Shin fracture is a fairly frequent occurrence. It is this type of injury that most often occurs in road traffic accidents involving a pedestrian. Shin bones rather thin, because they do not tolerate much mechanical load. The restoration of their integrity can take several months, in some cases such fractures lead to disability.
Anatomy of the lower leg
The lower leg, like the forearm, consists of two separate bones. Tibia located on the inner side of the leg, it is involved in the formation of the knee at the top and the ankle at the bottom. It has a muscle-free area on the front surface.
Fibula located on the outside, it is several times thinner than the tibial, but unlike the latter it is covered with muscles from all sides. The fibula is involved in the formation of the ankle joint. Between the bones there is a tight intercostal membrane, through which the neurovascular bundles pass.
The muscles of the leg are located in several layers. Their greatest number is located behind and outside, the smallest - in front and inside. These muscles are necessary for the mobility of the foot.
The nerves and vessels that pass between the muscles innervate and supply both the lower leg and the foot. That is why, in case of injuries to the leg, the mobility of the foot may suffer.
The pattern and frequency of occurrence of open shin fractures is largely associated with age and sex factors. Epidemiology is based on the general state of the organism and the type of activity. Very often injuries occur in athletes and people with pathological diseases that cause brittle bones.
According to the research done, shin fractures are more often affected by men than women. At risk are people whose work is related to road transport, as this is the likelihood of accidents, athletes, workers. But one cannot be 100% sure that the injury will not occur in people who are not in this category. That is, no one is insured against open injuries of the leg.
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Causes of open shin fracture
The main reason for the open fracture of the leg is the directional impact of a large force. Bones do not withstand strong pressure and break. Most often this occurs when falling on the leg, fixed or bent in an uncomfortable position. Shocks, falling heavy objects, accidents, sports injuries, pathological and chronic processes (tumor, osteomyelitis, tuberculosis) provoke bone damage.
There is a certain classification of open injuries, which is based on the site of injury, the location and number of bone fragments, the nature and extent of damage to the soft tissues, joints. Consider the main types of lesions:
- Single and multiple - with a single bone broken in one place and there are two fragments, and with multiple in several places because of what more than two fragments are formed.
- Straight, spiral, oblique - depend on the line of the defect. If the bone is cracked across, then it is straight, diagonally - oblique. If the line is uneven, then it is a spiral injury.
- With displacement and without displacement - depend on the location of bone fragments. If the injury is without displacement, then there is a normal position of fragments to each other. When offset, there are changes in the position of the bones, and if we compare them, they will not form a normal bone.
- Splintered and even - even have the same break line, splintered - uneven edges, teeth of different shapes and sizes.
- Intra-articular and extra-articular - if joint tissue is involved in the pathological process, then it is a severe intra-articular injury. If only the lower leg is hit, and the joints are intact, then this is intra-articular damage.
In addition, isolated injuries of one and both bones, the upper, middle or lower third:
- The proximal part of the tibia or the upper third of the tibial and small bones - this category includes injuries of the condyles, head and neck of the fibula, and tibial tuberosity.
- The middle part or the middle third of the shin bones is damage to the diaphysis.
- The distal part or the lower third of the tibia is the fracture of the ankles. As a rule, the injuries of this group are accompanied by injuries of the ankle or knee joint, which significantly complicates the overall picture.
The most complex injuries are most often caused by injuries in accidents and falls from a height. But regardless of the cause of the pathology, the more bone areas are damaged, the longer the process of treatment and rehabilitation.
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The mechanism of fracture development is based on the direct action of a force that is perpendicular to the bone axis. Pathogenesis is associated with strong impacts. In medical practice, this pathology is called “bumper fracture”, because a bump of a car bump almost always causes open injury to both limbs. A characteristic feature of damage is the direction of the shock wave. As a rule, the injury has a wedge-shaped shape with a lot of fragments in the wound area.
Athletes are more often diagnosed with injuries of the right tibia, since for many it is supporting and jolting. If the force was directed along the bone axis, damage to the ankle, the condyle of the tibia, and the ruptures of the cruciate ligaments develop.
Damages differ depending on the direction of the force of impact on the bone: spiral, transverse, helical, oblique. The worst tendencies are longitudinal. This is due to poor blood supply to the tibia. Another serious injury is spiral fractures. They occur during the rotational movements of the lower leg during fixation of the foot. Accompanied by bone fragments, strong muscle and skin breaks.
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Symptoms of an open shin fracture
As with any injury, damage to the bones is characteristic. Symptoms of an open shin fracture depend on the location of the defect, its cause and a number of other factors. The first one that the victim faces is severe pain, bleeding, and swelling. When trying to move a limb or palpate it, there is a crunch of bone fragments rubbing against each other. It’s impossible to rely on your leg, just as you can make an active movement with your lower leg. From the wound, protruding bone fragments are visible, and the leg is lengthening or shortening.
Shin injuries have a number of similar symptoms with other injuries of the lower limbs:
- Anatomical and functional disorders.
- In the area of the fracture appears excessive mobility of the legs.
- Severe pain and swelling appear at the site of injury, and ankle rupture or sprain may occur.
- If the injury is offset, hematomas and bruises appear.
If the bone has damaged the fibular nerve, then the foot hangs down and cannot be bent. When injured by fragments of blood vessels, the skin turns blue.
Main symptoms of an open shin fracture:
- Heavy bleeding
- Open wound with bones breaking through soft tissue and skin
- Sharp pain
- Mobility restriction
- Traumatic shock
- Dizziness, weakness, loss of consciousness
To diagnose the extent of damage and their localization, an x-ray, MRI or CT scan is performed on the victim. If the injury fell on the diaphysis, then edema and cyanosis develop with severe pain. The shin is severely deformed, the bone crunch is heard in the tissues, the foot is turned out. In case of injuries of the tibia on the leg, it is impossible to rely on, while, as with fibula fractures, support is possible.Distal injuries are characterized by severe pain and swelling, the foot is turned outward or inward, the support on the limb is impossible.
Pathological damage to the fibula or tibia can be suspected, knowing the first signs of fracture. The victim has a shortening of the lower leg and deformity of the limb. The shortening is due to the fact that the muscle tissue surrounding the broken bone, trying to connect it, so the limb is pulled up. Another characteristic feature is pain and bleeding, aggravated by attempts to move the leg or touch it.
The first signs include the appearance of swelling in the area of injury. It is associated with hemorrhage in the joint. At the same time, crepitus of bone fragments and increased leg mobility are observed. It is impossible to rely on the injured limb, and painful shock can cause loss of consciousness.
Fibular open fracture
The fibula consists of two epiphyses, it is thin, long and tubular. The main components of the ankle are the lower end of the bone (external, lateral ankle), which acts as a stabilizer of the joint. There are several types of open fractures of the fibula, which can be formed at different levels. But in most cases, damage occurs in the area of the lateral ankle, accompanied by dislocation and shortening of the foot, rupture of the distal syndesmosis.
The body of the bone has a triangular shape and three surfaces: lateral, medial, posterior. Between themselves, they are separated by rowing. Damage can be transverse, fragmentary, spiral and oblique. It is not difficult to diagnose pathology, as the injury has a vivid clinical picture:
- A strong feeling of pain and bleeding from bone-torn tissues.
- Swelling and limitation of range of motion.
- Damage to the peroneal nerve (possibly with a fracture of the neck and head of the bone).
- Drooping of the foot and the inability to bend it (appears with a complete rupture of the nerve).
Damage to the diaphysis, which is possible with a direct blow to the outer part of the lower leg, due to tucking of the foot, falling from a height, is most common. A variety of pathological bone diseases provoke their fragility, which can also cause injury. Fracture of the diaphysis increases the risk of injury to the fibular nerve.
Diagnosis of damage is based on symptoms. To identify the injured area, the victim is sent to x-ray (pictures are made in two projections). If there is a need for more thorough examination, a CT scan or MRI is performed.
The treatment is long and depends on the severity of the injury. The main danger of open injuries is the possibility of wound infection, which will significantly complicate the healing process. The risk of infection increases in the postoperative period when the victim's body is weakened. Without timely medical care, an open fracture of the fibula can lead to amputation of an injured limb or part of it.
Consider the treatment options for injury:
- If the damage occurred in the middle third of the bone, then plaster is applied to the leg from the middle of the thigh. In addition, the knee and ankle are immobilized for 2-3 weeks.
- If a fracture in the upper half without damage to the peroneal nerve, then put a plaster splint for a month. But for 2-3 days, the victim can walk, leaning on a crutch.
- Trauma to the head of the fibula with nerve damage is accompanied by severe hemorrhage and bruises. The patient is put a plaster cast to the middle of the thigh and fix the foot at a right angle.
It is mandatory to prescribe medications, physiotherapy, massage and therapeutic exercises. After 3-4 weeks, the plaster cast is replaced with a detachable knee-length splint.If the method of treatment did not give the desired results (the wrong treatment regimen, the presence of serious comorbidities), then full recovery and recovery may not occur. In this case, the victim loses the ability to move normally.
Open fracture of the tibia
The tibial bone is the long tubular bone that accounts for the most injuries to the lower leg. As a rule, when its fracture occurs, the deformity and fibular. An open fracture of the tibia is possible in case of high-energy injuries, that is, accidents, falls from a height or sports injuries. Very often, the pathology is combined with fractures of the pelvis, ribs, other limbs, injuries of the abdomen and chest.
- Sharp pain
- Bleeding from the site of injury
- Swelling and deformation of the legs
- Crepitus and pathological limb mobility
- Bruising on the skin
- Through the wound you can see fragments of bones.
To confirm the diagnosis, an x-ray of the lower leg is performed. The doctor determines the number of fragments, the presence of displacement and damage to the fibula, ankle or knee joints. If there is damage to the joints, an additional CT scan is performed. In case of damage to the nerves or vessels, consultation of a neurosurgeon, a neurologist and a vascular surgeon is required.
First aid consists of taking pain medication and limb immobilization. The skin around the wound must be cleaned of foreign bodies and dirt, closing it with a sterile dressing. If there is heavy bleeding, a tourniquet is applied to the thigh. In traumatic shock, antishock measures are shown.
Inpatient treatment can be surgical and conservative, it depends on the complexity of the injury. If the fracture is without displacement, then immobilization of the limb and wound treatment are shown. In other cases, make skeletal traction. Through the heel bone put the needle and impose a tire. In this position, the leg is within a month, after which a control X-ray is made. If there are signs of callus in the picture, then the traction is removed and gypsum is applied for 2-3 months. It is mandatory to conduct drug therapy, which consists of analgesics and drugs to stop infection from an open wound.
In severe cases and fragmentation fractures carry out surgery. The treatment is aimed at restoring the normal position of the bone fragments. Post-traumatic contracture warning is also provided. The operation is carried out after 7-10 days after the arrival of the victim in the hospital. During this time, swelling is reduced, and the general condition is normalized. The whole preoperative period the patient spends on skeletal traction.
During surgery, the doctor chooses the method of osteosynthesis, focusing on the nature and level of the fracture. For this purpose, various metal structures are used: locking rods, pins, plates. Extrafocal osteosynthesis with Ilizarov devices is often used. The period of fusion of the tibia with an uncomplicated fracture takes 3-4 months. For comminuted injuries, treatment can last six months or more. During the entire period of therapy, physiotherapy and physical therapy are carried out. After fusion, the patient is waiting for a rehabilitation course.
Open fracture of a shin with shift
A direct stroke in the transverse direction is the main cause of displaced fractures. Because of the injury, fragments of bone are formed, which are shifted in different directions. Their displacement may be peripheral, angular, lateral, fragments can be wedged in and go behind each other.
An open fracture of the lower leg is characterized by the following symptoms:
- Pain and crunch when getting injured.
- At the site of injury, a bruise and edema are formed with marked impairments in the motor function of the leg.
- Due to the displacement of fragments, the soft tissues and skin are torn.
- In place of the movement of fragments formed a depression or recess.
- The injured limb is shorter than healthy.
- The movement of the lower leg is carried out in an unnatural direction.
Very often such injuries cause traumatic shock. Treatment begins with matching displaced bones. This is necessary to give the limb the correct form and its normal fusion. The procedure is carried out manually or using special tools. In order that the victim does not suffer from pain, he is settled on his back and anesthesia is done. After that, the patient is taken by the thigh, and the second doctor grasps the leg, holding the heel and back of the foot. In this position, the doctors slowly stretch the limb and determine the position of the displaced fragments.
After the reduction, the doctor checks the length of the injured leg with a healthy one. If their parameters converge, then an open wound is treated and the lower leg is immobilized. After 10 days, the patient must undergo a control x-ray. This is necessary to confirm the normal accretion. If reposition cannot be performed, then metal structures are used to fix the displacements.
Peeled open shin fracture
Violation of the integrity of the bone with more than three fragments and the rupture of soft tissues is a comminuted open fracture of the leg. It is considered one of the most complex damage, as it carries the risk of soft tissue interposition, compression of nerves and blood vessels. With a large number of fragments during reposition, difficulties arise because the fragments cannot be compared.
Signs of comminuted open leg injury:
- Pain and bleeding
- Leg deformity and its pathological mobility
For the diagnosis of conduct x-rays. Treatment begins with the creation of conditions for fusion of fragments and the subsequent restoration of the functioning of the limb. At the first stage, the bone fragments are displaced and their fixation is carried out to prevent repeated shifts. The method of therapy depends on the nature and location of the injury, its severity, the general health of the injured person, the presence of concomitant injuries and diseases.
With a large number of fragments, the treatment is performed with the help of surgical restoration of the surface. Various methods are used for this: the Ilizarov apparatus, osteosynthesis with screws, plates and pins. In case of complex multi-joint intraarticular injuries with displacement, the operation is an absolute indication. In some cases, in case of damage to the tibia and fibula, the operation is performed only on the first one. With its restoration, the accretion of the second bone will occur by itself.
The duration of immobilization depends on the severity of the injury, but as a rule, it is 3-5 months. Rehabilitation to restore normal functioning of the legs and its motor functions takes 3-4 months. The patient is waiting for exercise therapy, massages, special gymnastics.
Open fracture of the lower third of the leg
Most often, leg fractures occur in the lower third of the leg. If the injury mechanism is direct (direct blows, car accidents), then a transverse fracture of one or two bones occurs. With indirect injuries (bending, rotation of the lower leg with a fixed foot) occurs spiral, ie, oblique damage.
An open fracture of the lower third of the leg is very dangerous, since it is observed in the passive position of the limb. In severe cases it is so pronounced that the surface of the foot can be put on any plane. On palpation, a strong pain appears, lateral deviations of the lower leg are determined. If both bones are broken, then there is a crepitus and the mobility of the fragments.
For accurate determination of the position of the defect, conduct x-rays. Treatment depends on the severity of the fracture, the presence of displacement, the state of soft tissue. The open wound is cleaned and disinfected, the fragments are surgically dislodged. For their fixation use needles, bolts or plates.For 1-1.5 months they impose a V-shaped plaster, but before that they use Beler's tire and a system of skeletal tension in order for the wound to subside and swelling gone. Damage in the lower third of the leg grows slowly, unlike injuries in the overlying sections. Full restoration of the limb takes 4-5 months.
Double open shin fracture
In frequency among the double damage to the tubular bones, a double open fracture of the leg takes first place. The mechanism of its origin in most cases is direct, but is accompanied by extensive damage to the surrounding tissues. Intermediate bone fragment enters the main blood supply, deforming the artery. It must be turned off from the bloodstream, as it causes delayed consolidation and frequent cases of nonunion. The duration of immobilization is lengthened and can reach 4-6 months.
Depending on the characteristics of the offset, there are four types of double open injuries of the lower leg:
- No offset
- Offset at the level of distal damage
- Offset at the level of proximal damage
- With offset intermediate fragment
All these types have a typical clinical picture with more or less pronounced signs of soft tissue rupture and bleeding. Diagnosis is carried out using x-ray in different projections. Treatment depends on the nature of the injury:
- At displacement, they are immobilized with a circular plaster cast, grabbing the knee joint for up to 4-5 months.
- If there is an offset at the level of the distal fracture, then reposition is shown with the help of skeletal traction within 1.5-2 months. This is necessary to eliminate the offset in length. After stretching, circular gypsum is applied to the upper third of the thigh for 3.5-4 months.
- When the intermediate fragment is displaced or at the level of the proximal fracture, open reduction is performed. Due to impaired blood supply, surgery should be with minimal trauma. For this purpose, use of extra-focal osteosynthesis or osteosynthesis with a rod lock. The duration of consolidation of injuries of this nature is 2 times longer than the period of adhesion of single fractures. Full restoration of the limb occurs in 7-10 months.
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Complications and consequences
The most difficult therapeutic effects are open fractures. This is due to the risk of possible displacement, debris, rupture of blood vessels and nerves. All consequences and complications are divided into three large groups, depending on when they appeared.
- Straight lines are observed at the time of injury.
- Early - appear a couple of days after the fracture.
- Late - appear after a long period of time after injury.
|Nature of defeat||Open fracture of the leg|
|Closed shin fracture|
|With offset||Shin fracture with displacement provokes a shift of bone fragments. To restore the whole bone, the debris is returned to its normal position, and then compared.|
Fractures with displacement are:
|No offset||Non-displaced shin fractures are complete, in which bone fragments are located normally. If you compare them, the whole bone is formed.|
|Number of injuries||Single||The bone is broken only in one place where there is a fragment.|
|Plural||Deformation of the bone occurred in different places. Fracture with two fragments.|
|Fragment edge shape||Smooth||Edge of the wreck smooth|
|Bone breaking line||Straight lines||The bone is broken straight.|
|Skew||The bone is injured diagonally.|
|Screw||The bone is damaged as a spiral.|
|Joint damage||Intra-articular||Involved joint structure.|
|Extra-articular||The drumstick is broken without injuring the joints.|
|Localization of injury||Fractures of the bone in the upper segment|
|Shin injuries in the middle third||Bumper fractures or diaphyseal fractures of the bones of the leg, diaphyseal injuries of the tibial or fibular bone.|
|Fractures of the bone in the lower third of the leg||injury to the ankles, while there may be a closed three-year or two-year old fracture.|
Important! Injury of the bones of the leg often provokes a fracture of the wedge-shaped and cubical bones of the foot. It is possible to diagnose pathology using X-ray.
There are various symptoms of a shin fracture. As a rule, the difference exists with a different location of the injury. But there are signs of fracture that occur in all cases.
Common clinical manifestations are:
- strong pain,
- swelling of the leg after a fracture,
- blueness or paleness of the skin at the fracture site,
- the inability to move the leg, while the person experiences acute pain and hears a characteristic bone crunch,
- lack of support for the broken leg,
- visible manifestations of injury (one leg shorter than the other, visible bone fragments that protrude from the wound),
- if the peroneal nerve is damaged, a hanging foot can be seen that cannot be bent,
- blood vessel damage that leads to blood loss. However, it is worth noting that with closed fractures, blood is poured into the region of deformation.
Important! Blood loss in injuries to the bones is a frequent occurrence, but it is difficult to talk about what the maximum blood loss can be. As in the assessment of blood loss (BCC), the size of the injured site and the nature of the fracture play a role. With small wounds, the BCC is 10%, and with large wounds - 40% and more.For closed fractures of the bones of the leg, 600–700 ml of blood loss are characteristic. But this indicator is conditional and there are many factors that can affect it.
The signs are characterized by proximal fractures of the leg:
- The position of the ankle is forced, sometimes slightly bent.
- The injured leg bone has a visible internal or external displacement.
- A strong displacement provokes the appearance of a tumor at the fracture site.
- On palpation of the damaged area there is a strong localized pain that does not spread to other areas, the crunch of debris. The patella is mobile.
- To make any movements with the foot is impossible.
For an accurate diagnosis prescribed passage of X-rays, KTM.
Fractures of the diaphysis of the bones of the leg are manifested by strong painful sensations, swelling and cyanosis of the skin of the leg. In addition, characteristic:
- shin deformity
- external displacement of the foot,
- tangible crunch of bone fragments,
- reliance on a broken bone is impossible (however, it is possible to rely on the leg when the fibula is deformed).
Signs characterized by ankle fractures:
- acute pain which is difficult to endure
- significant visible swelling,
- foot tucked.
As a rule, with such a lesion of the bones, the leg is not supported.
Fracture of the bones of the leg occurs under the influence of two main processes that provoke damage to the integrity of the bone:
In the first case, the ankle is injured under the direct influence of the load on the limb. For example, when a person fell on a fixed leg in one position, or when a strong direct impact (rarely occurs) affected a shin.
In the second case, the bone can be injured due to a small load, but the main reason for this is a disease that reduces the strength of the bone tissue (diffuse osteoporosis, osteomyelitis, tuberculosis, tumors, a genetic defect in bone development).
Pay attention! Both in the first and in the second case, injury to the lower leg may result in a fracture of the medial sphenoid bones. It is possible to diagnose an injury by means of carrying out an x-ray.
In case of fracture of the leg, it is important to provide first aid to the victim in a timely and correct manner. To do this, follow these steps:
- Anesthetize pain area to avoid pain shock.
- Try to gently undo the victim.
- If bleeding occurs, try to stop the blood loss by treating the wound with an antiseptic wound around the edges.
- Fix broken limb using a tire or other materials that are on hand.
Anesthesia - is the main action, as with an open fracture, and with a closed lesion of the bone. As an anesthetic, nonsteroidal anti-inflammatory drugs (Metamizole sodium, Pentalgin, Nimid or Nimesulide, Sedalgin, etc.) are used to relieve pain. If the victim is not able to take a pill, then it is recommended to administer the anesthetic medication as close as possible to the fracture site.
Next, remove the shoes from the foot, which is damaged. Why do you need to do this? The resulting leg injury leads to rapidly developing traumatic edema, which can provoke painful shock, so the shoes must be removed.
If a person has a leg injury that causes bleeding, it is necessary to stop the blood and treat the wound. With open fractures of the leg, the tissue is cut, which makes it difficult to provide a full examination and wound treatment, then determine the degree of danger of bleeding.
Usually, in the event of an open fracture, blood can flow or simply flow out of the wound. If a fragmentation fracture has triggered jet bleeding, this is a dangerous condition, as the injury damaged a large blood vessel.
What to do? First of all, it is necessary to stop blood loss with the imposition of a cotton swab, bandage or sterile tissue. This tampon is carefully laid in the wound, having tamped it tightly, after which the shank is tied up with a tight bandage that will allow fixing the tampon. Impose a tourniquet in this case is impossible, since it will provoke the contraction of muscles and the movement of bone fragments. This measure is dangerous the emergence of a new vascular damage. If the bleeding is insignificant, the tourniquet also does not impose, however, the edges of the wound are treated with an antiseptic.
Important! Bleeding is a dangerous phenomenon that requires immediate action!
Applying a splint for injuring shin bones
The basic rules for transport immobilization are the imposition of a tire. About how to properly impose a tire when injuring the legs, few know. But this is easy to do, the main thing to remember is that the imposition of a splint on fractures of the lower leg should fix and immobilize the current position of all injured tissues and bones.
The splint overlaps the injured leg so that the ankle and knee joint are immobilized. To do this, you can use the cramer's finished tire, if it is on hand, or find any two long objects (most often it is a stick, maybe even an umbrella).
These sticks are applied to the injured leg, imposing them in the lower third of the leg, so that one end of the stick is located at the heel (outside) and the second to the middle of the thigh (inner side). After this, the sticks are pinned to the foot in several places. After that, the patient waits for the arrival of the specialist and transportation to the hospital.
Who can not perform the operation?
Contraindications to surgery for fractures of the leg are as follows:
- Contact with the patient is absent.
- Rotational or angular displacement, and it can not be eliminated.
- There was a complete shift or shortening on the tire.
- The interposition of soft tissues is noted.
Under the above conditions, the operation is not performed.
Diaphyseal fractures of the shin bones take a long time to heal and the rehabilitation process after such injuries is long. Therefore, in order to improve certain functions of the musculoskeletal system, it is recommended to carry out a procedure of physiotherapy, which is selected specifically for different stages of rehabilitation:
1–10 day after fracture of the leg. Rehabilitation includes:
- Impact on edema, hematoma interference current.
- Irradiation with a UV lamp to destroy microorganisms.
- Conducting bromine electrophoresis to reduce severe pain.
- Conducting UHF.
- The use of interference currents.
- UV irradiation.
At the same time, it is necessary to remember about the development of the leg after a fracture of the lower leg and regular consultation with a specialist.
If the rehabilitation process is approached responsibly, it will be possible to restore all the functions of the injured leg by 100%. However, adaptation and rehabilitation after fractures, especially when it comes to multiple injuries with displacement, takes a long time. To this must be prepared.
The shin is the part of the skeleton between the thigh and the foot, consisting of two tubular bones (tibial and peroneal). The main load is borne by the larger tibia. The condyles (protrusions in the upper part of the tibia) are connected to the femur, forming the lower articular surface of the knee joint. With its lower part, the tibia articulates with the talus, forming the ankle joint.
The fibular bone is located on the outside, increases the stability and strength of the lower leg. Both bones of the lower leg are interconnected (at the top - by means of a common joint, in the middle part - by an interosseous membrane, at the bottom - by means of ligaments). At the lower ends of both bones of the tibia there are protrusions (ankles), which on both sides cover the ankle joint and give it transverse stability.
Usually occur when falling from a height. In young patients, they are more often split, in older patients - depressed. Fractures of the internal and external condyles are distinguished.
The patient complains of pain and swelling in the area of damage. The knee joint is enlarged as a result of hemarthrosis (accumulation of blood). The fracture of the external condyle is accompanied by a turning of the tibia outwards, a fracture of the internal condyle — by the deviation of the tibia medially. Movement in the joint sharply painful, limited. Reliance on the foot is impossible or difficult. For confirmation, radiography and MRI of the knee are performed.
Fracture of the tibia anesthetized, if necessary, carry out the puncture of the joint. When the condyles change without displacement, they apply a plaster cast for 1 month. At the end of immobilization prescribe physiotherapy and physical therapy. Full load is allowed after 2 months from the date of injury.
In case of displaced fractures with displacement, reposition is performed and plaster longestu are applied for 6-7 weeks. If it is impossible to satisfactorily compare fragments, skeletal traction is performed for up to 2 months. Full load is allowed after 3 months from the date of injury. Surgical treatment is possible with the use of screws, plates and the Ilizarov apparatus.
Fracture of the tibial shaft is the result of direct or indirect injury. If the interosseous membrane remains intact, there is no displacement of fragments in length. Possible angular offset and offset width.
The patient is worried about pain and swelling in the area of damage. The shin is deformed. Reliance on the foot is impossible. To confirm, make a radiography in two projections.
Perform analgesia fracture site. When the fragments are displaced, they are repositioned with the subsequent application of a plaster splint for a period of 2 months. Interposition of soft tissue (wedging of tissue between fragments) requires surgery.
Fracture diaphysis of the fibula develops due to a direct impact on the shin from the outside. Trauma is accompanied by pain at the fracture site and minor swelling. The patient retains the ability to lean on the leg. Unlike a bruise of a shin, at a turn of a fibular bone pain arises at lateral compression of a shin far from the place of damage. To confirm perform a radiography. The patient impose plaster Longuet for 3-4 weeks.
A diaphyseal fracture of both bones of the tibia occurs when hitting the tibia (“bumper fracture” in a traffic accident) or indirect injury (twisting, bending). A direct injury usually causes multiple fractures of the shin bones. When bent, a triangular fragment is formed on the inner side of the curvature, and when twisting, helical fractures of the shin bones occur.
The patient complains of a sharp pain in the area of damage. The shin is swollen, cyanotic, deformed. There is a deviation of the foot outwards. Crepitus and abnormal mobility of fragments is determined. Reliance on the injured leg is impossible. To confirm, perform radiography in two projections.
In case of fractures of the shin bones without displacement, the ability to reposition the fragments and keep them in the correct position, skeletal traction is performed for 4 weeks. Then impose plaster Longuet for a period of 3-4 months. If it is impossible to compare and retain fragments, soft tissue interposition, as well as to reduce the time of treatment and early activation of the patient, traumatologists apply surgical treatment. Screws, lockable rods, screws and external fixation devices are used.
Approximately 60% of the total number of fractures of the shin bones. Appear as a result of direct (blow to the ankle) and indirect (forced rotation, turning the foot inwards or outwards) injuries. Possible:
- isolated internal and external ankle fractures,
- biliocerebral fractures (fractures of both ankles),
- biliocerebral fractures in conjunction with a fracture of the anterior or posterior edge of the tibia (Potta-Desto fractures, another name is “trilobial fractures”).
Any fractures of the ankles can be accompanied by a torn ligament, displacement of fragments and subluxation of the foot (fractures), however, more often such injuries are observed with two-and three-year joints fractures. For a fracture of the external ankle, a subleft of the foot in the inside is characteristic;
Ankle joint is swollen, sharply painful. Reliance on the leg is difficult, with fractures impossible. With fractures, there is a deviation of the foot in the appropriate direction, with Potta-Desto fractures - bending of the foot in the plantar side. To confirm the diagnosis, radiography is performed in two, sometimes in three projections.
Anesthesia fracture, reposition, the imposition of a plaster splint. With a fracture of one ankle without displacement, the period of immobilization is 4 weeks, with bilobacteric fractures (including with subluxation of the foot) - 8 weeks, with Potta-Desto fractures and ruptures of the tibia syndesmosis - 12 weeks. The operation is shown when it is impossible to compare the bone fragments and soft tissue interposition.
What is a fracture of the leg?
A fracture of the leg is damage to the tibial or fibula bones, and sometimes both of them, due to the fact that the load on them is greater than they could bear. The injury is quite common, and on average is about 20% of the total number of fractures.
The drumstick is represented by two tubular bones, each of which has a body and two ends. The tibia is connected to the femur above and with the foot bones below. During a fracture, most often the bone, both large and small, breaks in the middle. Sometimes injuries are accompanied by complications. In the emergency room, most often people with such a problem are treated after a car accident. Although the cause of the fracture can be any direct and strong blow to the bone. Sometimes an additional factor that plays a role in the formation of a fracture becomes a disease: sarcoma or osteomyelitis.
There are several types of shin fractures, depending on their location:
Injuries to the neck and head of the fibula, as well as fractures of the tibial tuberosity and condyles. When these zones are affected, they talk about fractures of the bones of the lower leg in the upper part.
If the diaphysis of both bones or one of them is injured, then they speak of fractures of the lower leg in its middle part.
If an ankle fracture occurs, then they talk about a fracture of the lower leg in the lower part. This type of injury is most common and accounts for more than 60% of the total number of all fractures in a given area.
Trauma can also be open or closed, with and without offset. Depending on its nature and complexity will depend on the method of treatment, as well as its timing. The degree of severity depends on whether there is damage to the surrounding soft tissues, whether the joints, blood vessels, nerves and tendons are injured. Light injuries are usually caused by careless movement on the street, skating, industrial accidents. Severe injuries are the result of a fall from a height, participation in an accident, etc.
Shin fracture with displacement
Fracture of the lower leg, at which the displacement occurred, most often results from a direct impact in the transverse direction. At the same time fragments that can move in different directions are formed. The displacement may be lateral, peripheral, angular, with divergence, wedging in and climbing of the broken off parts.
Similar trauma is characterized by the following symptoms:
The length of the leg will be less, compared with a healthy limb. Most often, this does not even require additional measurements.The difference will be visible to the naked eye.
The movement of the leg can be carried out in an unnatural direction for it.
Sometimes fragments can move so much that they tear through the soft tissues and skin.
Sometimes a depression or hollow is formed in the place where the movement of fragments occurred.
The pain is the constant companion of any fracture, as well as a crunch during injury.
In the place of localization of the fracture a bruise and swelling is formed, with a pronounced impairment of the motor function of the limb.
Most often, the condition of the person who received a fracture of the leg with a shift is still satisfactory, but sometimes a traumatic shock can be observed.
The treatment will be started with the obligatory comparison of the fragments formed. This is necessary to give the limb the correct form and its subsequent normal fusion. Reposition is carried out either manually or with the help of special tools. For this, the victim must be laid on his back and anesthesia should be made with appropriate preparations. After that, one doctor holds the patient by the hip, and the other holds the leg in such a way that one hand holds the heel firmly and the other is the rear of the foot. Then, slow and systematic stretching of the muscles that have been pulled to the site of the fracture is carried out, and the position of the displaced fragments is determined with the help of probing. After the reposition is complete, the doctor will necessarily check the length of the limb and compare it with the length of the healthy leg. If the parameters converge, then you can begin to apply a plaster cast.
For control, the patient will have to go through an x-ray again after 10 days, so that the doctor can make sure that the bones of the lower leg become fused normally. Sometimes the skeletal traction method can be applied. The operation is required in the case when the closed reposition is impossible to implement, due to the fact that fixation of fragments requires the use of metal structures.
Features of treatment of the elderly, as well as patients of young age, who suffered a shin injury with displacement, consist in the fact that they must be left immobilized for the shortest possible time. That is why you should choose the least traumatic method of treatment.
Shin fracture without displacement
Fracture of the tibia without displacement - the injury is serious, but it proceeds somewhat easier than similar injury to her, but with fragments set in motion. Often, these fractures are subcutaneous, that is, when the whole periosteum from above holds the fragments remaining inside. The age group most often receiving this type of injury is children. This is explained by the fact that their bones are more elastic compared to the bones of adults. Doctors often refer to injury without displacement, as a fracture of the "green twig" type.
Symptoms of fracture of the leg without the formation of fragments are as follows:
Swelling at the site of injury.
The shortening of the limb, but not explicitly. You can see it only after taking certain measurements.
Irradiation symptom. When pressing on the leg anywhere, the pain will be localized exactly where the fracture occurred. It is this symptom that helps in most cases to make the correct diagnosis yourself.
Often, with such an injury, people try to continue on their own, as they believe that they simply have a severe injury. Such carelessness is dangerous in that the fragments that the periosteum holds may end up moving. This will aggravate the severity of the injury and prolong the time of treatment. Therefore, at the slightest suspicion of a fracture, the doctor must be seen. Because without an X-ray examination, it is very difficult to diagnose such an injury.
With a closed isolated fracture of the bones of the leg without the formation of displacement, no reposition is necessary.
It will be enough to apply a plaster cast that will be placed in the area from the foot to the knee, or slightly higher - to the middle of the thigh:
If the fibular bone is broken below, then the plaster will be applied to the knee.
If the fracture is localized in the middle or in the upper third of the bone, then the application of a plaster splint is shown. It can be removable. Fixes a fracture rigidly, without the possibility of movement.
Most often, immobilization lasts about three months. If the diaphysis of both bones was broken, then the period may increase to 4 months. After the removal of gypsum, the most common procedures are shown: exercise therapy, massage, physiotherapy. The opportunity to begin work duties will appear after 14 - 30 days, as the cast will be removed.
Closed shin fracture
Closed fracture of the leg is a very serious injury. It is characterized by the fact that damage to tissues located far from the bones does not occur, as well as the contact of the damaged area with the external environment is not observed.
When the fractures are closed, the bones of the ankle, the tibial condyle may suffer, its tuberosity may be torn off, the head of the fibula or the diaphysis of both bones may be damaged. If the distal end of the tibia is damaged, then the fracture can be both intra-articular and periarticular.
Symptoms of a closed fracture are as follows:
Sharp limitation of limb mobility. The person will simply not be able to lift his leg up.
If the shin is attempted to be slightly raised, the end of the tibia (proximal) will bulge under the skin.
If at feeling crepitations are heard, that is, characteristic crunches, then this symptom unambiguously indicates the presence of a closed type fracture. At the same time, one should not specially induce sound, since such manipulations can lead to displacement of fragments, which may be present under the skin.
If in patients who have not reached retirement age, closed fractures are more often split, since the bones have a solid structure, then in older people there are injuries indented due to the high porosity of the bone tissue.
Diagnostics, as a rule, is not difficult for an experienced physician, and palpation examinations are sufficient for him to determine a closed fracture. This results from the fact that bones of a shin are located close to skin and are not covered with a thick layer of muscles. However, radiological examination is indispensable. It will allow to identify the characteristic features of the fracture, the possible displacement of fragments. Pictures must be taken in several projections, most often in two.
The treatment is carried out in a hospital. The tasks that confront physicians are the restoration of the integrity of the bone, the removal of the pain syndrome, the return of the patient to normal life activity, which will proceed without restriction of movements.
The following methods are used:
Extensive, which implies traction of the damaged bone. It may be skeletal or adhesive.
Fixation method. It is realized by imposing a certain type of plaster cast.
Operational method, which involves fixing intraosseous using either metal plates or metal spokes, or metal rods, or metal wire.
But, naturally, before this or that method of fixing the limb is applied, it is necessary to reposition the fragments, if any. Often, the Delbe bandage is used to immobilize the fracture site. It has a number of advantages compared to ordinary plaster, since after it is applied a person can move the knee and ankle joints if they are not damaged. This dressing allows outpatient treatment, without tying the patient to the hospital bed.
First aid for fracture of the leg
There is a certain order of actions that must first be given to a person who has a fractured leg:
First, he needs to help overcome the pain symptoms. To do this, you must give the victim an anesthetic. For this fit any drug that is available. Pentalgin, Analgin, Nimesulide, Sedalgin, etc. are distinguished as suitable means. If you have medical skills, you can make an intramuscular injection, which will act much faster. Lidocaine, Novocain, Ultrakan and other drugs are used as suitable drugs. The closer to the site of the fracture the injection is carried out, the stronger the analgesic effect will be.
Then, with the limb that was injured, you should remove your shoes. This is done so that as a result of the edema that appears, the blood circulation in the limb is not disturbed. Also tight shoes necessarily lead to the fact that the pain in the leg will only increase. If in order to blow off the victim, it is necessary to move his leg, then it should be done according to certain rules. It is important to hold the limb in two places: in the ankle and knee joint.
If there is bleeding, then it must be stopped, and the edges of the wound must be treated with any available antiseptic. In order to determine the degree of damage, it is necessary to cut a layer of clothing, under which there is an injured limb. In the presence of bleeding, it is important to determine the degree of its danger. If blood flows out of a powerful stream, this is a sign of damage to a large vessel. To stop it, it will be necessary to apply a tampon on the wound, which can be made of cotton or a bandage. A bandage should be applied over the formed layer, but at the same time it should not be too tight to overtighten. Plait for such injuries is not recommended to impose. This is due to the fact that the muscles under it will stretch, and if fragments formed during the injury, they will undergo an even greater displacement. In addition, there is a risk of damage to the sharp edges of other vessels and increased bleeding. If the blood does not flow from the wound, but just oozing slowly, then the tampon should not be applied. Enough will be its antiseptic treatment. Suitable means such as: hydrogen peroxide, potassium permanganate, Zelenka or iodine, as well as any liquid based on alcohol. Only the edges of the wound are subject to treatment, it is impossible to pour any composition inside it.
The leg should be fixed by applying a splint. This is one of the most important stages of first aid. The drumstick must be securely fixed. The imposition of the tire is necessary to ensure that the injured limb is immobilized during transportation, since any movement of the affected limb can aggravate the injury, damage the nerves and blood vessels, ligaments and muscles. Binding tires will require cloth dressings and any two straight and long objects, such as an umbrella, a board, or a strong stick. They will need to be placed on the outside and inside of the leg. The end of the retainer should be on the heel, and begin approximately from the middle of the thigh. Then they need to be pinned to the leg in several places, but always in the knee and ankle joint. The wider the bandage, the more secure the fixation. In this case, the victim should be lying down
After these activities are completed, you must go with the victim to the nearest medical facility or wait for the ambulance team to arrive.
Shin Fracture Treatment
Fracture of the lower leg bones can occur in different places. In this case, treatment methods are used for the treatment of fractures, but in different combinations. However, the sequence of medical care is always the same.
Therefore, we can formulate several principles for treating a fracture of the leg:
Initially, the bone fragments are always repositioned. It is performed under local anesthesia and only by a surgeon. This is done using skeletal traction, or during the operation.
Then the bone fragments are subject to reliable fixation using one of the most appropriate devices.
Then requires the immobilization of the limb. For this, a plaster cast or specialized apparatus is used.
Naturally, in a specific case, specific devices are used that are optimally suitable for treating each patient. The choice remains for the traumatologist or the surgeon.
Immobilization in the fracture of the leg
Immobilization of the leg is important to perform according to several rules:
When applying a tire, it should be fixed in such a way that both joints: the knee and the ankle are immobilized.
Before the tire is imposed, it should be adjusted to the size of a broken limb. It is necessary to do this not on the injured person, but on yourself, in order not to cause him unnecessary suffering and not to aggravate the severity of the fracture.
Do not put a splint on a naked body. Clothes, if there is a need to cut, but do not remove.
If there are sharp edges and protrusions, they must first be wrapped with a soft cloth.
If the fracture is open, the splint is not placed on the side where the protrusion of the bone is visible.
It is better if the immobilization will be carried out by two people. One person at the same time should gently hold the limb, and the second to fix the clamp. This should be done carefully, but tightly. If the toes of the foot have not been injured, they should not be bandaged. This will allow to control blood circulation and, in case of its violation, relax the bandages.
Sometimes it happens that no available material can be found. Then you should pin one foot to the other.
Shin fracture surgery
Surgical intervention in case of fracture of the leg is not required very often and there are clear indications for it, among which are the following:
If reposition is not possible without opening, using conservative techniques.
If there is a double fracture of the tibia and there is a significant displacement of fragments.
If the position of soft tissue is greatly changed.
If there is a high risk of a closed fracture moving into an open one, or the nerves and vessels are clamped by the formed fragments.
The open nature of the injury.
When a fracture of both bones of the tibia is observed and an operation is needed, it is performed on a more massive bone, since the smaller one will later grow independently. During reposition, the preference for fixation of fragments with the help of metal constructions is given in the case when the bones do not grow together or pseudarthrosis of the bone is detected. In other cases, it is advisable to use specialized devices, for example, Tkachenko, Ilizarov, etc.
ICD-10 shin fracture code
The ICD of the last revision of the injury is encoded with the letter S. Shin fractures are coded S 82. The third digit indicates the exact location of the fracture, namely:
- S 82.1 - Anatomical structures of the knee epiphysis (end) of the tibia,
- S 82.2 - Diaphysis (of the body) of the tibia,
- S 82.3 - Ankle epiphysis of the tibia,
- S 82.4 - Isolated fibula fracture,
- S 82.5 - Internal ankle,
- S 82.6 - Outer ankle,
- S 82.7 - Multiple leg injuries,
- S 82.8 - Injuries to other parts of this anatomical region,
- S 82.9 - Unspecified fracture of the leg.
Causes of Shin Fracture
The main reason for the fracture is mechanical stressnot corresponding to the main axis of the bone, that is, its longitudinal size. Often this happens when a person falls from a height of his own height with a fixed foot. For example, when skiing, skating or rollerblading.At the same time, a person, falling, transfers the weight of the body from the longitudinal axis of the bones of the leg to the oblique or longitudinal and the bones break.
If a moving vehicle collides with a pedestrian, a shin fracture may also occur. It is also called “Bumper fracture”. The fact is that the bumper of the car just falls on the upper or middle third of the leg, where the injury occurs.
It should be remembered that in older people due to osteoporosis, fractures occur more often. For them, such car accidents are the most dangerous.
It is interesting! Doctors radiologists have a comic expression "fracture of the blonde." This is a fracture of the lower leg in the ankles, which occurs when a girl, walking in high heels, begins to fall, but manages to coordinate movements and stand on her feet. In this case, the ankles quickly deviate from the usual axis, and then return to their original state, but already having a crack or fracture.
Fractures with and without displacement
Fracture with offset they call such a trauma in which the bone fragments deviate from its axis, change position relative to each other, move away from each other or, on the contrary, enter one after the other. At the same time there is a high probability of damage to nearby anatomical structures.
At fracture without offset fragments are formed that remain in their former places. Such injuries are easier to treat, and they have fewer complications.
Open and closed fracture
Open called a fracture, which is accompanied by injury of the skin. This is an offset fracture, in which the bone breaks the skin from the inside and forms a wound. They are often accompanied by bleeding, always require surgery, and may be complicated by an infectious process.
With closed injury the skin remains intact, the risks of complications are greatly reduced.
Debris is a fracture, in which a bone has many small fragments, similar to fragments. They are often shifted from the main axis. The danger of them is that such splinters quite sharp and vessels and nerves are often injured. The treatment of such an injury is long and rather severe. The main way to get it is a traffic accident involving a pedestrian and a car.
Other types of fractures
In addition to these, there are several common types of fracture, namely:
- Multiple fractures. This is a trauma of one bone in different places. For example, the tibial at the knee and pineal glands and in the middle third of the diaphysis with a condyle or ankle fracture.
- Combined injuries. In this case, in addition to a fracture of the leg, symptoms of injury to the internal organs or other anatomical areas are observed.
- Combined injuries. This is a fracture of the leg in combination with fractures of the bones of another anatomical region.
Signs of a broken leg
The main symptoms that you should pay attention to if you suspect a shin fracture are:
- Sharp intense pain. It increases with pressure on the bone, trying to stand on the foot of the affected leg, decreases with immobilization.
- Swelling of the tissue around the fracture. Edema always occurs, but may have varying severity.
- Bone crunch with pressure at the fracture site,
- Pathological mobility bone area
- Bruise (hematoma, bruise) at the fracture site.
The main diagnostic method is x-ray of shinand also the areas of the two joints (ankle and knee). This method allows you to see the condition of the bones, determine the type of fracture, visualize the displacement of fragments. On an x-ray, a fracture looks like a dark line between parts of a bone that can go in any direction.
Another method is Magnetic resonance imaging (MRI). It allows you to look not only at the bones, but also at the tissues surrounding them. This way, it is possible to detect muscle breaks, tendons, damage to nerves and blood vessels.
Reposition and fixation
The reduction is juxtaposition of fracture fragments with displacement. Sometimes this can be done externally by applying force at certain points. After the fragments return to their places, they are fixed. Immobilization with a plaster splint can be sufficient for this. In more severe cases, reposition and fixation are performed during surgery.
The bones of the leg with proper fixation and compliance with the regime can grow together for 2-3 months. If there are complications, rehabilitation may take up to 4-6 months.
Damage to muscles, blood vessels and bones significantly lengthen recovery time. Full mobility of the foot can return only after six months or a year. Sometimes such injuries lead to lifelong disability. In older people, fractures heal poorly enough, in some cases, the bones do not grow together.
What clamps are used
I first use hard Gypsum Longuet. She must be worn before the formation of callus. Then you can replace the plaster with a solid bandage.
Later instead of a bandage, it is recommended to wear elastic retainer shin or ankle. The latter can be replaced by tight bandaging.
The clips are worn to complete healing of the fracture.
Exercise therapy and exercises to develop after the fracture
Therapeutic exercise is applied after the removal of the plaster splint. A set of exercises is developed by a doctor. This is usually simple exercises on the muscles of the foot and lower leg. For example, flexion and extension of the leg at the knee and ankle joints, movement of the fingers, circular movements in the indicated joints. The training regime is also determined by the doctor.
Medicines and nutrition
Drug treatment must be appointed only in the acute period. Most commonly used analgesics and nonsteroidal anti-inflammatory drugs. With significant tissue swelling, diuretics can also be used, for example, furosemide.
As an adjuvant therapy can be applied vitaminsand calcium preparations. Meals should be balanced. It is necessary to increase the consumption of sea fish, as well as fresh fruits and vegetables.