What does a fracture mean? Displaced fracture of the forearm. Fracture of the body more - and fibula

- this is a complete or partial violation of the integrity of the bone, resulting from an impact that exceeds the strength characteristics of the bone tissue. Signs of a fracture are abnormal mobility, crepitus (bone crunching), external deformity, swelling, limited function, and severe pain, with one or more symptoms absent. The diagnosis is exposed on the basis of the anamnesis, complaints, data of survey and results of a X-ray analysis. Treatment can be conservative or operative, involving immobilization using plaster casts or skeletal traction, or fixation by installing metal structures.

ICD-10

S42 S52 S72 S82

General information

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

Fractures can be single or multiple, complicated or not complicated by damage to various anatomical structures and internal organs. There are certain combinations of injuries that are common in clinical traumatology. So, with fractures of the ribs, damage to the pleura and lungs is often observed with the development of hemothorax or pneumothorax, if the integrity of the bones of the skull is violated, intracerebral hematoma may form, damage to the meninges and brain substance, etc. Treatment of fractures is carried out by orthopedic traumatologists.

Causes of the fracture

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

Classification

Depending on the initial structure of the bone, all fractures are divided into two large groups: traumatic and pathological. Traumatic fractures occur on a healthy, unchanged bone, pathological fractures occur on a bone affected by some pathological process and, as a result, have partially lost its strength. For the formation of a traumatic fracture, a significant impact is necessary: a strong blow, a fall from a fairly large height, etc. Pathological fractures develop with minor impacts: a small impact, a fall from a height of one's own height, muscle tension, or even a coup in bed.

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

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

epiphyseal(intra-articular) - accompanied by damage to the articular surfaces, rupture of the capsule and ligaments of the joint. Sometimes they are combined with a dislocation or subluxation - in this case they speak of a fracture-dislocation.
metaphyseal(periarticular) - occur in the area between the epiphysis and the diaphysis. Often they are driven in (the distal fragment is introduced into the proximal one). Fragment displacement is usually absent.
diaphyseal- formed in the middle part of the bone. The most common. They differ in the greatest variety - from relatively simple to severe multi-fragmented injuries. Usually accompanied by displacement of fragments. The direction and degree of displacement are determined by the vector of the traumatic effect, the traction of the muscles attached to the fragments, the weight of the peripheral part of the limb, and some other factors.

Taking into account the nature of the fracture, transverse, oblique, longitudinal, helical, comminuted, polyfocal, crushed, compression, impacted and avulsion fractures are distinguished. In the metaphyseal and epiphyseal zone, V- and T-shaped lesions occur more often. In case of violation of the integrity of the cancellous bone, the introduction of one fragment into another and compression of the bone tissue are usually observed, in which the bone substance is destroyed and crushed. With simple fractures, the bone is divided into two fragments: distal (peripheral) and proximal (central). With polyfocal (double, triple, etc.) injuries, two or more large fragments are formed along the bone.

All fractures are accompanied by more or less pronounced destruction of soft tissues, which is due to both direct traumatic effects and displacement of bone fragments. Usually, hemorrhages, soft tissue contusion, local muscle ruptures and ruptures of small vessels occur in the injury zone. All of the above, combined with bleeding from bone fragments, causes the formation of a hematoma. In some cases, displaced bone fragments damage nerves and great vessels. It is also possible to compress the nerves, blood vessels and muscles between the fragments.

Fracture symptoms

Allocate absolute and relative signs of violation of the integrity of the bone. Absolute signs are deformity of the limb, crepitus (bone crunch, which can be distinguished by the ear or determined under the doctor's fingers on palpation), pathological mobility, and with open injuries, bone fragments visible in the wound. Relative signs include pain, edema, hematoma, dysfunction, and hemarthrosis (only for intra-articular fractures). The pain is aggravated when trying to move and axial load. Swelling and hematoma usually occur some time after the injury and gradually increase. Violation of the function is expressed in the restriction of mobility, the impossibility or difficulty of support. Depending on the location and type of damage, some of the absolute or relative signs may be absent.

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

Complications

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

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

Diagnostics

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

The examination of the patient includes a thorough examination for possible complications. In case of damage to the bones of the limbs, it is imperative to check the pulse and sensitivity in the distal sections, in case of fractures of the spine and skull, reflexes and skin sensitivity are evaluated, in case of damage to the ribs, auscultation of the lungs is performed, etc. Particular attention is paid to patients who are unconscious or in a state of severe alcohol intoxication . If a complicated fracture is suspected, consultations of the relevant specialists (neurosurgeon, vascular surgeon) and additional studies (for example, angiography or EchoEG) are prescribed.

The final diagnosis is established on the basis of radiography. Among the radiographic signs of a fracture include a line of enlightenment in the area of damage, displacement of fragments, a break in the cortical layer, bone deformities and a change in the bone structure (enlightenment when fragments of flat bones are displaced, compaction in compression and impacted fractures). In children, in addition to the listed radiographic symptoms, with epiphysiolysis, deformation of the cartilaginous plate of the growth zone can be observed, and with fractures of the green branch type, limited protrusion of the cortical layer.

Fracture treatment

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

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

Conservative methods of treatment are divided into immobilization, functional and traction. Immobilization techniques (gypsum bandages) are usually used for fractures without displacement or with little displacement. In some cases, gypsum is also used for complex injuries at the final stage, after removal of skeletal traction or surgical treatment. Functional techniques are indicated mainly for compression fractures of the vertebrae. Skeletal traction is commonly used in the treatment of unstable fractures: comminuted, helical, oblique, etc.

Along with conservative methods, there are a huge number of surgical methods for treating fractures. Absolute indications for surgery are a significant discrepancy between the fragments, excluding the possibility of fusion (for example, a fracture of the patella or olecranon); damage to nerves and main vessels; interposition of a fragment into the joint cavity with intra-articular fractures; the threat of a secondary open fracture with closed injuries. Relative indications include interposition of soft tissues, secondary displacement of bone fragments, the possibility of early activation of the patient, reduction of treatment time and simplification of patient care.

Exercise therapy and physiotherapy are widely used as additional methods of treatment. At the initial stage, to combat pain, improve blood circulation and reduce edema, UHF is prescribed to remove the plaster cast, and measures are taken to restore complexly coordinated movements, muscle strength and joint mobility.

When using functional methods (for example, with compression fractures of the spine), exercise therapy is the leading treatment method. The patient is taught special exercises aimed at strengthening the muscular corset, decompression of the spine and the development of motor stereotypes, which exclude the aggravation of the injury. First, the exercises are performed lying down, then kneeling, and then in a standing position.

In addition, for all types of fractures, massage is used, which improves blood circulation and activates metabolic processes in the area of damage. At the final stage, patients are sent to spa treatment, iodine-bromine, radon, sodium chloride, coniferous-salt and coniferous therapeutic baths are prescribed, and rehabilitation measures are also carried out in specialized rehabilitation centers.

fracture is a medical term for a broken bone. Fractures are a fairly common problem, and according to statistics, the average person has two fractures in a lifetime. A bone fracture occurs when the physical force acting on the bone is stronger than the bone itself. Most often, fractures are caused by falls, blows, or other injuries.

fracture risk largely related to the age of the person. Fractures often occur in childhood, although fractures in children are usually not as complex as those in adults. Bones become more fragile with age, and fractures usually occur after falls, even those that would not entail any negative consequences at a younger age.

2. Types of fractures

There are many different fracture types, 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 how the bone breaks.

At displaced fracture the bone breaks into two or more pieces, which are arranged in such a way that their ends do not form a single line. When a bone breaks into many pieces, it is called comminuted fracture. During fracture without displacement the bone breaks, or a crack may form on it, but still the bone 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 an open fracture, the bone can 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 on superficial examination. An additional danger of an open fracture is the risk of infection of the wound and bone.

There are other types of fractures:

incomplete fracture where the bone bends but does not break. This type of fracture is most common in children.
transverse fracture- fracture at a right angle to the axis of the bone;
oblique fracture- fracture along a curved or inclined line;
Fracture with many fragments and fragments of bone;
pathological fracture Caused by a disease that weakens the bones. Cancer or, more commonly, osteoporosis can lead to pathological fractures. Fractures of the hip, wrist, and spine are most common due to osteoporosis.
Compression fracture, which arises from strong squeezing.

Classify fractures and depending on which bone was broken. The most common are leg fracture, hip fracture, arm fracture, spinal fracture, hip fracture, finger fracture, ankle fracture, clavicle fracture, rib fracture, jaw fracture.

3. Signs of a broken bone

Signs and symptoms of a broken bone may include:

swelling and bruising;
Deformity of the arm or leg;
Pain in the injured area, which increases with movement or pressure;
Loss of functioning of the damaged area;
In an open fracture, the bone protrudes from the skin.

The severity of the fracture depends on its location and how badly the bone and soft tissues located next to it have been damaged. Serious fractures without timely treatment are dangerous for their complications. This may be damage to the blood vessels or nerves, infection of the bone (osteomyelitis) or surrounding tissues.

The 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 most common skeletal injury. According to statistics, the incidence of such injuries is 11% -30% of the total number of all closed fractures, and fractures of the diaphysis (body) of the bones of the forearm account for 53.5% of injuries to the bones of the upper limbs. An elderly person, a young person, and a child can get such an injury.

A bit of anatomy. The forearm is formed on the basis of two bones: the ulna and the radius. They are connected to each other by an interosseous membrane. Determining the location of these bones is simple: the ulna runs along the side of the little finger, and the radius is on the opposite side, where the thumb is located. One bone or both can break. The severity of the fracture and its treatment directly depends on which part of the bones of the forearm is damaged: the upper third, middle or lower.

Symptoms of a fracture of the bones of the forearm

The signs of this injury depend on the type of fracture encountered.

Fracture of the body of the ulna. Human movements are limited. There is deformation and . Squeezing and probing the forearm causes severe pain.

Fracture of the radius. The forearm is deformed, the patient experiences sharp pains during palpation of the affected area, there is mobility of fragments. The person cannot actively rotate the forearm.

Fracture of the diaphysis of both bones. A common injury, almost always accompanied by displacement of bone fragments. The shortening and deformity of the forearm is clearly expressed. Usually, the injured person holds the injured limb with a healthy hand. Probing, lateral compression of the forearm causes intense pain throughout with increased pain at the fracture site. Fragment mobility is observed.

Fracture of the radius in a typical location. This type of injury is common in older women. The wrist region of the forearm is edematous. Visible deformation. Axial loading and probing causes severe pain. There may be a violation of sensitivity in the fourth finger of the hand, which indicates concomitant damage to the nerve branches.

Common Causes of a Forearm Fracture

You can break the bones of the forearm as a result of:

falling on the upper limb bent at the elbow or hitting this area;

direct blow to the forearm;

falling on a straight arm;

protection from a blow with a bent and raised forearm;

falling on the arm, leaning on the palm, or rarely, on the back of the hand;

sharp angular deformity of the forearm.

Diagnostics

To make a diagnosis, a doctor needs a clinical examination (external examination, probing the site of injury) and the results of an X-ray examination.

Treatment of fracture of the bones of the forearm

With an isolated diaphyseal fracture with displacement of the ulna, as well as the radius, treatment begins with reposition. This procedure is necessary for all types of displaced fractures. Its detailed description will be below.

When the reposition is carried out, a plaster splint is applied to the bent forearm of the patient, which should capture the areas of the wrist and elbow joints. The period of immobilization for a fracture of the ulna is 4-6 weeks, the radius - from five to six weeks.

Treatment of a fracture of the forearm with displacement of bone fragments is still one of the most difficult tasks of modern traumatology. Simultaneous reposition with such localization of the fracture is extremely difficult. It is even more difficult to keep bone fragments in the correct position for a long time.

Reposition begins with the study of radiographs. It can be performed manually or with the help of special devices and is performed under local anesthesia.

For rotational installation of fragments, stretching is performed, then the surgeon manually matches the ends of the broken bones. After, without weakening the traction and in the position achieved by reposition, a splint is applied to the damaged area. X-rays are taken to check the results. If the reposition is successful, then the bandage is converted into a circular one.

If the patient has massive edema, the splint remains until it disappears. When the edema has subsided, the patient needs to take a control x-ray to prevent re-displacement of bone fragments. After that, you can apply a plaster circular bandage for 10-12 days.

Starting from the second day, the patient should move his fingers, and on the 3-4th day - the shoulder joint. In addition, the patient must learn to perform rhythmic relaxation and muscle tension of the forearm, hidden by a plaster cast.

At the end of the immobilization period, the plaster cast is removed and the patient is prescribed therapeutic exercises and physiotherapy. The average recovery time is 12-14 weeks.

However, in the overwhelming majority of cases, doctors resort to surgical treatment of such fractures, since the elimination of all primary displacements and the prevention of secondary ones often fail. The problem is that, due to the tension of the interosseous membrane, fragments of the ulna and radius bones are approaching.

Surgical treatment consists in carrying out open reposition and osteosynthesis. The operation is best done on the second or fourth day after the injury. It is performed under general anesthesia.

Access to the bones is provided by two independent incisions. First, surgery is performed on the ulna. The ends of its fragments are isolated and set, then osteosynthesis is performed using metal fixators (metal plates, rods, knitting needles, wire sutures, etc.). Then a similar manipulation is performed on the radius.

At the end of the osteosynthesis, a plaster cast is applied to the limb bent at a right angle. Usually the period of immobilization is 10-12 weeks, sometimes it can be extended.

After the bandage is removed, the patient is prescribed gymnastics, massage, physiotherapy and mechanotherapy. It takes 14 to 18 weeks to recover from work.

Education: diploma in the specialty "Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012, she completed postgraduate studies in the specialty "Traumatology and Orthopedics" at the City Clinical Hospital. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.

- this is damage to the tibia or fibula, and sometimes both of them, due to the excess of a load on them greater than they could withstand. The injury is quite common, and on average accounts for approximately 20% of the total number of fractures.
The lower leg is represented by two tubular bones, each of which has a body and two ends. The tibia connects to the femur at the top and to the bones of the foot below. During a fracture, most often the bone, both large and small, breaks in the middle. Sometimes injuries come with complications. Most often, people with such a problem turn to the emergency room after suffering 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 is a disease: or.

There are several types of leg fractures, depending on their location:

Injuries to the neck and head of the fibula, as well as fractures of the tuberosity and condyles of the tibia. When these zones suffer, they talk about fractures of the bones of the lower leg in the upper part.

If the diaphyses of both bones or one of them are injured, then they speak of fractures of the lower leg in its middle part.

If there is a fracture of the ankle, then they speak of a fracture of the tibia in the lower part. This type of injury is the most common and accounts for more than 60% of the total number of all fractures in this area.

Also, the injury can be open or closed, with or without displacement. Depending on its nature and complexity, the method of treatment, as well as its timing, will depend. The severity depends on whether there is damage to the surrounding soft tissues, whether the joints, blood vessels, nerve endings and tendons are injured. Minor injuries, as a rule, are 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.
Displaced tibia fracture

A fracture of the lower leg, in which displacement occurred, is most often formed as a result of a direct blow in the transverse direction. In this case, fragments are formed that can move in different directions. Displacement can be lateral, peripheral, angular, with divergence, wedging and recurrence of broken parts.

Such an injury is characterized by the following symptoms:

The length of the leg will become smaller compared to 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 lower leg may be carried out in an unnatural direction for it.

Sometimes fragments can shift so much that they break through soft tissues and skin.

Sometimes a recess or depression is formed in the place where the movement of the fragments occurred.

Pain is an invariable companion of any fracture, as well as a crunch during an injury.

In the place of localization of the fracture, bruising and swelling are formed, with a pronounced violation of the motor function of the limb.

Most often, the condition of a person who has received a fracture of the lower leg with displacement is still satisfactory, but sometimes traumatic shock can be observed.

Treatment will begin with a mandatory comparison of the resulting fragments. This is necessary to give the limb the correct shape and its subsequent normal fusion. Reposition is carried out either manually or with the help of special tools. To do this, the victim must be laid on his back and anesthetized with appropriate drugs. After that, one doctor holds the patient by the thigh, and the other grabs the leg in such a way that one hand firmly holds the heel, and the second the back of the foot. Then, a slow and systematic stretching of the muscles pulled up to the fracture site is carried out, and at the same time, with the help of probing, the position of the fragments that have undergone displacement is determined. After the reduction is completed, the doctor will definitely check the length of the limb and compare it with the length of a healthy leg. If the parameters converge, then you can start applying a plaster cast.

For control, the patient will have to undergo an X-ray again after 10 days, so that the doctor makes sure that the fusion of the bones of the leg is normal. Sometimes a skeletal traction method can be applied. An operation is required when closed reduction cannot be performed, due to the fact that the fixation of fragments requires the use of metal constructions.

Features of the treatment of elderly people, as well as young patients who have received a shin injury with displacement, are that they must be left immobilized for the shortest possible time. That is why you should choose the least traumatic method of treatment.
Fracture of the lower leg without displacement

A fracture of the lower leg without displacement is a serious injury, but it proceeds somewhat easier than a similar injury, but with fragments that have come into motion. Often such fractures are subperiosteal, that is, when the whole periosteum from above holds the fragments remaining inside. The age group that is more likely to experience 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 an injury without displacement as a greenstick fracture.

Symptoms of a fracture of the lower leg without the formation of fragments are as follows:

Swelling at the site of injury.

Painful sensations.

Shortening of the limb, but not pronounced. It will be possible to notice it only after carrying out certain measurements.

Difficulty in mobility.

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 moving on their own, as they believe that they just have a strong one. Such carelessness is dangerous because, as a result, the fragments that the periosteum holds can begin to move. This will aggravate the severity of the injury and prolong the treatment time. Therefore, at the slightest suspicion of a fracture, it is necessary to see a doctor. Because without an X-ray examination, it is very difficult to diagnose such an injury.

With a closed isolated fracture of the leg bones without displacement, reposition is not needed.

It will be enough to apply a plaster cast, which will be placed in the area from the foot to the knee, or slightly higher - to the middle of the thigh:

If the fibula is broken below, then the plaster will be applied up to the knee.

If the fracture is localized in the middle or in the upper third of the bone, then the imposition of a plaster splint is indicated. It may be removable. Fixes the fracture rigidly, without the possibility of movement.

Most often, immobilization lasts about three months. If the diaphyses of both bones were broken, then the period may increase to 4 months. After removing the plaster, the most common procedures are shown: exercise therapy, massage, physiotherapy. The opportunity to start working duties will appear after 14 - 30 days, as the plaster will be removed.

Closed fracture of the tibia

A closed fracture of the tibia is a very serious injury. It is characterized by the fact that damage to tissues located far from the bones does not occur, just as there is no contact of the damaged area with the external environment.

With closed fractures, the bones of the ankle, the condyle of the tibia may suffer, the tuberosity may be torn off, the head of the fibular bone or the diaphysis of both bones may be damaged. If the distal end of the lower leg is damaged, then the fracture can be both intraarticular and periarticular.

The symptoms of a closed fracture are as follows:

Severe limitation of limb mobility. The person will simply not be able to lift his leg up.

If an attempt is made to slightly raise the lower leg, then the end of the tibia (proximal) will protrude under the skin.

If crepitations, that is, characteristic crunches, are heard during palpation, then this symptom clearly indicates the presence of a closed fracture. In this case, you should not cause the sound on purpose, since such manipulations can lead to displacement of fragments that may be 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, the injuries are depressed, which occurs due to the high porosity of the bone tissue.

Diagnosis, as a rule, is not difficult for an experienced doctor, and palpation examination is enough for him to determine a closed fracture. This is due to the fact that the bones of the lower leg are located close to the skin and are not covered with a thick layer of muscles. However, X-ray examination is indispensable. It will reveal the characteristic features of the fracture, possible displacement of fragments. Pictures must be obtained in several projections, most often in two.

Treatment is carried out in a hospital. The tasks that doctors face are restoring the integrity of the bone, relieving pain, returning the patient to normal life, which will proceed without restriction of movement.

The following methods are used for this:

Extension, which involves stretching the damaged bone. It can be skeletal or adhesive.

fixation method. It is implemented by applying a certain type of plaster cast.

An operative method that involves intraosseous fixation using either metal plates, or metal knitting needles, or metal rods, or metal wire.

But, of course, before this or that method of fixing the limb is applied, it is necessary to reposition the fragments, if any. Often, a Delbe bandage is used to immobilize the fracture site. It has a number of advantages over conventional plaster, since after its application, a person can move the knee and ankle joints if they are not damaged. This dressing allows outpatient treatment, without the patient being tied to a hospital bed.

Open fracture of the tibia

If open fractures of other bones of the human skeleton are a relatively rare phenomenon, then with a fracture of the lower leg they are much more common, which is quite explainable by its anatomical features. The tibia itself is located directly under the skin, so it often breaks through it with sharp edges, which leads to an open fracture. In addition, if the injury was received as a result of an accident, then it is heavily contaminated. This circumstance greatly aggravates her character.

The main symptoms of open fractures of the lower leg include:

A gaping wound with bones that have broken through the skin and soft tissues.

Traumatic shock.

Restriction of mobility.

Sharp pain.

Weakness and dizziness, up to loss of consciousness.

The most difficult therapeutic effects are injuries of an open type with the formation of splinters. This is due to the fact that nearby nerves and blood vessels are damaged. Sometimes the question of the need to amputate a limb may even arise.

The decisive factors are:

How extensive is the area of tissue damage.

What is the degree of circulatory disorders of the foot and lower leg.

No pulsation.

The area of damage to the skin. If it is very extensive and it is not possible to replace it, then this will become a decisive factor in favor of amputation of the limb.

The longer the decision to amputate is made, the greater the risk that it may develop. Treatment of any open fracture must be carried out as soon as possible. After its implementation, the introduction of several drainages is shown. It is more expedient to pass them through the holes made for this purpose. The wound should be fixed with a rare suture.

When an open wound does not form immediately, but as a result of a puncture by the edge of a fragment, it is secondary, then after treatment with antibacterial compounds, sutures are immediately applied, and drainage is not required to be inserted.

When a secondary wound is accompanied by damage to the skin in a large volume, then its transplantation is necessary. It is impossible to separate it from the fabric for the purpose of stretching. Another important feature in an open fracture is that the fragments must be set immediately after treatment with disinfecting compounds, but in no case vice versa. Because it can lead to blood poisoning. In modern medical practice, the use of osteosynthesis is increasingly being shown, which is also performed after decontamination of an open injury.

If the fracture is transverse, then one reduction will be sufficient, as a rule, the fragments are securely held. If the fracture is oblique or helical, then up to two sutures should be placed with fixation on the wire.

Also, in the treatment of open fractures of the lower leg, there is a tendency to insert a special metal rod inside the bone. It is empty inside, and has holes on the sides. Through it, special medicinal substances, including antibiotics, will be supplied to the bone marrow canal. After its installation, the imposition of gypsum is shown.

The prognosis for limb recovery after an open fracture of the lower leg largely depends on how well the primary antiseptic and antibacterial treatment was carried out. Proper immobilization of the limb plays a significant role. Treatment after the application of plaster is carried out similarly to therapy for a closed fracture, but it is natural that open injuries heal over a longer period of time.

There is a certain procedure that must first be provided to a person who has received a fracture of the lower leg:

To begin with, he needs help to overcome pain symptoms. To do this, you need to give the victim an anesthetic. For this, any drug that is available will do. As suitable means, they distinguish: Pentalgin, Analgin, Nimesulide, Sedalgin, etc. If you have medical skills, you can make an intramuscular injection, which will work much faster. Lidocaine, Novocain, Ultracan and other agents are used as suitable drugs. The closer to the fracture site the injection is made, the stronger the analgesic effect will be.

Then shoes should be removed from the limb that was injured. This is done so that as a result of the resulting edema, blood circulation in the limbs is not disturbed. Also, tight shoes will definitely lead to the fact that the pain in the leg will only intensify. If in order to undress the victim, it is necessary to move his leg, then this 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, while 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 the layer of clothing under which the injured limb is located. In the presence of bleeding, it is important to determine the degree of its danger. If blood flows out in a powerful stream, then this is a sign of damage to a large vessel. To stop it, you will need to apply a tampon to the wound, which can be made of cotton wool or a bandage. A bandage should be applied over the resulting layer, but it should not be pulled too tight. A tourniquet is not recommended for such injuries. This is due to the fact that the muscles under it will stretch, and if fragments form during the injury, they will undergo even greater displacement. In addition, there is a risk of damage to other vessels by sharp edges and increased bleeding. If the blood does not flow from the wound, but simply oozes slowly, then the swab should not be applied. Its antiseptic treatment will be enough. Suitable means such as: Hydrogen peroxide, Potassium permanganate, Zelenka or Iodine, as well as any alcohol-based liquid. Only the edges of the wound are subject to treatment; it is impossible to pour any composition into it.

The leg should be fixed by applying a splint. This is one of the most important steps in first aid. The shin will need to be securely fixed. Splinting is necessary so that the injured limb is immobilized during transportation, since any movement of it can aggravate the injury, damage the nerves and blood vessels, ligaments and muscles. To apply a splint, you will need fabric bandages 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 retainer should end at the heel, and start approximately from the middle of the thigh. Then they need to be bandaged to the leg in several places, but always in the knee and ankle joint. The wider the bandage, the more secure the fixation will be. In this case, the victim should be in the supine position.

After these activities are completed, you must go with the victim to the nearest medical facility or wait for the arrival of the ambulance.

Fracture of the bones of the lower leg can occur in different places. At the same time, fracture therapy methods are used for treatment, but in different combinations. However, the sequence of medical care is always the same.

Therefore, we can formulate several principles for the treatment of a fracture of the lower leg:

Initially, reposition of bone fragments is always performed. It is performed under local anesthesia and only by a surgeon. This is done with the help of skeletal traction, or during the operation.

Then the bone fragments are subject to reliable fixation using one of the most suitable devices.

Then requires immobilization of the limb. For this, a plaster cast or a specialized apparatus is used.

Naturally, in a certain case, specific devices are used that are optimally suited for the treatment of each patient. The choice is up to the traumatologist or surgeon.

Immobilization in case of fracture of the tibia

Immobilization of the lower leg is important to perform according to several rules:

When applying a splint, it must be fixed in such a way that both joints: the knee and ankle are immobilized.

Before the splint is applied, it should be corrected for the size of the broken limb. It is necessary to do this not on the injured person, but on yourself, so as not to cause him unnecessary suffering and not aggravate the severity of the fracture.

Do not put a splint on a naked body. Clothing, if necessary, should be cut, but not removed.

If there are sharp edges and protrusions, then they must first be wrapped with a soft cloth.

If the fracture is open, then the splint is not applied on the side where the protrusion of the bone is visible.

It is better if immobilization is carried out by two people. At the same time, one person should carefully hold the limb, and the second should bandage the retainer. This must be done carefully, but tightly. If the toes were not injured, then they should not be bandaged. This will allow you to control blood circulation and, if it is disturbed, relax the bandages.

Sometimes it happens that it is not possible to find any improvised material. Then you should bandage one leg to the other.

Surgery for a broken leg

Surgical intervention for a fracture of the lower leg is not required too 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 the fragments.

If the position of the soft tissues is greatly changed.

If there is a high risk of transition of a closed fracture to an open one, or there was a clamping of nerves and vessels by the formed fragments.

The open nature of the injury.

When a fracture of both bones of the lower leg is observed and an operation is needed, then it is carried out on a more massive bone, since the smaller one will subsequently grow together on its own. When carrying out reposition, preference is given to fixing fragments with the help of metal structures in the case when the bones do not grow together or, pseudoarthrosis of the bone is detected. In other cases, it is advisable to use specialized devices, for example, Tkachenko, Ilizarov, etc.

Rehabilitation after an injury is an integral part of the process aimed at restoring the functionality of the limb.

Its goals are:

The lower leg is the lower half of the leg from the foot to the knee. It consists of two bones - large and small, called the tibia. Fracture of the tibia is a common injury. The cause may be a traffic accident with aggravating consequences, when the health of the participants in the accident suffers. Another reason is fighting. If one participant kicks another on the shin, the direction of this blow is usually perpendicular to the leg of the victim. Such an impact on the lower leg often causes it to break. The third reason is the weakening of the bone structure of the injured. In women, this occurs during pregnancy.

Weakening of the bones is characteristic of patients with osteoporosis. In such situations, an accident can occur when falling on a slippery road or when the house hits a corner of furniture. Often, skiers break their lower limbs if, when falling, the leg with the ski gets stuck in an uncomfortable position.

The tibia at the top, at the entrance to the knee joint, ends with 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 sites are called condyles. From the immanent part of the leg - the medial condyle, from the outside - the lateral. At the bottom, a large bone has a growth that protrudes inward in relation to the body. This growth forms the inner (medial) ankle.

The small bone is much thinner than the large one. 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) ankle.

The structure of the lower leg is important to us, since there is a classification of injuries in the fracture of the lower leg, which is determined by what part of the bone and in what place is broken.

Types of tibia fractures

According to the location and type of injury, a fracture of the lower leg of the following types is distinguished:

By localization, fractures are: proximal (this is the upper part of the tibia and part of the knee joint, into which they enter from above) or distal (this is the lower part of the tibia and part of the ankle joint, where they enter from below). Fractures of the lower leg in the middle (in the region of the diaphysis) - diaphyseal fractures of the bones of the lower leg - another type of injury according to this classification. Ankle injury is divided into two types: lateral, if the fibula is broken, or medial, if the big one is broken.

Also, leg injuries of the described type are divided by severity into classes A, B and C. The easiest class A is a closed fracture, when the pieces are not displaced compared to the healthy state of the limb, and the tissues and joints are not affected. Class B implies 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 broken, blood vessels are torn, and nerves are damaged.

Fracture symptoms

Until the victim went to the doctor, he did not have 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 grade A injury. It heals without surgery, but the healing time is several months. It depends on the age and health of the victim. With such damage to the lower leg, the cracked pieces remain in position, held by the periosteum. This nuisance is often received by children playing in the playground without adult supervision. They can break a leg climbing ladders and cobwebs on the playground, because 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;
sensation of pain in the lower leg;
the diseased leg becomes a little shorter than the healthy one, although this cannot be determined without a measuring device;
a hematoma often forms at the fracture site;
inability to move the leg - movements cause sharp pain;
pressure on the injured leg anywhere causes pain localized at 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 trash - the fracture can go into the next category of severity - with a displacement. Therefore, in case of a fall and pain in the leg, it is necessary to call an ambulance, which will take the injured person to the hospital, and there he will be x-rayed and diagnosed.

Fracture with displacement

It can be class A or B. This leg injury occurs during a fight, when the opponent's boot hits the leg. Ugly situations of this type often occur near cafes and night bars between their drunken visitors. Debris is often displaced in various directions. Displacements are classified according to the position of the fragments into angular, lateral, wedged, and so on. Treatment of injuries of the described type is long and difficult. Signs:

the lower leg can move and turn in directions that were not available to a healthy leg;
the length of the bruised leg decreases, but this is not visible to the eye - it must be measured;
debris can damage the soft tissue of the leg and tear the skin, forming an open wound;
on palpation, a hollow in the leg may be felt;
the injured person is tormented by a sharp aching pain (as with other types of such injuries);
at the time of the injury, a creak and crunch was heard;
the leg swells rapidly, hematomas can form (if the tissues and skin are not already torn).

Treatment of such injuries of the leg occurs in the hospital with surgical intervention. After some time, calculated in months, sometimes a second operation is required, if during the first one it was necessary to insert a needle into the bone to align the pieces. Such injuries happen to skiers, climbers, skyscraper climbers, and to inexperienced car drivers and their passengers during traffic accidents.

Closed fracture of the tibia

A closed fracture is classified as either A or C, depending on the location of the injury. If the diaphysis is broken, then this is class A. With this type of damage to the leg, the tissues of the lower leg are damaged only in case of displacement, but the damage covers only the muscles adjacent to the injured area of the bone, and the outer tissues are not affected. Class C injury occurs if the injury touches the ankle or knee. Signs:

sharp pain when lifting a sore leg;
when lifting an injured limb, the broken end of the bone may bulge out on the skin;
a crunch is heard on palpation, it cannot be caused on purpose - this leads to a displacement of the debris.

In young victims, the fractures described are classified as split, and in the elderly, they are depressed, since their bones are porous in structure. An experienced doctor will determine the presence of an injury of the type described by palpation, without additional research. But radiography is still necessary to determine the position of the debris and to conclude whether an operation is needed, and if necessary, what exactly needs to be corrected in the location of the debris so that they grow together correctly.

Open fracture type

It belongs to class B or C. Such injuries are typical 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! Seek immediate medical attention because a bleeding wound in an unsterile environment can lead to blood poisoning. That is why such a lesion of the lower leg is classified as class B - moderate.

If the fracture occurred in the ankle, affected the joint, or damaged the nerve in the knee joint, it is classified as a severe injury of class C. The most significant signs:

bleeding from the resulting wound;
sharp pain when trying to move the leg;
traumatic shock;
the pain does not stop even in a stationary state;
weakness, dizziness that occurs in the victim;
possible loss of consciousness.

If the injury is attributed to the degree of extreme severity, the surgeon, in order to save the patient, may go for amputation of the leg. Without the consent of the victim, he, of course, will not do this. If the injured person is unconscious, the doctor will ask for consent for such an operation from his relatives. But the decision must be made without delay, because if gangrene begins, it threatens to be fatal.

If the patient turned to the traumatologist quickly, the medical workers carried out the initial treatment of the wound with high quality, the limb will heal safely and will work as before.

First aid for leg injury

First aid for a fracture of the lower leg includes the following steps:

Now the patient has received the necessary assistance, and you can safely wait for the arrival of the doctor.

Diagnosis of injury

To accurately determine the type and complexity of damage, it is usually sufficient to conduct x-rays in two projections. If the case is particularly difficult, and you need to understand exactly how the fragments are located, the doctor directs you to MRI, MRI or CT.

Possible Complications

The described injury can give complications if the treatment was prescribed by an unqualified specialist. Aggravating circumstances can be insufficiently responsibly rendered first aid, as well as the appointment of rehabilitation procedures without taking into account the patient's state of health. The list of possible complications includes:

The described consequences can be avoided if the damage to the limb is taken seriously and, despite the pain, it is reasonable to choose a hospital and a doctor for surgical treatment.

Treatment of a leg injury

In the hospital where the patient is taken, while the conclusion on the radiography is being prepared, the patient is again thoroughly washed with a wound. The doctor prescribes antibiotic injections to exclude the effects of infections introduced at the time of injury.

The general principles of therapy are the same for all types:

When the bone acquires its natural appearance, the plaster is removed and the rehabilitation period begins. For specific types of fracture, there is a specific treatment.

Proximal fracture

With the destruction of the upper part of the tibia, a puncture is required with pumping out excess fluid from the knee. Before this procedure, Novocain or Lidocaine is administered intramuscularly to the victim for pain relief. A closed fracture of the lower leg without displacement suggests that after that the leg is wrapped in a plaster cast and after the plaster has dried, it is left for an average of two months.

If a fracture of the lower leg with a displacement occurs, to return the fragments to their natural position, the patient is given an extension of the bones of the diseased leg for a period of one to two months. After the fragments fall into place, an immobilizing bandage (languette) 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 gypsum with the installation of the Ilizarov apparatus, which involves the introduction of plates and bolts into the soft tissues in the area of damage to fix the fragments.

When the head of a large bone is broken, a full-scale operation is performed to combine and fix the fragments. Then the leg is put on traction. And only after the end of the process, plaster is applied from the top of the thigh to the foot.

Fracture of the middle part of the leg

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. Then follows the imposition of a plaster cast, which covers almost the entire leg. The disadvantage of such immobilization is that after the removal of the plaster, the joints of the limbs do not perform their motor functions well.

In order not to negatively affect the work of the joints, the application of gypsum is sometimes replaced by the use of Hoffmann, Ilizarov and others. If the fragments are turned in different directions and planes, as in the previous case, you have to put the apparatus for traction for a month or two, and then lay the leg in a plaster cast for another two months. The full recovery period after this type of limb damage occurs in six months.

Diaphase fractures of the lower leg bones are much easier to treat than injuries in the lower and upper parts of the tibia. A double fracture (both tibia) requires a more complex operation under local or general anesthesia.

If your ankle is injured

This is a severe type of injury, class C. The ankle is affected, and care must be taken to restore its mobility after treatment and rehabilitation. The combination of fragments in this case is carried out during the operation with general anesthesia. The fragments are fixed with various devices, which will have to be removed after a few months during the second operation. After the first operation, the leg is wrapped with a plaster bandage, which captures half of the lower leg and stretches to the toes of the diseased leg.

When the shifted fragments of the ankle are combined, its swelling often occurs. To make it disappear, the leg is placed on the Beler splint and placed in traction. After it subsides, the ankle is placed in a plaster splint.

Rehabilitation is absolutely necessary. It is designed for:

inhibition of the process of atrophy and bringing the muscles into a pre-traumatic state;
bringing muscles into normal tone to start their functioning;
restoration of healthy blood circulation of the limb;
removal of edema from the injured surface;
bringing joints to healthy pre-traumatic mobility.

Immediately after the plaster is removed, the person is surprised to find that he still cannot walk without a crutch or stick. Therefore, he needs further observation by a traumatologist. To help the patient recover, the doctor prescribes rehabilitation procedures for him, the first of which can be called massage. It tones the muscles, restores blood circulation, makes the knee and foot move. If special ointments such as Chondroxide are used during massage, the effect will become noticeable even faster.

The doctor will recommend that the convalescent person take foot baths with the addition of sea salt. Some are helped by wraps with a cloth soaked in wax. At the same time, it is time to start the second powerful rehabilitation program - physiotherapy exercises.

Physiotherapy exercises change the complex as motor functions return to the leg. After removing the cast, experts advise slightly moving the joints in the supine position. As you go through the massage, taking baths, the leg acquires greater mobility. Physical therapy exercises become more active.

You can try to slightly raise the leg, after a few days raise it higher, turn the foot and knee in the raised state. Then do swings and rotational movements of the recovering limb. Standing on the floor, you need to try rolling from heel to toe and back. Now it's time for hiking. They complete the rehabilitation process. First, a person walks around the apartment, then you can walk to a bakery or pharmacy. Then comes the time of walking without restrictions.

The main thing in the rehabilitation period for its quick passage is to perform the procedures every day. Passes will push the convalescent back a few weeks.

Injury prevention

In order not to break your leg, you can try to follow certain rules.

Nutrition with the addition of foods containing bone-strengthening substances to the diet is the first rule. Eat more greens, nuts, dairy products. Add meat and fish to the menu. Dress salads with vegetable oil. Thus, you will provide the body with enough calcium, phosphorus, potassium, magnesium, manganese, sodium and other substances and vitamins for bones.

Attention! Dressing salads with vegetable oils helps the body absorb the calcium necessary for bones.

Do daily exercises that strengthen the muscles of the legs and back, this will help you maintain balance at the beginning of the fall.

Important! To prevent your child from breaking his leg, keep an eye on him while walking. Start with him learning to climb ladders and other yard structures gradually. First, let him climb one step up and climb down from it. Let him fall from the first step, support him at the same time. But he himself must understand that it will hurt to fall, that he must first practice, and then do risky exercises.

Beginning skiers and climbers are advised not to rush to complicate the slopes. First learn all the subtleties on easy sections, and then gradually complicate the routes. You don't have to prove to anyone that you are the best. Learn and then prove.

We advise motorists not to get behind the wheel while intoxicated, do not try to overtake the vehicle in front, learn and follow the Rules of the Road, get enough sleep before long trips and have a partner who will drive 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 a flat area - without trees and poles. And it is better that they were trained in a driving school. Another tip is not to talk on the phone while driving and not turn on your tablet or car TV.

If you take care of your own health, you will not have to go to the doctors.