Types of fractures of the tibia
Few people know how to fracture of the tibia can further affect a person's life.
Fractures rank third in frequency of occurrence among all types of injuries. The so-called violation of the integrity of the bones to bring her over. Because the body, for the most part, consists of tubular bones and their fractures occur most often.
What: fracture of the tibia
The first places are occupied by fractures of the arm and forearm. In third place are the fractures of the tibia. The violation of the integrity of the bones this part of the body have their own characteristics and differences.
If considered anatomically, the lower leg consists of two bones - more - and fibula. Tibia mainly performs a supporting function, so this disease is almost always defeats the possibility of a person standing upright. In addition, on the anterior surface of the tibia which tibia bone, almost no muscle, causing fracture of the tibia in most cases is open.
Fibula performs frame function for leg muscles and does not participate in creating the support.
Causes and symptoms of an open fracture of the tibia and other types of
The mechanism of development of injury in the fracture - direct impact forces perpendicular to the axis of the bone. This generally will give strong blows to the Shin. About ten years ago the main mechanism for the development of fractures of the Shin bones was hit by a bumper car (which is why in some medical Sciences coined the term “bumper-fracture”). Almost always there is a fracture of both limbs.
Its distinctive feature is the direction of wave impact, the fracture always takes on a wedge shape with the apex at the place of application of force and the base on the opposite of this point side. Bumper-fracture always tends to the formation of large amounts of debris in the wound area. His treatment is always carried out surgically and requires careful repositioning of bone fragments.
The athletes often develops a fracture of the right tibia, as most of it is support and shock limb.
If the force vector is directed along the axis of the bone, or fractures of the ankles, Shin bones, or, very rarely, ruptures of the cruciate ligament and fractures of the condyles of the tibia (not always developed).
Depending on as has been directed force on the tibia, isolated fractures: transverse, oblique and spiral orhelical.
Worst trend of fusion have longitudinal fractures. Due to the fact that tibia weakly gets it blood supply from the surrounding muscles, significantly increases the time of healing of fracture (failure to deliver the nutrients needed for building bone). Another negative factor is dense enough comparability of bone fragments, their mobility, which often leads to the development of a false joint at the fracture site.
This results in the inability of support on the affected foot and is an indication for re-treatment of the disease.
Spiral fractures occur in the case of the rotating motion of the tibia with a full commit of the foot. When the development of an extremely high risk of damage to the skin and muscles protruding bone atomtime, which complicates the subsequent PHO.
In addition, the fractures can be subdivided on anatomical grounds. Among them are fractures of the upper part of the tibia (cervical fracture, fracture of the head of the fibula, fractures of the tuberosity of the tibia), lesion of the diaphysis (isolated or combined) and injuries in the lower part of the tibia (ankle fractures).
As with any type of fracture, bone lesions of the tibia is characterized by common features.
First, the presence of the fracture can be set visually (presence in the wound of bone fragments, damage to their skin).
On the site of the fracture hematoma is often formed as a result of exposure of nearby vessels. Completely lost function of the limb.
Visually you can observe the shortening of the anatomical axis of the limb, especially if there is a fracture of the tibia with displacement of bone fragments. Palpation of the affected area is quite painful, however, there is usually no swelling in the adjacent tissues (which is typical for the development of the dislocation).
Most often, a fracture develops acutely, although the elderly as a result of progressive osteoporosis may develop a spontaneous fracture, and not always accompanied by intense pain.
Closed fracture of the tibia
This form of the disease is quite rare; most often found cracked bones. The major objective signs of lesions may be swelling of the skin around the fracture site, pain. The function of the limb is broken is not always what kind of an injury can be confused with a bruise.
For a more accurate diagnosis of the fracture should take advantage of the radiographic study (CT scan of the skeleton).
The best to do in two projections for a more accurate visualizationcrack or fracture.
Special preparation from the patient before the test isn't required. X-rays pass freely through the skin ( and gypsum) and reflected from the bone, which allows to obtain a clear picture of the injury.
In the picture you can see a clear fracture line or fracture bone (must be the defeat of the periosteum).
Feature of fracture in children is that there is no complete separation of bone fragments from each other. The bones are fixed due to the elastic periosteum, which fracture has a characteristic appearance of “broken green branches”.
Other studies are usually not required, although in children of early age to study the fracture site is preferable to carry out ultrasonic examination (so as not to expose the child to radiation load). Ultrasound perhaps due to the fact that the children's organism has not happened yet complete ossification of the skeleton and bone structure, there is still cartilage available for visualization on the ultrasound.
How to cure the developed fracture
First and foremost, the patient should immobilize the affected limb to prevent the divergence of fragments (with bumper comminuted fracture, the bone fragments and surrounding tissues.
It is best to use splinting (to make a splint out of scrap material or to use the bus Bellera). After the immobilization of the patient can be transported in the supine or sitting position in the emergency room or a specialized a specialized hospital.
Prehospital we need to introduce the patient an anesthetic drug to eliminate the effect of pain shock.
On delivery to the relevant institution may have several options:
- If the fracture is not severe, there is no destruction of surrounding muscles and skin, shifting, can be limited by the imposition of a plaster bandage and release the patient to outpatient treatment (all this is possible only after the image).
- If a more serious condition of the patient requires compulsory hospitalization. An experienced surgeon needs to decide on the further treatment of the patient.
Treatment of fracture of the tibia on the stationary phase could be undertaken in different areas, depending on the type and severity of the fracture.
If the fracture is transverse, but in the wound no bone shards, it is preferable to choose the tactics of plate osteosynthesis. For this purpose, special plate, which are installed at the border of the bone fragments and fixed with screws.
Screw fractures,on the contrary, is best treated by the use of metal rods or structures that are held inside the bones. Fixation intraosseous dense structure allows to achieve a better alignment of the faces of the fracture and speedy (as possible) to the ribs.
Both types of fractures can be treated using the devices in compression-distraction osteosynthesis (the Ilizarov method).
The essence of the next - outside, on the belt, is superimposed the device, consisting of rings and semirings. Through the bone are special spokes Kirchner, which is fixed in these rings. By changing the distance between the rings it is possible to achieve an optimal distance between the bone atomtime. This aspect is extremely important, as failure to comply with the required distance, the risk of development of a false joint, with excessive mapping worsen the indicators of full recovery, there is a risk of incorrect adhesions that can lead to shortening of the limbs and the need for re-fracture and the correct mapping.
If there is a severe comminuted fracture of the tibia required surgery. During intervention carry out primary surgical processing of the wound - remove the remains of the wound detritus, small bone fragments and, thus, reach the fracture site. Directly in the area of injury operating surgeon under direct vision holds the mapping of bone particles, and then posts them commit to a healthy, intact bone with plate plates, screws, and wire rims.
In this way it is possible to achieve almost complete recovery of the bone.
If there is a fracture with herniation of the bone fragments, you should resort to a skeletal traction. It will divide the offset fragments to give them the correct position. After stretching it is recommended that some time be in plaster for the repair of the wound.
Individual characteristics
The recovery period after a fracture of the tibia of each individual. It all depends on the state of metabolism, hormone levels, and trauma.
First and foremost, it should be remembered that, as mentioned before, the drumstick is not very well supplied with blood from the surrounding muscles. This is especially pronounced on the anterior surface, so fractures of this area heal for a very long time (may require being in a cast for over 6 - 8 months).
Superimposed plaster from the ankle to the middle third of the thigh orgluteal fold (it depends on the level of the fracture). The man shows a complete immobility; the movement is permitted only in bed. Forbidden to stand, to place emphasis on the affected leg as it worsens the conditions of saeplast.
In a few months (usually about 3) it is possible to withdraw the massive gypsum and go to use small bandages or splints. The load on the foot is still prohibited, however, in this period is necessary to restore the former range of motion in limbs. This is achieved by daily massage the atrophied muscles, their light warm-up.
Rehabilitation after the fracture is held in three stages
In the first stage restores the muscle tone and muscle strength. Patient is prescribed toning exercises, and drugs that help restore metabolic processes and neuromuscular control. In the second stage we are allowed to gradually increase the load on the affected limb. The patient demonstrates active movement in the limbs to improve blood flow. Allowed to walk a little.
The performance of such exercises can often lead to pain during their execution. You should accept that recovery will cause discomfort, but it is not necessary to do everything through the power, as thus yourself can only do harm, but not doing anything is also impossible, as can be disabled.
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Full recovery is observed after 6 to 8 months after the trauma. In recent months, it is recommended to conduct physical therapy and strengthening exercises to restore muscle tone and strength.