A leg fracture is the most common trauma in clinical practice. Patients of all age groups are affected, however, more often fractures are observed in the elderly. The course, recovery time, treatment methods and long-term effects depend on the nature and location. The main diagnostic measures are radiography, CT and MRI. Conservative (immobilization) and operative (osteosynthesis) treatment methods are possible.
Today, one of the most common injuries is considered a broken leg. So, every second case of skeleton damage occurs in fractures of the lower extremities. Most often, such injuries are isolated in nature, less often combined with a violation of the integrity of the pelvis, upper limbs or spine.
Fractures of the lower extremities usually occur in:
- the femur with damage to its head and neck at the level of the hip joint, body, condyles forming the knee joint;
- drumstick, during the injury of which the integrity of one, two tibia bones is violated;
- the foot, including damage to the bones of the tarsus, metatarsus and phalanx.
Injuries to the near and terminal sections of the bones can be intraarticular. In the latter case, there is an additional lesion of various parts of the joint – the cartilaginous surface, membrane, ligaments, tendons and muscles. Periarticular fractures of the legs are characterized by the insertion of bone fragments into each other, while damage to the bone body is accompanied by a shift of fragments.
Damage can be complete (bone destruction) and incomplete (cracking). Depending on the integrity of the skin, an open leg fracture is distinguished (bone fragments injure the skin, forming a wound) and closed (the skin is not damaged, there is no wound).
Given the line of bone injury, it is customary to distinguish oblique, transverse, longitudinal and helical fractures. By the nature of the fragments of damage, they are divided into:
- fragmented with many small bone fragments;
- polyfocal associated with the separation of large bone fragments;
- hammered, in which one bone fragment is wedged into another;
- compression, accompanied by compression of the bone and its “cracking”.
One of the most severe injuries of the femoral neck and open multi-fragmented fractures are considered, which are often accompanied by pain shock, wound infection and muscle damage. However, the most dangerous complication is fat embolism – a blockage of blood vessels by particles of fat that enter the bloodstream during bone marrow damage. According to statistics, more than 30% of cases of fat cell embolism are fatal.
Why is it formed
A leg fracture usually occurs after hitting an appropriate force, direct exposure to a heavy object; traumatic sports; falls from a height; gunshot or mine explosive wounds; criminal cases; industrial and transport accidents; rubble in the mines, snow in the mountains; natural disasters (earthquakes, tsunamis, etc.).
A separate type of violation of bone integrity is the so-called pathological forms that occur against a background of a number of bone diseases:
- metabolic disorders of vitamin D and calcium (rickets);
- hormonal disorders (increase in parathyroid hormone level);
- tuberculosis, gonorrhea, brucellosis infection;
- purulent inflammation of the bones (osteomyelitis);
- tumor neoplasms of bone tissue, metastases (daughter tumors);
- multiple inflammation of the joints (polyarthritis);
- decreased bone density (osteoporosis);
- hereditary diseases;
- replacement of bone tissue with fibrous (fibrous dysplasia).
In rare cases, fractures are observed in the fetus in the buttock or leg presentation (the child is located with the buttocks, legs to the exit of the pelvis). Typically, with such births, manual assistance is performed, during which a fracture of the femur is possible.
Symptoms of a leg fracture
A typical manifestation of a leg fracture is unbearable pain at the time of the injury, intensifying when you try to lean on the affected limb. Pain is extremely pronounced, can have a pulsating, cutting character.
Massive edema rapidly develops in the area of bone fracture. The skin turns pale, blue-red spots are detected on it – signs of subcutaneous hemorrhage (hematoma). With open forms, the skin “breaks through” – a wound is formed in which bone fragments, torn muscles and surrounding tissues are visible. Usually there is bleeding of varying severity.
A damaged limb loses normal mobility and becomes pathological (unnatural). So, normal movements are impossible, but the leg can bend at the level of the lower leg or mid-thigh.
When trying to rotate with a limb, a characteristic “crunching” occurs – crepitus associated with friction of bone fragments against each other. In this case, the displaced fragments of the broken bone can be felt under the skin.
Injuries of the femur are accompanied by intense pain, massive blood loss. In older patients, the femoral neck is most often damaged. So, pain arises in the area of the hip joint, aggravated by an attempt to move the hip. In the prone position, the injured limb is deployed outward, while it cannot be lifted out of bed (symptom of a “sticking heel”). Often an injured leg is shorter than a healthy one due to a shift in bone fragments.
Fractures of the body of the femur develop during direct, indirect impacts – bumps, falls, household, industrial injury. Middle-aged patients are affected. The first to occur is intense pain and diffuse edema, which often leads to a shock condition. The limb is shortened and curved. Unusual mobility is observed in the middle of the thigh. Displaced bone fragments are felt under the skin.
Injuries of the condyles of the thigh are noted in the elderly with a blow, falling to their knees. Usually there is pain in the knee joint and lower thigh. The articulation increases in volume due to hemorrhage in the joint cavity (hemarthrosis). During the shift of the fragments, the lower leg deviates inward or outward. The mobility of the knee joint is significantly limited, the support function is impaired.
Damage to the lower leg is considered the most common injury. So, fractures of the tibia are formed during a fall or direct exposure (often in an accident), while damage to the ankles is associated with tucking of the foot. Traumatized, as a rule, persons of younger and middle ages.
Injuries to the condyles of the tibia are a result of falling to the knees. Usually pathology is observed in one, less often in two condyles at once. Patients are concerned about pain around the knee joint. The range of motion in the joint is sharply reduced. The knee itself swells, and its volume increases due to intraarticular accumulation of spilled blood. Attempts to bend the leg are painful, the support is difficult.
Fractures of the body of the small and tibia are formed due to high-energy injuries. The first is unbearable pain in the lower leg, then extensive swelling develops. When trying to bend the leg, a crunch of rubbing bone fragments is heard. Reliance on the affected limb is impossible, nonphysiological mobility of the lower leg is observed. Displaced bone fragments are felt under the skin.
Damage to the ankles occurs when the foot is twisted or hit on the ankle joint. In clinical practice, a fracture of one or two ankles can be observed, less often the injury is combined with damage to the tibia. Often the injury is accompanied by subluxation of the ankle or a rupture of the ligaments. Typically, patients are concerned about soreness in the ankle joint, swelling and the inability to support the foot. Sometimes ankle deformity is observed.
Stop injuries occur less often than others and have a more favorable course. So, heel fractures are associated with landing on the heel bones when falling or jumping from a height. Pain and swelling usually occur. Pressure on the heel is not possible, which is why the patient rests on the forefoot.
Damage to the bones of the tarsus is formed during the eversion of the foot or the fall of a heavy object on the leg. Often, patients complain of pain and swelling of the rear of the foot. At the same time, support on the foot and movements with it are difficult.
Fractures of the metatarsal bones and phalanges appear when bumps or a heavy object falls on the feet. Usually there is pain and swelling in the final section of the foot and fingers. Pressure on the front edge of the foot is painful, which is why patients rest on their heels.
Diagnosis of leg fractures includes:
- Inspection by a traumatologist, during which palpation of the affected area is performed;
- X-ray is the “gold standard” that allows you to visualize damaged bones, displaced bone fragments, as well as concomitant dislocations and subluxations.
In complex clinical cases with additional damage to the joints, computed or magnetic resonance imaging may be required.
Leg fracture treatment
Therapeutic measures include first-aid emergency care, as well as specialized treatment.
Emergency care during open leg fractures consists in covering the wound surface with a bandage and applying a tourniquet above the area of injury in order to stop massive arterial bleeding.
Be careful! Before using the tourniquet, the affected limb rises for several seconds. Then the tourniquet is stretched and placed above the wound on top of the clothes. The date and time of application are noted on a piece of paper or on the patient’s body. In the summer season, the tourniquet can be left for two hours, in the winter – for an hour.
Further, the tactics of help with open and closed forms are not different: patients are given powerful painkillers (Ketanov, Tramadol), and the limb is immobilized (immobilized) with tires or any improvised means (long sticks, etc.).
Tires are applied over clothing from the back and sides of the legs. The points of the bone protrusions are protected by a soft layer (cotton). Typically, the site of a fracture of the leg, as well as the higher and lower joints, is subject to immobilization. So, in case of fractures:
- tire feet impose from the end of the fingers to the middle of the lower leg;
- tibia – from the sole of the foot to the middle third of the thigh;
After providing emergency care, the patient must be hospitalized in the trauma unit for the purpose of further examination and treatment.
The general principles of the specialized treatment of leg fractures are restoration of bone integrity and its immobilization for a certain period.
In case of injuries of the femoral neck, osteosynthesis (fastening of bones with metal structures), hip replacement (replacement) are mainly used. In case of injuries of the thigh body, skeletal traction is carried out (reduction of fragments by means of weights), fixation with pins. After condylar fractures of the thigh, the treatment consists in applying gypsum for 2 months, conducting traction. Less commonly used is osteosynthesis with bolts and screeds.
For injuries of the condyles of the tibia, immobilization with a plaster cast for 2 months is performed. In the case of displacements, traction, transosseous osteosynthesis using the Ilizarov apparatus is used. After fractures of the bodies of the bones of the lower leg, fixation with block rods is carried out. While ankle injuries require prolonged immobilization (4-12 weeks) or the operative connection of bone fragments with screws and knitting needles.
Fractures of the foot bones require immobilization by means of a plaster cast for 4-6 weeks. For complex damage to the phalanges, finger fixation with needles can be used.
Be careful! Today, surgical osteosynthesis is the leading method for fracture correction. This method allows not only to effectively restore the integrity of damaged bones, but also significantly reduce the rehabilitation period.
The primary prevention of leg fractures is to prevent: strikes of the appropriate strength or direct exposure to a heavy object; traumatic sports; falls from a height; gunshot or mine explosive wounds; criminal cases; industrial and transport accidents; rubble in the mines or snow in the mountains; consequences of natural disasters (earthquakes, tsunamis, etc.).
In order to maintain normal bone architectonics, the following are necessary:
- Adequate intake of vitamin D and calcium (prevention of rickets);
- Normalization of hormonal disorders;
- Prevention of tuberculosis, gonorrhea and brucellosis infections, as well as purulent bone inflammation (osteomyelitis);
- Therapy of tumor neoplasms of bones and metastases (with breast cancer, prostate, etc.);
- Treatment of multiple joint inflammation (polyarthritis) and a decrease in bone density (osteoporosis);
- Monitoring the patient’s condition when replacing bone tissue with fibrous (fibrous dysplasia);
- Adequate delivery assistance with gluteal presentation of the fetus.
Secondary prevention consists of:
- stop bleeding by tight bandaging (venous) or applying a tourniquet (arterial);
- limb immobilization and fast transportation to a medical facility;
- timely provision of specialized assistance.
Remember, leg fractures are considered the most dangerous limb injuries. These injuries are often complicated by bleeding, infection of the wound and fat embolism of blood vessels, which in one third of cases leads to death.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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