking force found from previous studies ranged from 965.3N to 6400N. Due to individual mass, anthropometric measurements, technique, and level of expertise between athletes, this range varies greatly. As seen in multiple cadaver testing studies, a tibial fracture from a blunt impact can occur with impact forces between 3386N and 12206N. Synthetic tibia testing showed no significant difference regarding impact forces or bending moment at fracture, with synthetic tibial fractures having a force threshold of 2873N[12]. Given these values, it is very possible for a round kick to the shin to fracture the tibia. This is also seen in practice during a UFC fight, where a blunt force kick to the shin resulted in a tibial fracture[9]. However, to exert the required amount of force to cause a fracture is very difficult, and the forces of a round kick to a punching bag may not directly translate to a competition or practice scenario due to the unpredictable movement of the opponent. When the opponent is in motion, this, along with the natural variability in each individual’s kick, can alter the angle at which the tibia is struck. This varied angle can change the direction in which forces are applied, affecting the magnitude and distribution of the force along each axis. Moreover, caution is advised when comparing values across different studies, due to the accuracy and methodology with which the measurements were obtained.

3.2 Controversies

Promoting protective gear, such as shin guard usage during sparring matches or training, is the most relevant application of these studies. Shin guards reduce the risk of serious injury by providing a shock-absorbing layer between the tibia and the impact,  enhancing energy dissipation[23]. This protective equipment lowers peak impact forces by increasing the time over which the impact occurs and therefore reducing the loading rate of the force applied to the tibia. However, the usage of protective gear, including shin guards and headgear, is prohibited in UFC and most other combat sports. Arising from this is the controversy of safety over authenticity. In an attempt to maintain the genuineness and viewer appeal of the sport, there is minimal permissible use of protective gear to prevent serious injury. However, it has been shown that 28.6% of MMA competitions result in an injury[24]. While shin guards are proven to reduce the force of impacts by 41%-77%, effectively reducing the risk of serious injuries, they are not permitted in MMA competitions[25][26]. Furthermore, athletes are left to rely solely on shin conditioning to lower their own mental pain tolerance in the shin, meaning that the bone and soft tissue are left to absorb the full impact load[23]. There remains considerable debate over whether modern combat sports place athletes at unnecessary risk, compromising long-term bone health and injury safety thresholds in pursuit of performance optimization and spectator entertainment.

3.3 Strengths & Limitations

Each study utilized in this review brings a different angle and understanding of the mechanics and impact forces of kicks commonly seen in MMA. Falco et al.’s study captured a broad, realistic range of kicking ability by comparing novices and athletes across multiple kick distances. The wide scope of kicks and techniques, in addition to the varying experiences of novices and experienced athletes, is useful in understanding the impact forces in general sparring populations.

The studies by Buśko et al. and Górski and Orysiak narrow the focus to Olympic-level roundhouse kicks, which is valuable because they isolate high-performance athletes using one of the most powerful and technically refined kicks. With smaller, specific samples and more controlled kicking conditions, these studies provide a clearer picture of peak force generation in elite contexts. O’Sullivan et al.’s experiment contributes to the variable of target height. By directly comparing trunk-level versus head-level kicks, their results highlight how distance, effort, and biomechanics shift force output. Their measurement of 6400N at the lower target demonstrates the significance of kick conditions and how they alter outcomes. Together, these studies complement one another, capturing variation across skill levels, elite performance in a single technique, and how situational factors like height can amplify or reduce impact forces.

Despite the breadth of these studies, there still exist many limitations in relation to this criterion in the context of combat sports. One of the biggest limitations in this area of research is that the population of interest for this study can not be directly examined when looking at fracture thresholds. Firstly, living humans can not be used in experiments examining the risk of tibial fracture due to the severity of the resulting health implications. Because of this, cadaveric studies are commonly preferred as the bones are more biofidelic than ATDs or animal models. Unfortunately, while bone properties do not vary largely after death, cadaver populations typically make up a very different demographic than those susceptible to tibial fractures from combat sports. Cadaver populations often have a higher mean age, resulting in potential changes in bone properties, including bone density. One of the studies examined, for example, used specimens with a mean age of 55, while, in reality, the group at highest risk of tibial fracture is males between the ages of 10 and 30 [8, 13]. This could cause results to be shifted towards a lower injury tolerance than what would actually be observed among the population of interest.

Along with the limitations in the testing specimens used, there exist limitations in the variability between people and sports. The title combat sports encompasses numerous specific sports, as well as a diverse range of athletes. Because of this, it is hard to truly quantify force or moment metrics because there will be variability in each kick. Additionally, many of the studies looked at in this review are related to Taekwondo, and although many modern combat sports build off these techniques, the studies may not accurately represent all combat sport motions or forces. Other specifics, such as location of impact, or the angle of contact, may vary person to person, all of which can have different implications for the risk of injury. In this review, we looked specifically at force and moment measurements from kicks in general, but in reality, there would be other factors that would play a role in the likelihood of tibial fracture. Examples of this may include the angle and contact area of impact, as both factors can affect force distribution throughout the tibia.

As such, due to the differences in testing methodology, age and athlete groups, and target heights, there are large differences in the reported round-kick forces. Specifically, the bags used in each study had different masses, stiffnesses, and calibration methods, which can significantly alter recorded forces. In addition, testing of different athletes results in varying peak forces due to weight, gender, martial arts, and overall experience. As mentioned previously, lower target heights allow athletes to drive more body mass forward, leading to much higher impact forces than kicks at head-height. Furthermore, while the studies explored trunk, abdomen, and head level impacts, kicks are not limited to this selection and can impact any part of the body. Thus, while trunk, abdomen, and head-level kicking forces were explored, it is important to note that the values reported do not account for the entire body.

3.4 Future Work

As outlined in the limitations, cadaveric injury studies are superior to ATD models or animal testing, due to their biofidelity. However, cadaver specimens often have a high mean age, which is not completely representative of the younger, fighter population. Therefore, future work on this topic could involve the development of a biofidelic ATD for lower limb injuries. Synthetic tibias provide a potential solution to address this limitation. Prior studies have shown there are no significant differences between the impact forces and bending moments during fracture when compared to cadaveric tibias. By using composite tibial surrogates with a distinct cortical "shell" and cancellous "core," which match the tubular shape and wall thickness observed in human CT data, and by encircling the bone with silicone- or gel-based soft tissue layers that replicate the geometry and stiffness of muscle, fat, and skin in a typical MMA fighter, current ATD lower legs could be made more biofidelic. The way loads are transmitted and how the model deforms and fails under impact would be further improved by adding anatomically realistic ankle and knee joints, whose stiffness and damping are adjusted to published human ligament and cartilage properties. Development of a biofidelic lower leg model would not only be useful in tibial fractures in combat sports, but could be used for other blunt traumas resulting in tibial fracture, such as pedestrian-vehicle collisions, motorcycle crashes, or other high-impact sports such as skiing.

In addition to dummy improvements, future work should also investigate and incorporate the finite element analysis (FEA) and computational modeling to evaluate load impacts on tibias in a wide range of kicking scenarios. FEA models provide insight into the integration of material heterogeneity, strain-rate effects, soft-tissue deformation, and joint mechanics in ways that are not possible with experimental setups alone. By calibrating these models using existing cadaveric and synthetic tibia data, researchers could simulate how specific variables, such as angular velocity, impact location, athlete mass, or different blocking techniques used in different martial arts, affect stress distributions and fracture risk. Computational modeling would also allow investigators to systematically vary parameters like impact angle or bone mineral density to represent different fighter demographics, providing a controlled environment to test conditions that cannot be ethically or practically recreated. Combining current studies and data with simulations and modeling technologies would provide a more complete understanding of tibial fracture mechanisms and improve injury prediction in real-world combat sport scenarios.

Another area for future work could include measuring kicking forces specifically towards the lower limbs. As stated, many of the papers regarding kicking forces involve kicks upward to the head or trunk; these are not completely representative of the forces and mechanisms of kicking to the lower limbs. An experimental study that has subjects kick towards the shin or lower limb level will allow for a more complete image of forces exerted in tibial fracture impacts.

References

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  2. ↑ “Long bones: Medlineplus medical encyclopedia image,” MedlinePlus, https://medlineplus.gov/ency/imagepages/9582.htm  (accessed Nov. 10, 2025).
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