Fracture of the lower leg bones with and without displacement - closed and open fracture, treatment, first aid

Treatment of tibia fractures is one of the most common tasks in the life of a traumatologist. Fractures of the tibia are most often high-energy, that is, they occur as a result of a fall from a height, traffic accidents, or twisting of the body around a fixed tibia (for example, when the leg is stuck between stones or is fixed by a ski boot and the body is twisted to the side). Low-energy fractures are possible in grandparents with osteoporosis. Most often, both bones of the leg are broken at once. Depending on the location where the bone is broken, fractures of the upper middle and lower third of the tibia can be distinguished; in addition, fractures of the articular ends forming the knee and ankle joints, ankle fractures, and so-called pilon fractures can be distinguished separately, but we will tell you about this in other articles.

What is a tibia fracture?

A tibia fracture is an injury to the tibia or fibula bones, and sometimes both of them, due to the excess of a load on them that is greater than they could withstand. The injury is quite common, and on average accounts for approximately 20% of the total number of fractures.

The lower leg is represented by two tubular bones, each of which has a body and two ends. The tibia connects to the femur at the top and to the bones of the foot at the bottom. During a fracture, most often the bone, both large and small, breaks in the middle. Sometimes injuries are accompanied by complications. Most often, people with this problem come to the emergency room after a car accident. Although the cause of a fracture can be any direct and strong blow to the bone. Sometimes an additional factor that plays a role in the formation of a fracture is a disease: sarcoma or osteomyelitis.

There are several types of tibia fractures, depending on their location:

Injuries of the neck and head of the fibula, as well as fractures of the tuberosity and condyles of the tibia. When these areas are affected, they speak of fractures of the tibia bones in the upper part.
If the diaphyses of both bones or one of them are injured, then they speak of fractures of the tibia in its middle part.
If an ankle fracture occurs, then they speak of a fracture of the tibia in the lower part. This type of injury is the most common and accounts for more than 60% of the total number of all fractures in this area.

Also, the injury can be open or closed, with or without displacement. Depending on its nature and complexity, the method of treatment, as well as its timing, will depend. The severity depends on whether there is damage to the surrounding soft tissue, whether joints, blood vessels, nerve endings and tendons are injured. Minor injuries are usually caused by careless movement on the street, ice skating, or industrial accidents. Severe injuries are the result of falling from a height, participation in an accident, etc.

Contraindications

There are a number of contraindications for performing external osteosynthesis of the tibia or its other variants. These include:

severe lesions, disorders of the nervous system;
severe damage to the surrounding tissues of the leg;
osteoporosis;
infectious diseases, fever, intoxication;
immunodeficiency states;
allergy to anesthetics;
exacerbation of any chronic pathologies.

The doctor may determine other temporary or permanent contraindications that will limit the intervention.

Displaced tibia fracture

A displaced fracture of the tibia is most often formed as a result of a direct blow in the transverse direction. In this case, fragments are formed that can move in different directions. The displacement can be lateral, peripheral, angular, with divergence, wedging, and insertion of broken parts.

This type of injury is characterized by the following symptoms:

The length of the leg will become shorter compared to a healthy limb. Most often, this does not even require additional measurements. The difference will be visible to the naked eye.
The movement of the lower leg can be carried out in an unnatural direction for it.
Sometimes the fragments can shift so much that they break through the soft tissue and skin.
Sometimes a depression or depression forms in the place where the movement of the fragments occurred.
Pain is a constant accompaniment of any fracture, as well as a crunch during injury.
At the site of the fracture, bruising and swelling form, with a pronounced impairment of the motor function of the limb.

Most often, the condition of a person who has suffered a displaced fracture of the tibia is still satisfactory, but sometimes traumatic shock can occur.

Treatment will begin with the mandatory comparison of the resulting fragments. This is necessary to give the limb the correct shape and its subsequent normal fusion. Reposition is carried out either manually or using special tools. To do this, the victim must be placed on his back and anesthetized with appropriate drugs. After this, one doctor holds the patient by the thigh, and the other grabs the leg so that one hand firmly holds the heel and the other the back of the foot. Then a slow and systematic stretching of the muscles pulled to the site of the fracture is carried out, and with the help of palpation the position of the fragments that have been displaced is determined. After the reduction is completed, the doctor will definitely check the length of the limb and compare it with the length of the healthy leg. If the parameters converge, then you can begin to apply a plaster cast.

For control, the patient will have to undergo an x-ray again after 10 days so that the doctor can make sure that the fusion of the leg bones is happening normally. Sometimes the skeletal traction method can be used. An operation is required when closed reduction cannot be performed due to the fact that fixation of fragments requires the use of metal structures.

Features of the treatment of elderly people, as well as young patients who have received a displaced leg injury, are that they must be left immobilized for as short a period as possible. That is why you should choose the least traumatic method of treatment.

Fracture of the tibia without displacement

A fracture of the tibia without displacement is a serious injury, but it is somewhat easier than a similar injury, but with fragments that have begun to move. Often such fractures are subperiosteal, that is, when the periosteum, which is intact on top, holds the fragments remaining inside. The age group that is most likely to experience this type of injury is children. This is explained by the fact that their bones are more elastic compared to the bones of adults. Doctors often refer to a non-displaced injury as a greenstick fracture.

Symptoms of a tibia fracture without the formation of fragments are as follows:

Swelling at the site of injury.
Painful sensations.
Shortening of the limb, but not clearly expressed. It can only be noticed by taking certain measurements.
Hematoma formation.
Difficulty in mobility.
Irradiation symptom. When pressing on the leg anywhere, the pain will be localized exactly where the fracture occurred. It is this symptom that helps in most cases to make the correct diagnosis yourself.

Often, with such an injury, people try to continue moving on their own, because they believe that they just have a severe bruise. Such carelessness is dangerous because, as a result, the fragments held by the periosteum can begin to move. This will aggravate the severity of the injury and prolong the treatment time. Therefore, at the slightest suspicion of a fracture, you should see a doctor. Because without an x-ray examination, it is very difficult to diagnose such an injury.

In case of a closed isolated fracture of the leg bones without displacement, reduction is not necessary.

It will be enough to apply a plaster cast, which will be placed in the area from the foot to the knee, or slightly higher - to the middle of the thigh:

If the fibula is broken below, a cast will be applied to the knee.
If the fracture is localized in the middle or upper third of the bone, then the application of a plaster splint is indicated. It can be removable. Fixes the fracture rigidly, without the possibility of movement.

Most often, immobilization lasts about three months. If the diaphyses of both bones were broken, the period may increase to 4 months. After removing the cast, the most common procedures are indicated: exercise therapy, massage, physiotherapy. The opportunity to begin work duties will appear after 14–30 days after the plaster is removed.

Forecast

If you seek help from a specialist in a timely manner, the prognosis is favorable. By following the doctor's instructions and taking the necessary medications, complications most often do not occur. If proper therapy is absent, the crack may expand, which will lead to a full fracture, displacement of bone fragments, improper fusion or deformation processes in the lower leg with disruption of the physical functions of the lower limb. Also, a hematoma formed at the site of injury can become infected, and this, in turn, can provoke a phlegmonous process or even gangrene. Don't expect the crack to heal on its own. It is urgent to contact a specialist to undergo an examination, make a correct diagnosis and receive appropriate treatment.

Open and closed fracture of the tibia

Closed fracture of the tibia

A closed fracture of the tibia is a very serious injury. It is characterized by the fact that damage to tissues located far from the bones does not occur, just as there is no contact of the damaged area with the external environment.

With closed fractures, the bones of the ankle and the condyles of the tibia may be damaged, its tuberosity may be torn off, the head of the fibula or the diaphysis of both bones may be damaged. If the far end of the tibia is damaged, the fracture can be either intra-articular or periarticular.

Symptoms of a closed fracture are as follows:

Sharp limitation of limb mobility. The person will simply not be able to lift his leg up.
If an attempt is made to raise the shin slightly, the end of the tibia (proximal) will protrude under the skin.
If, upon palpation, crepitations are heard, that is, characteristic crunching sounds, then this symptom clearly indicates the presence of a closed type fracture. In this case, you should not cause the sound on purpose, since such manipulations can lead to the displacement of fragments that may be present under the skin.

If in patients who have not reached retirement age, closed fractures are more often split, since the bones have a solid structure, then in older people the injuries are depressed, which occurs due to the high porosity of the bone tissue.

Diagnosis, as a rule, is not difficult for an experienced doctor and palpation examination is enough for him to determine a closed fracture. This is explained by the fact that the bones of the lower leg are located close to the skin and are not covered with a thick layer of muscle. However, it is impossible to do without X-ray examination. It will reveal the characteristic features of the fracture and possible displacement of fragments. Pictures must be taken in several projections, most often in two.

Treatment is carried out in a hospital setting. The tasks that doctors face are restoring bone integrity, relieving pain, returning the patient to normal life activities, which will proceed without restriction of movements.

The following methods are used:

Extension, which involves stretching the damaged bone. It can be skeletal or adhesive.
Fixation method. It is implemented by applying a certain type of plaster cast.
An operative method that involves intraosseous fixation using either metal plates, or metal knitting needles, or metal rods, or metal wire.

But, naturally, before one or another method of limb fixation is applied, it is necessary to reposition the fragments, if any. A Delbe bandage is often used to immobilize the fracture site. It has a number of advantages over conventional plaster, since after its application a person can move the knee and ankle joints if they are not damaged. This bandage makes it possible for outpatient treatment, without tying the patient to a hospital bed.

Open fracture of the tibia

If open fractures of other bones of the human skeleton are a relatively rare phenomenon, then with a fracture of the tibia they occur much more often, which is quite explainable by its anatomical features. The tibia itself is located directly under the skin, so it often breaks through it with sharp edges, which leads to an open fracture. In addition, if the injury was received as a result of an accident, then it can be heavily contaminated. This circumstance significantly complicates her character.

The main symptoms of open fractures of the tibia include:

Bleeding.
A gaping wound with bones that have broken through the skin and soft tissue.
Traumatic shock.
Limitation of mobility.
Sharp pain.
Weakness and dizziness, up to loss of consciousness.

Open injuries with the formation of fragments are the most difficult to treat. This occurs because nearby nerves and blood vessels are damaged. Sometimes the question may even arise about the need to amputate a limb.

The deciding factors are:

How extensive is the area of tissue damage?
What is the degree of disruption of the blood supply to the foot and leg.
No pulsation.
Area of damage to the skin. If it is very extensive and it is not possible to replace it, then this will be a decisive factor speaking in favor of amputation of the limb.

The longer it takes to decide to amputate, the greater the risk that gangrene may develop. Any open fracture must be treated as quickly as possible. After this, the introduction of several drainages is indicated. It is more expedient to pass them through the holes made for this purpose. The wound should be fixed with a rare suture.

When an open wound does not form immediately, but as a result of a puncture by the edge of a fragment and is secondary, then after treatment with antibacterial compounds, sutures are immediately applied, and there is no need to insert drainage.

When a secondary wound is accompanied by large-scale damage to the skin, its transplantation is necessary. It cannot be separated from the fabric for the purpose of stretching. Another important feature in case of an open fracture is that the fragments must be set immediately after treatment with disinfecting compounds, but in no case vice versa. Because this can lead to blood poisoning. In modern medical practice, the use of osteosynthesis is increasingly indicated, which is also carried out after disinfection of an open injury.

If the fracture is transverse, then one reduction will be sufficient; as a rule, the fragments are held securely. If the fracture is oblique or helical, then up to two sutures should be placed with fixation on the wire.

Also, when treating open fractures of the tibia, there is a tendency to insert a special metal rod into the bone. It is empty inside and has holes on the sides. Through it, special medicinal substances, including antibiotics, will be supplied to the bone marrow canal. After its installation, plaster application is indicated.

The prognosis for limb recovery after an open fracture of the tibia largely depends on how well the initial antiseptic and antibacterial treatment was carried out. Proper immobilization of the limb plays a significant role. Treatment after applying a cast is carried out similarly to therapy for a closed fracture, but it is natural that open injuries heal over a longer period of time.

First aid for a broken leg

There is a certain order of actions that must first be provided to a person who has received a fracture of the tibia:

First, he needs to be helped to overcome the pain symptoms. To do this, it is necessary to give the victim a painkiller. Any drug that is available is suitable for this. Suitable agents include: Pentalgin, Analgin, Nimesulide, Sedalgin, etc. If you have medical skills, you can carry out an intramuscular injection, which will act much faster. Lidocaine, Novocaine, Ultracan and other drugs are used as suitable drugs. The closer to the fracture site the injection is made, the stronger the analgesic effect will be.
Then the shoes should be removed from the limb that was injured. This is done so that as a result of the resulting edema, blood circulation in the limb is not impaired. Also, tight shoes will definitely lead to the fact that the pain in the foot will only intensify. If in order to take off the victim’s shoes it is necessary to move his leg, then this should be done according to certain rules. It is important to hold the limb in two places: at the ankle and knee joint.
If there is bleeding, it must be stopped, and the edges of the wound must be treated with any available antiseptic. In order to determine the extent of the damage, it is necessary to cut the layer of clothing under which the injured limb is located. If bleeding is present, it is important to determine the degree of its danger. If blood flows out in a powerful stream, this is a sign of damage to a large vessel. To stop it, you will need to apply a tampon to the wound, which can be made of cotton wool or a bandage. A bandage should be applied over the resulting layer, but it should not be pulled too tightly. It is not recommended to apply a tourniquet for such injuries. This is explained by the fact that the muscles underneath will be stretched, and if fragments are formed during the injury, they will undergo even greater displacement. In addition, there is a risk of damage to other vessels by sharp edges and increased bleeding. If blood does not flow out of the wound, but simply oozes slowly, then there is no need to apply a tampon. Antiseptic treatment will be enough. Suitable products include: Hydrogen peroxide, Potassium permanganate, Zelenka or Iodine, as well as any alcohol-based liquid. Only the edges of the wound are subject to treatment; you cannot pour any composition into it.
The leg should be fixed by applying a splint. This is one of the most important stages of first aid. The shin will need to be securely fixed. The application of a splint is necessary to ensure that the injured limb is immobilized during transportation, since any movement of it can aggravate the injury, damage nerves and blood vessels, ligaments and muscles. To apply a splint, you will need fabric bandages and any two straight and long objects, such as an umbrella, a board or a strong stick. They will need to be placed on the outside and inside of the leg. The clamp should end at the heel and start approximately from the middle of the thigh. Then they need to be bandaged to the leg in several places, but always in the knee and ankle joint. The wider the bandage, the more secure the fixation will be. In this case, the victim should be in a lying position.

After these activities are completed, you must go with the victim to the nearest medical facility or wait for the ambulance team to arrive.

Treatment of a tibia fracture

Fractures of the lower leg bones can occur in different places. In this case, fracture therapy techniques are used for treatment, but in different combinations. However, the sequence of medical care is always the same.

Therefore, several principles for treating a tibia fracture can be formulated:

Initially, the bone fragments are always repositioned. It is performed under local anesthesia and only by a surgeon. This is done using skeletal traction, or during surgery.
Then the bone fragments must be securely fixed using one of the most suitable devices.
Immobilization of the limb is then required. For this, a plaster cast or a specialized apparatus is used.

Naturally, in a given case, specific devices are used that are optimally suited for the treatment of each patient. The choice remains with the traumatologist or surgeon.

Immobilization for a tibia fracture

It is important to perform immobilization of the lower leg according to several rules:

When applying a splint, it must be fixed in such a way that both joints: the knee and ankle are immobilized.
Before the splint is applied, it should be adjusted to the size of the broken limb. This must be done not on the injured person, but on yourself, so as not to cause him unnecessary suffering and not to aggravate the severity of the fracture.
Do not apply a splint to a naked body. Clothes, if necessary, should be cut, but not removed.
If there are sharp edges and protrusions, they must first be wrapped in soft cloth.
If the fracture is open, then the splint is not applied on the side where the protrusion of the bone is visible.

It is better if immobilization is carried out by two people. One person should carefully hold the limb, and the second should bandage the fixator. This must be done carefully, but firmly. If the toes have not been injured, then they should not be bandaged. This will allow you to control blood circulation and, if it is disrupted, loosen the bandages.

Sometimes it happens that it is not possible to find any available material. Then you should bandage one leg to the other.

Surgery for a broken leg

Surgical intervention for a tibia fracture is not required very often and there are clear indications for it, among which are the following:

If reposition is not possible without opening, using conservative techniques.
If there is a double fracture of the tibia and significant displacement of the fragments is observed.
If the position of the soft tissues is greatly changed.
If there is a high risk of a closed fracture turning into an open one, or if nerves and blood vessels are pinched by the resulting fragments.
Open nature of the injury.

When there is a fracture of both bones of the leg and surgery is needed, it is performed on the more massive bone, since the smaller one will subsequently heal on its own. When performing reposition, preference is given to fixing fragments with metal structures in cases where the bones do not heal or bone pseudarthrosis is detected. In other cases, it is advisable to use specialized devices, for example, Tkachenko, Ilizarov, etc.

On topic: 12 folk methods for home treatment

Rehabilitation period

After surgery, it is important to strictly follow all doctor’s recommendations for rehabilitation. This is important for normalizing blood circulation, which speeds up healing and reduces the risk of secondary complications. Physiotherapy, exercise therapy, and sets of special gymnastics exercises are indicated to prevent joint contractures and weakening of muscle tone. In addition, early activity prevents congestive pneumonia and thrombosis.

Massage courses that are carried out at certain stages of rehabilitation are useful. During treatment, it is necessary to take control images that allow you to evaluate the dynamics of bone restoration.

Our clinic performs osteosynthesis of the lower leg and you can find out the price of the operation from the doctor at a preliminary consultation. Doctors at the clinic carry out various types of interventions, even in complex cases. It is important not to delay your visit if you need surgery. In addition, in our clinic you can undergo preliminary examination, preparation for surgery and post-operative rehabilitation.