Treatment

Closed helical fracture of the tibia. Fracture of the fibula and tibia. Best adaptation of the tie bolt support elements. Exercises for a broken leg

Lower leg injuries often result in the victim having a confirmed fracture of the tibia. The reason for this is a force that exceeds the strength of the bone tissue. There can be many reasons for this condition, but the most common cause is a blow to the shin, a jump or a fall. Damage statistics increase significantly in winter and are often associated with extreme sports.

The peculiarity of this bone is that it is covered with a small number of tissues, especially in front. Along with the tibia, the tibia is often damaged. As we age, bone loses minerals and becomes brittle, increasing the risk of injury.

The human tibia is a unique formation that includes the tibia and fibula. The bone has a triangular body, the anterior edge, its outer and inner surface can be felt under the skin without any problems.

At the top are the condyles of the tibia, which have articular surfaces that are part of the knee joint. The tibial tuberosity is located in front; the tendon of the quadriceps femoris muscle is attached to it. Below the lateral condyle is the articular platform of the fibula.

In the lower part, the tibia has an extension that forms the articular platform of the ankle joint. On the inside, the platform is limited by the ankle of the same name, and on the back by the edge. It is these formations that are susceptible to injury and often with displacement.

Each case of injury is unique in its own way, which affects the specifics of treatment and rehabilitation. The following types of damage can be distinguished:

with offset;
no offset;
driven in;
helical;
splintered.

In the upper third, injuries occur in the area of the condyles. In the middle third, fractures are more often comminuted, helical, and displaced. Non-displaced fractures in this region are extremely rare. The body may be damaged in the lower third; in this case, the fractures are impacted. Also in the lower third, the inner malleolus or posterior edge, which is part of the ankle joint, is damaged.

Open or closed injuries deserve special attention. A closed injury in which there is no damage to the skin is considered safe. With an open fracture, the bone and surrounding soft tissue become infected, which can result in osteomyelitis. Also, the fracture can become secondary open, in such a situation the skin is damaged by bone fragments. This happens when the victim is transported incorrectly or when an attempt is made to correct the deformity.

Symptoms

As a rule, making the correct diagnosis is often not difficult, especially if the fracture involves displacement of the tibia. To make a correct diagnosis, it is necessary to take into account the characteristic symptoms. Among them you can highlight:

Pain at the site of injury, which intensifies when trying to stand on your leg, move it, or after lightly tapping the heel.
When palpating the anterior crest of the bone, the pain intensifies.
Also, upon palpation, it is easy to notice the deformation of the bone; fragments can crepitate.
Upon visual inspection of the lower leg, the deformity is noticeable to the naked eye.
Open fractures are characterized by the presence of bone fragments in the wound.
When an oblique or spiral fracture occurs, a subcutaneous hematoma occurs at the site of injury.

Fractures in the upper third of the head of the fibula can cause nerve damage. In a situation where the small tibial nerve is damaged by fragments, the foot hangs.

Diagnostics as confirmation of a guess

But despite the simplicity of diagnosis, sometimes questions remain. In particular, the amount of displacement, the presence of fragments, whether the fracture is associated with the joint cavity or not, whether additional examination is indicated. Most often, doctors prescribe x-ray examinations and imaging. The technique allows you to diagnose a fracture of the tibia and fibula. If the nerve is damaged, electroneuromyography is indicated.

If the fracture is in the condyle area or comminuted, an MRI is indicated. The technique allows you to clarify the type of fracture, especially if the fracture of the tibia is not displaced, invisible on an x-ray.

Features of first aid

In order for a fracture of the tibia to bring a minimum number of complications, it is important to provide the victim with first aid. Immediately after injury, the limb should be immobilized. This can be done using a special splint or any available means. Correctly provided first aid consists of fixing the knee and ankle joints.

Before the diagnosis is made, any other actions are prohibited, especially those related to the reduction of fragments or deformities. Cold applied to the site of injury will help reduce the intensity of pain. You can wrap any item from the freezer in a towel and apply it for 15-20 minutes with a break of 10.

If there is a wound, a sterile bandage is applied to it if possible. And if there is bleeding, a tourniquet should be applied to the thigh area. The duration of applying a tourniquet in summer is no more than 2 hours, and in winter 1.5. After this period, if the victim could not be taken to the hospital, the tourniquet is loosened somewhat. A screw fracture of the tibia is especially dangerous in terms of bleeding, since sharp fragments injure not only the skin, but also large arteries.

Fracture treatment

As with other skeletal injuries, the treatment process can go in two ways - conservative and surgical. But taking into account the fact that the bone is supporting and if it is damaged, displacement is observed, preference is given to surgery. The doctor will help you decide in more detail after all the examinations have been completed. It makes sense to consider all the advantages and disadvantages of each method.

Conservative option

On the advice of a doctor or due to fear of an upcoming intervention, a person choosing conservative treatment wonders how long to walk in a cast. There is no clear answer to this question; on average, the fusion time is approximately 3 to 3.5 months.

Immediately after admission, a cast should be applied if the fracture is not displaced, which is relatively rare. When there is displacement, the stage of conservative treatment or preparation before surgery is skeletal traction. The procedure is performed under local or general anesthesia, depending on the condition of the victim. A special knitting needle is passed through a certain area (often the heel), to which weights are attached. The victim spends about 6 weeks in this position, and then a plaster cast is applied for 4 months.

The disadvantage of the technique is the absence of rigid fixation of the fragments; traction does not allow them to be firmly held. Also, for the entire period of traction, the person remains virtually bedridden and it is not always possible to put bone fragments in their place, which requires surgery. However, before the operation, the ligaments and tissues are stretched, making comparison much easier.

Operation as a solution to the problem

As already mentioned, the tibia is a supporting bone; due to this feature, a person needs to be put on his feet as soon as possible. Surgery will help solve this issue. The main indication for it is the presence of multiple fragments or a displaced fracture. When each part of the bone is damaged, its own techniques are used, for which appropriate fixators have been developed.

If the upper or lower part of the bone is damaged, plate placement is indicated. If the middle part is damaged, a pin is installed inside the bone. The surgery will take place under general anesthesia. When installing the fixator, a special surgical approach is used. When placing a plate, the fracture is fixed in an open manner; placement of a pin can be done closed. However, if there are a large number of fragments, exposure of the fracture zone is indicated before placing the pin.

The fixators are designed for lifelong use, but approximately a year after installation, subject to consolidation of the fracture, they can be removed. In case of an open fracture, the doctor can install an external fixator or a device using the Ilizarov technique. Such devices reliably fix the fracture and enable the doctor to provide ongoing wound care.

The installation of plates and intraosseous fixators for open fractures is contraindicated until the wound has healed. There are also other contraindications.

Contraindications to surgical treatment

There are always situations where surgery can do more harm than good. They should always be taken into account by the attending physician before deciding on surgical intervention. Contraindications are:

wound or abrasion at the site of the intended intervention;
mental disorders of the patient;
the presence of chronic decompensated pathology of the heart, lungs, liver and kidneys;
severe diabetes mellitus;
blood clotting problems (such as hemophilia);
suffered strokes, heart attacks;
if the person did not move independently before the injury.

Use of medications

In order for the body to cope with the fracture, it needs a little help; for this purpose, medications are used both at the stage of conservative and surgical treatment.

First on the list you can put calcium preparations (Calcium D3 nycomed, Osteogenon, Kalcemin, Structum). They promote bone mineralization with calcium, and thanks to vitamin D, the microelement is better absorbed by the body.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain. Frequently used drugs are:

Aertal;
Revmoxicam;
Xefocam;
Nimid et al.

The optimal drug and dose will be determined by your doctor, since self-medication can negatively affect your health. An addition are chondroprotectors, especially if the fracture is associated with the surface of the joint or the latter is immobilized for a long time. Among the representatives of this group of drugs are:

Mucosat;
Chondroitin complex;
Protekon et al.

The course of treatment is three months, then a break is taken for a month, after which treatment continues. The drugs have a cumulative effect, so even after the drug is discontinued, its effect continues.

Recovery after damage

An important stage is rehabilitation after a fracture of the tibia, which consists of several stages. Just remember that rushing through the rehabilitation process is not the best choice. Therefore, its intensity should increase gradually. When walking, crutches are used first, and then a walker, a cane, followed by a full load.

Massage and gymnastics

Any procedure is performed under the supervision of the attending physician, exercise therapy instructor or massage therapist. Massage allows you to warm up the muscles and speed up blood circulation in the tissues. First, stroking is performed, followed by rubbing and kneading. Methods may be different, it all depends on the level and qualifications of the massage therapist.

Gymnastics helps ensure that rehabilitation after a fracture of the tibia goes faster by performing a special set of exercises. At the initial stage, exercises should be performed only under the supervision of a specialist, initially without load. Afterwards, on the recommendation of the exercise therapy instructor, the load can be added.

Set of exercises

Before using any therapeutic exercises, you must consult with your doctor or exercise therapy instructor.. You need to start by sitting on the bed and hanging your leg, it should bend at the knee joint. Gradually, the healthy leg may act as a load, putting pressure on the operated leg. You can try to bend your leg with your hands. Movements should also be carried out in the ankle joint, flexion and extension are repeated 20 times.

Afterwards you need to lie on your back and try to sit up with the help of an instructor, doctor or stranger. When the exercise is completed, you need to again take a horizontal position. The emphasis is placed with the help of the hands, which are wrapped around the bed; in this position, one straight leg should be raised, and then the other. To ensure that the result does not keep you waiting, 6 to 8 repetitions are performed. If pain begins to bother you, training should be stopped immediately.

Physiotherapy

An important stage of rehabilitation treatment is physiotherapy. Like gymnastics techniques, a large number of them and the optimal procedure will be determined by your doctor.

After injury, electrophoresis is indicated. The procedure allows the penetration of drugs into tissues using electric current. Magnetic therapy can speed up fusion by accelerating blood flow. The procedure also allows you to increase metabolism in cells.

Anesthetic gels and ointments penetrate tissue better using ultrasound. Regeneration can be accelerated by alternating currents, which can be obtained through the diodynamic procedure.

After the metal is placed, physiotherapy procedures are limited, especially those in which currents are used. After surgery, ultraviolet radiation gives the effect. The technique promotes the formation of vitamin D, which allows calcium to be better absorbed.

A shin fracture is a serious injury, since if the approach to treatment and rehabilitation is incorrect, a person risks remaining disabled and losing the ability to walk. In most cases, the cause of disability can be a fracture of the tibia, since it is the supporting bone, and the fibula provides additional stability to the ankle joint. You should not expect a quick result after an injury, however, with the right approach it will not keep you waiting.

Fractures of the diaphysis of the lower leg bones see each other often. Most often, fractures are caused by indirect force, for example in skiers who suddenly turn their body and fall while keeping their foot fixed. Along with this, a spiral fracture appears. Fractures of the leg bones are often open. Fractures of the tibia diaphysis can occur at different levels: in the upper, middle and lower third. Fractures are more common in the lower and middle third. Bone cracks in supramalleolar fractures quite often end up in the ankle joint.

There are fractures of the diaphysis of one tibia or fibula and fractures of both bones of the leg without displacement and with displacement of fragments! With oblique, screw and comminuted fractures of one tibia, the fragments can be displaced due to movement or bending of the fibula. In children, in addition to simple fractures, subperiosteal fractures of the tibia are quite often seen. In the distal region, in older children, epiphysiolysis of the tibia of varying degrees is observed, often with a triangular separation of the posterior edge of the metaphysis. At the same time, with displaced epiphysis, the fibula above the outer malleolus breaks. Displacement during epiphysiolysis occurs forward and outward.

Symptomatology and clinic. The patient tries not to move his leg. There is swelling and hematoma. The tibia in the area of the fracture is deformed. The axis of the tibia is curved. Along with this, an angle is formed, open anteriorly and outwardly. In most cases, the peripheral fragment is turned outward under the weight of the foot. Shortening usually occurs within 1-3 cm. The end of the upper fragment protruding anteriorly is quite often well contoured and palpated under the skin. The skin over it is often pale from pressure. The sharp end of the central fragment can easily puncture the skin or lead to necrosis in this area. Abnormal mobility and bone crepitus are detected at the fracture site. When both bones of the leg are fractured, touching the fibula is painful. It should be taken into account that more often the fibula in fractures of the diaphysis breaks above and less often below the tibia. When the fibula is intact, displacement of tibial fragments is often observed. Patients will be able to lift their leg, but the load on it is not feasible.

An isolated fracture of the fibula, especially in the upper and middle sections, is often not recognized due to the huge array of muscles in this area. Patients will not only be able to move their leg, but also step on it, despite the fact that they also experience pain. When palpating the fibula, the patient experiences pain at the fracture site. If there is a fracture in the area of the head of the fibula, pay special attention to the movement of the fingers and foot, since the peroneal nerve is often damaged along with this.

Crucial for the diagnosis, especially for non-displaced fractures and fractures of one bone, is a radiograph taken in two projections.

Treatment for fractures of the diaphysis of the lower leg bones

Fractures of the tibial shaft without displacement treated with a bedding-free plaster cast, which is applied to the foot, lower leg and up to the middle of the thigh. For transverse fractures, after 8-10 days a stirrup is applied and the patient is allowed to walk using two sticks. On the 20th day they walk with one stick or stick. For oblique, screw and comminuted fractures of the tibia without displacement, a stirrup is applied on the 25-30th day. To avoid secondary displacement of fragments in a plaster cast, patients first walk with the help of two sticks with a small load on the limb. The load on the affected limb slowly increases. After 4-5 weeks, the patient walks with one stick. A plaster cast is applied for 6-7 weeks. Working capacity is restored in 2-2.5 months.

For displaced fractures of the tibial diaphysis First, skeletal traction is used on a standard splint. The wire is performed through the calcaneus or the supramalleolar region of the tibia. A load of 6-7 kg is suspended from the arc. After 2-3 days, a control radiograph is taken. If the fragments have been reduced, the load, starting from the 8-10th day, is slowly reduced and by the 15th day it is brought up to 4-6 kg. On the 25th day, the traction is removed and a plaster cast is applied to the middle of the thigh. After 2 days, the stirrup is plastered and the patient is allowed to walk initially with two sticks. On the 30-40th day the patient walks only with a stick. After 8-9 weeks after the injury, the plaster cast is removed. The period of restoration of working capacity is 2.5-3.5 months.

For fractures of the fibula in the lower third A plaster cast is immediately applied to the knee. After 2 days, the stirrup is plastered. On the 3-4th day the patient begins to walk without sticks, stepping on his foot. The plaster cast is removed after 2-3 weeks. The recovery period is 4-5 weeks.

For fractures of the fibula in the middle and upper half A plaster splint is applied for 2-3 weeks. On the 2-3rd day the patient is allowed to walk without a cane with full weight bearing on the leg. Once the plaster cast is removed, physical therapy and physiotherapy are prescribed. The ability of patients to work is restored 3-5 weeks after the end of the injury.

For transverse fractures of both tibia bones without displacement A bedding-free plaster cast is used, which is applied to the middle of the thigh. On the 11-12th day, the stirrup is attached. On the 20-25th day, the patient is allowed to walk with the help of two sticks, first without weight, and then with weight on the leg.

For oblique, screw and comminuted fractures of both tibia bones without displacement create skeletal traction on a standard splint, since when treating these fractures with a plaster cast, regardless of immobilization, secondary displacements occur. A 4-5 kg load is suspended from the Arc. On the 20-30th day, when there is already a soft callus between the fragments, a plaster cast is applied to the middle of the thigh. A day later, the stirrup is plastered. On the 27-30th day the patient begins to walk with the help of two sticks. The plaster cast is removed 2-2 months after the injury. The patient is prescribed physical therapy, massage and physiotherapy. Working capacity is restored after 3-3.5 months.

Displaced fractures of the diaphysis of both tibia bones treated with traction on a standard splint. Traction is applied immediately after the patient’s admission. The wire is performed through the heel bone, and from time to time through the supramalleolar region. A load of 7-9 kg is suspended from the arc. After 2-3 days, a control radiograph is taken. If the fragments have been reduced, the load is slowly reduced and by the 15th day it is brought to 5-7 kg. The valgus position can be corrected by lateral traction to the outside. In case of transverse fractures, to avoid overstretching, when the fragments are reduced, the load is reduced to 5-6 kg. On the 24-30th day, traction is stopped and a plaster cast is applied to the middle of the thigh. When applying a plaster cast, it is necessary to prevent the possibility of curvature of the axis of the leg (curvatures back and outwards are most often observed). After 2 days, the stirrup is plastered. The plaster cast is removed 2.5-3 months after the end of the injury. The working capacity of patients is restored after 3.5-4.5 months.

If the reduction of fragments by the methods described above failed, timely reduction and osteosynthesis were demonstrated.

In children, subperiosteal fractures and non-displaced fractures treated with a deep plaster splint. The splint is bandaged with a soft bandage. The bandage is removed after 4-6 weeks. P in the presence of displacement in older children They also use skeletal traction on the heel bone. After 3 weeks, the traction is removed and a plaster cast is applied.

Handbook of Clinical Surgery, edited by V.A. Sakharov

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Fracture shin is a fairly common injury, both in adults and children. This fracture can be relatively mild or severe, depending on the number of bone fragments and their relative position, as well as the degree of damage to the surrounding soft tissue. Treatment of a tibia fracture is carried out only by a traumatologist or surgeon on the basis of long-term immobilization (immobilization) of the limb in the knee and ankle joints, necessary for bone fusion. Before immobilization, the bone fragments are compared to their normal position, which is fixed with knitting needles, bolts, plaster, pins and other devices for treating fractures. Treatment of a tibia fracture ends with a period of rehabilitation necessary for the complete restoration of all functions of the leg.

Fracture of the leg - definition and general characteristics

The shin is the part of the leg from the knee to the ankle joint. A tibial fracture is a violation of the integrity of any part of the bones that make up a given part of a person’s leg. Since the human shin consists of two bones - the tibia and tibia, a fracture of either one of them or both at once is possible. In principle, most often only a fracture of the tibia is recorded while maintaining the integrity of the fibula. However, there is also a simultaneous fracture of both tibia bones of the leg. A fracture of only the fibula with preservation of the integrity of the tibia is extremely rare.

Tibia fractures can vary in severity, depending on how much of the bone is broken, how the bone fragments are located, how much damage there is to soft tissue, blood vessels and joints, and whether there are complications. Therefore, it is impossible to call all tibia fractures relatively mild or severe. The severity of each fracture must be assessed individually, based on the listed signs.

Mild fractures are usually isolated fractures of the tibia, obtained in a fall on the street, skating rink or in another place, and not combined with other injuries to bones and soft tissues. Severe fractures of the tibia occur when performing complex movements, falls from a height, car accidents, etc.

Causes

The main cause of tibia fractures is the impact of a large force on a small area of the bone. The bone cannot withstand very strong pressure and breaks. Most often, great pressure occurs when you fall on a leg that is bent or fixed in an awkward position, for example, in a ski boot, skates, between some objects, etc. Less commonly, a fracture occurs due to a direct and very strong impact on the leg, for example, the fall of a heavy object, an impact, etc.

Photos of shin fractures

This photograph shows the appearance of a leg with a closed, non-displaced tibia fracture.

This photograph shows the appearance of a leg with an open tibia fracture.

This photograph shows a view of a leg with a closed displaced fracture.

Classification of tibia fractures and brief characteristics of varieties

Currently, there are several classifications of tibia fractures based on the site of injury, the nature, number and location of bone fragments, as well as the degree of damage to soft tissues and joints.

Single and multiple fractures of the tibia. Depending on the number of bone fragments formed, tibia fractures are divided into single and multiple. With a single fracture of the tibia, the integrity of the bone is broken in only one place. And in this place there are two free ends of the broken bone (fragment). With multiple fractures, the integrity of the bone is broken in several places simultaneously, resulting in the formation of more than two bone fragments.

Straight, oblique and spiral fractures. Depending on the nature of the fracture line, they are divided into straight, oblique and spiral. If the bone breaks exactly across, then it is a direct fracture. If it breaks diagonally, then it is an oblique fracture. If the fracture line is uneven, resembling a spiral, then this is, accordingly, a spiral fracture.

Smooth and comminuted fractures. In addition, depending on the shape of the edge of the fragment, fractures are divided into even and comminuted. Straight fractures have the same fracture line, which appears to have been neatly filed. Comminuted fractures are uneven fractures that form teeth of various shapes and sizes on the broken bone.

Fractures of the tibia with and without displacement. Depending on the location of the bone fragments, fractures with displacement and without displacement are distinguished. Fractures without displacement are characterized by the normal position of bone fragments relative to each other. If such fragments are simply combined, they form a bone. Displaced fractures are characterized by a change in the position of bone fragments relative to each other. If such fragments are compared with each other, they do not form normal bone. You first need to return them to their normal position and only then compare them. The displacement can be rotational, angular, etc.
Open and closed fracture of the tibia. Depending on the presence or absence of soft tissue damage, tibia fractures are divided into open and closed. Accordingly, open fractures are those in which, in addition to bone damage, there is an open wound formed by torn muscles and skin. One of the ends of the broken bone may stick out in the lumen of this open wound. Closed fractures are those in which the skin remains intact and the muscles are minimally damaged, as a result of which bone fragments remain in the thickness of the tissue.

Extra-articular and intra-articular fractures of the tibia. In addition, depending on the presence of damage to the knee or ankle joints, tibia fractures can be intra-articular or extra-articular. If the fracture involves joint structures, it is called intra-articular and is considered severe. If only the tibia is broken, but the joints remain intact, then the fracture is called extra-articular.

Fractures of one or both bones of the leg, as well as their upper, middle and lower thirds. In addition, there is a classification of tibia fractures based on which part of the bone was damaged. In order to have a good understanding of this classification, you need to know the structure of the tibia and fibula. So, both bones consist of a long main part, which at both ends turns into rounded and wide formations. The main long part of the bone, enclosed between the two thickened ends, is called diaphysis. The terminal thickenings are called epiphyses. It is the epiphyses of the tibia that participate in the formation of the knee and ankle joints. The part of the diaphysis and epiphysis located closer to the knee are called proximal, and those closer to the foot are called distal. The proximal epiphysis has two projections called condyles, which are necessary for the formation of the knee joint and the attachment of ligaments.

Depending on which part of the leg was damaged, its fractures are classified into the following three types:
1. Proximal tibia fractures (upper third of the tibia and fibula). These include fractures of the condyles and tuberosities of the tibia or the head and neck of the fibula;
2. Mid-tibia fractures (middle third of the tibia). These include fractures of the diaphysis of the tibia and fibula;
3. Fractures of the distal tibia (lower third of the tibia). These include ankle fractures.

Fractures of the distal and proximal parts of the legs almost always involve damage to the knee or ankle joint, which makes the injury severe.

Severity

Currently, the severity of a tibia fracture is determined by its belonging to one of three types - A, B or C. Mild fractures are classified as type A, moderate - to B and severe - to C. In general, we can say that they are considered mild closed fractures without displacement and with minimal trauma to soft tissues. Moderate fractures can be open or closed with injury to soft tissues, but without damage to joints or nerves. Severe fractures are those that damage joints, nerves and blood vessels.

Symptoms of a tibia fracture

The symptoms of tibia fractures differ somewhat depending on the location of the injury, but there are also common clinical signs. So, with any location of the fracture, severe pain, swelling and discoloration of the skin appear. When you try to move a limb or feel it, you can hear the crunch of bone fragments rubbing against each other. It is impossible to lean on a broken leg. It is also impossible to make any active movement of the lower leg. Externally, shortening or lengthening of the leg, or bone fragments protruding from the wound may be visible.

If the broken bone has injured the peroneal nerve, the foot begins to droop and cannot be bent. If bone fragments have injured blood vessels, the skin of the lower leg becomes pale or bluish.

The above symptoms are common to all tibia fractures. Below we will consider specific symptoms characteristic of fractures of various locations.

Proximal tibia fractures characterized by a forced slightly bent position of the leg at the knee joint. The shin is displaced outward or inward. With strong displacement of the broken condyles directly under the knee joints, severe swelling and deformation are formed. When palpating the knee joint, lower leg and the site of injury, the following signs of a fracture are revealed:

Pain at the site of injury that does not spread to other areas of the leg;
The noise of bone fragments rubbing against each other;
Patella mobility;
Mobility in the knee of the aligned leg;
An attempt to make an active movement of the lower leg is impossible.

A person can lean on his leg with great difficulty.

To clarify the diagnosis of a fracture, it is necessary to perform an x-ray, computed tomography or magnetic resonance imaging.

Diaphyseal fractures characterized by severe pain, swelling and cyanosis of the skin of the leg. The lower leg is deformed, the foot is deviated outward, and the crunching of bones can be heard in the thickness of the tissue. With fractures of the tibia, a person cannot bear even minimal weight on his leg. And if only the fibula is fractured, supporting the leg is quite possible.

Distal tibia fractures (ankle fractures) characterized by very severe pain and swelling. The foot may be turned inward or outward, and support on the leg is impossible.

Treatment

General principles of treatment of tibial fractures

To treat different types of tibia fractures, various modifications of the same techniques are used, which lead to recovery and fusion of bones in the shortest possible time. However, the general sequence of actions in the treatment of any fracture of the tibia is exactly the same, and therefore it can be considered the principles of treatment for this injury.

So, treatment of any fracture of the tibia is carried out by sequentially applying the following actions:
1. Reposition of bone fragments, which consists in giving pieces of bone a normal position necessary for subsequent proper fusion. Reposition can be carried out by the surgeon's hands simultaneously under local anesthesia, using a skeletal traction system, or during surgery. The operation is performed either for open fractures or for unsuccessful reduction by hand or by skeletal traction.
2. Fixation of bone fragments in a normal position using various devices, such as Kirschner wires, side loops, bolts, plates, Ilizarov, Kostyuk, Kalnberz, Tkachenko, Hoffmann devices, etc.
3. Immobilization of the limb by applying a plaster splint or installing compression-distraction devices (for example, Ilizarov, Kostyuk, Kalnberz, Tkachenko, Hoffman, etc.) for several weeks or months until a callus forms and the fracture heals.

In each specific case, the methods and materials used for reposition, fixation of bone fragments and immobilization of the limb may be different, and their choice is made by a surgeon or traumatologist based on the specifics and characteristics of the fracture. If some methods are ineffective, they can be replaced by others in the process of treating a fracture. Let's consider the features of treatment of fractures of various parts of the leg and the optimal methods for this.

Treatment of proximal tibia fractures

Immediately after the patient is admitted to the hospital, an anesthetic drug (Novocaine, Lidocaine, etc.) is injected into the area of injury, the joint is punctured and the blood accumulated in it is removed. If the fracture is closed and without displacement, then immediately after pain relief a plaster cast is applied to the leg for 1 month. After a month, the plaster is removed and rehabilitation measures are prescribed. You can fully put weight on your leg 2 months after the injury.

If the fracture is displaced, then after pain relief the fragments are repositioned and then fixed with simultaneous immobilization by applying a plaster splint for 6 to 7 weeks. If it is impossible to compare the fragments with your hands, then reposition is carried out using the method of skeletal traction for 4 to 8 weeks. After traction, depending on the thickness of the callus, either a tight bandage or a plaster splint is applied to the leg, leaving it until the bones are completely fused. You can fully put weight on your leg 3 months after the fracture.

Currently, the application of a plaster splint is often replaced by the installation of an Ilizarov apparatus with the preliminary introduction of special screws and plates into the tissue, which hold bone fragments in the correct position after reposition. In this case, healing of the fracture occurs without applying plaster.

Treatment of diaphysis fractures

In case of displaced fractures of the tibia or both bones of the leg, reduction must be done under local anesthesia. After this, a plaster cast is applied from the middle of the thigh to the fingertips for 2.5 - 3 months. However, the consequence of long-term wearing of a plaster splint is stiffness of the knee and ankle joints, therefore, if possible, doctors prefer to immobilize the limb using rod compression-distraction devices such as Kostyuk, Ilizarov, SKID, Hoffman, etc.

Oblique, spiral, splinter and other fractures of the diaphysis of the tibia bones, which tend to secondary displacement of fragments, must be treated using a skeletal traction system. That is, after repositioning the fragments, the person was placed on a skeletal traction system for 3–4 weeks, after which a plaster splint was applied from the middle third of the thigh to the fingertips for another 1.5–2.5 months.

Full recovery from injury occurs after 5–6 months, and you can begin walking without crutches and a cane after 4–4.5 months.

Treatment of ankle fractures

Ankle fractures are severe because they always involve damage to the ankle joint. Therefore, reposition of bone fragments is most often performed during surgery. The fragments are fixed with knitting needles, bolts or plates, after which a B-shaped plaster cast is applied from the middle of the lower leg to the beginning of the toes. The cast is applied for 3 to 7 weeks, depending on the volume of surface formed by the bone fracture.

If, after repositioning bone fragments, there is very large swelling on the leg, then the lower leg is placed on a Beler splint on a skeletal traction system until the swelling decreases. Only after the swelling has subsided is a plaster cast applied to the leg.

If a fracture of the head of the tibia occurs, manual reduction is impossible, and it is performed during a surgical operation, after which the person is placed on a double skeletal traction system for 3 to 4 weeks. Then a plaster boot is placed on the leg for 3 – 3.5 months. If skeletal traction is not performed, the bones will heal incorrectly, and the foot will acquire a deformed shape that can only be corrected by repeated surgery.

Complete healing of an ankle fracture occurs 6 to 7 months after the injury, but for the best rehabilitation it is recommended to wear an arch support for a year after removing the cast.

Operations for tibia fracture

Operations for a fracture of the tibia are performed if there are the following indications for them:

Fractures in which it is impossible to reposition the fragments using conservative methods;
Double fractures of the tibia with severe displacement;
Change in the normal position of soft tissues;
Danger of skin rupture, compression of nerves or blood vessels with bone fragments;
Open fracture.

If both bones of the leg are broken, then the operation must be performed only on the tibia, since after restoration of its normal structure the fibula heals on its own. During the operation, fixation of bone fragments is required.

When the bones of the leg are fractured, two types of operations are performed to reposition the fragments and restore the integrity of the soft tissues:
1. Reposition with fixation of fragments with metal structures (plates, knitting needles, screws, etc.) followed by fixation with a plaster splint.
2. Reposition of fragments with simultaneous fixation by applying a compression-distraction device.

Repositioning of fragments with a metal plate is used to treat nonunion or pseudarthrosis of the tibia. In all other cases, it is preferable to treat fractures by applying compression-distraction devices, for example, Ilizarov, Kalnberz, Tkachenko, Hoffmann, etc.

After a broken leg

After a broken leg, a person should direct all his physical and mental strength to recover from the injury. It is necessary to understand that a fracture is a serious injury that violates not only the integrity of bones, but also soft tissues. And during the period of immobilization of the limb, necessary for the fusion of bone fragments, atrophic changes in the muscles and congestion are added due to impaired blood and lymph circulation in the compressed soft tissues. However, with due persistence, all these violations are reversible, that is, they are completely eliminated.

Understanding the possibility of complete recovery after an injury, you need to know and imagine that this process is long, difficult, sometimes excruciating and very painful. After all, you will actually have to re-learn how to perform the simplest movements that were previously done automatically, without even thinking about them. You cannot feel sorry for yourself, indulge in your reluctance to walk and do exercises that may cause pain, because the more time passes after the injury, the more difficult the process of restoring functions will be. Also, for successful rehabilitation, it is very important to put aside the fear of breaking a leg again, which literally fetters many people who have experienced such an injury. Remember that the only factor that makes it impossible to fully restore the functions of the leg after a fracture is insufficient persistence in achieving the goal. If you don’t give up and work hard on your leg every day, then after a while its functions will be completely restored.

Tibia fracture - rehabilitation

The process of rehabilitation of a tibia fracture is a set of measures aimed at the speedy and durable fusion of bone fragments, as well as the complete restoration of all functions of the limb. Rehabilitation is aimed at achieving the following specific goals:

Elimination of atrophy of the muscles of the lower leg and thigh;
Normalization of tone and elasticity of the lower leg muscles;
Normalization of blood circulation in the muscles and tendons of the lower leg;
Normalization of mobility of the knee and ankle joints;
Elimination of congestion in the soft tissues of the lower leg;
Normalization of motor activity of the leg.

To achieve all these goals in the rehabilitation process, the following four main methods are used:
1. Physiotherapy. A person performs daily physical exercises with dosed and selected loads, which help restore muscle structure, normalize blood circulation, eliminate stagnation and inflammation, and also prevent muscle atrophy and joint contractures;
2. Massages and rubbing. Performing daily massages and rubbing is necessary to prevent joint stiffness, degeneration of the lower leg muscles and scar formation in soft tissues;
3. Physiotherapeutic procedures aimed at reducing the inflammatory process, improving healing and restoration of tissue structure, intensifying metabolism and blood flow in the vessels of the leg;
4. Diet, which includes foods rich in calcium, vitamins, iron and other microelements.

The listed techniques in various combinations are used throughout the entire rehabilitation period, which lasts 2–4 months. However, since at different stages of recovery it is necessary to carry out various activities aimed at achieving strictly defined goals, three main periods of rehabilitation can be roughly distinguished:
1. The first stage of rehabilitation lasts 2–3 weeks from the moment the plaster is removed;
2. The second stage of rehabilitation lasts for 2 – 3 months and begins immediately after the first;
3. The third rehabilitation period continues for a month after completion of the second.

At the first stage of rehabilitation You should definitely massage and rub the skin and muscles of the lower leg with your hands and using special creams containing substances that promote tissue restoration, such as cedar oil, Collagen Plus, Chondroxide, etc. In addition, in addition to massages, it is recommended to take baths with sea salt , wax and ozokerite wraps, as well as magnetic therapy sessions. At the first stage of rehabilitation, you should not load the limb with exercises, as this can provoke severe pain. It is recommended to simply gently move your foot in different directions, raise and lower your leg, bending it at the knee joint, and also strain and relax your calf muscles.

At the second stage of rehabilitation it is necessary to restore all functions of the leg. To do this, they continue to do massages and warm baths, after which they begin active exercises. A set of exercises for developing and restoring leg functions after a tibia fracture consists of the following movements:

swing to the sides, forward and backward from a standing position;
alternately rising on your toes and lowering on your heels from standing and sitting positions;
walking as much as possible and sustainably;
crossing the legs in a “scissors” fashion while lying down;
rotation of the raised leg with the foot in different directions.

These exercises can be performed in different modes and variations, but be sure to do them every day. For example, you can do some exercises on Monday, others on Tuesday, etc. The duration and strength of the loads are determined by pain. That is, exercises are performed every day until the leg begins to hurt very much. And the load is given until pain appears. For example, when walking, you should lean on your leg as much as the pain allows. And you need to walk until the pain becomes unbearable. Remember that, unfortunately, the development and restoration of leg function is a painful stage of rehabilitation after any fracture, including the tibia. However, if you do not perform exercises while overcoming the pain, the functions of the leg will not be fully restored, the gait will not become normal, etc.

At the third stage of rehabilitation it is necessary to attend physical therapy courses and engage in various programs aimed at strengthening the leg muscles.

In addition, for successful rehabilitation after a tibia fracture, it is necessary to create a diet in such a way that it includes foods containing large amounts of silicon and calcium, such as milk, cottage cheese, fish, soybeans, hazelnuts, bran bread, sesame seeds, beans , persimmon, cauliflower, raspberries, pears, radishes, currants, etc. It is also recommended to take vitamins E, C and D, which promote rapid healing of the fracture and better absorption of calcium and silicon.

Special mention should be made of physiotherapy in rehabilitation after a tibia fracture. At different stages of rehabilitation, it is recommended to resort to different physiotherapeutic techniques to improve especially necessary functions.

In the first ten days after a fracture, the following physiotherapeutic procedures are recommended:

Interference currents (promote the resorption of hematomas, the convergence of swelling and the relief of pain);
Ultraviolet irradiation (destroys pathogenic bacteria, preventing wound infection);
Bromine electrophoresis for severe pain.

From 10 to 40 days after injury, the following physiotherapy methods are recommended for use:

Interference currents (normalize metabolism and accelerate tissue healing and bone fusion);
UHF therapy (improves blood flow, strengthens the immune system and accelerates the restoration of tissue structure);
Ultraviolet irradiation;
Massotherapy.

Exercises for a broken leg

Exercises for a broken leg are aimed at restoring normal functioning of the leg, increasing muscle strength and acquiring a full range of motion.

After removing the plaster or various external structures such as the Ilizarov apparatus, it is recommended to perform the following exercises to develop the leg after a tibia fracture:

Walking on level and uneven surfaces in shoes and barefoot with support on the injured leg. You need to try to walk as much and as often as possible.
Standing on one leg, make rotational movements with the foot of the injured leg.
While sitting on a chair or other surface, make rotational movements with the foot of the injured leg.
Swinging movements with legs in different directions. To perform them, you need to stand on both legs and rest your hands on the back of the chair. From this position, you should slowly and carefully lift the injured leg up and hold it suspended for a few seconds, then lower it to the floor. 10 repetitions must be performed on each leg. In addition to swinging your legs forward, it is recommended to also swing them backwards and to the sides.
Stand up straight, leaning on both legs and resting your hands on the table, back of a chair, window sill or any other stable object. Slowly rise onto your toes and transfer your body weight back to your heels. Do at least 30 repetitions.
Lie on your back and start swinging your legs in different directions.

A month after the removal of the cast, training on exercise machines under the supervision of a physical therapy doctor is added to the specified set of exercises. It is very useful to exercise on an exercise bike for 10 minutes daily.

First aid for a broken leg

The general sequence of first aid for a broken leg is as follows:

Give painkillers;
Remove shoes from the injured foot;
Stop the bleeding and treat the edges of the wound;
Secure the leg using a splint or any available materials.

Let's look at each point in more detail.

Anesthesia

First of all, in case of a tibia fracture, if possible, the pain syndrome should be relieved. To do this, you can give a person a tablet of any painkiller (for example, Analgin, Nimesulide, Pentalgin, Sedalgin, MIG, etc.) or intramuscularly inject a solution of a local anesthetic (Novocaine, Lidocaine, Ultracaine, etc.). The anesthetic solution should be injected as close as possible to the site of the bone fracture.

Then it is necessary to remove the shoes from the person’s feet, since the rapidly increasing traumatic swelling will provoke severe compression of the tissues, which will cause increased pain. You should move your leg carefully, supporting it by the knee and ankle joints with both hands (Figure 1). If it is necessary to change the position of the injured leg, it should always be moved in this way.

Picture 1– Rules for moving the leg when the tibia is fractured.

Treating the wound and stopping bleeding

After this, carefully cut or tear the clothing on the leg and inspect the surface of the skin of the lower leg. If there is an open and bleeding wound, then you should determine whether the bleeding is dangerous. If blood flows out in a stream, the bleeding is dangerous because a large blood vessel has been damaged by bone fragments. In this case, you should stop the bleeding by tamponade the wound with any piece of clean cloth, bandage, cotton wool, gauze, etc. To do this, fabric or cotton wool is carefully pushed into the wound, compacting each layer with a finger or some other instrument. A loose regular bandage is applied over the tamponade. It is not recommended to stop bleeding by applying a tourniquet, since in a complex fracture, tightening the muscles can lead to the displacement of bone fragments, which will rupture the vessel in another place, which will aggravate the situation.

If blood is simply oozing from the wound, then there is no need to pack the wound. In this case, you should simply treat the edges of the wound with any antiseptic at hand (potassium permanganate, Chlorhexidine, hydrogen peroxide, iodine, brilliant green, any alcohol-containing liquid, etc.), without pouring it into the wound opening.

Tibia fracture splint

After bandaging the wound and stopping the bleeding, the most important stage of first aid for a fracture of the leg begins, which consists of immobilizing the leg (immobilization), which is necessary to fix the current position of soft tissues and bones in order to avoid their movement, during which they can rupture blood vessels, nerves, and muscles. and ligaments, thereby aggravating and aggravating the injury.

It is necessary to apply a splint to the injured leg in such a way that the knee and ankle joints are immobilized (see Figure 2). To do this, you need to take any two (stick, umbrella, etc.) available straight and relatively long objects (at least half a meter) and apply them to the injured leg from the outside and inside so that one end is at the level of the heel, and the second reached mid-thigh. Then these items are tightly bandaged to the leg in several places using any available means - laces, ties, bandages, pieces of fabric, etc. Before tying a long object to your leg, it is advisable to wrap it in a soft cloth.

The support of the entire human body lies on the legs. The leg skeleton consists of different bones, damage to which disrupts normal human movement. The shin bones are the main structures of the leg, which can be injured under excessive loads.

A fracture of the tibia (tibia), as well as a fracture of the fibula, are quite common occurrences. Typically, out of 100 types of fracture, 10% are tibial fractures. As a rule, such damage is dangerous. Injuries are usually recorded in the central region of the bone, but there are also situations in which the intercondyles of the tubercle of the tibia are also noted.

The tibia consists of two fragments: the tibia and fibula. The tibia is long and bulky. It includes the body and two ends of the joint. The tibia takes part in the formation of the knee and ankle joints. In this case, the knee joint is formed due to the participation of the proximal end, and the ankle joint – due to the distal part of the bone.

The fibula is located near the tibia, at its ends there are 2 heads, which are connected to each other using almost flat joints. Due to this, sliding in the area of the bone head is limited. Both the proximal and distal heads of the bone contain articular surfaces, which are represented by narrow slit-like spaces.

The tibia and fibula are no longer fused with each other; the fibula is somewhat free in its movements. But for strength, a fibrous membrane is stretched between these bones, which is also called the interosseous membrane. Unlike the tibia, the fibula does not participate in the formation.

Classification

Fractures of the tibia and fibula occur as often as injuries to other bones. However, there are a number of differences between both fragments and reasons why injury occurs.

Fractures of the tibia are usually classified:

Stable, in which the fracture of the tibia occurs without displacement, or it is not significant. As a rule, such injuries are localized along the axis and the fragments do not move during the fusion process.
Transverse, in which the line of damage is perpendicular to the axis.
Displaced fractures are characterized by damage in which the bone axis is disrupted and bone fragments are separated. As a rule, such fractures do not heal on their own; as a result, surgical intervention is required.
Oblique, in which the line of injury is at an oblique angle. The victim as a result of such a fracture experiences progressive instability. Damage often occurs in combination with the fibula.
Comminuted, in which there are 2 or more fragments.
Spiral, screw, helical fractures of the tibia, in which the damage is marked in a spiral, etc.
Closed fractures, which are characterized by the integrity of the skin and the absence of visible debris and wounds outside the skin. Often the injury is localized, has severe swelling, and hematoma. If help is not provided in a timely manner, blood circulation in the localized area will be impaired, as a result of which muscle cells will die. In severe cases, limb amputation is required.
Open fractures, which are characterized by the presence of an open wound and debris extending beyond its boundaries. With open fractures, bleeding and damage to muscle tissue, ligaments and tendons often occur. Complications often develop and recovery takes a long time.

It is also common to distinguish:

intra-articular and extra-articular fractures of the tibia;
fractures of the head of the fibula without displacement;
fracture of the tibial tuberosity;
fracture of the tibial diaphysis;
fractures of the distal metaepiphysis of the tibia;
marching fractures, stress fractures, compression fractures.

Fractures of the fibula are mostly classified according to the same characteristics, therefore they are distinguished:

Fractures of the fibula with and without displacement.
Fractures of the head (neck or body) of the fibula;
Isolated fractures of the fibular diaphysis;
Transverse fractures;
Splintered or fragmented;
Spiral fractures.

General characteristics include:

March fractures.
Avulsion fractures.
Fractures of the lower third of the bone.
Fractures of the upper third of the bone.
A double fracture in which both bones are broken (occurs frequently).
Figurative fractures.

Trauma code according to ICD 10

Fracture of the tibia code according to ICD 10 in combination with a fracture of the fibula (with ankle joint)

Causes

The causes of damage to the shin bones have some similarities and differences. In both cases, the injury occurs as a result of strong pressure on the bone, which can occur during a fall or blow. As a result of the impact, if there is still an additional load, the bone will become mixed and a fracture will occur.

Such injuries are usually multiple and dangerous due to complications. The greatest danger is posed by open fractures with numerous injuries and blood loss.

The tibia bone tissue is injured more often, and damage to both tibia bones at once also often occurs.

The tibia, fractures of which occur more often, is injured for the following reasons:

Falling from height.
Technogenic disasters.
Natural disasters.

As a rule, damage to the tibia due to these factors is not isolated and is combined with multiple other injuries.

A fibula fracture occurs as a result of:

Falls from heights.
Impact of a direct ramming blow to the outer part of the shin (in case of an accident).
A “screwing” movement, at the moment when the shin is tightly fixed.

Most often, injury occurs to the epiphysis or neck of the bone. As an example, a model with a pin is often used. With a talus impact, the pin opens, causing one part of it to move to the side; the same thing happens when the fibula is damaged. The damage may be at the back or at the top. The interosseous membrane is also damaged.

Symptoms

The signs of a tibia fracture are similar to injuries to other limb bones.

In both cases, pain occurs in a localized area.
It is almost impossible to step on your foot, causing severe pain and discomfort.
The lower leg itself is swollen, and a hematoma forms in the affected area.
Limb deformity occurs.
Numbness in the lower part of the leg, sometimes bluish skin.
If the fracture is open, there is blood loss and damage to tissues located near the wound.

With a fracture of the fibula, the same basic symptoms of a fracture are present. However, the pain may not be as pronounced, or the victim may not feel it at all. This is primarily due to the fact that the blood vessels are damaged, the leg goes numb, and the pain does not fully manifest itself. Signs may be accompanying.

Additional symptoms of a fibula fracture are often identified:

edema;
bleeding;
with an open fracture - a protruding piece of bone;
with avulsion – a hanging limb.

First aid

has its own similarities.

If a fracture of the fibula or a fracture of the tibia occurs, you must:

Reduce the severity of pain to avoid painful shock in the victim.
In case of blood loss, consult an emergency specialist and try to stop the bleeding. To do this, the edges of the wound are treated with an antiseptic, and the damaged area is covered with a sterile, loose bandage.
After this, immobilization is carried out to prevent further displacement. To do this, the injured limb must be raised and secured; if you have shoes, it is advisable to remove them. The injured leg is immobilized and a splint is applied. For this purpose, you can use any items that are at hand (plywood, board, sticks). It is important to apply the splint in such a way that the lower part covers the ankle, and the upper part reaches the upper thigh.

After providing first aid, the victim must wait for the ambulance to arrive and, if possible, go to the emergency room with him. This is necessary in order to testify about what happened and inform the doctor what was taken prematurely, what

Note!

The relevance of the problem of first aid requires knowledge that can be put into practice.

Diagnostics

Fractures of the tibia and fibula are diagnosed using x-rays. In some cases, a CT, MRI or ultrasound result may be needed. The doctor will inform you about a specific type of diagnosis as necessary.

Diagnosis and treatment tactics for all fractures of the tibia are as follows:

Inspection and interview of the victim.
Determining the nature of the damage (whether the articular surface of the tibia and fibula is broken, identifying the edge of the fracture, determining a closed or open fracture).
Performing radiography. This type of study is carried out in two projections, and thanks to the image you can find out which bone is broken - the tibia or fibula, as well as identify the number of bone injuries and their location.

Treatment

When treating fractures of the tibia, use:

Conservative therapy
Surgical intervention.

Conservative treatment of a non-displaced fracture of the tibia is carried out using pain blockade and the application of a plaster cast. The plaster should fix the knee, lower leg and foot. If the displacement was minor, local closed reduction is performed using local anesthesia. The immobilization period for normally located fragments is 1.5-4 months. If the injury is complex, it may take longer - 4-6 months. They usually wear a cast for the same amount of time.

Note!

For fractures of the tibia, the time frame for treatment and recovery varies. In some cases, when the fracture is not significant, without displacement and multiple fragments, the doctor may apply a plaster cast and, after a control image at 21 days, remove it if the bones have fused. Sometimes it may take longer because the healing time, for example, is longer in older people.

What is fracture consolidation?

Consolidation (or fusion) is a process by which damaged bone fragments grow together. Consolidation takes place in 4 stages:

The first stage - 3 days - multiple penetration of leukocytes to the site of the lesion and resorption of dead tissue occurs.
The second stage is multiple reproduction of cells of the skeletal system, mineralization of bone, filling of cartilage tissue.
The third stage is the restoration of blood supply to the affected area.
The fourth stage is the fusion of the bone, the creation of the periosteum, and its penetration with blood vessels.

The period of consolidation for the tibia and the small fibula is 60-120 days, depending on the location of the lesion.

For the purpose of fixation and immobilization, a tight bandage or orthosis is used. A splint is applied that will fix the leg until the fragments are completely fused.

What to do if you have a displaced tibia fracture

If a displaced tibia fracture occurs, the following is indicated:

Anesthetize the localization of the injury using painkillers.
Perform skeletal traction. To do this, it is fixed with a special knitting needle, which is secured to the side and a load is hung on it. Due to this, the muscles are stretched and the bone fragments cannot fit together. In a state of skeletal traction, reposition is performed, after which the patient must continue to be in traction until the moment when a callus growth does not form.
The growth of callus is checked from time to time using a photograph, and if everything goes well, the traction is removed after 5-6 weeks. Then a plaster cast is applied, which fixes the position of the aligned bones.
The plaster is worn for 2-4 months, after which, when the plaster splint is removed, the recovery period begins.

Surgical treatment

The operation is indicated in cases where bone fusion does not occur for a long time; when injuries are numerous and nerves and blood vessels are affected, as well as when we are talking about an open fracture of the proximal tibia.

The operation for a fracture of the proximal tibia, as well as other parts of the tibia, is carried out in several stages:

Stage 1– pain relief with potent local anesthetics or.

Stage 2– open osteosynthesis. For fractures in the epimetaphysis or proximal metaepiphysis of the tibia, osteosynthesis must be carried out carefully, paying attention to soft tissues, since the course of further treatment depends on the degree of their damage. For fractures of the proximal tibia, minimally invasive closed osteosynthesis is also used.

Stage 3– fixation of bone fragments with rods. Screws, pins, plates, and an Ilizarov apparatus can also be used.

Fixation using rods: it is inserted into the bone canal, after making an incision in the skin, so that one end is outside the canal. With this, reliable fixation of bone fragments is achieved. Then, when the bones grow together, the rod is removed.

Fixation using a plate: if the patient who is injured is an elderly person, plates are used. They are inserted through pre-prepared holes, after which they are screwed to the bones with self-tapping screws. Thanks to this, the position of the fragments is recorded until they are completely fused.

This method of fixation cannot be used by children, and those for whom the method will damage the periosteum and disrupt the growth of bone tissue.

Fixation using self-tapping screws: if an angular injury to the longitudinal bone occurs with displacement, bone fragments are fixed using self-tapping screws. As soon as the fragments grow together, the screws are removed.

Fixation using an Ilizarov device: the device itself is a rigid frame that is fixed over the leg. It is assembled on knitting needles, which are inserted into the holes of the bone fragments themselves and brought out. Thanks to this device, the fixation is rigid, and the position of the fragments themselves can be adjusted.

Stage 4– limb immobilization, regular photographs during the immobilization process.

As a rule, in case of a displaced fracture of the tibia and fibula, surgery is performed immediately. Because every minute counts. If help is not provided in time, the limb may be cut off due to necrosis of damaged tissue and possible sepsis.

Rehabilitation

Rehabilitation after fractures of the tibia and displaced fractures of the fibula is carried out after the fragments have healed and the plaster or other fixation has been removed. As a rule, doctors select a set of rehabilitation exercises on their own, and recommend wearing an elastic bandage.

How to develop a leg after a fracture

Rehabilitation after fractures of the tibia is long and includes:

Developing the leg after a fracture of the tibia. In this case, the leg needs to be developed as early as possible (only after medical confirmation), since during the process of wearing a plaster boot, the muscle tissue gradually begins to atrophy. But you should understand that exercises with maximum loads cannot be performed so as not to cause repeated displacement, since the bone has not yet become stronger. Loads should be carried out gradually.
Another effective and useful method of rehabilitation after a fracture of the tibia is massage. It helps to warm up muscle tissue and improve blood circulation, resulting in a faster recovery process. The duration of recovery procedures should be determined by a doctor. As a rule, it is 7-10 days. Sometimes it may take longer.
You can also use physiotherapeutic agents, which improve the nutrition of injured tissues and cells, and regeneration processes occur faster.
A set of physical exercises is determined by a rehabilitation doctor, who takes into account the condition at the time of injury and the condition at the time of recovery. At the same time, special rehabilitation techniques are selected, thanks to which the restoration of the limb will proceed faster. Therapeutic exercise is performed from the initial development of the lower leg, after which the patient must gradually rise to his feet without outside help and squat.

In addition to all the measures described above, it is important to get rid of bad habits and excess weight. According to medical prescriptions, it is necessary to carry out the entire range of rehabilitation measures and take medications.

Massage

As mentioned above, massage has a beneficial effect on the recovery process, so it must be carried out as carefully as possible. If the tibia hurts a little after a fracture, massage will help relieve some of the pain.

Complications and consequences

Complications of a fracture of the tibia and fibula are different. The most dangerous thing is amputation of a limb as a result of necrosis of damaged tissues and the onset of sepsis, after an infected hematoma. But this can be avoided if assistance is provided to the victim in a timely and correct manner. Also, if the patient does not self-medicate and does not resort to traditional medicine, esotericism, etc. to treat a fracture.

What else could happen? Consequences of a fracture:

The bone fragments did not heal properly, and immediate surgery with six months of immobilization was required.
Arthritis and osteoarthritis developed.
The fracture damaged the peroneal nerve.
An open wound became infected.
A vascular complication has occurred.

Prevention

In order to prevent a fracture of the posterior edge of the tibia or both tibias, you need to watch what you are stepping on, in other words, “look at your feet.” You should take care of your health, monitor your weight and eliminate unhealthy foods and habits. It is recommended to treat any illnesses in a timely manner and take care of yourself.

Buy shoes of the right size. This rule also applies to the choice of rollers, skates, etc. It is not recommended to overuse heels. If you pay attention to yourself in time, you will be able to avoid many problems, including fractures of the tibia and fibula. Be healthy!

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

Tibia fracture is a fairly common injury among the population. The tibia is one of the tubular strong bones of the body. It is believed that this injury is not dangerous when compared with fractures of other tubular bones.

Often a fracture of the tibia is accompanied by damage to its companion, the fibula. The tibia has a body and two articular ends endowed with articular surfaces. The bone is limited above by the knee joint, and below it passes into the ankle joint.

Varieties

In modern medical practice, there is more than one classification of tibia fracture. Varieties are based on the location of the damage, its nature, the presence of bone fragments and the degree of damage to nearby tissues.

Displaced fracture. Such an injury is accompanied by a displacement of the axial line of the bone when bone fragments are separated;
A stable fracture is a fracture that is difficult to notice. Fragments of damaged bone are located along the unchanged bone axis. Such an injury, as a rule, is not accompanied by displacement of tibial fragments;
Transverse fracture. This type of fracture is accompanied by a line running perpendicular to the axis of the bone;
Oblique fracture. The line of traumatic force runs at an angle to the bone, and most often this type of fracture is unstable;
A spiral (helical) fracture is a fracture caused by a force twisting along the axis of the bone;
Fracture with fragments. A fracture is said to occur when the tibia breaks into three or more fragments;
A fracture that is not accompanied by skin damage is called closed;
An open fracture is diagnosed when bone fragments somehow become embedded in the skin and cause bleeding from the wound. Also, this type of fracture entails damage to the soft structures of the body, such as nerves, ligaments, tendons and muscles.

An injury involving a fracture of the distal metaphysis of the tibia is called a pilon fracture. A common cause of this injury is road traffic accidents and bad landings. A head fracture is part of the structure of fractures of the upper part of the tibia, often combined with fractures of the tuberosity of the bone.

Condyle fracture

Fracture of the tibia condyles is divided into two types - single and double. According to statistics, this type of fracture occurs when falling onto straightened legs from a sufficiently high height.

As a rule, a condyle fracture leads to massive hemorrhage into the knee joint. In medical practice, you can find two more types of condyle fractures - complete and incomplete. In the first case, a total fracture is observed, accompanied by complete or fragmentary detachment of the condyle.

An incomplete condyle fracture is said to occur when various cracks or depressions are observed. In addition, there are fractures of the intercondylar eminence, accompanied by injuries to the cruciate ligaments. This type of fracture is quite rare.

Symptoms

A tibial fracture can be identified by the following symptoms or signs:

the victim is unable to stand on the affected leg;
severe pain localized right at the fracture site. When you try to palpate or simply touch, the pain intensifies;
edematous phenomena leading to external changes in color in the area of injury;
audible bone crepitus and visible bone deformation. May be accompanied by changes in bone attributes (shape, length);
various paresthesias. The patient may complain of a lack of sensitivity in the damaged area or muscle weakness: bone fragments, at the time of a fracture or accidental movement, can touch the passing nerves, damaging them;
in case of damage to the passing veins or arteries, the pulse in the main vessels may be absent, and the limb takes on a bluish color.

First aid

Prehospital care is aimed at eliminating acute symptoms that need to be treated as a priority. At this stage of treatment, the victim is given painkillers to relieve intense pain, and the injured limb is immobilized.

The last point of first aid involves transport immobilization with special tires or improvised means (for example, boards, plywood, sticks).

Fixation must be carried out so that the means fixing the limb cover the ankle joint from below, and from above the upper third of the thigh. When there is a wound, hemostatic measures are provided using a hemostatic tourniquet.

But first, the wound must be washed and cleaned of foreign objects. If the injury is accompanied by massive hemorrhages and, consequently, traumatic shock, the patient is given plenty of fluids and anti-shock treatment methods are carried out.

Treatment

Inpatient treatment includes two types - conservative therapy and surgical intervention. Treatment tactics largely depend on the type of fracture. As a rule, for stable fractures, conservative therapy methods are used, including the application of a plaster cast. For other complicated fractures, skeletal traction techniques are used.

In this case, a metal pin is pushed through the heel bone, and the limb is placed on a splint. The presence of a comminuted fracture is an indication for surgical treatment, where various types of metal structures are used: plates, rods and intraosseous pins.

Rehabilitation and recovery

The complex of getting back on your feet includes exercise therapy and physiotherapy. The physical therapy system includes exercises for extension, flexion of the leg at the knee joint and ankle.

This also includes working the calf muscles and various types of squats. The complex of physiotherapy includes procedures aimed at accelerating the regeneration of damaged tissues.

Massage sessions are also effective: manual manipulation of the skin has an auxiliary effect on the muscles and stimulates blood flow. They begin the rehabilitation process as early as possible.

The sooner the patient begins recovery, the greater the chance of a full recovery. The leg that was previously in a plaster cast is somewhat atrophied, therefore, immediately after removing the plaster, contractures are developed.

An important component of any rehabilitation is a comprehensive, rational and balanced diet. Dietitians deal with similar issues and create an individual daily diet, which includes various biological additives, vitamins C and D, and calcium.

The recovery period for patients with such a fracture averages three to four months. For more severe fractures, the rehabilitation period increases to six months.