Fracture of the leg – violation of integrity of one or several bones of the lower extremity as a result of a trauma. Is extremely widespread damage. Weight, terms and methods of treatment, and also the remote consequences can significantly differ depending on level and features of a change. The general signs of fractures of the leg are hypostasis, pain, violation of a support and movements. Often pathological mobility and a krepitation comes to light. For specification of the diagnosis use a X-ray analysis and KT, in some cases appoint MRT and an arthroscopy. Perhaps both conservative, and expeditious treatment.
Fracture of the leg
Fracture of the leg – extremely widespread trauma. Statistically, 45% of total number of skeletal damages are the share of fractures of the lower extremities. Are a consequence of accidents in life more often (for example, falling on a slippery surface). The second and third places on prevalence are taken by fractures of legs owing to road incidents and falling from height. Besides, criminal incidents, and also production or natural disasters can become the reason of a trauma.
The fracture of the leg can be isolated or multiple or be observed as a part of the combined trauma (polytrauma). Combinations to fractures of bones of the top extremities, basin changes, injuries of a thorax, ChMT, injury of a kidney, spinal fractures and a stupid injury of a stomach are possible. Treatment of fractures of the leg is performed by traumatologists. Depending on weight of damage both out-patient observation, and hospitalization in a hospital is possible. Both conservative techniques, and various operational methods of treatment are applied.
Fractures of the leg can be full and incomplete (cracks). The fractures of legs which are reported with the external environment through a skin wound are called open. If there is no wound, the change is closed. Depending on features of the line of a break and character of otlomk in traumatology allocate the following types of fractures of legs:
- Cross – the line of a break is located cross to a dlinnik of a bone.
- Slanting – the line of a break is at an angle to a dlinnik of a bone.
- Longitudinal – the line of a break is located along a dlinnik of a bone.
- Spiral – the line of a break has the helicoid form (such damages are usually formed as a result of sharp violent twisting of an extremity).
- Polyfocal – there are two or larger bone fragments.
- Splintered – there are several splinters.
- Shattered – there is a set of small splinters.
- Compression – are followed by compression of a bone. At the same time the bone bursts, flattened out, squeezed and deformed.
- Driven – are followed by introduction of one otlomk in another.
- Detachable – from a bone the small fragment is broken off (similar damages can be observed, for example, at a sheaf separation in the place of its attachment).
Taking into account the level of a fracture of the leg allocate:
- Femur fractures, including damages of the proximal end of a bone (changes of a head and neck of a hip, and also mezhvertelny and chrezvertelny changes), diafizarny changes and damages of the disteel end of a bone (changes of condyles of a hip).
- Fractures of bones of a shin, including damage of the proximal end of a bone (changes of condyles of a tibial bone), diafizarny changes (fractures of both bones of a shin, the isolated injuries of a tibial bone and low-tibial bone) and injuries of the disteel end of a bone (fractures of anklebones).
- Fractures of bones of foot, including damage of a tarsus, phalanxes of fingers and plusnevy bones.
Injuries of the proximal and disteel ends of a bone can be intra articulate (epifizarny) or circumarticular (metafizarny). At intra articulate fractures of legs the accompanying damages of various articulate structures are observed, including – a cartilage, the capsule and sheaves. The combination to an incomplete dislocation or dislocation is possible. Circumarticular fractures of legs are formed in a transitional zone between the articulate end and a diaphysis and quite often happen driven. Diafizarny changes arise in a middle part of a bone and usually are followed by the shift of otlomk.
Hip fracture – the severe injury which is followed by the expressed pain syndrome and considerable blood loss owing to bleeding from otlomk. Weight of damage and need of fixing of fragments with use of skeletal extension or a massive plaster bandage causes sharp decrease in mobility of patients that, especially in the presence of other injuries or associated diseases, can become the reason of development of dangerous complications, including – decubituses and stagnant pneumonia. In the first three days after a trauma the fatty embolism is possible.
Fractures of a neck of a hip are intra articulate and more often arise at the elderly patients having osteoporosis. The fracture of the leg is formed owing to falling of the house or on the street, at considerable decrease in durability of a bone its integrity can be broken even at awkward turn in a bed. The patient complains of moderate pain in a joint, pain amplifies at the movements. The leg is developed knaruzh, in situation on a back of the patient cannot independently raise a heel over a bed. At the shift of otlomk shortening of an extremity comes to light. Hypostasis of field of damage, as a rule, insignificant.
The diagnosis is confirmed by means of a X-ray analysis of a coxofemoral joint. Because of insufficient blood supply the hip neck badly grows together, the full-fledged bone callosity, as a rule, is not formed, otlomk "grab" among themselves connecting fabric that causes high percent of exits to disability. Taking into account this circumstance a preferable way of treatment at such fractures of the leg is operation – an osteosynthesis a three-blade nail, endoprosthesis replacement or a bone autoplasty.
If the general state does not allow to carry out surgical intervention, use skeletal extension. The patient of senile age impose a plaster boot with the cross level excluding rotation of an extremity. It allows to provide formation of a fibrous callosity at preservation of sufficient physical activity of the patient.
Vertelny changes are extra articulate and are more often formed at patients of working-age. Signs of a fracture of the leg the same, as at injury of a neck of a hip, however the symptomatology is expressed more brightly, more expressed pain syndrome and considerable hypostasis of the injured area is observed. For diagnostics the X-ray analysis of a coxofemoral joint is also used. Similar damages usually well grow together without operation. To the patient for 8 weeks impose skeletal extension, and then replace it with a plaster bandage. For early activization of patients various operational techniques can be used, including – an osteosynthesis by a plate, a three-blade nail or screws.
Diafizarny fractures of a hip arise at a direct or indirect trauma. The blow, falling from height, road accident or a production trauma can be an immediate cause of a fracture of the leg. More often people of working-age suffer. The powerful muscles fastening to a femur influence otlomk, "delaying" or developing fragments therefore at such fractures of the leg the expressed shift is in most cases observed.
There is sharp pain and considerable hypostasis, on skin bruises can develop. The extremity is shortened, the hip is deformed, the krepitation, pathological mobility comes to light. Traumatic shock is in some cases possible. For confirmation of the diagnosis the hip X-ray analysis is appointed. Treatment conservative or quick. At a receipt stage for prevention of development of shock high-quality anesthesia is performed. Then skeletal extension is imposed or the hip osteosynthesis is carried out by a plate, a pin or a core.
Myshchelkovy fractures of a hip are intra articulate. Meet at elderly more often, arise during the falling or blow in a knee. Are followed by sharp pain in a knee and the lower part of a hip. The support and the movements are limited. The knee joint is edematous, is defined . At changes of condyles with shift the shin deviation inside or knaruzh is observed. For specification of the diagnosis appoint a X-ray analysis of a knee joint. At receipt the joint is punktirut, then impose plaster or skeletal extension. If otlomk cannot be compared, perform operation – an osteosynthesis screws, a plate or bolts couplers.
Shin fractures – the most widespread fractures of legs. Result from high-energy impact, for example, of motor transportation incident or falling from height. An exception – fractures of anklebones which are, as a rule, formed at a leg podvorachivaniye. Can come to light at people of any age, however, in general prevalence of patients of working-age is observed.
Changes of condyles of a tibial bone are intra articulate and more often arise owing to falling from height. Are possible as the isolated changes of an internal or external condyle, and a simultaneous change of two condyles. The knee joint is edematous, in it is defined . The movements and a support are painful, sharply complicated. The diagnosis is specified on the basis of a X-ray analysis, use MRT of a knee joint less often. Treatment – the puncture, anesthesia, at fractures of the leg without shift carry out an immobilization a plaster bandage, at damages with shift impose skeletal extension or carry out operation (an osteosynthesis plates, screws or Ilizarov's device).
Diafizarny fractures of bones of a shin. Are formed as a result of a straight line or an indirect high-energy trauma. The change only tibial or only a low-tibial bone or a fracture of both bones of a shin is possible (most widespread). At fractures of one bone of shift of otlomk it is not observed, or it less expressed more simply gives in to correction as the second bone remains whole and holds broken in rather correct situation. Fractures of both bones – heavier, at them there is an expressed shift more often and the thicket needs surgical intervention.
Damage is shown by pain and the expressed hypostasis. Pathological mobility, a krepitation is observed. The support is impossible, the movements are strongly complicated. The diagnosis is confirmed by means of a X-ray analysis. Treatment of changes of one of shin bones more often conservative – if necessary carry out a repozition, then impose plaster. Treatment of injuries of both bones of a shin can be conservative or quick. In the first case for 4 weeks impose skeletal extension, and then carry out an immobilization a plaster bandage. In the second carry out a focal osteosynthesis with use of the blocked cores, screws, is more rare – plates, or an extra focal osteosynthesis with imposing of the device of Ilizarov.
Fractures of anklebones – very widespread damage. Such fractures of legs arise at a foot podvorachivaniye more often, are a consequence of direct stroke to the area of a joint less often. The fracture of one anklebone (internal or external), a fracture of both anklebones (a dvukhlodyzhechny change) and a fracture of both anklebones in combination with damage of a rear or first line of a tibial bone (a trekhlodyzhechny change) is possible. The trauma can be followed or not be followed by an incomplete dislocation, shift of otlomk and a rupture of sheaves. In most cases, than more anklebones are broken – the probability of existence of the aggravating moments (an incomplete dislocation, shift etc.) is higher.
There is sharp pain. The area of a joint is edematous, the movements and a support are sharply complicated or impossible. At an incomplete dislocation and shift of fragments deformation of field of damage comes to light. The diagnosis is confirmed by means of a X-ray analysis of an ankle joint. Treatment – anesthesia, a repozition, plaster. The term of an immobilization is defined, proceeding from the number of the broken anklebones (for 4 weeks on each anklebone), that is 4 weeks at odnolodyzhechny changes, 8 – at dvukhlodyzhechny and 12 – at trekhlodyzhechny. At impossibility of adequate comparison of fragments and elimination of an incomplete dislocation surgical intervention – an anklebone osteosynthesis is shown by screws, plates or spokes.
Fractures of bones of foot
The fracture of a calcaneal bone is usually formed when falling from height. Can be inside - or extra articulate, to be followed or not to be followed by the shift of fragments. The calcaneal area is edematous, expanded, sharply painful, the support is impossible. For specification of the diagnosis carry out a heel X-ray analysis. At fractures of the leg without shift impose plaster, at shift carry out the closed repozition, in particularly complex cases sometimes mount Ilizarov's device.
Fractures of bones of a tarsus – such fractures of legs meet rather seldom, result from a podvorachivaniye of a leg, falling or direct stroke. Are followed by pain, foot hypostasis, difficulty of a support and movements. The diagnosis is confirmed by means of a foot X-ray analysis. Treatment conservative – plaster within 1-1,5 months.
Fractures of bones of an instep and fingers – rather widespread fractures of legs. Are more often formed owing to blow or falling of a heavy subject on foot. Shift is sometimes observed. A disteel part of foot is edematous, painful, the support is complicated. For specification of the diagnosis use a X-ray analysis. Treatment usually conservative – a plaster bandage (in the presence of shift – with a preliminary repozition). At impossibility to hold otlomk in the correct situation make fixing by a spoke.