Lower leg injuries often result in the victim having a confirmed fracture of the tibia. The reason for this is a force that exceeds the strength of the bone tissue. There can be many reasons for this condition, but the most common cause is a blow to the shin, a jump or a fall. Damage statistics increase significantly in winter and are often associated with extreme sports.
The peculiarity of this bone is that it is covered with a small number of tissues, especially in front. Along with the tibia, the tibia is often damaged. As we age, bone loses minerals and becomes brittle, increasing the risk of injury.
Anatomical features
The human tibia is a unique formation that includes the tibia and fibula. The bone has a triangular body, the anterior edge, its outer and inner surface can be felt under the skin without any problems.
At the top are the condyles of the tibia, which have articular surfaces that are part of the knee joint. The tibial tuberosity is located in front; the tendon of the quadriceps femoris muscle is attached to it. Below the lateral condyle is the articular platform of the fibula.
In the lower part, the tibia has an extension that forms the articular platform of the ankle joint. On the inside, the platform is limited by the ankle of the same name, and on the back by the edge. It is these formations that are susceptible to injury and often with displacement.
Causes
Damaging factors most often do not lead to a fracture of the tibia, but are only the cause of a crack, since this part of the skeleton is very strong. Integrity, even to the point of fracture, suffers in the following situations.
- A strong beat;
- Falling from a long distance;
- Injuries at work or during sports activities;
- Road accident.
Types of damage
Each case of injury is unique in its own way, which affects the specifics of treatment and rehabilitation. The following types of damage can be distinguished:
- with offset;
- no offset;
- driven in;
- helical;
- splintered.
In the upper third, injuries occur in the area of the condyles. In the middle third, fractures are more often comminuted, helical, and displaced. Non-displaced fractures in this region are extremely rare. The body may be damaged in the lower third; in this case, the fractures are impacted. Also in the lower third, the inner malleolus or posterior edge, which is part of the ankle joint, is damaged.
Open or closed injuries deserve special attention. A closed injury in which there is no damage to the skin is considered safe. With an open fracture, the bone and surrounding soft tissue become infected, which can result in osteomyelitis. Also, the fracture can become secondary open, in such a situation the skin is damaged by bone fragments. This happens when the victim is transported incorrectly or when an attempt is made to correct the deformity.
First aid
The success of treatment and the duration of the rehabilitation period directly depend on how correctly the assistance was provided to the victim. The following actions are mandatory before the ambulance arrives.
- Relief of pain symptoms using any painkillers;
- Immobilization of the leg using a splint. Any rigid objects, such as boards, can be used as a tire. The two parts of the tire should be fixed on the outer and inner sides. A cloth or bandage is used for fixation. The ankle and knee joints should be immobilized as thoroughly as possible
- Try to clean the leg of visible dirt in case of an open injury and disinfect the edges of the wound with an antiseptic. After such treatment, be sure to use a sterile bandage to cover the wound;
- Apply a tourniquet to the thigh area if necessary if bleeding is severe.
Symptoms
As a rule, making the correct diagnosis is often not difficult, especially if the fracture involves displacement of the tibia. To make a correct diagnosis, it is necessary to take into account the characteristic symptoms. Among them you can highlight:
- Pain at the site of injury, which intensifies when trying to stand on your leg, move it, or after lightly tapping the heel.
- When palpating the anterior crest of the bone, the pain intensifies.
- Also, upon palpation, it is easy to notice the deformation of the bone; fragments can crepitus.
- Upon visual inspection of the lower leg, the deformity is noticeable to the naked eye.
- Open fractures are characterized by the presence of bone fragments in the wound.
- When an oblique or spiral fracture occurs, a subcutaneous hematoma occurs at the site of injury.
Fractures in the upper third of the head of the fibula can cause nerve damage. In a situation where the small tibial nerve is damaged by fragments, the foot hangs.
Possible complications
Every parent worries and is interested in the dangers that damage to the tibia in childhood can entail.
It is known that the bones of a growing organism grow together faster compared to the bones of adults. Based on this, it can be said with a high probability that the undesirable consequences of such injuries are practically reduced to a minimum.
Complications can arise if the injury is incorrectly diagnosed, which will lead to improper bone healing.
In order to prevent such situations during the recovery period, it is recommended that the child undergo periodic radiographic examinations.
After a long time, if the child has complaints, a mandatory consultation with a specialist is necessary.
Diagnostics as confirmation of a guess
But despite the simplicity of diagnosis, sometimes questions remain. In particular, the amount of displacement, the presence of fragments, whether the fracture is associated with the joint cavity or not, whether additional examination is indicated . Most often, doctors prescribe x-ray examinations and imaging. The technique allows you to diagnose a fracture of the tibia and fibula. If the nerve is damaged, electroneuromyography is indicated.
If the fracture is in the condyle area or comminuted, an MRI is indicated. The technique allows you to clarify the type of fracture, especially if the fracture of the tibia is not displaced, invisible on an x-ray.
Fracture treatment
As with other skeletal injuries, the treatment process can go in two ways - conservative and surgical. But taking into account the fact that the bone is supporting and if it is damaged, displacement is observed, preference is given to surgery. The doctor will help you decide in more detail after all the examinations have been completed. It makes sense to consider all the advantages and disadvantages of each method.
Conservative option
On the advice of a doctor or due to fear of an upcoming intervention, a person choosing conservative treatment wonders how long to walk in a cast. There is no clear answer to this question; on average, the fusion time is approximately 3 to 3.5 months.
Immediately after admission, a cast should be applied if the fracture is not displaced, which is relatively rare. When there is displacement, the stage of conservative treatment or preparation before surgery is skeletal traction. The procedure is performed under local or general anesthesia, depending on the condition of the victim. A special knitting needle is passed through a certain area (often the heel), to which weights are attached. The victim spends about 6 weeks in this position, and then a plaster cast is applied for 4 months.
The disadvantage of the technique is the absence of rigid fixation of the fragments; traction does not allow them to be firmly held. Also, for the entire period of traction, the person remains virtually bedridden and it is not always possible to put bone fragments in their place, which requires surgery. However, before the operation, the ligaments and tissues are stretched, making comparison much easier.
Operation as a solution to the problem
As already mentioned, the tibia is a supporting bone; due to this feature, a person needs to be put on his feet as soon as possible. Surgery will help solve this issue. The main indication for it is the presence of multiple fragments or a displaced fracture. When each part of the bone is damaged, its own techniques are used, for which appropriate fixators have been developed.
If the upper or lower part of the bone is damaged, plate placement is indicated. If the middle part is damaged, a pin is installed inside the bone. The surgery will take place under general anesthesia. When installing the fixator, a special surgical approach is used. When placing a plate, the fracture is fixed in an open manner; placement of a pin can be done closed. However, if there are a large number of fragments, exposure of the fracture zone is indicated before placing the pin.
The fixators are designed for lifelong use, but approximately a year after installation, subject to consolidation of the fracture, they can be removed. In case of an open fracture, the doctor can install an external fixator or a device using the Ilizarov technique. Such devices reliably fix the fracture and enable the doctor to provide ongoing wound care.
The installation of plates and intraosseous fixators for open fractures is contraindicated until the wound has healed. There are also other contraindications.
Contraindications to surgical treatment
There are always situations where surgery can do more harm than good. They should always be taken into account by the attending physician before deciding on surgical intervention. Contraindications are:
- wound or abrasion at the site of the intended intervention;
- mental disorders of the patient;
- the presence of chronic decompensated pathology of the heart, lungs, liver and kidneys;
- severe diabetes mellitus;
- blood clotting problems (such as hemophilia);
- suffered strokes, heart attacks;
- if the person did not move independently before the injury.
Rehabilitation
The goal of the rehabilitation period is to accelerate the formation of callus and stabilize muscle tone.
These goals can be achieved through an individually designed course, which includes the following techniques:
- Massage;
- Three periods of physiotherapy;
- Exercise therapy.
Also, do not forget about a diet rich in minerals and vitamins. The diet should consist of a large amount of greens, fruits and vegetables, aspic, eggs, liver and seafood, lean meat and dairy products.
Recovery after damage
An important stage is rehabilitation after a fracture of the tibia, which consists of several stages. Just remember that rushing through the rehabilitation process is not the best choice. Therefore, its intensity should increase gradually. When walking, crutches are used first, and then a walker, a cane, followed by a full load.
Massage and gymnastics
Any procedure is performed under the supervision of the attending physician, exercise therapy instructor or massage therapist. Massage allows you to warm up the muscles and speed up blood circulation in the tissues. First, stroking is performed, followed by rubbing and kneading. Methods may be different, it all depends on the level and qualifications of the massage therapist.
Gymnastics helps ensure that rehabilitation after a fracture of the tibia goes faster by performing a special set of exercises. At the initial stage, exercises should be performed only under the supervision of a specialist, initially without load. Afterwards, on the recommendation of the exercise therapy instructor, the load can be added.
Advantages of tibial osteosynthesis surgery
The main advantage of such an intervention is the ability to create conditions for the fastest, full healing of a fractured leg bone. This is realized due to two conditions. The first is the reliable and most accurate fixation of all bone fragments in their places. The second is the process of early restoration of tissue functions with improved blood flow and acceleration of the regeneration process. Through the use of various structures, the bones are reliably connected, while the limb remains mobile.
Such operations are performed for complex fractures - if both bones are damaged at the same time. In addition, osteosynthesis of the left or right tibia may be recommended if the ankle area is involved in the process, if fragments are displaced and surrounding tissues are injured.