Fractures of bones of foot according to various data make 2,5-10% of number of all changes. Fractures of bones of foot arise both as a result of direct damage, and owing to an indirect trauma (an unsuccessful jump, a podvorachivaniye of foot, falling). The importance of fractures of bones of foot is defined by high interdependence of all elements of this part of a body. Any change of a form of one of foot bones at a change leads to change of a form and function of all foot. Thus, fractures of bones of foot quite often cause the subsequent violation of a normal support on foot, development of flat-footedness and secondary arthroses. With the diagnostic purpose roentgenograms of foot in 2-3 projections are carried out. Concerning fractures of bones of foot the opened/closed repozition with the subsequent immobilization for up to 1,5 months is carried out.
Fractures of bones of foot
Fractures of bones of foot according to various data make 2,5-10% of number of all changes. The importance of fractures of bones of foot is defined by high interdependence of all elements of this part of a body. Any change of a form of one of foot bones at a change leads to change of a form and function of all foot. Thus, fractures of bones of foot quite often cause the subsequent violation of a normal support on foot, development of flat-footedness and secondary arthroses.
Foot consists of 26 bones tied among themselves by small joints and a large number of sheaves. Allocate three departments of foot: tarsus, instep and phalanxes of fingers. The tarsus is formed calcaneal, collision, cubical, boatshaped and three wedge-shaped bones.
Proksimalno (is closer to the center of a body) a collision bone unites to shin bones. Distalno (is farther from the center of a body) bones of a tarsus are jointed with instep bones which, in turn, form joints with bones of the main phalanxes of fingers.
Fractures of bones of a tarsus
Fractures of a collision bone
The collision bone has the features distinguishing it from other bones of foot. First, pressure of all weight of a human body is transmitted through a collision bone on foot. Secondly, the collision bone is the only bone of foot to which any muscle is not attached. Thirdly, the collision bone plays a significant role in formation of the arches of foot.
Fractures of a collision bone meet in traumatology seldom (about 3% of total number of fractures of bones of foot), concern to group of heavy injuries of bones of foot and are quite often combined with other damages (fractures of anklebones, foot dislocations, fractures of other bones of foot). Distinguish fractures of a body, a head, a neck, the lateral or rear edge of a collision bone.
Fractures of a collision bone are result of an indirect trauma more often (podvorachivany feet, a jump, falling from height). Becomes more rare the damage reason sdavleny feet or direct stroke by a heavy subject.
The patient complains of sharp pains in the damaged area. Foot and an ankle joint are edematous, on skin hemorrhages, mainly – in an internal anklebone are visible. At the shift of otlomk deformation comes to light. The movements in an ankle joint are almost impossible because of pain.
Sharp morbidity when probing at the level of an articulate crack is defined, and at fractures of a neck of pain are stronger expressed in front, and at changes of a back shoot – on a back surface of a knaruzha from an Achilles tendon.
For confirmation of a fracture of collision bone, definition of its localization, detection of character and degree of shift of fragments carry out a X-ray analysis in 2 projections.
At a change with shift the urgent repozition of otlomk is shown. It is necessary to consider that at increase in prescription of a trauma comparison of bone fragments sharply is at a loss or at all becomes impossible. Failure of the closed repozition is the indication to open reposition or imposing of skeletal extension.
At changes of a back shoot plaster is imposed for 2-3 weeks, at other fractures of a collision bone – for 4-5 weeks. About 3-4 weeks to the patient recommend to take out the injured leg from the tire and to make the active movements in an ankle joint.
In the subsequent appoint LFK, massage and physiotreatment. Restoration of working capacity happens in 2,5-3 months. Within a year after a trauma recommend to patients carrying instep supports for the prevention of traumatic flat-footedness.
Fractures of a boatshaped bone
This kind of fractures of bones of foot, as a rule, results from a direct trauma (falling of a heavy subject on the back of foot). Its sdavleniye between wedge-shaped bones and a head of a collision bone becomes more rare the reason of a fracture of boatshaped bone. Quite often fractures of a boatshaped bone are combined with other fractures of bones of foot.
The support on a leg is limited because of pain. The swelling and hemorrhages on the back of foot come to light. Probing of a boatshaped bone, turn of foot of a knutra and knaruzha, and also assignment and reduction of foot cause sharp morbidity in the field of a change. For confirmation of a fracture of boatshaped bone carry out a foot X-ray analysis in 2 projections.
At fractures of a boatshaped bone without the shift of bone fragments the traumatologist applies a circular plaster bandage with carefully otmodelirovanny arches of foot. At changes with shift the repozition is carried out. If otlomk cannot be otreponirovat or held, open reposition is carried out. Fixing by a plaster bandage is carried out within 4-5 weeks.
Changes cubical and wedge-shaped bones
Falling of a heavy subject on the back of foot becomes the trauma reason usually. Soft fabrics in the field of damage are edematous. Pain during the probing, pressure, turns of foot of a knutra and knaruzha comes to light. For confirmation of this type of fractures of bones of foot the X-ray analysis has great value. Treatment – a circular plaster bandage for the term of 4-5 weeks. Within a year after such fracture of bones of foot the patient has to carry an instep support.
Fractures of plusnevy bones
Fractures of plusnevy bones on frequency win first place among all fractures of bones of foot. Usually arise at direct influence of the injuring force (sdavleny feet, falling of weight or moving of foot a wheel). Can be multiple or single. Depending on the level of damage allocate changes of a head, a neck and body of plusnevy bones.
Single fractures of plusnevy bones very seldom are followed considerable the shift of fragments as the bones of an instep which remained whole perform function of the natural tire, holding otlomk from shift.
At single fractures of plusnevy bones local hypostasis on the back and a sole, pain comes to light at a support and probing. Multiple fractures of plusnevy bones are followed by the expressed hypostasis of all foot, hemorrhages, pain at a palpation. The support is complicated or impossible because of pain. Deformation of foot is possible. The diagnosis is confirmed by data of a X-ray analysis in 2 projections, and at changes of the basis of bones of an instep – in 3 projections.
At fractures of bones of an instep without shift impose the back plaster tire for a period of 3-4 weeks. At changes with shift carry out the closed reposition, carry out an open osteosynthesis or impose skeletal extension. Fixing term at such fractures of bones of foot is extended up to 6 weeks. Then to the patient apply a special plaster bandage "with a heel", and in the subsequent recommend to use orthopedic tabs.
Fractures of phalanxes of fingers of foot
This kind of fractures of bones of foot, as a rule, arises at direct influence of the injuring force (weight falling, blow in fingers). Fractures of average and nail phalanxes of fingers in the subsequent do not break function of foot. The wrong union of fractures of the main phalanxes can lead to development of post-traumatic arthroses of plusnefalangovy joints, restriction of mobility and pains when walking.
The injured finger is cyanotic, edematous, is sharp at the movements, palpation and axial loading. Fractures of a nail phalanx often are followed by formation of a subnail hematoma. For confirmation of fractures of phalanxes carry out roentgenograms in 2 projections.
At fractures of phalanxes of fingers of foot without shift impose the back plaster tire. At the shift of otlomk carry out the closed repozition. Bone fragments fix spokes. At fractures of a nail phalanx without shift the immobilization with use of a leykoplastyrny bandage is possible. The term of fixing depends on weight of a change and makes from 4 to 6 weeks.