What does a fracture mean? Fractures of both forearm bones. Fracture of the leg - definition and general characteristics

It accounts for 12.57% of all fractures of the upper extremities.

According to the mechanism of injury there are: transverse fractures of both bones at the same level under direct force; fracture due to rotational force; fracture in the lower third (Wheel fracture).

Fractures of both forearm bones can be:

1) subperiosteal

2) breaks like a green twig

3) complete fractures

For periosteal fold fractures - immobilization for up to three weeks; with fractures, with fractures localized in the diaphysis, often with angular displacement.

Clinic: pain, swelling of the hematoma, deformation in the forearm. Movement in the joint is painful.

Complete fractures

In the clinic: pain, swelling, deformation, hematoma, dysfunction of the limb. X-rays are taken in 2 projections of the bones of the forearm. Possible epiphysiolysis of the head of the ulna, metaepiphysiolysis requiring ideal reposition. When the diaphysis of the bones of the forearm is fractured under anesthesia, displacement in length, width, and angular displacement is eliminated. Fixation is carried out with a splint from the fingertips to one third of the shoulder. Circular - circular dressings are not applied. Possible in as a last resort If there is a fracture in one third of both bones, apply two splints. Immobilization for children under 7 years old - 4 weeks, for older ones - 5-6 weeks.

Permissible displacements for forearm fractures:

1. Angular:

a) in the lower third of the forearm in children under 5 - 6 years of age the angle is up to 30°, in older children it is no higher than 15 -20%.

b) along the diaphysis up to 5 - 6 years 12 - 15°, in older people 8-10.

2. In the anteroposterior direction across the diameter. When displaced, the interosseous gap should not exceed 1/2 - 1/3 of the diameter.

3. By lenght, if the fragments are displaced in the anteroposterior direction.

If displacements are greater than permissible, surgical treatment is indicated.

Isolated fracture

An isolated fracture of the radius (trans. Wheel) accounts for 15% of the total number of forearm fractures. More often found in the lower third. The mechanism of injury is direct impact.

Clinic: pain, swelling, hematoma, deformation of the third third of the forearm, impaired pronation movement.

Osteoepiphysiolysis

This type of damage occurs in 10.7%. Epiphysiolysis is the separation of bones along the growth cartilage. Often, with epiphysiolysis, bone tissue is torn off; this is osteoepiphysiolysis. The mechanism of injury is a fall on an outstretched arm with emphasis on the hand.

Clinic: pain, swelling, hematoma, deformation at the fracture site. The x-ray shows a displacement of the epiphysis in relation to the metaphysis (to the rear to the radial side).

Isolated fracture of the ulna

Occurs in 2.8% of cases. The mechanism of injury is a direct blow to the area of ​​the ulna.

Clinic: pain, swelling, deformation, hematoma. On the radiograph in 2 projections there is displacement of bone fragments of the ulna (with displacement of fragments along the width and at an angle).

Monteggia fracture

A complex fracture in which there is a dislocation of the head of the radius and a fracture in the third third of the ulna. Movement in the elbow joint is limited. The x-ray shows a dislocation of the head of the radius, a fracture in the second third of the ulna.

Galeazzi's fracture

Reverse Monteggia fracture. Dislocation of the head of the ulna, fracture of the radius. Rarely seen. Radial alignment is combined with alignment of the dislocated ulnar head.

A plaster cast is applied in the middle position of the forearm for a period of 3 weeks.

Fracture of metacarpal bones and phalanges

Occurs in 0.59% according to the Turner Institute, in 11.8% according to emergency rooms. The mechanism of injury is a fall of heavy objects, a bone bruise on a hard object, the blow falls on the back of the hand. Most often, fractures are non-displaced.

Clinic: pain, swelling, hematoma at the fracture site, pain at the fracture site when moving the fingers. When fragments are displaced, deformation occurs. The diagnosis is confirmed by an x-ray of the hand in two projections.

9. Questions on the topic of the lesson:

1. Features of fractures of the upper limb in children.

2. Features of diagnosing upper limb injury

3. Timing of appearance of ossification nuclei.

4. Principles of treatment of fractures in children at different ages
groups.

5. Fusion of fractures in different age groups.

6. Features of exercise therapy and rehabilitation in a child with a fracture.

7. Complications, their features in connection with incomplete ossification

8. Specify the classification of injury to the upper limb, distal and proximal humerus

10. Test tasks on the topic:

1. CLOSED REDUCTION OF SURACONYLICAL FRACTURE OF THE HUMERUS IS STARTED IN CHILDREN

1) from eliminating rotational displacement

2) from eliminating the offset in width

3) eliminating displacement along the length

4) eliminating angular displacement

5) eliminating displacement in width and length

2. AN EARLY X-RAY SYMPTOM IN EPIPHYSEOLYSIS OF THE DISTAL END OF THE HUMERUS IS

1) destruction of the metaphysis of the humerus

2) the presence of a visible bone fragment

3) increase in the angle of inclination of the epiphysis in relation to the longitudinal axis of the diaphysis

4) visible callus

2) Doletsky

4) Epstein

5) Rokitsky

4.. AMONG FRACTURES OF THE PROXIMAL END OF THE HUMERUS THE MOST COMMON OPTION

1) fracture of the I/O shoulder

2) fracture surgical cervix

3) subcapital fracture

4) fracture of the condyles

5) fracture of the s/w shoulder

5. FOR AN AVOID FRACTURE OF THE INTERNAL EPICONYLE 12-14 YEAR OLD AGED, FIXATION OF THE FRAGMENTS IS MOST PREFERABLE

1) Ilizarov apparatus

2) plate

3) splint

4) bone suture

5) Kirschner wire

6. MONTAGGI FRACTURE-DISCLOSURE IS

1) dislocation of the bones of the forearm on one arm and a fracture on the other

2) dislocation of the hand and fracture of the forearm bones in the middle third

3) dislocation of the forearm bones in the elbow joint and a fracture of one of the bones of the lower forearm bones

4) dislocation of the ulna and fracture of the radius

5) dislocation of the head of the radius and fracture of the ulna at the border of the middle and upper third on the arm of the same name

7. NOT CHARACTERISTIC FOR OLENARY PROCESS AVOIDANCE

1) hematoma

2) broken Gunther triangle

3) positive symptom Marx

4) restriction of movements

5) Manteja's symptom

8. FOREARM WITH FRACTURE OF THE EXTERNAL CONDYLE

1) given

2) allocated

3) rotated inward

5) internally rotated and adducted

09. CHARACTERISTIC FOR FRACTURE-DISCLOSATION OF THE HEAD OF THE HUMERAUS

1) shoulder shortening

2) the shoulder is not abducted

3) there are no “springy” movements

4) during passive movements a “bone crunch” is felt

5) all of the above are true

10. TIME FOR SHOULDER IMMOBILIZATION AFTER REDUCTION OF THE DISLOCATION IS

1) 1-2 weeks

2) 4 weeks

3) 6 weeks

4) 8 weeks

5) 10 weeks

Sample answers to test tasks on the topic:

11. Situational tasks on the topic:

Task No. 1

The child was injured on the road. Complains of pain in the hip headache, difficulty in taking a deep breath.

1. Make a preliminary diagnosis.

2. What assistance should be provided at the scene of the incident?

3. Algorithm for X-ray examination.

4. Prevention of complications after hospital treatment.

5. Types of childhood injuries, main age groups taken into account in childhood injuries.

Task No. 2

A 4-year-old child was admitted to the pediatric surgery clinic with a diagnosis of epiphysiolysis of the proximal head of the humerus.

1. Indicate the data characteristic of epiphysiolysis of the proximal head of the humerus in a 4-year-old child.

3. Duration of immobilization

4. Types of callus

5. Outpatient rehabilitation.

Task No. 3

A child was admitted to the pediatric surgery clinic with a diagnosis of apophysiolysis of the medial condyle of the left humerus.

1. What data are characteristic of apophysiolysis of the medial condyle of the left humerus?

2. Additional examination methods.

3. Duration of immobilization with permissible mixing.

4. The basic principles of managing a trauma patient are

5. Outpatient rehabilitation.

Task No. 4

A 7-year-old child with an incised wound of the right forearm in s/3 went to the emergency room.

1. What should your tactics be?

2. Types of tendon suture.

3. Duration of immobilization.

4. Outpatient rehabilitation.

5. Criteria for discharge to work for a trauma patient.

Problem #5

A 13-year-old boy fell from a tree and hit the third third of his right shoulder.

I contacted a traumatologist with complaints of pain in the third shoulder, there was swelling of the limb, and the child could not lift it.

1. Make a diagnosis.

2. What examination needs to be carried out?

3. Prescribe treatment.

4. Types of childhood injuries, main age groups taken into account in childhood injuries.

5. Duration of immobilization.

Sample answers to problems

– this is a complete or partial violation of the integrity of the bone resulting from an impact exceeding the strength characteristics bone tissue. Signs of a fracture include abnormal mobility, crepitus (bone crunch), external deformity, swelling, limited function and severe pain, while one or more symptoms may be absent. The diagnosis is made on the basis of anamnesis, complaints, examination data and X-ray results. Treatment can be conservative or surgical, involving immobilization using plaster casts or skeletal traction, or fixation by installing metal structures.

ICD-10

S42 S52 S72 S82

General information

A fracture is a violation of the integrity of a bone as a result of traumatic impact. Is a widespread injury. Most people experience one or more fractures during their lifetime. About 80% of the total number of injuries are fractures of long bones. Along with the bone, surrounding tissues also suffer during injury. More often there is a violation of the integrity of nearby muscles, less often compression or rupture of nerves and blood vessels occurs.

Fractures can be single or multiple, complicated or uncomplicated by damage to various anatomical structures and internal organs. There are certain combinations of injuries that are frequently encountered in clinical traumatology. Thus, with fractures of the ribs, damage to the pleura and lungs is often observed with the development of hemothorax or pneumothorax; if the integrity of the skull bones is violated, the formation of an intracerebral hematoma, damage to the meninges and substance of the brain, etc. Treatment of fractures is carried out by orthopedic traumatologists.

Causes of fracture

Violation of bone integrity occurs with intense direct or indirect exposure. The direct cause of a fracture can be a direct blow, a fall, a car accident, an industrial accident, a criminal incident, etc. There are typical mechanisms of fractures of various bones that cause the occurrence of certain injuries.

Classification

Depending on the initial structure of the bone, all fractures are divided into two large groups: traumatic and pathological. Traumatic fractures occur on a healthy unmodified bone, pathological fractures occur on a bone damaged by some pathological process and as a result, partially lost its strength. To form a traumatic fracture, a significant impact is necessary: ​​a strong blow, a fall from a fairly high height, etc. Pathological fractures develop with minor impacts: a small impact, a fall from a height of one’s own height, muscle strain, or even turning over in bed.

Taking into account the presence or absence of communication between the area of ​​damage and the external environment, all fractures are divided into closed (without damage to the skin and mucous membranes) and open (with a violation of the integrity of the skin or mucous membranes). Simply put, with open fractures there is a wound on the skin or mucous membrane, but with closed fractures there is no wound. Open fractures, in turn, are divided into primary open, in which the wound occurs at the time of traumatic impact, and secondary open, in which the wound is formed some time after the injury as a result of secondary displacement and damage to the skin by one of the fragments.

Depending on the level of damage, the following fractures are distinguished:

  • Epiphyseal(intra-articular) - accompanied by damage to the articular surfaces, rupture of the capsule and ligaments of the joint. Sometimes they are combined with dislocation or subluxation - in this case they speak of fracture-dislocation.
  • Metaphyseal(periarticular) - occur in the area between the epiphysis and diaphysis. They are often impacted (the distal fragment is embedded in the proximal one). As a rule, there is no displacement of fragments.
  • Diaphyseal– are formed in the middle part of the bone. The most common. They are distinguished by the greatest variety - from relatively simple to severe multi-fragmented injuries. Usually accompanied by displacement of fragments. The direction and degree of displacement are determined by the vector of the traumatic impact, the traction of the muscles attached to the fragments, the weight of the peripheral part of the limb and some other factors.

Taking into account the nature of the fracture, there are transverse, oblique, longitudinal, helical, splintered, polyfocal, crushed, compression, impacted and avulsion fractures. V- and T-shaped injuries occur more often in the metaphyseal and epiphyseal zones. In case of integrity violation spongy bone Usually there is the penetration of one fragment into another and compression of bone tissue, in which the bone substance is destroyed and crushed. At simple fractures the bone is divided into two fragments: distal (peripheral) and proximal (central). With polyfocal (double, triple, etc.) injuries, two or more large fragments form along the bone.

All fractures are accompanied by more or less pronounced destruction of soft tissue, which is caused both by direct traumatic effects and by displacement of bone fragments. Typically, hemorrhages, soft tissue bruises, local muscle ruptures and ruptures of small vessels occur in the area of ​​injury. All of the above in combination with bleeding from bone fragments causes the formation of a hematoma. In some cases, displaced bone fragments damage nerves and great vessels. Compression of nerves, blood vessels and muscles between fragments is also possible.

Symptoms of a fracture

There are absolute and relative signs of a violation of bone integrity. Absolute signs are deformation of the limb, crepitus (bone crunch, which can be distinguished by the ear or determined under the doctor’s fingers during palpation), pathological mobility, and in open injuries - bone fragments visible in the wound. To the number relative characteristics includes pain, swelling, hematoma, dysfunction and hemarthrosis (only for intra-articular fractures). The pain intensifies with attempted movements and axial load. Swelling and hematoma usually occur some time after the injury and gradually increase. Dysfunction is expressed in limited mobility, impossibility or difficulty in support. Depending on the location and type of damage, some of the absolute or relative signs may be absent.

Along with local symptoms, large and multiple fractures are characterized by general manifestations caused by traumatic shock and blood loss due to bleeding from bone fragments and damaged nearby vessels. At the initial stage, there is excitement, underestimation of the severity of one’s own condition, tachycardia, tachypnea, pallor, cold sticky sweat. Depending on the predominance of certain factors, blood pressure may be reduced, or less often, slightly increased. Subsequently, the patient becomes lethargic, lethargic, blood pressure decreases, the amount of urine excreted decreases, thirst and dry mouth are observed, severe cases loss of consciousness and respiratory problems are possible.

Complications

Early complications include skin necrosis due to direct damage or pressure from bone fragments from the inside. When blood accumulates in the subfascial space, subfascial hypertension syndrome occurs, caused by compression of the neurovascular bundle and accompanied by impaired blood supply and innervation of the peripheral parts of the limb. In some cases, as a result of this syndrome or concomitant damage to the main artery, insufficient blood supply to the limb, gangrene of the limb, and thrombosis of the arteries and veins may develop. Damage or compression of the nerve can lead to paresis or paralysis. Very rarely, closed bone injuries are complicated by suppuration of the hematoma. Most common early complications open fractures are wound suppuration and osteomyelitis. With multiple and combined injuries, fat embolism is possible.

Late complications of fractures are improper and delayed fusion of fragments, lack of fusion and pseudarthrosis. With intra-articular and periarticular injuries, heterotopic para-articular ossifications often form, and post-traumatic arthrosis develops. Post-traumatic contractures can form with all types of fractures, both intra- and extra-articular. Their cause is prolonged immobilization of the limb or incongruence of the articular surfaces due to improper fusion of fragments.

Diagnostics

Since the clinical picture of such injuries is very diverse, and some signs are absent in some cases, when making a diagnosis, much attention is paid not only clinical picture, but also to clarify the circumstances of the traumatic impact. Most fractures are characterized by a typical mechanism, for example, when falling with emphasis on the palm, a fracture of the radius often occurs in a typical place, when twisting a leg - a fracture of the ankles, when falling on the legs or buttocks from a height - a compression fracture of the vertebrae.

The patient's examination includes a thorough examination for possible complications. If the bones of the extremities are damaged, the pulse and sensitivity in the distal parts must be checked; in case of fractures of the spine and skull, reflexes and skin sensitivity, if the ribs are damaged, auscultation of the lungs is performed, etc. Particular attention is paid to patients who are unconscious or in a state of severe alcohol intoxication. If a complicated fracture is suspected, consultations with relevant specialists (neurosurgeon, vascular surgeon) and additional studies (for example, angiography or echoEG) are prescribed.

The final diagnosis is made on the basis of radiography. To the number radiological signs fracture includes a line of clearing in the area of ​​damage, displacement of fragments, break of the cortical layer, bone deformation and change bone structure(lucidation due to displacement of fragments of flat bones, compaction due to compression and impacted fractures). In children other than those listed radiological symptoms, with epiphysiolysis, deformation of the cartilaginous plate of the growth zone may be observed, and with greenstick fractures, limited protrusion of the cortical layer.

Fracture treatment

Treatment can be carried out in an emergency room or in a trauma department, be conservative or operative. The goal of treatment is the most accurate comparison of fragments for subsequent adequate fusion and restoration of function of the damaged segment. Along with this, in case of shock, measures are taken to normalize the activity of all organs and systems; in case of damage to internal organs or important anatomical formations, operations or manipulations are carried out to restore their integrity and normal function.

At the first aid stage, pain relief and temporary immobilization are carried out using special splints or improvised objects (for example, boards). For open fractures, remove contamination around the wound if possible, and cover the wound with a sterile bandage. At heavy bleeding apply a tourniquet. Measures are taken to combat shock and blood loss. Upon admission to the hospital, a blockade of the injury site is performed, reposition is carried out under local anesthesia or general anesthesia. Reposition can be closed or open, that is, through the surgical incision. Then the fragments are fixed using plaster casts, skeletal traction, as well as external or internal metal structures: plates, pins, screws, knitting needles, staples and compression-distraction devices.

Conservative treatment methods are divided into immobilization, functional and traction. Immobilization techniques (plaster casts) are usually used for non-displaced or slightly displaced fractures. In some cases, plaster is also used for complex injuries at the final stage, after removal of skeletal traction or surgical treatment. Functional techniques are indicated mainly for vertebral compression fractures. Skeletal traction is usually used in the treatment of unstable fractures: comminuted, helical, oblique, etc.

Along with conservative methods, there is great amount surgical methods for treating fractures. Absolute indications before surgery there is a significant discrepancy between the fragments, excluding the possibility of fusion (for example, a fracture of the patella or olecranon); nerve damage and great vessels; interposition of a fragment into the joint cavity during intra-articular fractures; the threat of a secondary open fracture with closed injuries. Relative indications include interposition of soft tissues, secondary displacement of bone fragments, the possibility of early activation of the patient, reducing treatment time and facilitating patient care.

As additional methods Treatments widely use exercise therapy and physiotherapy. At the initial stage, to combat pain, improve blood circulation and reduce swelling, UHF is prescribed to remove the plaster cast; measures are taken to restore complexly coordinated movements, muscle strength and joint mobility.

When using functional methods (for example, for compression fractures of the spine), exercise therapy is the leading therapeutic technique. The patient is taught special exercises aimed at strengthening the muscle corset, decompressing the spine and developing motor patterns that prevent aggravation of the injury. First, the exercises are performed lying down, then on your knees, and then in a standing position.

In addition, for all types of fractures, massage is used to improve blood circulation and activate metabolic processes in the area of ​​damage. At the final stage, patients are referred to Spa treatment, prescribe iodine-bromine, radon, sodium chloride, pine-salt and pine medicinal baths, and also carry out restoration measures in specialized rehabilitation centers.

A tibial fracture is an injury that is accompanied by a violation of the integrity of the fibula and/or tibia bones lower limb. This type of injury accounts for 10% of all fracture locations. One of the most common causes of shin bone fractures is car accidents. You should know that a fracture of the leg bones is a serious injury and is often accompanied by complications. To prevent this, it is necessary to quickly recognize the injury and perform all necessary first aid actions, as well as urgently seek specialized medical care.

Features of the structure of the lower leg

The lower leg consists of two long tubular bones: the fibula and the tibia. At the top they are connected to femur and the patella, forming the knee joint, and from below they articulate with the talus bone of the foot, forming the ankle joint.

Tibia much larger than the fibula and located on the inside of the lower leg. Her top part has 2 flat areas that form articular surfaces for articulation with the femur. Between these condyles there is an elevation to which the intra-articular joints are attached. knee ligaments. The body of this bone has a triangular cross-section. It ends with a small bony protrusion on the inside of the leg - the inner malleolus, which takes part in the formation of the articular surface of the ankle joint.

Fibula much smaller and thinner, located with outside shins. In the upper part it has a small thickening, which is attached to the side surface tibia, and below ends with the outer ankle, which also takes part in the formation of the ankle.


The structure of the bones of the lower leg (right and left legs)

Causes of tibia fracture

Depending on the cause of the injury, traumatic and pathological fractures of the tibia are distinguished. In the first case, a violation of the integrity of the bones occurs under the influence of a force that exceeds the resistance of healthy bone tissue. In the second, the bone breaks even under the influence of minimal load, but against the background of an underlying disease that significantly reduces bone strength, for example, with osteomyelitis, tuberculosis, osteoporosis, malignant primary and metastatic tumors, genetic defects bone development.

In approximately 95% of cases we have to deal with traumatic rather than pathological fractures. In such cases, a violation of the integrity of the lower leg may occur:

  • when falling on a leg that is fixed in one position, for example, in a ski boot, sandwiched between objects;
  • with a direct blow to the shin area (car accidents, falling of a heavy object, blow with a stick, kick).


An example of a shin bone fracture due to a direct blow

Classification of injury

According to the International Classification of Diseases, 10th revision (ICD 10), a fracture of the leg bones is coded S82.

Depending on which part of the bones is damaged, tibia fractures are distinguished:

  • elevations between the condyles of the tibia;
  • tibial condyle;
  • diaphysis (body) of the tibia, fibula or both at once (upper, middle and lower third);
  • inner or outer ankles.

Depending on the presence of damage to the skin during trauma, a closed and open fracture of the tibia is distinguished.


Closed fracture of the tibia with displacement of bone fragments (you can notice a clear deformation of the leg and its shortening)

If the displacement of bone fragments is taken into account in the classification, then a fracture of the tibia is distinguished with and without displacement.

Depending on whether parts of the leg bones that take part in the formation of joints are involved in the fracture, a distinction is made between extra-articular (violation of the integrity of the bone diaphysis) and intra-articular (broken condyles, intercondylar eminence, ankles). The latter belong to the group severe injuries and, as a rule, complex operations are required to compare bone fragments and restore the function of the damaged joint (knee or ankle).

If we take into account the nature of the line of violation of the integrity of the bone, then fractures of the tibia occur (this parameter also depends on the mechanism of injury):

  • straight (the break line has a clear horizontal direction);
  • oblique (the fracture line runs diagonally along the bone);
  • spiral (the break line is uneven, resembles a spiral).

Also, fractures of the tibia can be single, when there is only one fracture line and no more than 2 bone fragments are formed, or multiple. In the latter case, the injury results in more than 2 fragments.

Symptoms of shin bone fractures

Signs of a shin bone fracture vary depending on the location of the injury. Let's consider the symptoms of the main types of violation of the integrity of the tibia and fibula.

  • acute pain in the knee;
  • swelling and rapid increase in diameter of the knee joint;
  • inability to perform active movements and a sharp increase in pain during passive movements in the knee joint;
  • hemorrhage into the joint cavity - hemarthrosis.


The arrow indicates a fracture of the intercondylar eminence of the tibia

Condylar fracture

  • severe pain in the knee area;
  • swelling and increase in volume of the knee joint;
  • lack of active and pain with passive movements in the knee;
  • deviation of the tibia to the side when fragments are displaced.

Fracture of the body of the tibia and fibula

  • intense pain;
  • swelling and deformation of the leg at the site of the fracture;
  • external signs injuries - bruises, hematomas, a wound on the skin due to an open fracture, from which bone fragments may protrude;
  • shortening of the leg along the axis;
  • loss of motor and support function of the limb;
  • bone crepitus at the site of a violation of the integrity of the skeleton;
  • palpation of bone fragments under the skin;
  • in case of damage to the nerve fibers, the patient’s foot hangs down, he cannot move it, and the sensitivity of the skin below the site of damage is also impaired;
  • if the blood vessels are injured, the pulse in the arteries of the foot disappears, the skin becomes cold and pale, paresthesia develops, and signs of external or internal hemorrhage are observed.

Ankle fractures

  • pain in the ankle area;
  • swelling of the ankle area, enlargement of the leg in the lower part in diameter;
  • bleeding under the skin or wound in case of an open fracture;
  • lack of active movements in the ankle and severe pain when trying passive ones;
  • deformation of the foot and its forced position - deviation outward or inward.


The image (lateral and frontal projection) clearly shows a fracture of the tibia and tibia with displacement in the upper third

Confirming the diagnosis is very simple. To do this, you need to conduct an x-ray examination. A high-quality x-ray will determine not only the presence of a fracture, but also clarify its location, type and size.

Possible complications after a fracture

Complications can arise both due to the fracture itself, and in the case of delayed or inept first aid, improper treatment, lack of necessary measures on rehabilitation. Let's consider the main ones:

  1. Damage to blood vessels and the risk of ischemic gangrene with loss of part of the lower limb or hemorrhagic shock if external bleeding from a large vessel is delayed.
  2. Damage to the nerves, which is accompanied by impaired motor activity of the foot and gait disturbance.
  3. Fat embolism – life-threatening emergency, which consists in the entry of particles of adipose tissue from the bone canal into the lumen of the blood vessels.
  4. Infectious complications in open fractures.
  5. Post-traumatic deformity of the lower limb.
  6. Formation of a false joint, which leads to loss of the supporting function of the leg.
  7. Formation of contracture or ankylosis, post-traumatic deforming osteoarthritis in the case of intra-articular fractures.
  8. Osteomyelitis, which is often a consequence of treatment of fractures using the Ilizarov apparatus.


If the nerves of the lower leg are damaged, the patient cannot lift the foot towards himself

If there is a fracture of the leg bones or there is a suspicion of it, you must call ambulance, since this injury can be complicated by bleeding, which is life-threatening and requires urgent stopping. Also, the emergency doctor will be able to prescribe effective analgesic therapy, carry out correct transport immobilization, treat the wound, if any, and deliver the patient to the hospital as soon as possible in the correct position.


Basic principles of first aid for a broken leg: remove clothing from the leg, numb and immobilize the broken leg

What should you do before the ambulance arrives? Let's consider the basic principles of first aid:

  1. Carefully remove shoes and clothing from the affected leg, trying not to move the limb at all.
  2. Give an over-the-counter pain reliever if you have one on hand.
  3. Stop the bleeding with one of known methods in case of an open fracture and treat the edges of the wound with an antiseptic.
  4. Secure the limb using a special splint or improvised means.

Important! Under no circumstances should you try to straighten a broken leg yourself. Such actions can provoke the development traumatic shock, damage to blood vessels with the development of bleeding or nerve fibers. This should only be done by a specialist in a trauma hospital under anesthesia and after radiography and determination of the type of fracture.

Perhaps immobilization is the most important stage of first aid for such an injury. The splint must be applied in such a way as to immobilize not only the bones of the lower leg, but also 2 adjacent joints (knee and ankle).

Standard tires are suitable for this: plastic, pneumatic, plastic, and in their absence, you can use improvised means (boards, plywood, strips of iron, brushwood). Splints are applied from the upper third of the thigh to the tips of the toes, with the knee joint extended at 180º and the ankle joint bent at an angle of 90º. Improvised tires or standard ones must first be covered with cloth, cotton wool, or foam rubber. Next, such a structure is tied to the leg with bandages, as shown in the figure below.


This is what transport immobilization should be like for a fracture of the leg bones

Principles of treatment

Methods and methods of treatment differ depending on the type of fracture, its location, the severity of the injury and the presence of complications. But in each case, one general treatment algorithm can be identified, which consists of 4 stages.

Reposition of bone fragments

It consists of giving the bone fragments the correct position, which will ensure their rapid fusion and restoration of the anatomical integrity of the damaged bone. This can be achieved conservatively (closed reduction or bone realignment). It is used only in the case of a closed, uncomplicated, single fracture in the area of ​​the body of the leg bones without displacement.

But in the overwhelming majority of cases it is necessary to resort to open reduction, when comparison of fragments is carried out during surgery.

Fixing a broken bone

After repositioning, the bone fragments must be fixed in the correct position. For this purpose, various devices and devices are used for internal or external fixation: Kirschner wires, bolts, plates for osteosynthesis, lateral loops, Ilizarov, Kalnberz, Kostyuk, Hoffmann, Tkachenko, etc.


Ilizarov apparatus for fixation of bone fragments

Prolonged immobilization

Necessary for the formation of callus and proper healing of the fracture. For this purpose, plaster casts, splints, special orthoses, and splints for the lower leg are used. They also install special compression-distraction devices.

Rehabilitation

This is the final stage of treatment of any injury, including a fracture of the leg, which includes a set of various measures aimed at the complete and rapid restoration of all functions of the limb. Typically, a rehabilitation program includes therapeutic exercises, massage, physiotherapeutic procedures, dietary food and takes place in several stages.

Thus, a fracture of the tibia is a common type of injury from which no one is immune. All people who care about their health should know about the signs of such an injury and the principles of providing first aid for it, since you never know what situation a person may find himself in, and someone’s life may depend on his knowledge.

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