Fracture- This medical term, which denotes a broken bone. Fractures are a fairly common problem, and statistically the average person will have two fractures in their lifetime. A bone fracture occurs when physical strength, affecting the bone, turns out to be stronger than the bone itself. Fractures are most often caused by falls, blows, or other injuries.
Risk of fracture is largely related to a person’s age. Fractures often occur in childhood, although fractures in children are usually not as complex as in adults. With age, bones become more fragile, and fractures usually occur after falls, even those that would not entail any consequences. negative consequences at a younger age.
2. Types of fractures
There are many different types of fractures, but most often Fractures are classified into fractures with displacement and without displacement, open and closed. The division of fractures into displaced and non-displaced fractures is based on the way the bone breaks.
At displaced fracture the bone is broken into two or more pieces that are arranged so that their ends do not form a single line. If a bone is broken into many parts, it is called comminuted fracture. During non-displaced fracture the bone breaks or may develop a crack, but the bone still remains straight and retains the ability to move.
Closed fracture is a fracture in which the bone breaks, but there is no open wound or puncture on the surface of the skin. During open fracture the bone may pierce the skin. Sometimes, with an open fracture, the bone may break the skin, but then return to its original position and not be visible upon superficial examination. An additional danger of an open fracture is the risk of infection of the wound and bone.
There are some other types of fractures:
- Incomplete fracture, in which the bone bends but does not break. This type of fracture most often occurs in children.
- Transverse fracture– fracture at right angles to the axis of the bone;
- Oblique fracture– fracture along a curved or inclined line;
- Fracture with multiple fragments and bone fragments;
- Pathological fracture– caused by a disease that weakens the bones. Pathological fractures can be caused by cancer or, more commonly, osteoporosis. The most common fractures that occur due to osteoporosis are the hip, wrist, and spine.
- Compression fracture, which occurs from strong compression.
Fractures are also classified depending on which bone was broken. The most common are leg fracture, hip fracture, arm fracture, spine fracture, femoral neck fracture, finger fracture, ankle fracture, collarbone fracture, rib fracture, and jaw fracture.
3. Signs of a bone fracture
Signs and symptoms of a bone fracture may include:
- Swelling and bruising;
- Deformation of an arm or leg;
- Pain in the damaged area, which intensifies with movement or pressure;
- Loss of function of the damaged area;
- In an open fracture, there is bone protruding from the skin.
The severity of a fracture depends on its location and how much damage to the bone and soft fabrics located next to it. Serious fractures without timely treatment dangerous for their complications. This may include damage to blood vessels or nerves, infection of the bone (osteomyelitis) or surrounding tissue.
Recovery time after a fracture depends on the age and health of the patient, as well as the type of fracture. Small fractures in children heal within a few weeks. A serious fracture in an elderly person will require several months of treatment.
The shin is the lower half of the leg from the foot to the knee. It consists of two bones - the large and small, called the tibia. A shin bone fracture is a common injury. The cause may be a traffic accident with aggravating consequences, when the health of those involved in the accident suffers. Another reason is a fight. If one competitor kicks another in the shin, the direction of the kick is usually perpendicular to the victim's leg. This impact on the lower leg often causes it to break. The third reason is weakening bone structure injured. In women, this occurs during pregnancy.
Weakened bones are common in people with osteoporosis. In such situations, an accident can occur when you fall on a slippery road or when the house hits the corner of furniture. Skiers often break their lower limbs if their leg and ski get stuck in an awkward position when they fall.
The tibia at the top, at the entrance to the knee joint, ends in a thickening with two flat areas, which are the bases for attaching the joint. Between the platforms there is an elevation called the head. The platforms are called condyles. From the immanent part of the leg - the medial condyle, from the external - lateral. Below, the large bone has a growth that protrudes inward in relation to the body. This growth forms the medial malleolus.
The small bone is much thinner than the large bone. It is located on the outside of the leg. At the top there is a thickening with which this bone is attached to the tibia. Below there is also a thickening that enters the ankle and forms the outer (lateral) malleolus.
The structure of the tibia is important for us, since there is a classification of injuries in case of a fracture of the tibia, determined by which part of the bone and in what place is broken.
Types of tibia fractures
Based on the location and type of injury, the following types of tibia fractures are distinguished:
According to their location, fractures are: proximal (this is top part tibia and the part of the knee joint into which they enter from above) or distal (this is the lower part of the tibia and the part of the ankle joint where they enter from below). Fractures of the tibia in the middle (in the area of the diaphysis) - diaphyseal fractures of the tibia bones - another type of injury according to this classification. Ankle injuries are divided into two types: lateral, if the fibula is broken, or medial, if the tibia is broken.
Also, leg injuries of the described type are divided according to severity into classes A, B and C. The easiest class A is a closed fracture, when the pieces are not displaced compared to healthy condition limbs, but tissues and joints were not damaged. Class B involves the presence of a displaced fracture with fragments, when the patient has an open wound in the area of damage. The most severe class C is attributed to cases where the integrity of the joints is compromised, blood vessels are torn, and nerves are damaged.
Symptoms of a fracture
Until the victim consulted a doctor or had an X-ray examination, the type of injury can be approximately determined by the symptoms.
Signs of a closed fracture without displacement
This is a class A injury. It heals without surgical intervention, but the treatment period is several months. It depends on the age and health status of the victim. With such damage to the leg, the cracked pieces remain in the desired position, held by the periosteum. This trouble is often experienced by children playing on the playground without adult supervision. They can break a leg while climbing ladders and cobwebs on the playground, since they do not yet have the dexterity of an adult. Signs of such a case are:
- swelling of the leg at the site of injury and in neighboring areas;
- feeling of pain in the lower leg;
- the diseased leg becomes slightly shorter than the healthy one, although you can’t find out without a measuring device;
- a hematoma often forms at the fracture site;
- inability to move the leg – movements cause severe pain;
- Pressing anywhere on the injured leg causes pain localized to the site of injury.
If the victim does not attach importance to the situation and tries to get home on his own, even if he broke his leg when he went out to take out the garbage, the fracture may move into the next most serious category - displaced. Therefore, if you fall and have pain in your leg, you need to call an ambulance, which will take the injured person to the hospital, and there they will take an x-ray and make a diagnosis.
Displaced fracture
It can be class A or B. This leg injury occurs during a fight when an opponent's boot hits the leg. Ugly situations of this type often occur near cafes and night bars between their drunken visitors. Debris often moves in different directions. Displacements are classified according to the position of the fragments into angular, lateral, wedging, and so on. Treatment of injuries of the type described is long and difficult. Signs:
- the lower leg can move and rotate in directions that were inaccessible to the healthy leg;
- the length of the injured leg decreases, but this is not visible to the eye - you need to measure it;
- debris can damage the soft tissue of the leg and tear the skin, forming an open wound;
- upon palpation, a depression in the leg may be felt;
- the injured person is tormented by sharp It's a dull pain(as with other types of such injuries);
- at the time of injury, a creaking and crunching sound was heard;
- the leg rapidly swells, hematomas may form (if the tissue and skin are not already torn).
Treatment of such leg injuries occurs in a hospital with surgical intervention. After some time, calculated in months, a second operation is sometimes required if during the first one a needle had to be inserted into the bone to align the pieces. Such injuries happen to skiers, climbers, extreme sports enthusiasts climbing skyscrapers, and to inexperienced car drivers and their passengers during road accidents.
Closed fracture of the tibia
A closed fracture is classified as class A or C, which is related to the position of the injury. If the diaphysis is broken, then this is class A. With this type of leg injury, the tissues of the lower leg are damaged only in case of displacement, but the damage only affects the muscles adjacent to the injured area of the bone, and the external tissues are not affected. A Class C injury occurs when the injury involves the ankle or knee. Signs:
- sharp pain when lifting the affected leg;
- when lifting an injured limb, the broken end of the bone may stick out as a lump on the skin;
- a crunching sound is heard upon palpation; it cannot be caused on purpose - this leads to displacement of the fragments.
In young victims, the described fractures are classified as split, and in older victims, they are classified as depressed, since their bones are porous in structure. An experienced doctor will determine the presence of an injury of the described type by palpation, without additional research. But radiography is still necessary to determine the position of the fragments and conclude whether surgery is needed, and if so, what exactly needs to be corrected in the location of the fragments so that they grow together correctly.
Open type of fracture
Belongs to class B or C. Such injuries are typical specifically for the lower leg, since there is almost no tissue between the bone and the skin, and the sharp broken edge of the bone often tears the skin. In this case, contamination of the wound area matters.
Attention! It is necessary to consult a doctor immediately, since blood poisoning may occur due to the formation of a bleeding wound in a non-sterile environment. That is why such damage to the lower leg is classified as class B - moderate severity.
If the fracture occurs in the ankle area, affects a joint, or damages a nerve in the knee joint area, it is classified as a severe class C injury. The most significant signs are:
- bleeding from the resulting wound;
- sharp pain when trying to move your leg;
- traumatic shock;
- the pain does not stop even when standing still;
- weakness, dizziness that occurs in the victim;
- loss of consciousness is possible.
If the injury is considered to be extremely severe, the surgeon may amputate the leg to save the patient. Of course, he will not do this without the consent of the victim. If the injured person is unconscious, the doctor will ask his relatives for consent to such an operation. But the decision must be made without delay, because if gangrene begins, it can be fatal.
If the patient contacts a traumatologist quickly, medical workers If the initial treatment of the wound was carried out efficiently, the limb will heal safely and will work as before.
First aid for shin injuries
First aid for a broken leg includes the following steps:
Now the patient has been given necessary help, and you can calmly wait for the doctor to arrive.
Diagnosis of injury
To accurately determine the type and complexity of the damage, it is usually sufficient to take x-rays in two projections. If the case is particularly complex, and you need to understand exactly how the fragments are located, the doctor will refer you for an MRI, nuclear MRI or CT scan.
Possible complications
The described injury can cause complications if treatment was prescribed by an unqualified specialist. Aggravating circumstances may include insufficiently responsible first aid, as well as the prescription of rehabilitation procedures without taking into account the patient’s health condition. The list of possible complications includes:
The described consequences can be avoided if you take the damage to the limb seriously and, despite the pain, take a reasonable approach to choosing a hospital and doctor for surgical treatment.
Treatment of lower leg injury
In the hospital where the patient is taken, while the X-ray report is being prepared, the patient’s wound is thoroughly washed again. The doctor prescribes antibiotic injections to eliminate the effects of infections introduced at the time of injury.
The general principles of therapy are the same for all types:
When a bone acquires its natural look, the plaster is removed, and the rehabilitation period begins. There are specific treatment options for specific types of fractures.
Proximal fracture
If the upper part of the tibia is destroyed, a puncture is required to pump out excess fluid from the knee. Before this procedure, the victim is injected intramuscularly with Novocaine or Lidocaine for pain relief. A closed, non-displaced fracture of the tibia involves wrapping the leg in a plaster cast and leaving it for an average of two months after the plaster has dried.
If a displaced fracture of the tibia occurs, to return the fragments to their natural position, the patient undergoes traction of the bones of the affected leg for a period of one to two months. After the fragments are in place, an immobilizing bandage (splint) is applied for a period of one and a half to two months. Traction is required when the doctor cannot move the bone fragments into the desired position with his own hands. Some surgeons replace the application of plaster with the installation of an Ilizarov apparatus, which involves inserting plates and bolts into the soft tissue in the area of damage to fix the fragments.
When the head breaks big bone To combine and fix the fragments, a full-scale operation is performed. Then the leg is placed in traction. And only after the process is completed, a plaster cast is applied from the top of the thigh to the foot.
Mid-tibia fracture
If the diaphase is damaged, the anesthesiologist gives the patient local anesthesia, and the surgeon then combines the fragments so that the outline of the bone appears. This is followed by the application of a plaster cast, which covers almost the entire leg. The disadvantage of such immobilization is that after removing the plaster, the joints of the limbs do not perform their motor functions well.
In order not to negatively affect the functioning of the joints, the application of plaster is sometimes replaced by the use of Hoffmann, Ilizarov and others apparatuses. If the fragments are rotated in different directions and planes, as in the previous case, you have to install a traction apparatus for a month or two, and then put the leg in a plaster cast for another two months. The full recovery period after this type of limb injury occurs in six months.
Diaphase fractures of the shin bones are much easier to treat than injuries in the lower and upper parts of the tibia. A double fracture (of both tibias) requires a more complex operation under local or general anesthesia.
If your ankle is injured
These injuries are of a severe type and belong to class C. The ankle is affected, and care must be taken to restore its mobility after treatment and rehabilitation. In this case, the combination of fragments is carried out during surgery under general anesthesia. The fragments are fixed with various devices, which will have to be removed in a few months during a repeat operation. After the first operation, the leg is wrapped in a plaster cast, which covers half of the lower leg and extends to the toes of the affected leg.
When dislocated ankle fragments are combined, swelling often occurs. To make it disappear, the leg is placed on a Beler splint and placed in traction. After it subsides, the ankle is placed in a plaster splint.
Rehabilitation is absolutely necessary. It is intended for:
- inhibiting the process of atrophy and bringing muscles to a pre-traumatic state;
- bringing muscles to normal tone to begin their functioning;
- restoration of healthy blood circulation in the limb;
- removing swelling from the injured surface;
- bringing joints to healthy pre-traumatic mobility.
Immediately after removing the cast, the person is surprised to discover that he still cannot walk without a crutch or a cane. Therefore, he needs further observation by a traumatologist. To help the patient recover, the doctor prescribes rehabilitation procedures, the first of which can be called massage. It tones the muscles, restores blood circulation, and makes the knee and foot move. If you use special ointments like Chondroxide during massage, the effect will become noticeable even faster.
The doctor will recommend that the recovering person take foot baths with the addition of sea salt. Some people find it helpful to wrap themselves in wax-impregnated cloth. At the same time, it’s time to start a second powerful rehabilitation program - physical therapy.
Therapeutic exercise changes the complex as motor functions return to the leg. After removing the cast, experts advise slightly moving the joints while lying down. As the massage and bathing progress, the leg gains greater mobility. Physical therapy exercises become more active.
You can try to slightly raise your leg, after a few days raise it higher, and rotate your foot and knee while raised. Then make swings and rotational movements with the recovering limb. While standing on the floor, you should try rolling from heel to toe and back. Now it's time hiking. They are completing the rehabilitation process. First, a person walks around the apartment, then you can walk to a bakery or pharmacy. Then comes the time to walk without restrictions.
The main thing in rehabilitation period To complete it quickly, perform the procedures every day. Absences will push the recovery back several weeks.
Injury Prevention
To avoid breaking your leg, you can try to follow certain rules.
Nutrition with the addition of foods containing fortifying foods to the diet skeletal system substances is the first rule. Eat more greens, nuts, and dairy products. Add meat and fish to the menu. Season salads with vegetable oil. This way you will provide the body with enough calcium, phosphorus, potassium, magnesium, manganese, sodium and other substances and vitamins for bones.
Attention! Salad dressing vegetable oils Helps the body absorb calcium necessary for bones.
Do daily exercises that strengthen the muscles of your legs and back, this will help you maintain your balance when you start to fall.
Important! To prevent your child from breaking his leg, keep an eye on him while walking. Start teaching him how to climb ladders and other yard structures gradually. First, let him climb up one step and get down from it. Let him fall from the first step, support him while doing so. But he himself must understand that falling will hurt, that he must first train, and then do risky exercises.
Beginner skiers and climbers are advised not to rush to complicate the slopes. First learn all the subtleties on easy sections, and then gradually increase the complexity of the routes. You don't have to prove to anyone that you are better than everyone else. Learn and then prove.
We advise motorists not to drive while drunk, not to try to overtake the vehicle ahead, to learn and follow the Rules traffic, get enough sleep before long trips and have a partner who will sit behind the wheel and give you time to rest. If you decide to teach your wife or daughter to drive a car, do it on deserted roads in flat areas - without trees or poles. It is better that they undergo training at a driving school. Another tip is not to talk on the phone while driving and do not turn on your tablet or car TV.
If you take care of your health yourself, you won’t have to see a doctor.
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
Isolated fracture of the radius (lane of the Wheel), accounts for 15% of total number 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. Movements in elbow joint 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. Mechanism of injury - falling of heavy objects, bruising of a bone on a hard object, impact on the back side brushes 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 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 task on this topic:
11. Situational tasks on this topic:
Task No. 1
The child was injured on the road. Complains of pain in the hip, headache, and 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 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 with a diagnosis of apophysiosis was admitted to the pediatric surgery clinic. medial condyle left humerus.
1. What data are characteristic of apophysiolysis of the medial condyle of the left humerus?
2. Additional Methods examinations.
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
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 crashes. 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. From above they connect with the femur and patella, forming the knee joint, and 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. Its upper 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 slight thickening, which is attached to the lateral surface of the tibia, and from below it ends with the external malleolus, 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 bones. 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, osteomyelitis, tuberculosis, osteoporosis, malignant primary and metastatic tumors, genetic defects in 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 international classification diseases 10 revision (ICD 10) 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 of injury - bruises, hematomas, a wound on the skin with 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 case of delayed or inept first aid, improper treatment, lack of necessary rehabilitation measures. Let's consider the main ones:
- 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.
- Nerve damage that accompanies the disorder motor activity feet, gait disturbance.
- Fat embolism is a life-threatening emergency condition that occurs when particles of fatty tissue from the bone canal enter the lumen of the blood vessels.
- Infectious complications with open fractures.
- Post-traumatic deformity of the lower limb.
- Formation of a false joint, which leads to loss of the supporting function of the leg.
- Formation of contracture or ankylosis, post-traumatic deforming osteoarthritis in the case of intra-articular fractures.
- 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
IN mandatory If you have a fracture of the leg bones or suspect one, you need to call an 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 look at the basic principles first aid:
- Carefully remove shoes and clothing from the affected leg, trying not to move the limb at all.
- Give an over-the-counter pain reliever if you have one on hand.
- Stop the bleeding with one of known methods in case of an open fracture and treat the edges of the wound with an antiseptic.
- 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. Usually, rehabilitation program includes therapeutic exercises, massage, physiotherapeutic procedures, dietary food and takes place in several stages.
Thus, a fracture of the tibia is common species injuries 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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