Leg injuries occur in people of any age and gender. The lower limbs are made up of different bones, and it is necessary to understand how to help a victim with fractures of different parts of the limb. Why is a broken leg dangerous, and what symptoms should you pay attention to first?
General information
Leg fractures are an extremely common injury, accounting for 45% of the total number of skeletal injuries.
A leg fracture can be isolated or multiple, or observed as part of a combined injury.
The severity, timing and methods of treatment, as well as long-term consequences, can vary significantly depending on the level and characteristics of the fracture. Common signs of leg fractures are swelling, pain, and loss of support and movement. Pathological mobility and crepitus are often detected. To clarify the diagnosis, radiography and CT are used; in some cases, MRI and arthroscopy are prescribed. Both conservative and surgical treatment are possible.
Diagnosis of injuries
If any of the symptoms of a fracture appear, you should immediately consult a doctor. The specialist will examine the injured leg, ask about the mechanism of the injury, and examine the leg for associated phenomena. After a visual examination, the patient is sent for examination:
- X-ray. X-rays of the affected area of the leg are performed in two projections. The image will help the doctor determine the nature of the fracture, its location and features. If a photograph in two projections does not produce results, then another one is taken. The image allows the doctor to determine whether the patient needs surgery or whether a simple fixing bandage can be used;
- CT (computed tomography). The study allows us to examine damage to blood vessels, nerve endings, ligaments and bones. CT scans are performed only in cases of severe injuries or if therapeutic interventions do not produce the desired results.
Additionally, a general blood test is taken from the patient to rule out infection. If not only the leg is injured, then all studies are carried out after first aid is provided and when the patient’s life is not in danger.
Classification of fractures
Leg fractures can be complete or incomplete (cracks). Fractures of the legs that communicate with the external environment through a wound on the skin are called open. If there is no wound, the fracture is closed.
Depending on the characteristics of the fracture line and the nature of the fragments in traumatology, the following types of leg fractures are distinguished:
- Transverse - the fracture line is located transverse to the length of the bone.
- Oblique - the fracture line is at an angle to the length of the bone.
- Longitudinal - the fracture line is located along the length of the bone.
- Helical - the fracture line has a spiral shape (such injuries are usually formed as a result of a sharp forcible twisting of the limb).
- Polyfocal - there are two or more large bone fragments.
- Splintered - there are several fragments.
- Shattered – there are many small fragments.
- Compression – accompanied by compression of the bone. In this case, the bone cracks, flattens, is compressed and deformed.
- Impacted - accompanied by the introduction of one fragment into another.
- Avulsion – a small fragment breaks off from the bone (for example, when a ligament is torn off at the site of its attachment).
Taking into account the level of leg fracture, the following are distinguished:
- Femur fractures;
- Fractures of the leg bones;
- Fractures of the bones of the foot.
Injuries to the proximal and distal ends of the bone can be intra-articular (epiphyseal) or periarticular (metaphyseal). With intra-articular leg fractures, concomitant damage to various articular structures is observed, including cartilage, capsule and ligaments. Possible combination with subluxation or dislocation.
Will there be consequences?
Many people who experience injury worry that they will not be able to recover properly. At the same time, doctors say that it is quite possible to rehabilitate. “If the patient followed the specialist’s instructions and followed all the instructions, then gradually the person after the injury will return to his normal lifestyle,” notes the orthopedic traumatologist.
So the key to successful recovery is correctly provided first aid and detailed treatment prescribed by a specialist.
There are contraindications. Be sure to consult your doctor.
Healing of a fracture
After a fracture, the body immediately tries to restore the bone tissue to its original state. It takes six weeks to several months for the bone to heal completely.
Immediately after the fracture, bleeding begins from the damaged vessels of the periosteum (Fig. 1). A blood clot called a hematoma forms. The blood coagulates, stops flowing, and fibrous connective tissue gradually forms at the site of the clot. After a few days, hard tissue called calluses develops in the area of the hematoma. Cells called fibroblasts begin to produce collagen fibers, the main protein in bone and connective tissue. The chondroblasts then begin to produce fibrous cartilage. This tissue toughens the calluses by eliminating the gap between the bone parts. This process lasts about three weeks.
Callus after a fracture. Next, osteoblasts begin to produce bone cells, turning the calluses into calluses. This bone shell provides the necessary protection for 3-4 months before the bone goes through the final stages of healing.
A fairly large amount of time must pass before the bone is ready to take on the full load. Osteoclasts and osteoblasts will work for several months to transform the callus into full-fledged bone tissue. These cells also reduce the bulge, returning the bone to its original appearance. Blood circulation improves along with an influx of nutrients such as calcium and phosphorus, which strengthen bones.
Even the most minor fractures require medical attention to ensure the healing process occurs as quickly as possible.
Fig.1
Rehabilitation
When an elderly person is seriously injured, all care for him falls on his relatives. This is not only hygiene, taking medications and nutrition (which must be high in calories and healthy so that the patient receives all the necessary nutrients), but also rubbing, massage and other measures to prevent blood stagnation.
After forced immobility for a long time, older people often have to relearn how to walk and control their body. The patient’s relatives should be prepared not only for long treatment, but also for rehabilitation, which can take a couple of months or a whole year. Atrophied muscles will have to be trained regularly so that the muscle corset is sufficiently strengthened.
The importance of using physiotherapeutic procedures for fractures
After a fracture, the first thing you need to do is restore the integrity of the damaged bone. For this purpose, methods of traction, immobilization and surgery are used.
But no less important is the return of mobility, innervation, and trophism of the injured limb. Medicine has many methods aimed at rehabilitation after fractures, and one of the most significant is physiotherapy.
The importance of physiotherapeutic procedures at the stages of treatment and rehabilitation after fractures is difficult to overestimate. As part of complex therapy, they promote recovery and return to work, and alleviate the patient’s condition. The main objectives of physiotherapeutic treatment:
- prevention of muscle atrophy and contracture formation;
- reduction of swelling;
- elimination of pain syndrome;
- improvement of microcirculation and tissue nutrition;
- prevention of infectious and inflammatory processes in open fractures.
A properly selected set of procedures not only promotes recovery, but also reduces the drug burden on the body.
The choice of specific methods of physiotherapeutic treatment directly depends on the stage of bone tissue regeneration.
The following types of physiotherapy are indicated: UHF, MAGNETOTHERAPY, ELECTROPHORESIS, MASSAGE, LYAPKO APPLICATION THERAPY, ETC.
Contraindications
Bony osteosynthesis of the tibia or other techniques are not performed if contraindications are identified, which include:
- nervous system disorder;
- severe damage to the surrounding tissues of the leg;
- presence of osteoporosis;
- the presence of infectious diseases, fever, intoxication;
- diagnosis of immunodeficiency state;
- allergies to painkillers;
- chronic pathologies in the acute phase.
The attending physician may include other painful conditions of the patient as contraindications that prohibit temporary or permanent intervention.
Application therapy Lyapko
Lyapko applicators in various modifications (plates, rollers, application belts, application tapes) are an original, powerful device with many health-improving therapeutic capabilities. Their action is based on the principles of traditional Chinese medicine - superficial multi-needle acupuncture, as well as on the general physiological mechanisms of life.
Mechanisms of action of the applicator
The high healing effect of Lyapko applicators is due to a combination of intense reactions:
- reflex-mechanical;
- galvano-electric;
- immunological.
The clinical effects of the multi-needle therapy method are manifested in analgesic, antispasmodic, anti-inflammatory, anti-edematous, neurotrophic and immunomodulatory effects. Also in the regulation of the functions of the autonomic nervous system, normalization of the processes of excitation and inhibition in the central nervous system.
Application therapy for injuries and fractures of the lower extremities, femoral neck fractures.
If there are metal plates, pins, or fragments in the patient’s body, then any type of electrophysiotherapy is contraindicated for them and the only means of physiotherapeutic treatment is the Lyapko applicator. Lyapko application therapy can be used from the first days of an injury or fracture; it is combined with all types of medication and physiotherapeutic treatment.
How to use the applicator, application zones
In 90% of cases it is necessary to act on the pain zone, and to increase efficiency on additional and auxiliary zones. The general formulation should always include the core area (spine area).
Additional and auxiliary zones should be used in cases where, for a number of reasons, it is impossible to influence the main zone (plaster applied, wound surface). To enhance the therapeutic effect, it is advisable to include in the formulation an effect on symmetrical areas of the healthy side.
The main zones are located on the back surface of the torso, head, and neck.
They are named the main ones due to the fact that the areas of skin on both sides of the spine and directly above the spine are closest to the exits of the roots of the cranial and spinal nerves and other structures.
Auxiliary zones: anterior surface of the torso, head and neck.
Accessory zones: zones of the skin of the lower and upper extremities, which are secondary (peripheral) in relation to the (central) structures of the spinal cord and brain.
Improved technique
The Ladisten Orthopedics and Traumatology Clinic offers an alternative solution. Its founder, Dr. Veklich, improved the Ilizarov apparatus. The Veklich apparatus is installed in a minimally invasive way. It can be used to increase height or correct disproportion of limbs.
In case of bone injuries, surgical intervention to install the device cannot be avoided. Its design is almost identical to the Ilizarov apparatus, but instead of spokes, titanium rods with a diameter of 6 mm are used. The rod can be applied only on one side, reducing the risk of osteomyelitis significantly. It also does not come into contact with nerves and blood vessels. The entire structure is not too bulky and reliably holds damaged bone fragments.
General recommendations
In the old days, healers, when treating fractures, practiced this method: they used a small file to cut copper powder from an old copper coin. A little of this powder (1/10 gram) was stirred in milk or sour cream, or rubbed with egg yolk and given to the patient orally, 2 times a week. This accelerated the healing of fractures.
You need to eat food rich in vitamins and microelements such as: manganese, copper, zinc, phosphorus, calcium, magnesium, vitamins B6, B9, B12, C, D, K. All these elements help absorb calcium and protein - from which the body and will build bone tissue.
It is advisable to use mumiyo internally and externally (in solution) on the fracture area.
In the first days, with pathology of muscles, bones and joints, you need to remain calm, but in the future you need to gradually increase physical activity. If muscles do not work, they quickly weaken and atrophy. Without load, the functioning of the ligamentous-articular apparatus is disrupted, which prolongs the process of recovery and recovery from injury, and increases the likelihood of injuries in the future.
After removing the cast, the muscles are always painfully tense, require gradual stretching, and the joints need to be “developed.” After removing the plaster, pain can appear in almost all parts of the back, since immobilization of both the upper and lower extremities after fractures leads to a gross violation of the stereotype of movements of the whole body and the appearance of pronounced asymmetries of the body.
Therefore, to prevent the appearance of muscle pain in the back, from the first days of the fracture, you should use flat applicators on your back for 20-30 minutes in the evening, roll your back with the “Large Roller M”, “Universal Roller M” in the morning and afternoon for 3-5 minutes (until a uniform pink color appears). Do a back massage using the Pharaoh massager.
When applying a plaster in the first days, severe swelling and increased pain at the fracture site often appear, leading to the need to cut into the plaster.
First of all, you need to use any flat applicators: “Romashka M”, “Insoles Plus”, “Quadro”, “Chance” on the lumbosacral zone of the spine, where the innervation to the limb comes from - the main zone, if there is access there.
Then it is recommended to act on all free surfaces of the legs above and below the fracture site (plaster cast), as well as on the healthy leg, focusing on the symmetrical site of the fracture, this reflexively reduces swelling and pain on the damaged limb. The impact can be carried out either with a flat applicator or with a roller. You can also use static-dynamic applicators: “Magic tape “Health”, belt “Universal M”, belt “Baby”. They need to be fixed on the limb for a longer time from 30 to 60 minutes 2-3 times a day.
For injuries, use the same technique. If the skin over the injured area of the limb is not damaged, then you can act on the site of injury. In case of bruises, to avoid the occurrence of swelling, hematomas, you can fix any flat applicator, application tape or roll it with a roller to this place.
Application zones (Fig. 2): main 7.8; additional 18; auxiliary 26, 28, 30, (22, 27, 29).
Fig.2
Apply appliqué insoles to the feet or roll them with the “Large Roller M” or “Universal Roller M”.
The duration of exposure on the fractured side is 2 times longer than on the healthy leg. For example, we apply static applicators to the lumbosacral area and the sore leg for 15–20 minutes, and symmetrically to the healthy leg for 5–7 minutes. The same technique for injuries.
Additional recommendations. Good results are achieved by short-term effects on symmetrical zones of a healthy limb, correspondence zones on the hands and feet, used in Su Jok therapy (Fig. 3)
You can roll with a “Needle Ball”, “Large Roller M”, “Universal Roller M”, “Face Roller M”, and also press with the “Speck” applicator.
Fig.3
Clinical example.
Patient G., 56 years old, fell from a stepladder at the dacha, received a closed fracture of both bones of the right leg with displacement, and was hospitalized at K+31 by the insurance company. On the day of admission, a complete preoperative examination of the patient was performed, skeletal traction was applied, and he was hospitalized in the department.
On the same day, osteosynthesis of the tibia fracture was performed with a pin with locking, and the fibula with a plate and screws. Activated on the second day. On the third day he was discharged in satisfactory condition for outpatient follow-up treatment.
6 weeks after surgery, axial load on the limb is allowed. The fracture healed 12 weeks after surgery in a satisfactory position.
The patient is fully activated, walks without additional support without limping, and is not bothered by pain. The attentive reader will be able to notice
Femoral neck fractures
Femoral neck fractures are intra-articular and most often occur in elderly patients suffering from osteoporosis.
A leg fracture occurs due to a fall at home or on the street. As the strength of the bone decreases, its integrity may be disrupted even when the body turns in bed.
Due to insufficient blood supply, the femoral neck heals poorly, a full bone callus, as a rule, is not formed, the fragments are “grabbed” together by connective tissue, which causes a high percentage of disability. Taking into account this circumstance, the preferred method of treatment for such leg fractures is surgery - osteosynthesis with a three-blade nail, endoprosthetics or autologous bone grafting.
If the general condition does not allow surgical intervention, skeletal traction is used. Elderly patients are given a plaster boot with a transverse bar that prevents rotation of the limb. This allows for the formation of fibrous callus while maintaining sufficient physical activity of the patient.
For fractures of the femoral neck, after surgical treatment of the hip joint, application therapy is used as measures aimed at developing the joint, improving blood supply, increasing muscle tone, and helping to get out of a depressive state.
It is recommended to roll the healthy, sore leg with a roller, place large flat applicators on the sore and healthy legs, on the lumbosacral area and the buttocks area.
The use of applicators on the back and on the chest area in front is a means of preventing pulmonary congestion, which can lead to pneumonia and death of the patient.
For many elderly patients, such procedures helped them avoid these complications and return to normal life.
Rehabilitation period
Compliance with all instructions of the attending physician in the postoperative period is a necessary condition for the speedy fusion of the bone and restoration of the functionality of the limb. Doctors' recommendations are aimed at normalizing blood circulation in order to speed up healing and reduce the possibility of postoperative complications. The usual guidelines for this time are:
- physiotherapy;
- exercise therapy;
- gymnastic exercises.
This prevents joint contractures, decreased muscle tone, and prevents the possibility of congestive pneumonia and thrombosis.
At a certain stage, massage courses are prescribed. During the entire rehabilitation course, control photographs of the injured limb are taken to assess the degree of recovery.