Fractures of bones of a shin make 10% of total number of changes. The current, methods and terms of treatment depend on level and the volume of damage and differ at fractures of bones of a shin of various localization. Diagnosis of fractures of shin is carried out by a radiographic research. Intra articulate fractures of a shin demand additional carrying out KT or MPT of a joint, in certain cases - its punctures. Treatment of fractures of shin consists in a repozition of otlomk and imposing of a plaster bandage. Skeletal extension can be applied to an effective repozition. For fixing of otlomk operation with application of metal plates or screws, and also installation of the device of Ilizarov can be required.
Fractures of bones of a shin make 10% of total number of changes. The current, methods and terms of treatment depend on level and the volume of damage and differ at fractures of bones of a shin of various localization.
Shin – the part of a skeleton between a hip and foot consisting of two tubular bones (tibial and low-tibial). The main loading is born on itself by larger tibial bone. Condyles (ledges in the top part of a tibial bone) connect to a femur, forming the lower articulate surface of a knee joint. The tibial bone is jointed by the lower part with a collision bone, forming an ankle joint.
The low-tibial bone settles down from the outer side, increases stability and durability of a shin. Both bones of a shin connect among themselves (above – by means of the general joint, in a middle part – by means of an interosseous membrane, below – by means of sheaves). On the lower ends of both bones of a shin there are ledges (anklebones) which from two parties cover an ankle joint and give it cross stability.
Depending on localization the traumatology distinguishes:
- fractures of bones of a shin in its top part (fractures of a neck and a head of a low-tibial bone, changes of a bugristost and condyles of a tibial bone);
- fractures of bones of a shin in its middle part (the isolated diafizarny fractures of a tibial and low-tibial bone, changes of a diaphysis of both bones of a shin);
- fractures of bones of a shin in its lower part (fractures of anklebones).
Fractures of bones of a shin in the top and lower departments concern to group inside - or circumarticular changes.
Changes of condyles
Usually arise when falling from height. At young patients more often happen split, at elderly – pressed. Allocate changes of internal and external condyles.
The patient shows complaints to pains and hypostasis in the field of damage. The knee joint is increased in volume as a result of a gemartroz (a blood congestion). The change of an external condyle is followed by turn of a shin of a knaruzha, a change of an internal condyle – a deviation of a shin of a knutra. The movements in a joint are sharply painful, limited. The support on a leg is impossible or complicated. For confirmation the X-ray analysis, MRT of a knee joint is carried out.
The fracture of a tibial bone is anesthetized, if necessary carry out a joint puncture. At a change of condyles without shift apply a plaster bandage for 1 month. Upon termination of an immobilization appoint physiotreatment and physiotherapy exercises. Full loading is resolved in 2 months from the moment of a trauma.
At changes of condyles with shift carry out a repozition and impose plaster to steak for 6-7 weeks. At impossibility of satisfactory comparison of otlomk carry out skeletal extension for up to 2 months. Full loading is resolved in 3 months from the moment of a trauma. Perhaps expeditious treatment with use of screws, plates and Ilizarov's device.
The change of a diaphysis of a tibial bone is result of a direct or indirect trauma. If the interosseous membrane remains intact, the shift of otlomk on length does not arise. Perhaps angular shift and shift on width.
The patient is disturbed by pain and hypostasis in the field of damage. The shin is deformed. The support on a leg is impossible. For confirmation do a X-ray analysis in two projections.
Carry out anesthesia of the place of a change. At the shift of otlomk carry out a repozition with the subsequent imposing plaster steaks for a period of 2 months. At interposition of soft fabrics (a vklinivaniya of fabrics between otlomka) operation is necessary.
The change of a diaphysis of a low-tibial bone develops owing to direct stroke to a shin outside. The trauma is followed by pain in the place of a change and insignificant hypostasis. The patient keeps an opportunity to lean on a leg. Unlike a shin bruise, at a fracture of a low-tibial bone morbidity at side compression of a shin far from the place of damage appears. For confirmation carry out a X-ray analysis. To the patient impose plaster to steak for 3-4 weeks.
The Diafizarny fracture of both bones of a shin arises at blow in a shin ("the bumper change" at road incident) or an indirect trauma (twisting, bending). The direct trauma usually becomes the reason of multisplintered fractures of bones of a shin. When bending the triangular splinter on curvature inside is formed, and when twisting there are spiral fractures of bones of a shin.
The patient complains of sharp pain in the field of damage. The shin is edematous, cyanotic, deformed. The deviation of foot of a knaruzha is observed. The krepitation and pathological mobility of otlomk is defined. The support on the injured leg is impossible. For confirmation carry out a X-ray analysis in two projections.
At fractures of bones of a shin without shift, opportunities to otreponirovat otlomk and to hold them in the correct situation carry out skeletal extension within 4 weeks. Then impose plaster to steak for a period of 3-4 months. At impossibility to compare and hold otlomk, interpositions of soft fabrics, and also traumatologists apply expeditious treatment to reduction of terms of treatment and early activization of the patient. Screws, the blocked cores, screws and devices of external fixing are used.
Fractures of anklebones
Make about 60% of total number of fractures of bones of a shin. There are as a result of a straight line (blow in an anklebone) and indirect (the forced turn, podvorachivany feet of a knutra or a knaruzha) injuries. Are possible:
- the isolated fractures of an internal and external anklebone;
- dvukhlodyzhechny changes (fractures of both anklebones);
- dvukhlodyzhechny changes in combination with a change of the first or rear edge of a tibial bone (Potta-Desto's changes, other name – "trekhlodyzhechny changes").
Any fractures of anklebones can be followed by a rupture of sheaves, the shift of otlomk and an incomplete dislocation of foot (perelomovyvikha), however, such damages are more often are observed at two - and trekhlodyzhechny changes. For a fracture of an external anklebone the incomplete dislocation of foot of a knutra, is characteristic of a fracture of an internal anklebone – an incomplete dislocation of foot of a knaruzha.
The ankle joint is edematous, is sharp . The support on a leg is complicated, at perelomovyvikha is impossible. At perelomovyvikha the foot deviation in the relevant party is observed, at Potta-Desto's changes – bending of foot in the plantar party. For confirmation of the diagnosis carry out a X-ray analysis in two, sometimes – in three projections.
Change anesthesia, repozition, imposing plaster steaks. At a fracture of one anklebone without shift the term of an immobilization makes 4 weeks, at dvukhlodyzhechny changes (including – with a foot incomplete dislocation) – 8 weeks, at Potta-Desto's changes and ruptures of an intertibial sindesmoz – 12 weeks. Operation is shown at impossibility of comparison of bone fragments and interposition of soft fabrics.