In case of a fracture of the tibia, osteosynthesis, a surgical operation, is performed to restore the integrity of the bone. During the intervention, the fragments obtained from fractures of the tibia and fibula are repositioned and fastened. The operation is performed to ensure the most favorable physiological conditions for bone fusion. Securely fixed fragments grow together, remaining in the correct position.
Osteosynthesis of the tibia is a radical treatment method, therefore it is not recommended for all patients, but only for those for whom conservative treatment has not helped or diagnostic studies show its inappropriateness.
In modern conditions, treatment of tibia fractures using osteosynthesis is used much more often than before. This is facilitated by the greater efficiency of the method compared to conservative methods (plaster application). The development of medicine allows us to significantly modernize surgical techniques. This is an opportunity to perform surgical intervention in a minimally invasive manner, using modern structures and materials for bone fixation.
What is a comminuted fracture of the spine
Among the many types of spinal fractures, comminuted is considered one of the most dangerous and difficult to treat. Doctors note that this type of injury accounts for about 12% of all diagnosed injuries.
A compression-comminuted fracture of the spine is characterized by breaking off pieces of bone. As a result, more than two fragments are formed - if pressure is applied to it, there is a high risk of damage to nerves, spinal cord and blood vessels.
The more fragments there are, the higher the risk that a person will be paralyzed. Therefore, if you suspect such an injury, the most important thing is to ensure complete immobility for the victim.
What consequences can develop from bone fractures?
Severe displaced fractures affecting the femur or pelvis can be life-threatening. The rehabilitation period involves rest. The patient should not move actively, otherwise the fragile bones will shift again. This leads to the negative consequences of fractures in the elderly. Blood circulation slows down. Against the background of increased coagulability, which is characteristic of older people, the risk of blood clots and blockage of arteries increases.
Thromboembolism is not the only risk. Due to stagnant processes, pneumonia develops. Slow blood flow can cause a heart attack. Bedsores appear on the skin - necrotic areas formed due to constant pressure.
Classification of injury
There is a gradation of such a fracture, divided into three categories: open and closed with displacement and without displacement, articular and extra-articular.
Open/closed
The open type is characterized by damage to tissues and skin. In extreme cases, the shrapnel can pierce the skin and come out. This type is the most dangerous because it often results in severe damage to the nerves and spinal cord, rehabilitation can take several years, and the patient can become disabled. However, according to statistics, this type of damage is diagnosed in a small number of applicants - in order for the bone to “pierce” the skin, a strong mechanical impact is needed, often in different directions.
The closed type is more common. In this case, the tissue remains intact; if there is damage, it is internal, directly at the site of the bone fragment.
Articular/extra-articular
A comminuted fracture of the 12th vertebra or other parts of it can be articular or extra-articular. The difference between them lies in the involvement of the joints - the areas that are formed by the articular processes. Injuries vary in the degree of negative impact on the body and impairment of motor ability.
With/without offset
The difference between these two types of injury is the displacement of vertebral fragments in one direction or another. If it is present, the likelihood of spinal cord injury greatly increases. The patient's level of pain will change, as will the level of loss of mobility and other symptoms accompanying the injury.
Causes of frequent fractures in older people
Bones are organs with a complex structure. In their depths lie nerve fibers and blood vessels that feed the cells. The internal cavity contains bone marrow, which is responsible for the synthesis of new blood cells. Outside, it is surrounded by bone tissue formed by structural elements - osteoblasts, osteocytes and osteoclasts. The main function of the skeleton is musculoskeletal. It provides mobility and maintains body position in space.
Bone tissue is unique. It is light, durable and moderately elastic at the same time. Such properties are determined by the chemical composition. Minerals give hardness, and organic compounds give flexibility. They protect cells from premature destruction.
As you age, your bone structure changes. The density inherent in a young body is lost. Minerals are washed out, so the bones become loose and porous. Cavities form inside them, which increase every year. Senile osteoporosis develops, a chronic disease that worries older people. With this pathology, bones lose strength and become fragile. It can be asymptomatic for many years. It is diagnosed at the first fracture, which is caused by a slight bruise or fall.
Factors provoking the development of osteoporosis:
- genetic predisposition;
- endocrine disorders - hyperthyroidism, diabetes mellitus;
- digestive disorders - malabsorption, recovery after gastric resection;
- liver or kidney pathologies;
- rheumatoid arthritis;
- blood diseases - lymphoma, leukemia;
- obstructive pulmonary disease;
- nervous exhaustion;
- starvation, nutritional deficiency;
- long-term use of glucocorticosteroids, immunosuppressants, thyroid hormones.
Causes of injury
A compression-comminuted fracture of the lumbar spine is not so easy to obtain. This form of injury occurs when too much pressure is placed on the body and the spinal column seems to compress. Under the influence of forces, the vertebrae cannot withstand and crack. The stronger the impact, the higher the likelihood that one or more fragments will break off.
Much less often, injuries are diagnosed due to strong twisting or a direct blow to the area of future injury.
Most often, people involved in extreme sports, acrobatics, and skydiving suffer from a comminuted fracture. You can get damaged by getting into a car accident.
Permanent fixation of fragments
Fragments of the lower jaw can be fixed using conservative and surgical methods.
Permanent fixation can be carried out using: steel standard tape splints (Vasiliev splints), Tigerstedt dental wire splints, dental dentogingival and supragingival plastic splints, which are made in dental laboratories (they are rarely used nowadays).
In recent years, some clinics have begun to use orthodontic screws, which are inserted through the mucosa into the alveolar processes of the jaws, 3 pieces on each side, after which a rubber rod is put on the heads of the screws, providing intermaxillary fixation. This avoids the time-consuming procedure of double-jaw splinting. On the other hand, when inserting screws, the roots of the teeth can be damaged; in addition, there are often situations when the screw, under the action of a rubber rod, becomes mobile, which leads to inadequate intermaxillary fixation and removal of the screw.
If conservative treatment methods do not produce an effect, osteosynthesis is used - this is a surgical method that, with the help of devices, allows you to fix the fragments and eliminate their mobility. Osteosynthesis is performed if the patient has comminuted fractures of the lower jaw, or the displacement of the fragments is so pronounced that they do not allow closed reduction. Osteosynthesis is also indicated in the absence or insufficient number of teeth in the patient.
Approximately 30% of patients with mandibular fractures require surgical treatment. Currently, osteosynthesis is one of the leading methods of surgical care, and is used much more often than in the past.
This is due both to an increase in the arsenal of technical means for performing surgery (the presence of physiodispensers, titanium miniplates), which leads to improved surgical techniques, greater predictability of results, and to the requests of patients, which are aimed at a more comfortable course of the post-traumatic period, reducing the time of intermaxillary fixation, and in some cases, complete abandonment of it.
Methods for treating fractures using surgical techniques make it possible to compare and fix mobile bone fragments in a normal anatomical position. This helps reduce treatment time and achieve early restoration of lower jaw function. However, according to various data from Russian and foreign clinics, there is also a negative aspect of using osteosynthesis - about 30% of patients experience complications after using this technique. This is due to the use of materials to hold fragments: steel, titanium, etc. Even the most bioinert alloys are not ideal. Being in bone tissue, they undergo corrosion and cause galvanosis, which negatively affects the recovery process and can cause purulent-inflammatory complications and pain reactions.
Symptoms of a comminuted fracture of the spine
When a person has a comminuted fracture of the thoracic vertebra and or the injury is localized in other areas, this makes itself felt by several symptoms:
- Severe pain at the site of injury. It will be difficult for the patient to even turn around a little - some people lose consciousness from a sharp attack of pain.
- Limited mobility. Here a lot depends on the location. If the cervical spine is damaged, the patient will not be able to turn his head, and the lumbar spine will not be able to turn his body.
- The appearance of pronounced edema at the site of injury. When you try to apply pressure, severe pain occurs.
- Paralysis of limbs. A person may not move both his legs and arms.
- Disruption of the pelvic organs. The patient may experience defecation or urination, and in the long term, sexual dysfunction occurs.
- Loss of skin sensitivity. Because of the numbness, the victim will not feel any palpation or needle pricks.
The more severe the case, the more severe the symptoms will be. For example, loss of sensation or paralysis is often associated with a violation of the integrity of the nerves and spinal cord in a certain region. The victim may lose the creation due to painful shock.
Types of fractures
Fracture
- partial or complete violation of the integrity of the bone. Most often, fractures occur when a bone is suddenly exposed to significant mechanical force when the skeletal system is not changed. Such fractures are called mechanical (traumatic). The integrity and continuity of the bone can also be disrupted by the pathological process developing in it. Such a fracture is called pathological (spontaneous). It can occur without any external influence or it can be very minor.
Violation of bone integrity under the influence of mechanical force is always accompanied by damage to soft tissues. The degree of damage to the latter, as well as the nature of the fracture, largely depends on the strength of the mechanical impact. A violation of the integrity of a bone, when the connection between its parts is not broken, is usually called a crack (fissura).
In clinical practice, fractures are quite common. So, according to the Institute of Emergency Medicine named after. Sklifosovsky in Moscow, fractures of various bones were detected in 33.2% of cases, i.e., almost every third patient admitted with injury had a bone fracture. In this case, fractures were most often localized in the bones of the extremities (61.2%). According to statistical data from outpatient departments, a significant place among bone fractures is occupied by fractures of the bones of the foot and hand (62.5%).
Most cases of fractures occur between the ages of 20 and 40 in men. The incidence of certain types of fractures is closely related to certain seasons. Thus, spinal fractures are more common in the summer during the swimming season, and ankle fractures and epiphyseal bone fractures are more common in winter due to falls on icy roads. Fractures of the lower extremities.
Classification of fractures:
Depending on whether the bone wound communicates with the external environment through damaged body tissue or not, all fractures should be divided into closed and open. This division of fractures is fundamentally very important, because with open fractures, there is always a danger of pathogenic microorganisms entering the wound and developing a purulent or putrefactive inflammatory process in the fracture zone. This must always be taken into account when providing first aid to a victim with a fracture, and even more so when treating fractures.
According to location, fractures are divided into diaphyseal, metaphyseal and epiphyseal
.
Epiphyseal (intra-articular)
fractures are the most severe.
With them, the configuration of the joint is sharply disrupted and very often a persistent disturbance of movements in it remains. In some cases (especially in children), there is a separation of the epiphysis, the so-called epiphysiolysis, which is most often observed in the area of the epiphysis of the humerus, radius and tibia.
Metaphyseal (periarticular fractures)
They are often fixed due to the adhesion of one bone fragment to another. Otherwise, they are called driven in. The periosteum is often not damaged in these fractures. Therefore, such fractures often have the character of cracks in the form of longitudinal, radiant and spiral lines.
In clinical practice, diaphyseal fractures are more often encountered .
Taking into account the mechanism of fracture formation, it is customary to distinguish fractures from axial compression, from flexion, from torsion. The mechanism of various types of bone fractures is based on the laws of mechanics, according to which molecules, under the influence of injury, either approach each other (compression, compression fractures) or move away from each other (avulsion fractures). Or, finally, they move in relation to each other as if along a screw thread (spiral, helical fractures). The degree of bone destruction depends on the duration of exposure of the bone to an external traumatic factor and the direction of the force of this factor.
Fractures from compression or compression can occur both longitudinally and transversely to the axis of the bone. Long tubular bones are more often damaged when they are compressed in the transverse direction than in the longitudinal direction. Compression of these bones in the longitudinal direction leads to the formation of impacted fractures. Often compression fractures are localized in the spine, the vertebral bodies of which seem to be flattened.
Flexion fractures occur from direct and indirect violence. The bone bends to the limit of its elasticity and breaks. In this case, on the convex side of the bone, a rupture of its surface parts occurs, and a series of cracks running in different directions is formed. The bone breaks, sometimes forming a triangular fragment.
Fractures caused by twisting along the longitudinal axis of the bone are called torsion, spiral or helical. These fractures are localized in large tubular bones (femur, shoulder, tibia). The fracture is usually located away from the point of application of force.
Avulsion fractures occur due to a sharp muscle contraction that occurs suddenly. In this case, sections of the bone are torn off, to which the sharply contracted muscle is attached.
Depending on the degree of violation of the integrity of the bone, fractures are usually divided into complete and incomplete (cracks). In a complete fracture, the bone is damaged along its entire tissue length, which allows the bone fragments to move relative to each other (displaced fractures). With incomplete fractures, displacement of bone fragments does not occur (fractures without displacement). A typical example of an incomplete fracture is a subperiosteal fracture, which occurs in children under 15 years of age.
According to the direction of the bone fracture line, it is customary to speak of transverse fractures.
(the fracture line is perpendicular to the axis of the bone),
longitudinal
(the fracture line runs along the axis of the bone).
Oblique
(the fracture line is directed towards the axis of the bone at an angle),
helical or spiral
(twisting of bone fragments along its axis). The reasons that lead to the displacement of bone fragments during a bone fracture can be divided into three types: 1) primary displacement, which occurs due to the action of physical force and the direction of its action; 2) secondary displacement caused by contraction of the muscles attached to the broken bone; 3) tertiary displacement, formed when secondary external mechanisms act on the damaged bone (improper transportation from the site of injury, restless behavior of the patient). When bone fragments are displaced, muscles, tendons, and nerves can become wedged between them, which significantly complicates the course of the fracture and affects its treatment (interpositional fractures). Depending on the number of damaged areas of the bone, it is customary to distinguish between single and multiple bone fractures.
Multiple fractures are also spoken of in cases where the victim has several broken bones.
If a bone fracture causes damage to organs located in the area where the fracture is located, then such fractures are called complicated. If a fracture is not accompanied by damage to organs, then it is called simple, however, it should be noted that in reality there are no simple fractures, since with a fracture there is always damage to the soft tissue in the area of its location. But since these tissue injuries do not require special treatment, these fractures are considered uncomplicated.
Complicated include fractures of the skull with damage to brain tissue, fractures of the pelvis with damage to the pelvic organs, open fractures, and fractures of bones with damage to large vessels and nerves.
Go to the Rehabilitation section
Treatment of comminuted fracture of the spine
For the success of treatment, correct diagnosis at the time a person is admitted to the hospital and the correct course of recovery are important.
Conservative treatment
If the patient received a mild comminuted fracture of the L1 spine or another area, the spinal column is stable, and there is only one fragment, conservative treatment can be used. The person is prescribed a course of painkillers, as well as a special regimen of physical activity.
Depending on the severity of the injury, you will have to spend up to two months in bed. For about another six months, it will be impossible to put any physical stress on the spine - patients are not even allowed to bend over.
You will also need to wear a special corset that limits movement. You will have to get used to this, but restoration of performance and a normal life are at stake.
Surgical therapy
Surgery on a comminuted fracture of the spine will be the only way out. When there are many fragments, the patient's tissue and bone marrow are severely damaged. In this case, often the fragments will need to be removed, normal blood circulation and the integrity of the spinal column restored, and ligaments and muscles sutured. It is possible to install an implant.
Diagnostic methods
To determine a fracture of the zygomatic bone, methods such as visual inspection and palpation are used. In difficult cases, an X-ray examination is prescribed to clarify the severity of the damage, as well as determine the optimal recovery tactics. The resulting image reflects a violation of tissue integrity, as well as a likely decrease in the transparency of the axillary areas and the continuity of the outer radius of the orbit near the affected area.
Features of treatment
The treatment plan is determined by the symptoms of the pathology, the results obtained during the X-ray examination, as well as the assessment based on the results of the medical examination. The priority task is to restore the intact bone structure. In situations where the anomaly is characterized by a displacement of the cheekbone, surgical intervention is prescribed, the purpose of which is to correct the position of the separated elements.
If the injury is not associated with displacement, it is possible to limit oneself to conservative therapy, which involves taking medications selected based on the indications of the clinical picture. The agents used include anti-inflammatory, analgesic, antibacterial substances, and neuroprotectors. In situations where there is a possibility of contact between the wound and a dirty surface, administration of tetanus serum is also recommended. Standard conservative treatment tactics include:
- Ensuring a calm state for a period of 10-14 days, with partial fixation of the jaw;
- Use of low-temperature compresses in the first 48 hours;
- Eating liquid foods and prescribing physiotherapeutic procedures.
In case of severe pain, analgesics are also prescribed. In the future, magnetic therapy, electrophoresis and UHF, as well as other procedural measures, can be used to relieve swelling and pain.
Surgical intervention involves the use of one of the author’s techniques, which include the Keene, Duchant, Dubov and Limberg protocols. Within each operation, the preparatory stage is important, during which the risk to the patient’s health is assessed, the appropriate type of anesthesia is determined, and an action plan is drawn up. The rehabilitation period involves the use of painkillers and antibiotics, as well as a course of physical therapy.
Rehabilitation after injury
In order for recovery after a comminuted fracture of the L1 vertebra or other area to be successful, you need to carefully follow the recommendations of an orthopedic traumatologist
and don't overload your body.
In the first six months, doctors require you to wear a corset, and also prescribe a complex of exercise therapy, individually selected for the patient. Serious activity is excluded - there is a danger of injury to the nerve roots by the displaced vertebra.
The further course of rehabilitation depends on what happens in the first months. A long recovery may be required with a gradual return of mobility to the limbs - some patients learn to walk again. In the later stages, massage, acupuncture and other similar physiotherapy techniques are prescribed.
Recommendations
Treatment of mandibular fractures involves long-term immobilization of the jaws, which becomes a significant psychological problem for the patient. The success of treatment directly depends on how closely both the doctor and the patient act together and take the process seriously.
For the entire period of healing of the fracture, the patient is prescribed a diet (maxillary table No. 1 and No. 2); food is allowed to be taken only in a creamy consistency (well boiled and passed through a blender). In most cases, opening the mouth is impossible, because... The patient has an intermaxillary rubber traction device installed. Food is supplied through tubes, tubes and sippy cups.
From the moment of double-jaw splinting or osteosynthesis, the splints are left in place for an average of 21–30 days. If the doctor has confidence in the favorable course of the recovery process, then it is possible to reduce the period of wearing the intermaxillary rubber traction.
Even after removing the splints, the patient cannot fully open his mouth for 1-2 weeks. To restore the function of the chewing and facial muscles, he is prescribed myogymnastics.
Consequences and possible complications
The worst consequence is complete or partial paralysis. Complications include loss of sensation in the limbs, decreased body mobility, and the occurrence of seizures or fainting. If the fracture is open and the necessary treatment is not provided, sanitary requirements are not met, the risk of large-scale necrosis in the patient is also dangerous. To prevent the consequences from leading to disability, you must strictly follow the doctor’s instructions. The doctor needs to regularly examine the patient, do MRIs and use other diagnostic methods.
Metal Kirschner spokes
This type of wire was first used to treat fractures of the lower jaw in 1933. Intraosseous insertion of these wires can be carried out both percutaneously (without incisions) and with soft tissue incisions.
In 1975 V.V. Donskoy used an original technique, with which he inserted a wire into the branch of the lower jaw through the mucosa without an incision, then carried out a reposition, and fixed it like a splint to the teeth or to a splint. Later, in 1988, Deryabin E.I. and Osipov V.Yu., and Yu.G. Kononenko and G.P. Ruzin proposed modifications of this method in 1991. Today there are many techniques where the wire suture is combined with knitting needles, staples, surrounding wire ligatures, etc.