A tenth of all injuries are fractures of the lower leg bones. Most of the latter are: fractures of the outer and inner ankle. Such injuries are possible when exposed to intense impact force that occurs during road traffic accidents, unfortunate accidental falls in combination with an unnatural position of the limb or foot. Considering that large bones are damaged, surrounding soft tissues and blood vessels may be involved. Such injuries are accompanied by severe pain and significant blood loss.
Anatomy of the lower leg bones
Anatomically, the free lower limb is divided into the thigh, lower leg and foot. The proximal (upper) part of the tibia is fixed to the thigh, forming the knee joint, and in the distal (lower) part the ankle joint. The bone structures of the lower leg are represented by large tubular bones:
- tibia, located medially (closer to the median plane);
- fibula, located laterally (further from the median plane).
Content:
- Anatomy of the lower leg bones
- Fractures
- Symptoms of shin bone fractures
- Help with fractures of part of the lower limb
- What not to do
- Conclusion
The distal epiphyses (lower ends) of both bones expand downward, forming the so-called medial (inner) and lateral (outer) ankles, respectively. These bones are connected to each other by fibrous joints, tibiofibular syndesmosis, interosseous membrane, and joints. The lower leg bones are often damaged in lower extremity injuries.
Possible knee injuries
The loads on the connected apparatus in the knee of athletes are very serious, so when they are exceeded, injuries occur. In this case, displacement is observed, and the shape of the joint changes due to swelling. This means that the injury is accompanied by damage to blood vessels and leakage of blood into the nearby area. The injury causes pain when trying to bend or straighten the leg at the knee. Ruptures inside simultaneously damage blood vessels and blood flows out faster. Swelling appears quickly. With ordinary bruises, the joint swells gradually.
Knee injuries that occur at home, on the sports field, require the application of a round bandage of cotton wool and gauze around the patella - it is fixed in a motionless state. Then cold should be applied. Putting pressure on your leg is strictly prohibited; you should immediately contact a medical facility and conduct a detailed diagnosis.
An unnatural position of the limb during a fall or stress can cause complete rupture of the ligaments, their cracks or sprains. A sharp pain appears, the lower leg deviates to the side, and subcutaneous hemorrhage can be observed. Joint swelling due to rupture of blood vessels appears within an hour.
The first thing to do when a ligament is torn or there is pain at its location is not to try to move the damaged area, if possible, apply ice.
People who subject themselves to physical activity sometimes experience a tear of the meniscus, the cartilage tissue located inside the knee. In this case, part of it may end up in the joint cavity and will interfere with moving the knee. It is impossible and not recommended to eliminate the consequences of such infringement on your own. The joint is fixed motionless and the person is taken to the hospital.
The displacement of the patella can be corrected on your own, after which you must apply a fixing bandage and take an x-ray in the hospital. If necessary, the surgeon will remove blood accumulated in the muscles and apply a plaster cast. If these measures are neglected, then due to weakness and poor healing of the ligaments, patellar dislocation may occur in the future.
A sprained leg is one of the most severe and painful injuries, after which surgery under general anesthesia will be required. The tibia moves back or forward, causing compression or rupture of blood vessels and nerves, which can lead to painful shock. Disruption of blood supply is dangerous because tissues do not receive oxygen and necrosis begins. Swelling and changes in the shape of the joint are typical signs of such damage. Movement of the joint becomes impossible due to a violation of the position of the bones relative to each other. Reduction requires general anesthesia and manipulation under sterile conditions. If a long trip to the hospital is necessary, and there are signs of ruptured blood vessels, then you can lightly pull the injured leg by the foot to try to move the lower leg closer to the natural position of the bones, but this must be done with extreme caution, since the procedure is extremely painful - a person with a low pain threshold may lose consciousness or experience painful shock. Transportation of an injured person is possible only if immobilized with a medical or homemade splint.
An intra-articular fracture is characterized by severe pain, changes in the shape and swelling of the joint, and internal hemorrhage. Swelling extends to the lower leg. This injury is extremely serious, as it requires the application of plaster along the lateral surface of the ribs to the very bottom of the limb, as well as along the inner side of the thigh to the foot. After this, the person is in a supine position until the plaster is removed.
With direct static pressure on the kneecap, a fall from a high point, or a push from behind, a crack or fracture of the patella may occur. It is accompanied by swelling due to ruptured blood vessels and pain. A dent can be seen in the fracture between the bone pieces. It is necessary to take the victim by the arms and help him walk to the nearest first aid station, where he will be given a splint. After this, the injured person can step on his leg and the next step is to contact a trauma surgeon.
When open, initially apply a clean bandage, trying not to change the position of the leg, so as not to move the bones even more. The person is placed on a stretcher and taken to the hospital in an ambulance. If foreign objects get into the wound, it is strictly forbidden to remove them yourself. It is necessary to carefully cover the wound with a bandage, trying not to touch the foreign object.
Fractures
A fracture is a violation of the integrity of the bone structure. Fractures of the lower leg bones, depending on the location, are divided into injuries in the area:
- proximal (upper) segment:
- diaphyseal (middle) segment;
- distal (lower).
Damage to the ankle segment (in the ankle area) is considered separately.
Fractures are also divided depending on the damage to the joint:
- periarticular;
- intra-articular.
Based on damage to the diameter of the bone, fractures are divided into: complete and incomplete.
Based on the presence of splinters and bone fragments, there are fractures:
- simple;
- complex (with the presence of fragments).
Damage to the shin bones is a common and quite serious injury. Therefore, it is important to properly provide assistance to a victim with such an injury.
How to use a splint on different parts of the body
Let's consider the rules of first aid for fractures depending on the area of injury.
Hand and fingers
In this case, a wire bus is used. The length is selected from the fingertips to the elbow joint. The arm should be carefully bent at a right angle (at the elbow). The tire is placed on a flat surface, and the hand is lowered from above. Next, the splint is fixed with a bandage, and the hand is suspended on a scarf.
Forearm
Use a wire or solid tire. The length is selected based on the following calculation: the upper third of the shoulder (above the elbow) – the base of the fingers. The hand is bent at a right angle, a small amount of cotton wool or gauze is placed in the fingers, which the victim should lightly squeeze with his fingers. The splint is applied to the outer surface of the arm and bandaged. The hand is fixed with a scarf.
Shoulder
A wire bus at least a meter long is used. The size is selected as follows: from the shoulder, across the back and to the base of the fingers of the opposite hand.
The injured arm is gently removed from the body, the elbow joint is bent at a right angle. A gauze roll should be placed in the armpit. A little more gauze or cotton wool should be placed in the palm of the hand (we lightly squeeze the victim with our fingers). The splint is placed along the back of the arm from the healthy shoulder through the back and to the base of the fingers. The splint is fixed with a bandage, and the arm is suspended on a scarf.
Ribs
Immobilization is done using a bandage or by wrapping the chest in a towel.
Foot and ankles
A wire splint is used, which is applied from the area just below the knee. The lower end of the tire is brought to the base of the fingers. The device is applied along the outer surface of the leg (the transition from the lower leg to the foot is formed at a right angle) and fixed with a bandage.
Shin
Two tires are used (wire or solid). One of them is applied on the outer surface of the leg, and the second on the back surface. An external splint is applied from the upper third of the thigh to the foot, where an L-shaped bend is made. Both devices are fixed with bandages.
Hip
Here you will need three tires: rear, outer and inner. Correctly installing such a structure can only be done with an assistant (or better yet, two), since the victim will have to be lifted (to place the rear tire). The outer tire is laid last. This is all fixed with bandages.
Pelvis
The victim is placed on a wooden board (moreover, all parts of the body are raised at the same time - this is difficult to do alone). A fabric cushion (from any available material) is placed under the knees. The hips are separated by approximately 25 cm, after which they are secured with a belt.
Spine
It also involves a wooden shield and a complex procedure for simultaneously lifting all parts of the body. A fabric cushion is placed under the fracture area (if the fracture is in the neck, a special collar or cotton-gauze structure is used).
Symptoms of shin bone fractures
Similar to any bone fracture, the main signs are:
- intense pain at the site of injury, sharply increasing with movement;
- inability to support the leg;
- deformation, unnatural position of the limb;
- redness or cyanosis of the skin, and if the integrity of the skin is damaged, there may be a wound, then they speak of an open fracture;
- local swelling, swelling of soft tissues;
- a feeling of crepitus (crunching) at the site of injury;
- lack of foot movement in case of a tibia fracture and injury to the main nerves of the lower limb (usually the peroneal nerve).
Fixing splints for an injured shin
The lower leg is the most commonly injured leg. A closed fracture occurs without damage to the skin; we see an abnormal displacement of the damaged part of the leg. When a fracture occurs, the victim feels severe pain, and swelling quickly appears at the site of injury. To avoid moving the bones further, it is absolutely forbidden to lean on a limb, even if the injured person can do so. With closed bone injuries, internal bleeding occurs, which can lead to the death of nerves, so the victim must be taken to a medical facility as soon as possible for surgery.
A fracture of the leg requires immediate immobilization of the damaged organ. It is more convenient to make a Kramer splint from scrap materials, which is modeled in accordance with the shape of the leg, placing fabric folded in several layers inside to cushion movement. The splint must be applied over the entire back surface of the leg, starting from the subgluteal fold, ending with the heel, then bent and ensure the immobility of the entire foot. For stronger fixation, it is advisable to use additional side splints made of plywood on both sides of the injured leg. They must be carefully bandaged to the limb.
Of course, you don’t always have the necessary equipment at hand, so you can improvise. If it is possible to find an easily bendable plastic material, it is placed on the sides of the leg, covering the heel and placing a board of a suitable size on the foot. This improvised splint should be bandaged from the knee to the toes.
An umbrella, a cane, a ski pole, branches - all this can serve as improvised tires in a difficult situation when nothing else is at hand. The most important thing is to immobilize and fix the ankle joint and foot.
If you could not find anything at all that would serve as a splint, then, as a last resort, you can fix the broken leg by tightly bandaging it to the healthy one using any fabric - a towel, scarf, piece of clothing.
If an open fracture occurs with damage to the skin and bleeding, then you must first stop the bleeding by pressing your finger on the artery above the fracture site. Then you need to apply a hemostatic tourniquet and be sure to record the time when it was applied. Broken bones that are visible from the wound should not be touched with hands, so as not to cause infection. You should carefully apply a sterile cloth over the wound surface and go to the emergency room.
The spiral upward method of laying the bandage is simple - it is a few circular wraps of the bandage on the ankle, then rise up, covering the underlying bandage by about two-thirds with each subsequent stroke. To model the shape of the leg, it is necessary to make bends along the front part of it. The bandage should be secured under the knee with several circular turns. Another dressing option is a scarf. It is done using a scarf, which is placed with the long side below the injury site, and the triangular side above.
If there is a special medical bandage with rubber fibers, it can also be used with the leg elevated, so as not to provoke stagnation of lymph, moving from bottom to top, since lymphatic vessels can be damaged. It is important to ensure that no folds form and that the bandage is not pulled too tight.
Help with fractures of part of the lower limb
First aid for a broken leg, main directions of action:
- Stop bleeding if present;
- if there are signs of arterial bleeding (scarlet blood may flow in a stream), a tourniquet is applied above the injury, taking into account the possibility of its removal during immobilization (applying a splint) and with a time stamp of application;
- treatment around the wound with an antiseptic, a sterile pressure bandage.
- Anesthesia
- the administration of analgesics is carried out intramuscularly, intravenously by specially trained people;
- local cold, apply ice, cold water bottles wrapped in cloth.
- Immobilization of a limb with fixation of at least two joints (knee and ankle):
- the injured leg is tied to the healthy one above and below the injury;
- splinting with improvised materials (boards, cardboard) wrapped in soft material. The main splint should run along the back of the leg.
General rules for applying splints
- The splint must be prepared before the application procedure begins. It will be impossible to adjust the tire parameters during the process (more precisely, it is possible, but dangerous).
- Immobilization is carried out in such a way that two nearby joints (above and below the fracture) are immobilized (fixed).
- If possible, cotton wool or gauze should be placed under the tire (along its entire length).
- If the nature of the injury allows, the limb should be brought to a position in which the muscles are least tense.
- For closed fractures, splints are applied directly to clothing and shoes.
- In case of an open fracture, it is strictly forbidden to change the position of the bone fragments.