Fracture of the lower limb is a fairly common injury. In this case, the integrity of the bone structures and adjacent tissues is violated, so that the damage is massive.
There are many varieties of this kind of injury. Common signs are: swelling, severe pain, impaired mobility and support. The timing and methods of treatment depend on the type of fracture, severity and location.
Classification
Depending on the line of damage and the nature of the damage, the following types of fractures of the lower extremities are distinguished:
- Transverse. The line of damage is transverse to the length of the bone structure.
- Slanting. The line is at an angle.
- Longitudinal. The line is along the length of the bone structure.
- Screw-shaped. In this case, the fracture line has the shape of a spiral (this happens when the limbs are twisted sharply).
Depending on the number of fragments, they allocate:
- Polyfocal. There are more than 2 large bone fragments.
- Splintered. Several fragments are separated.
- Shattered. There is a large amount of small debris.
Depending on the nature of the injury, there are:
- Compression. The bone is compressed, cracked, flattened, deformed.
- Knocked in. In this case, one chip is embedded in another.
- Tear-off. A fragment is separated from the bone structure.
Depending on the level of the fracture on the lower limb, they are distinguished:
- Fracture of the bones of the lower leg. This includes injuries to both the main part of the bone and its edges.
- Fracture of the bones of the foot. In this case, the tarsal, metatarsal, and phalanxes of the fingers are also damaged.
- Fractured femur. This includes the head and neck of the femur.
Injuries to the distal and proximal ends of bone structures are intraarticular and periarticular. In the first case, the ligaments, capsule, cartilage are also damaged. In parallel, there may be a dislocation or subluxation. Periarticular fractures are usually located in the area between the end of the articulation and the diaphysis.
ICD-10 code
Fracture of the lower limb, according to the ICD-10 classification adopted in 2016, belongs to the general class "Injury, poisoning and certain other consequences of external causes (S00-T98)". But there are a lot of bones in the lower limb, so there are several subclasses.
Fracture of the femur is combined with some injuries of the hip joint. It is included in the subclass "Injuries of the hip and thigh area". In this block itself, the fracture has the codeS72.
ICD-10 code for ankle fracture - S82. It is included in the block "Injuries of the knee and lower leg". In addition to these fractures, this includes joint damage.
Fractures of the foot have the code S92. They belong to the large block “Injuries in the ankle and foot area.”
All of these blocks have many subcategories, which include injuries to various bone structures.
Symptoms
When a fracture of the lower limb, the following general symptoms are distinguished, which appear in most cases:
- pain at the site of injury, it has a dull and aching character, does not go away;
- pain, if a person tries to step on the foot, there is a sharp and throbbing;
- limited mobility;
- blue skin at the site of injury, swelling, symptoms of hematoma;
- crepitus, which occurs due to the fact that the debris rub against each other;
- characteristic sharp sound, similar to a crunch, occurs at the time of injury;
- unnatural mobility at the site of injury, but this only applies to tubular bones, that is, the femur, tibia and metatarsal;
- bone is visible if there is an open fracture;
- the ability to feel the wreckage if there is a shift;
- unnatural leg position;
- increased body temperature;
In addition, the length of the affected limb may decrease compared to the he althy one. When the patella is fractured without displacement, swelling occurs. There is also a complete disruption of the functioning of the articularjoints. If there is a fracture of the toes or the entire area, then the functions will be impaired only partially, and the leg will swell slightly.
Signs of a fracture can be seen with other injuries. For example, this applies to cracks or dislocations. If the temperature rises, the sore spot swells and turns red, this indicates the development of inflammatory processes. Be sure to tell the traumatologist about such symptoms.
As for the closed fracture of the bones of the lower extremities, the characteristic symptoms are as follows:
- leg shape changes a lot;
- crunch on palpation;
- mobility is unnatural;
- blackening of the skin at the site of injury after some time (caused by blood stasis).
It is usually difficult for a person who has not received a fracture before to determine such an injury. But you need to get to the emergency room as soon as possible.
An open fracture is considered even more dangerous, as there is a possibility of infection in the wound. The skin in this place is very hot. The integrity of the tissue is broken. The injury is characterized by bleeding and swelling. The main difference is that the bones protrude on the surface of the skin. Because of this, aching pain is felt in injured tissues (including muscles).
Reasons
The following causes of mechanical damage are distinguished:
- strike with a heavy object;
- falling from a great height;
- traffic accident;
- an accident of any kind;
- during sports;
- when injured by a firearm;
- violation of safety rules during childbirth (injury to the newborn).
There is another group of factors that reduce the density of bone structures, which increases the likelihood of a fracture:
- osteomyelitis;
- bone tuberculosis;
- cancer diseases;
- Fibrous type dysplasia;
- genetic pathologies;
- polyarthritis;
- osteoporosis.
Most diseases that can lead to bone loss usually develop with age.
First Aid
First aid is an important stage of pre-medical treatment. Follow these steps if the victim has a leg injury:
- If there is heavy bleeding (that is, vessels are damaged), then a tourniquet is required. But you need to keep it no more than 2 hours. Always keep track of the time.
- If there is respiratory or heart failure, then use anesthetics to treat the wound and take analgesics to reduce pain.
- Immobilize the leg and transport the victim to the hospital.
All these actions must be completed as quickly as possible.
Rules for applying a tourniquet
With an open fracture, there is a risk of severe bleeding. When applying a tourniquet, the following rules must be observed:
- Before applying the tourniquet, raise the leg. Just 5 minutes is enough. This is required for the outflow of blood in the veins.
- Under the tourniquet itself, place a gauze bandage or bandage. You can put it on clothes.
- A tourniquet is required on the middle of the thigh.
- The first 2 times you need to wrap the tourniquet very tightly.
- In warm weather, keep the tourniquet for no more than 1.5 hours, and in cold weather - up to an hour. After this time, you need to loosen it, but pinch the artery with your fingers. Enough 15 minutes. If after this the bleeding has not stopped, then you need to apply a tourniquet above or below the previous place. For a child, a tourniquet is applied for no more than an hour.
If all actions are performed correctly, the bleeding stops. The skin below the tourniquet will be lighter and cooler, and the pulse will not be felt. The leg may become numb.
Rules for fixing the leg in case of a fracture
When a leg is broken, it must be fixed. To do this, it is necessary to accurately determine the location of the damage. If the fracture is closed, then you can find out by pain and swelling in the area of injury.
Before all actions, it is required that the victim take painkillers. The person needs to be calmed down and everything explained. You can not take off his clothes or shoes. If the pants are too tight and interfere with the inspection of the affected limb, then the material will have to be cut.
The Dieterichs technique is used to fix the legs. But before all the actions, it is required to overlay the limb with a soft material, cotton wool. This will prevent bedsores. With an open type of fracture, a tourniquet is applied, but so that it does not interfere with the splint, and it would not be necessary to disassemble the entire structure.
Forfixing the legs use a frame made of metal or wood. If the fracture is obtained in the cold season, then the limb must be additionally insulated. In case of a fracture of the lower leg, fixation is performed according to the Cramer method. This secures the back of the leg.
Diagnosis
Diagnosis includes the following:
- survey (determine the situation in which the injury was received);
- palpation of the affected area;
- radiography;
- MRI.
The last 2 research methods help determine the exact location of the debris and the condition of the bones.
Treatment
Treatment depends on the severity of the pathology. Hospitalization should be done as soon as possible. Drug treatment is not included in the therapy, but the doctor may prescribe painkillers, as well as vitamin preparations with a high content of calcium.
Treatments are as follows:
- closed bone reduction;
- operation with minimal tissue incisions;
- plaster cast.
Gypsum for a broken toe or any other bone structure of the lower limb is applied for any type of open or closed injury. The term of wearing such a design depends on the severity of the damage. You can also use plastic plaster on the leg. But this is determined by the treating doctor. In case of a fracture of the calcaneus, the orthosis ideally helps to relieve the injured limb.
In addition, they use the technique of stretching the bones so that they remain in the right places if there are fragments. It takes up to 2.5 months.
Surgicalintervention is prescribed in the following cases:
- open fracture;
- comminuted fracture;
- failed extraction and closed recovery.
The operation fixes the bone fragments better, so recovery will be faster.
Hip fracture
Fracture of the femur is a severe injury that is accompanied by bleeding. Complications include bedsores and congestive pneumonia. In addition, a fat embolism is possible in the first 3 days.
Fracture of the femoral neck refers to intra-articular. It most often occurs in older people with osteoporosis. The fracture occurs when you fall. The limb will be turned outward. In the supine position, the patient will not be able to lift the heel.
An injured limb looks shorter than a he althy one. Swelling is small. The femoral neck will not heal well due to insufficient blood flow. As a rule, a surgical operation is performed - bone autoplasty, osteosynthesis, or endoprosthetics.
The trochanteric fracture belongs to the group of extra-articular. It usually occurs in people of working age. The symptoms will be the same as if the integrity of the femoral neck is broken, but they are more pronounced.
The swelling is very strong, as is the pain. But such fractures heal well even without surgical intervention. Within 2 months, skeletal traction is required, and then a plaster cast. If you need to recover quickly, then an operation is performed - osteosynthesis.
Shaft fracturehips are usually caused by an accident, a fall, or an accident at work. As a rule, with such an injury there will be a displacement due to the fact that the muscles pull and unfold the fragments. Severe pain is felt, swelling, bruising appears. The leg is shortened and the hip is deformed.
A strong painkiller is needed first to prevent shock. After that, an extract or osteosynthesis is used.
Condylar fractures are intra-articular. They usually appear in older people. The most common cause is a fall or a blow. There is a sharp pain in the knee and lower thigh. Movement is limited, it is impossible to rely on a limb. The knee area swells, hemarthrosis develops. If there is an offset, then the lower leg is deflected.
For treatment, traction or plaster is used. If it is not possible to combine the fragments, then osteosynthesis is performed.
Shin fractures
Shin fractures are among the most common. They occur due to an accident, a strong and vigorous impact on the bone, or a fall from a great height. The only exception is an ankle fracture, which usually occurs when the foot is twisted. In this case, there is also a rupture of the ligaments.
Fractures of the condyles of the tibial bone structure are intra-articular. They occur in most cases due to a fall from a height. It can be damaged as one condyle (external or internal), or both at once.
Hemarthrosis develops in the knee, swelling appears. Movement is difficult. For treatmentperform puncture and anesthesia. Then plaster is applied, and if there is a displacement, then traction, osteosynthesis or the Ilizarov apparatus are used.
Diaphyseal fractures of the bone structures of the lower leg, if both are damaged at once, are considered a very serious injury. Most often there is a displacement that requires surgical intervention. After reposition, plaster is applied.
Fractures of the bones of the foot
Fractures of the calcaneus usually occur when falling from a great height. Be sure to know where the talus is. This is one of the bony structures of the tarsus. It connects to the heel bone.
Fracture can be both intra-articular and extra-articular, with or without displacement of fragments. In the place where the talus and heel structures are located, swelling and severe pain appear. Can't rely on. The heel is greatly expanded. If there are no displacements, then plaster is applied. Otherwise, a closed reduction is carried out. In severe cases, they can mount the Ilizarov apparatus.
The sphenoid bones of the foot are 2 tarsal structures. Their fractures are very rare. It can occur with a direct blow, fall, tuck. The tissues in the area of the sphenoid bones of the foot swell, there is pain, problems with movement and support. Will have to wear a cast until 1.5 months.
When fractures of the bones of the metatarsus and fingers, which is a fairly common injury, often the appearance of confusion. The distal region of the foot swells, pain appears. Leaning on the leg is very difficult.
Treatment involves the use of a plaster cast. If there is an offset, then firstrepositioning takes place. Fixation with knitting needles is carried out in the case when it is impossible to fix the breaks in the desired position.
In any case, you can't do without the help of specialists.
