Anatomy and position relative to other bones
The musculoskeletal system (MSA) in adults is represented by active and passive parts. The active component includes muscles and ligaments. The passive fragment is indicated by a skeleton consisting of bones and their joints. In the adult human body, this part is represented by 208 bones. In order for the human body weight to be correctly redistributed during life, the inside of the bones is hollow. Thanks to this, the weight of the skeleton is less in comparison with the total mass, however, despite this, the structure of the bones is strong, which allows the body to function adequately to the loads applied.
To appreciate the physiological significance of the tibia, it is necessary to understand their topography. The tibia is located in the lower part of the skeleton (leg area), between the thigh and foot, in contact with the tibia. Above, the tibia is limited by the knee joint, below by the ankle. The small bone is connected to the foot through the lateral malleolus through the ankle joint. Large ligaments are located between the shin bones.
According to the length, the fibula is divided into 3 parts: the diaphysis (body) and 2 epiphyses (upper, lower fragment). The body of the bone is bent towards the back and twisted along the axial direction. The diaphysis is represented by a prism and consists of three faces: medial, lateral and posterior. Each face is separated by a ridge. The medial and lateral edges are separated by the anterior protrusion, the inner (medial protrusion) subdivides the medial and posterior sides of the bone, the posterior ridge is located between the posterior and lateral sides.
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At the back of the MBC there is an opening for the exit of blood vessels and nerves. From this hole, a special canal runs distally into the bone, communicating through holes with canals in other areas of the skeleton. On the inner side between the bones there is a delimiting edge. The upper epiphysis, represented by the head, is in contact with the tibia on its articular side. The apex is pointed. The head is connected to the diaphysis of the fibula through the neck.
One of the most important formations of the fibula is the peculiarity of its topography and interaction with the bones of the foot and leg through the lower epiphysis. The distal part of the bone is often called the lateral malleolus. This ankle can be easily palpated through the skin when the foot is flexed forward.
On the inner side of the lower epiphysis there is an articular side that provides the connection between the talus and the lateral malleolus. Slightly higher in the fibula there is a small roughness that connects to the fibular notch in the tibia. Posteriorly on the fibula there is an ankle groove. The peroneus tendon passes through this depression.
Tibia fracture
At the pre-hospital stage, the victim is given pain medication and the lower leg is immobilized with a special splint or improvised means (for example, two boards). It is necessary that the lower part of the splint “grabs” the ankle joint, and the upper part reaches the upper third of the thigh. In case of open fractures, foreign bodies and large contaminants are removed from the skin around the wound, and the wound is covered with a sterile bandage. If there is heavy bleeding, apply a tourniquet to the thigh. In the presence of traumatic shock (can develop with multiple and combined injuries), anti-shock measures are carried out.
The tactics of inpatient treatment depend on the level and nature of the damage and can be conservative or surgical. For stable non-displaced tibial fractures (extremely rare), immobilization with a plaster cast is possible. In other cases, it is necessary to apply skeletal traction. The needle is passed through the heel bone, the leg is placed on a splint. The average initial load for an adult is 4-7 kg and depends on body weight, degree of muscle development, type and nature of displacement of fragments. Subsequently, if necessary, the weight of the load can be reduced or increased.
In the future, two options are possible. With conservative treatment, skeletal traction is maintained for 4 weeks, ensuring the correct alignment of the fragments. After radiological signs of callus appear, the traction is removed and a cast is placed on the leg for another 2.5 months. At the initial stage, the patient is prescribed analgesics. During the entire treatment period, exercise therapy and physical therapy are indicated. After removing the plaster, rehabilitation measures are carried out.
Indications for surgical treatment are comminuted fractures, in which it is impossible to restore the normal position of the fragments using conservative methods. In addition, surgical treatment is used to early mobilize patients and prevent the development of post-traumatic contractures. In most cases, operations are performed a week or more after the patient's admission to the hospital. By this time, the patient’s condition usually normalizes, the swelling of the limb decreases, and doctors have time to conduct a comprehensive examination in order to identify contraindications to surgical intervention. In the preoperative period, the patient is in skeletal traction.
In the surgical treatment of tibial fractures, various metal structures are used, including intramedullary pins, plates and locking rods. The choice of osteosynthesis method is carried out taking into account the nature and level of the fracture. In most cases, intramedullary (intraosseous) osteosynthesis of the tibia is preferred. In addition, for such injuries, extrafocal osteosynthesis with Ilizarov apparatuses is widely used - this method allows you to restore the normal relationship of fragments not only simultaneously (during surgery), but also in the postoperative period. It can be used to treat the most complex injuries, including comminuted fractures with the formation of a bone defect. The disadvantage of the technique is the presence of a massive and inconvenient external metal structure.
Impact on functions in the musculoskeletal system
The leading function performed by the fibula, established during the process of ontogenesis, is ensuring rotation in the ankle. Rotation in this case is the rotation of the lower leg and foot to the right or left in relation to each other. Considering the anatomical structure and location, under the influence of a strong traumatic aspect, bone tissue is susceptible to fractures.
Typically, the fracture first appears in the tibia as it takes the lead during walking. Massive injuries or strong local effects of a negative factor can cause damage to the tibia, often with rupture of soft tissues and movement of bone fragments. Fractures occur in various parts of the fibula. Most often observed in the lower epiphysis.
Options for fibula fractures:
- transverse;
- oblique;
- spiral;
- splintered;
- fragmentary.
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Fractures are usually combined with subluxation and dislocation of the foot, rupture of the distal syndesmosis between the tibia, and shortening of the bone. To understand that a fracture of the entire or fragment of the fibula has occurred, it is necessary to note a number of characteristic symptoms, the main of which are pain at the site of the lesion, which increases with palpation and movements in the ankle or applying a vertical load, and swelling.
The pain is constant and intensifies when walking or standing. Such symptoms usually occur after a leg injury or fracture. To restore bone function to full extent, it is necessary to consult a traumatologist as soon as possible.
Benign bone formations
Bone tumors
- a relatively rare pathology. Benign formations are more common in young people; as a rule, they are localized in the tubular bones, while lesions in the lower extremities are found twice as often as in the upper extremities.
Modern classification of benign bone tumors:
1) Bone-forming tumors: osteoma, osteoid-osteoma, osteoblastoma
2) Cartilaginous tumors: chondroma, chondroblastoma, osteochondroma
3) Giant cell tumor
4) Vascular tumors: hemangioma, lymphangioma
5) Other connective tissue tumors: lipoma, fibroma
6) Other tumors and tumor-like lesions: neurofibroma, odontoma, solitary bone cyst, aneurysmal bone cyst, non-ossifying fibroma, eosinophilic granuloma, fibrous dysplasia.
Diagnosis of tumor formations of bones is difficult due to the lack of obvious early symptoms - pain is not expressed or absent; tumor growth is absent or very slow, bone deformation without changes in the surrounding soft tissue.
The capabilities of various radiation methods for diagnosing skeletal diseases have now expanded significantly. However, at the first stage, all patients need to undergo classical radiography in standard projections, depending on the area of interest, since this method is basic and most accessible, and allows in almost all cases to obtain the necessary information and make the correct diagnosis without using expensive and inaccessible imaging techniques such as CT and MRI.
Benign bone tumors are characterized by the following general radiological signs: clear contours, a rim of sclerosis, often swelling of the bone, absence of periosteal reaction, slow growth, solitary nature of the lesion.
Osteoma
There are spongy osteoma, osteoma consisting of cortical and spongy substance, and osteoma from a solid compact substance. The first two types are observed on long tubular bones; compact osteomas affect the flat bones of the skull.
- spherical, spiky shape, - the tumor sits on the bone on a wide, regular stalk, — the cortical layer in osteoma is not damaged. - contours are smooth, even, - the spongy network of bone and tumor continuously passes into each other. | |
- round, spherical or ovoid shape, - the tumor gives a homogeneous structureless shadow. |
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- males are affected 4 times more often, - observed mainly at the age of 10-20 years, - localization: cortical layer of the diaphysis of long tubular bones (tibia and fibula), in the spine - in the area of the arches or spinous processes, - morphologically - a delimited formation, a “nest” located in compact or spongy bone tissue and surrounded by a wide zone of sclerotically compacted bone, - calcification of osteoid tissue is more pronounced in the center of the lesion - the picture is “eggs in a nest”: the focus of destruction is a “nest” - round, oval in shape, small in size (diameter 0.5-1 cm); zone of sclerotic compaction of bone tissue - clearly delimits the “nest” of the tumor, along the periphery it passes into the unchanged bone structure. |
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- in addition to bone tissue, it also contains cartilage, covering the surface of the tumor in the form of a cap, - comes from the humerus, from the meta-epiphyses in the area of the knee joint, in the head of the fibula, thoracic spine (comes from the arches or processes), - the tumor sits on a wide stalk and rises on the bone in the form of a cauliflower. - its surface is lumpy, its contours are sharply defined, - the cortical substance of the bone passes to the surface of the tumor or protrudes into the middle of the growth, crumbling into separate layers of bone, running in the form of rays to the surface of the tumor, - its pattern is not homogeneous, consists of bone islands, fan-shaped bundles and septa lying among the light background of cartilage, — osteochondromas have a high potential for malignancy. |
Chondroma - phalanges, metacarpals, metatarsals, less commonly carpal bones, vertebral processes, anterior ends of the upper ribs, pelvic skeleton, sternum and very rarely long tubular peripheral bones are affected, - in small cylindrical bones, chondromas nest in the diaphysis and epiphyses, in large tubular bones - only in the metaphyseal bones, - as a rule, cartilaginous tumors are multiple and are most often observed in one or more on the phalanges of the hands and metacarpal bones, - most often the process is bilateral, but not symmetrical. | |
- tumors are spherical or oval, sometimes located centrally and swell the bone from the inside, sometimes eccentrically and more superficially and are associated only with the cortex of the bone, - the tumor consists of a transparent, cartilaginous background on which islands, dots of lime or bone substance are visible, - the outer contours are smooth and, with a benign course, are not interrupted, - at the site of fusion of tumor balls, the bone septum is sometimes thick, in other cases it is thinned or absent, - with damage to the epiphyseal cartilages, one can see inhibition of bone growth in length or its curvature, - often centrally located chondroma is complicated by a pathological fracture, - the cortical layer is uneven and thickened in places, - with chondroma, the surface of the bone is rough. |
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- affects people aged 20 to 40 years, - localization femur - distal end, proximal end of the tibia, distal end of the radius. From flat bones - pelvic bones and scapula, very rare localization in the vertebrae, - loneliness and isolation of the lesion, - the location of the tumor is characteristic in the epimetaphyseal region, which is significantly swollen and deformed, has the appearance of a coarsely tuberous hemisphere, a club, - the tumor reaches the articular cartilage and breaks off, - grows in all directions, but the main growth occurs along the long axis of the bone towards the c/3 diaphysis of the bone, - the diameter of the tumor can increase the normal diameter of the tumor by 3-5 times. | |
- with large tumors, the cortex dissolves and the tumor is surrounded on all sides by a thin shell consisting of the walls of superficially located cells. | |
- marginal saucer-shaped defect, — the cortical layer at the affected area is absorbed, and at the border with the defect the crust is sharpened, not undermined and does not have any periosteal layers, - the contours of the defect are sharp, - pathological fractures in 12% of cases. |
Hemangioma
This is a vascular tumor, comes from the bone marrow of those bones that contain red bone marrow, can be observed at any age and does not depend on gender, the favorite localization is the vertebral body and flat bones of the skull, and is asymptomatic.
When a hemangioma is localized in the flat bones of the cranial vault, the following occurs: - swelling of the bone and destruction of the cortical layer, the periosteum is raised by the tumor, - a structural pattern is characteristic - thin and coarser bone beams scatter from the center of the tumor to its surface in a radial or fan-shaped manner. | |
X-ray picture of hemangiomas in the vertebrae: - instead of the normal structure of the vertebra, vertical, and sometimes single, horizontal, transverse, coarse columns and trabeculae appear, - individual oval or round enlightenments are visible, bordered by a dense bone border, - the vertebral body has the appearance of a swollen barrel, the arches are often involved in the process. |
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- initially, the central focus of bone destruction is round in shape, has a structureless hemogenic appearance, is bordered by a shell-like thinned bone crust, without periosteal reaction, - then a focus of calcification appears in the center of the tumor, connected to the periphery by sometimes radially located linear bone bridges, - pathological fractures are possible. |
- odontogenic (dental) ectodermal origin, i.e. develops from the enamel organ and has a typical histological structure, - occurs in the lower jaw, upper jaw, also in the tibia and ulna, - occurs at any age, but more often in young people (from 15 to 35 years), - a focus of bone resorption growing from the depths of the central areas of the lower jaw, the cortical layer swells from the inside out and often becomes thinner, — at first the defect is homogeneous, then large or small cellularity appears (due to cyst-like degeneration of the tumor tissue). |
Benign bone tumors are a pathology that can affect both infants and the elderly. Most of these formations have a favorable prognosis in terms of quality of life and malignancy. The exception here is cases of giant cell tumor, which is capable of degeneration. Timely detection and adequate treatment help avoid serious deterioration in the patient’s health.