Like any injury, bone damage has characteristic signs. Symptoms of open shin fracture depend on the location of the defect, its cause and a number of other factors. The first thing the victim faces is severe pain, bleeding and swelling. When you try to move a limb or palpate it, there is a crunch of bone fragments rubbing against each other. It is impossible to lean on one's leg, as well as to commit an active motion of the shin. From a wound it is visible sticking out splinters of a bone, also elongation or a shortening of a leg is observed.
Injuries of the lower leg have a number of similar signs with other injuries of the lower limbs:
- Anatomical and functional disorders.
- In the area of fracture appears excessive mobility of the leg.
- In the place of trauma there is severe pain and swelling, a rupture or sprain of the ankle joints is possible.
- If the injury with a shift, then there are bruises and bruises.
If the bone has damaged the peroneal nerve, the foot hangs down and it can not be bent. When injured with fragments of blood vessels, the skin turns blue.
The main symptoms of an open shin fracture:
- Severe bleeding
- An open wound with bones breaking through soft tissues and skin
- Sharp pain
- Mobility limitation
- Traumatic shock condition
- Dizziness, weakness, loss of consciousness
To diagnose the degree of damage and their location, the victim is given an X-ray, MRI or CT scan. If the injury fell on the diaphysis, then there is edema and cyanosis with severe pain. The shin is strongly deformed, a crunch of bones is heard in the tissues, the foot is turned outward. With injuries of the tibia on the leg it is impossible to lean on, while, as with fractures of the fibula, the support is possible. Distal injuries are characterized by severe soreness and swelling, the foot is turned outward or inward, a support on the limb is impossible.
Pathological damage of the peroneal or tibia can be suspected, knowing the first signs of fracture. The victim has a shorter leg and deformity of the limb. The shortening is due to the fact that the muscular tissues surrounding the broken bone are trying to connect it, so the limb is pulled up. Another characteristic feature is pain and bleeding, which are amplified when trying to move the leg or touch it.
The first signs include the appearance of swelling in the area of trauma. It is associated with a hemorrhage in the joint. In this case, crepitation of bone fragments and increased mobility of the foot are observed. It is impossible to rely on a damaged limb, and a pain shock can cause loss of consciousness.
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An open fracture of the fibula
The fibula consists of two epiphyses, it is thin, long and tubular. The main components of the ankle are the lower end of the bone (outer, lateral ankle), which acts as the stabilizer of the joint. There are several types of open fractures of the fibula, which can be formed at different levels. But in most cases, the damage occurs in the region of the lateral ankle, accompanied by dislocation and shortening of the foot, rupture of the distal syndesmosis.
The body of the bone has a triangular shape and three surfaces: lateral, medial, posterior. They are divided among themselves by rowing. Damage is transverse, fragmentary, spiral and oblique. Diagnosing pathology is not difficult, because the trauma has a vivid clinical picture:
- A strong sense of pain and bleeding from bone-ruptured tissues.
- Puffiness and limitation of movement.
- Damage to the peroneal nerve (possibly with a fracture of the neck and head of the bone).
- The hanging of the foot and the inability to bend it (appears when the nerve is completely ruptured).
Most often there is damage to the diaphysis, which is possible with a direct impact on the outside of the shin, due to the turn of the foot, a fall from the height. A variety of pathological diseases of the bones provokes their fragility, which can also cause injury. Fracture of the diaphysis increases the risk of injuring the nerve of the fibula.
Diagnosis of damage is based on symptoms. To identify the injured area, the victim is sent to X-ray (the images are made in two projections). If there is a need for a more thorough examination, CT or MRI is performed.
The treatment is lengthy and depends on the severity of the injury. The main danger of open injuries is the possibility of infection of the wound, which will significantly complicate the process of recovery. The risk of infection increases during the post-operative period, when the patient's body is weakened. Without timely medical assistance, an open fracture of the fibula may lead to amputation of the injured limb or part of it.
Consider the treatment options for injury:
- If the damage occurred in the middle third of the bone, then a gypsum from the middle of the hip is placed on the leg. In addition, immobilization of the knee and ankle is carried out for 2-3 weeks.
- If a fracture in the upper half without damage to the peroneal nerve, then impose a plaster tutor for a month. But for 2-3 days, the victim can walk, leaning on a crutch.
- Injury of the fibular head with nerve damage is accompanied by severe hemorrhage and bruises. The patient is given a plaster bandage to the middle of the thigh and fixes the foot at a right angle.
Mandatory appoint medicines, physiotherapy procedures, a course of massage and therapeutic gymnastics. After 3-4 weeks, the gypsum bandage is replaced with a removable longtail to the knee. If the therapy method does not give the desired results (an incorrect therapy regimen, the presence of serious co-morbidities), then full recovery and recovery may not occur. In this case, the victim loses the ability to move normally.
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Open fracture of the tibia
The tibia is a long tubular bone, which accounts for most of the leg injuries. As a rule, with its fracture, deformation and peroneal strain occurs. An open fracture of the tibia is possible with high-energy injuries, that is, accidents, falling from a height or with sports injuries. Very often, pathology is combined with fractures of the pelvis, ribs, other limbs, abdominal and thoracic injuries.
- Sharp pain
- Bleeding from the place of injury
- Edema and deformities of the foot
- Crepitation and pathological limb mobility
- Bruising on the skin
- Through the wound you can see fragments of bones
To confirm the diagnosis, the shin is radiographed. According to the pictures, the doctor determines the number of fragments, the presence of bias and damage to the fibula, ankle or knee joints. If there is damage to the joints, an additional CT scan is performed. If the nerves or blood vessels are damaged, a neurosurgeon, neurologist and vascular surgeon must be consulted.
The first aid consists of taking an anesthetic and immobilizing the limb. The skin around the wound must be cleaned of foreign bodies and contamination, covered with a sterile bandage. If there is severe bleeding, then put a tourniquet on the thigh. In case of traumatic shock, anti-shock measures are shown.
Inpatient treatment can be operative and conservative, it depends on the complexity of the injury. If the fracture is without displacement, then immobilization of the limb and wound processing are indicated. In other cases, skeletal traction is done. Through the heel bone put the spoke and apply a tire. In this position, the leg is located for a month, after which the control x-ray is made. If the picture shows signs of a callus, then the traction is removed and the plaster is applied for 2-3 months. It is mandatory to use drug therapy, which consists of analgesics and drugs to stop infection from an open wound.
In particularly severe cases and with fragmentation fractures, surgical intervention is performed. The treatment is aimed at restoring the normal position of bone fragments. Also, posttraumatic contractures are prevented. The operation is carried out 7-10 days after the patient's admission to the hospital. During this time, edema decreases, and the general condition is normalized. The entire preoperative period of the patient spends on a skeletal tract.
During the operation, the doctor chooses the method of osteosynthesis, focusing on the nature and level of the fracture. For this purpose, various metal structures are used: locking rods, pins, plates. Very often, extra-osseous osteosynthesis is used by Ilizarov's apparatus. The period of adhesion of the tibia with uncomplicated fracture takes 3-4 months. With comminuted trauma, treatment can last six months or more. During the entire period of therapy, physiotherapy and exercise therapy are performed. After the adhesion of the patient's bone, a rehabilitation course is awaited.
Open fracture of the tibia with displacement
Direct shock in the transverse direction is the main cause of fractures with displacement. Because of the injury, bone fragments are formed, which move in different directions. Their displacement can be peripheral, angular, lateral, fragments can wedge in and go for each other.
An open fracture of the tibia with displacement is characterized by the following symptoms:
- Pain and crunch when getting injured.
- In the place of lesion, bruising and swelling with marked disturbances of the motor function of the foot are formed.
- Due to the displacement of fragments, soft tissues and skin are torn.
- At the site of the movement of the fragments, a depression or a depression is formed.
- The injured limb is shorter than the healthy one.
- The movement of the shin is carried out in an unnatural direction.
Very often such traumas cause traumatic shock. Treatment begins with the comparison of displaced bones. This is necessary for giving the limb a regular shape and its normal fusion. The procedure is carried out manually or with the help of special tools. In order for the victim not to suffer from pain, he is settled on his back and anesthetized. After that, the patient is taken for the thigh, and the second doctor grasps the leg, holding the heel and the back of the foot. In this position, the doctors slowly stretch the limb and determine the position of the displaced fragments.
After the repositioning, the doctor checks the length of the damaged leg with a healthy one. If their parameters converge, then treat the open wound and immobilize the shin. After 10 days the patient must undergo a control x-ray. This is necessary to confirm normal fusion. If the reposition can not be carried out, metal structures are used to fix the displacements.
Splintered open shin fracture
Breach of the integrity of the bone with more than three fragments and rupture of soft tissues is a splintery open fracture of the shin. It is considered one of the complex injuries, since it carries the risk of interposition of soft tissues, compression of nerves and vessels. With a large number of fragments during reposition, difficulties arise, since fragments can not be compared.
Symptoms of a comminuted open leg injury:
- Pain and bleeding
- Leg deformation and pathological mobility
For diagnostics, an X-ray is performed. Treatment begins with the creation of conditions for the fusion of fragments and the subsequent restoration of the functioning of the limb. At the first stage, the bone fragments are displaced and fixed to prevent repeated shifts. The method of therapy depends on the nature and location of the injury, its severity, the general health of the victim, the presence of concomitant injuries and diseases.
With a large number of fragments, the treatment is performed by surgical restoration of the surface. For this, various methods are used: Ilizarov apparatus, osteosynthesis with screws, plates and pins. In complex multi-lobular intraarticular injuries with displacement, the operation is an absolute indication. In some cases, with damage to the tibia and fibula, the operation is performed only on the first. When it is restored, the fusion of the second bone will occur itself.
The duration of immobilization depends on the severity of the injury, but as a rule, this is 3-5 months. Rehabilitation for the restoration of normal functioning of the leg and its motor functions takes 3-4 months. The patient is waiting for exercise therapy, massages, special gymnastics.
Open fracture of lower third of lower leg
Most often, the fractures of the legs fall on the lower third of the shin. If the mechanism of a direct injury (directed bumps, car accidents), then there is a transverse fracture of one or two bones. With indirect injuries (kink, rotation of the shin with a fixed foot), a helical shape occurs, that is oblique damage.
An open fracture of the lower third of the tibia is very dangerous, since it has a passive limb position. In particularly severe cases, it is so pronounced that the surface of the foot can be placed on any plane. When palpation appears severe soreness, lateral deviations of the lower leg are determined. If both bones are broken, then there is crepitation and mobility of the fragments.
To accurately determine the position of the defect, X-rays are performed. Treatment depends on the severity of the fracture, the presence of displacement, the state of soft tissues. The open wound is cleaned and disinfected, the fragments are removed surgically. To fix them, use knitting needles, bolts or plates. For 1-1,5 months, a V-shaped gypsum is applied, but before that, use the Belera bus and the system of skeletal tension, in order to heal the wound and the puffiness has come down. Damage in the lower third of the shin grows slowly, unlike injuries in the overlying areas. Complete restoration of the limb takes 4-5 months.
Double open shank fracture
In frequency among double injuries of tubular bones, a double open fracture of the tibia takes first place. The mechanism of its origin is direct in most cases, but is accompanied by extensive damage to surrounding tissues. The intermediate bone fragment enters the main blood supply, deforming the artery. It must be turned off from the blood stream, as this causes slow consolidation and frequent cases of non-admission. The duration of immobilization is extended and can reach 4-6 months.
Depending on the features of displacement, there are four types of double open shin injuries:
- Without bias
- With offset at the level of distal injury
- With displacement at the level of proximal injury
- With the displacement of the intermediate fragment
All these species have a typical clinical picture with more or less pronounced signs of soft tissue rupture and bleeding. Diagnosis is carried out using radiography in different projections. Treatment depends on the nature of the injury:
- When displaced, immobilization is carried out with a circular cast strip, wrapping the knee joint for up to 4-5 months.
- If there is an offset at the level of the distal fracture, then reposition with skeletal traction for 1.5-2 months is shown. This is necessary to eliminate the displacement along the length. After extension to the limb, circular gypsum is applied to the upper third of the thigh for 3.5-4 months.
- When the intermediate fragment is displaced or at the level of the proximal fracture, an open reposition is performed. Due to impaired blood supply, surgical intervention should be with minimal trauma. For this purpose apparatuses of extra-osteosynthesis or osteosynthesis with a rod fixative are used. The duration of consolidation of injuries of this nature is 2 times longer than the period of fusion of single fractures. Complete restoration of the limb comes in 7-10 months.
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