Fracture of the lower leg is a violation of the integrity of both bones, the tibia and tibia, which connect the thigh to the distal lower limb. Severe injury is most often the result of traffic accidents. Damage causes acute pain, deformation of the lower leg, as well as pathological mobility at the fracture site. The nature and degree is determined by x-ray, long-term treatment, using special metal structures.
Every tenth victim with a suspected violation of the integrity of the bones is diagnosed with a fracture of the leg. This is a serious injury, which can be accompanied by significant blood loss, as well as damage to the muscles and tendon-ligamentous apparatus.
The lower leg is the part of the lower limb that consists of two tubular bones: the tibia, which is larger and carries the main load, and the fibula. In the upper part with the knee joint, the bones of the lower leg are connected through the condyles, and in the area of the ankle joint by ligaments. Near the foot on both bones there are ankles, from which a “fork” is formed, wrapping around the ankle and ensuring its stability.
Bone fracture can occur in any part of them, in addition, the articular surfaces of the bones are no exception.
Fracture can be complicated:
- rupture of vessels and nerve trunks
- muscle fiber damage;
- violation of the integrity of the joint capsule;
- rupture of ligaments, tendons;
- meniscus damage.
In traumatology, there is a large classification of shin fractures. First of all, when examined, the condition of the skin is striking. If there is no wound surface, exposing muscles and bones, then the fracture is closed, otherwise open damage is recorded.
Given the localization of the fault line:
- fracture of the pineal gland inside the joint;
- destruction of the tibia or tibia in its middle part, isolated tibial damage is more common, less often the simultaneous fracture of the entire tibia;
- violation of the integrity of the ankles.
By severity, a fracture can be distinguished with and without displacement. In most cases, a more complex injury with displaced fragments is observed. This is due to the location in this part of the leg of the calf muscle, which is quite large, and can by inertia provoke a discrepancy in the broken bone.
- transverse with a perpendicular arrangement of the damage line;
- longitudinal – runs parallel to the bone;
- oblique – damage occurs at an angle;
- comminuted – fragmented bone with the formation of small fragments;
- helical – with a spiral trajectory of force.
In addition, a leg fracture can be multiple when the bones break in two or more places. With combined injuries – combined with fractures of other bones (chest, skull, and others), as well as complicated ones, when internal organs, vessels, and nerves are damaged.
Most often, an injury occurs when a shin is exposed to a force that exceeds the strength characteristics of the bones. The following situations are more often predisposing external factors:
- Falling during skiing, skating, roller skating, when the body weight is shifted to the side, and the foot remains in the correct position;
- Direct hit on an inclined path;
- Fall from height with landing on its side;
- Traffic accidents, when the injured pedestrian is diagnosed with a “bumper” fracture, which is due to the location of the car bumper at the height of the man’s lower leg;
- Fracture of the “blonde” – damage to the ankle when falling in high heels.
For the elderly, minor traumatic effects are sometimes sufficient. This is due to a decrease in bone strength with age-related changes with leaching of calcium or osteoporosis.
The clinical picture develops immediately after an injury. At the time of bone fracture, characteristic symptoms appear:
- Intense pain, which increases with palpation of the bone, as well as at the time of edema;
- Swelling around the site of damage can have different intensities;
- During trauma, the patient hears a click, and subsequently, during palpation, the grinding of bone fragments (crepitation);
- Fragments of bones are visible at the site of injury, through an open wound – with an open fracture, protruding under the skin, if the damage is closed;
- Subcutaneous hematoma of an extensive nature;
- In case of damage in the knee joint – hemarthrosis (hemorrhage in the joint bag);
- At the site of injury – pathological mobility;
- The tibia is unnaturally deformed;
- Inability to lean on the foot and move independently.
Epiphyseal fractures are less painful manifestations. But with such an injury, signs of an inflammatory reaction often appear: redness and swelling of the knee, local increase in body temperature, impaired mobility.
Open fractures in most cases are accompanied by bleeding. In this case, if the artery is damaged, the blood of a bright red color beats a fountain, if the integrity of the venous vessel is violated – a dark cherry stream of blood.
With complex injuries, the development of traumatic shock is possible. In this case, the general condition deteriorates sharply – there is a pronounced decrease in blood pressure, dizziness, a state of collapse. Great blood loss is accompanied by general weakness, in some cases, fainting.
If an injury has occurred, and external signs indicate a fracture of the lower leg, urgent measures are taken:
- lay the patient, examine the injured leg;
- in the presence of bleeding, apply a hemostatic tourniquet;
- with an open wound surface, treat it with an antiseptic solution (3% hydrogen peroxide), cover with a sterile gauze cloth;
- immobilize the leg with a tire or improvised means, fixing the knee and ankle joint, in the absence of suitable objects – you can bandage the injured limb to a healthy one;
- give pain medication – Baralgin, Ketorol;
- call an ambulance or deliver it yourself to a trauma center.
The traumatologist is engaged in clarifying the nature of the damage to the lower leg. First of all, an external examination and clarification of the circumstances and time of the injury is carried out. A complete picture of the fracture can be obtained using radiography. According to the picture, the doctor makes a description of the injury, specifying the type and severity of a leg fracture. After that, the final decision on the method of treatment is made.
A complete list of therapeutic procedures is made taking into account all associated injuries. With simple fractures, a conservative treatment is sufficient by comparing the fragments with the efforts of the hands and fixing them in the correct position, applying a plaster cast or using polymer bandages.
Of the medicines prescribed:
- NSAIDs for relieving pain and inflammation – Ketoprofen, Indomethacin;
- antibiotics for open fracture – Erythromycin, Ampicillin.
Before immobilization, reposition (connection of parts of the bones) is performed in a closed or open way. If surgery is required to correct an injury with displacement, the bone is fixed with a special metal structure.
If a leg fracture does not respond to conservative therapy, surgical treatment is prescribed:
- Reposition by an external method through the skin with fixing the bones with knitting needles.
- The connection of the parts of the bone with the introduction of spokes during the operation, which is carried out in an open way.
- The introduction of the Ilizarov apparatus or other structures into the bone structure.
In the future, the course of bone marrow formation is controlled by x-rays. During this period, calcium preparations (Calcemin) and chondroprotectors (Teraflex, Arthra) are prescribed to improve metabolic and regeneration processes.
The process of bone fusion in fracture of the lower leg takes a different period of time:
- with simple uncomplicated injuries – 2-3 months;
- complex fractures heal – 4-6 months;
- open injury with damage to blood vessels – up to 12 months.
A full recovery can take from 6 months to 1 year. The speed of recovery depends not only on the nature of the damage, but also on the general state of health.
To prevent fracture of the lower leg, you must follow the safety rules in everyday life, at work, on the street, during the passage of the roadway. It is important to lead a healthy lifestyle and eat right, which is the prevention of diseases that affect bone strength. Regular exercise will strengthen muscle tissue and increase physical stamina. If injuries could not be avoided, timely diagnose and follow the doctor’s recommendations.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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