Fracture of the tibia is a common violation of the integrity of long bones. Along with this injury, as a rule, there is damage to the fibula. Most hip fractures are caused by accidents and falls from great heights. It is not difficult to understand that a person has broken his leg, especially when it comes to an open type fracture of the tibia. Learn about the classification of leg injuries, how to treat them and possible complications in this article.
Anatomical structure of the lower leg
The bone we are going to talk about today is tubular. In comparison with other fragments of the skeleton, it has a significant length and volume. The tibia consists of a body and two joints at its ends. It is this part of the lower limb that is involved in the structure of the knee and ankle joints. In this case, the ankle is formed due to the distal fragment, and the knee is formed due to the participation of the proximal end.
Next to the tibia is the fibula. It is located in the back of the limb and has similar heads at both ends (proximal and distal), connected with flat joints, which limits sliding in this part of the lower leg.
The tibia and fibula are not fused together, while the latter is less mobile, since it does not participate in the formation of the knee joint. A fibrous membrane stretched between two bones guarantees high strength for them and protection from light blows and damage.
Fractures of the tibia in the tenth revision of the ICD
Injuries of the lower leg in the current edition of the International Classification of Diseases are designated by the general code S82. This subsection includes various types of damage, each of which is marked with an additional number. In addition to a fracture of the tibia, ICD codes are attached to injuries of the ankle and knee, which belong to the group of intra-articular.
Subcategories of section S82 are required for optional application in the presence of additional characteristics of the state when it is impossible or impractical to carry out multiple coding. To accurately identify the type of tibial fracture, the ICD-10 clearly distinguishes between open and closed tibial injuries.
Each patient in a personal medical history or disability certificate cansee the entry with the cipher. The injury coding system allows you to keep statistics and analyze cases of recovery or complications, including those after fractures of the tibia. ICD-10 is used by all member countries of the World He alth Organization.
Types of injury
ICD established the official classification of tibial fractures. The code S82.0 is assigned to damage to the patella. Code S82.4 is reserved exclusively for fibula fractures. Code S82.1 is assigned to proximal tibial fractures, including damage to the condyles, head, tuberosity, plateau. To clarify the diagnosis, use S82.5, which refers to damage to the internal bones of the ankle or ankle, and S82.7, to determine multiple fractures.
Depending on the site of injury, a fracture of the tibia can be of several types. Doctors distinguish the following types of violations of the integrity of the lower leg:
- partial, in which there is no significant harm to he alth and well-being;
- complete - in this case, a fracture of the bone structure occurs, affecting muscle tissue, ligaments.
In addition, there are open and closed fractures of the tibia. In the first case, the injury is isolated, in the second case, displacement occurs. A closed fracture is more dangerous for the he alth and life of the patient, because when broken, sharp bone fragments can damage not only the surrounding soft tissues, but also blood vessels.
Depending on the vector of the force impact on the lower leg, there are other typesdamage:
- stable is a fracture of the tibia without displacement, that is, the crushed parts remain in their original position, without provoking ruptures of muscle fibers, tendons and ligaments;
- oblique - in this case, the fault runs at an angle;
- longitudinal - the line of damage is visible to the naked eye;
- helical - a fairly rare type of injury in which a fragment fragment turns 180 ° from its natural position.
Fractures of the legs are diagnosed with the same frequency as injuries to other parts of the body. At the same time, such injuries have a number of specific features.
How to recognize a fracture: characteristic symptoms
The tibia is large in size, so it is almost impossible not to notice the damage. Immediately after the injury, the victims feel a sharp pain in the lower limb.
Severe pain is not the only symptom of a tibial fracture. Patients describe their condition as follows:
- unable to step on foot;
- visually noticeable deformity and shortening of the injured leg in relation to the he althy limb;
- shortening of an injured limb in relation to a he althy one;
- violation of tissue sensitivity.
When an open shin injury occurs, hemorrhage occurs, and fragments of bone can stick out of the wound. Severe swelling is evidence of a distal tibial fracturelimbs.
Pain in a fracture of the lower leg will increase dramatically when trying to lean on the leg. Due to the increasing pressure on the heel in the standing position, the mobility of the limb is minimized. A fracture can also be recognized by the unnaturally curved position of the limb.
Signs of damage in a child
If there is no doubt about the diagnosis with an open injury of the lower leg, then examination is indispensable to confirm a closed fracture of the tibia. Compared with adults, damage in children is less pronounced. Usually the damage is not visible from the outside, while the victim will complain of discomfort in the leg. It is difficult for a child to step on an injured leg, just like an adult.
At the same time, the pain syndrome in children is significantly different from the manifestations of a fracture in adults. If the injured limb is at rest, the pain may subside for a while or be mild, aching and dull in nature. As soon as the victim makes a new attempt to lean on the foot, the sharp pain will return.
In children, a hematoma quickly forms around the site of a broken bone. The leg itself may look deformed, and in the area of the fracture, atypical tissue mobility occurs. In childhood, the sensitivity of the foot disappears extremely rarely. Loss of innervation, in which the limb becomes pale and cold, may be evidence of ruptured blood vessels. If a person receives an open injury, doubt itscharacter does not have to.
The cause of a fracture of the tibia in children is most often an unsuccessful fall from a height of more than 1.5 m. In active sports and martial arts, a shin injury is also a common injury. A fracture can also occur in people suffering from bone pathologies (osteomyelitis, bone tuberculosis, osteoporosis, oncological diseases).
Complicated injuries
Intercondylar fracture of the tibia is a relatively rare case in the practice of traumatologists. Often such damage is not independent, but accompanies other injuries of the lower leg. In this case, patients feel acute pain in the area of the patella, while the functions of the joint itself are fully preserved. The danger of such a fracture lies in the likelihood of damage to the peroneal nerve, which is fraught with the development of serious consequences, sometimes to the complete loss of leg functionality.
When the lateral condyle of the tibia is fractured, the ankle swells, support on the limb becomes impossible, there is a noticeable deviation of the foot inward. To confirm the diagnosis, the affected patient is sent for x-rays, which are performed in several projections.
In case of complicated fractures of the lower leg, as a rule, they resort to surgical treatment using the Ilizarov apparatus, implantation of special plates and screws into the bone. In such cases, the displacement can be recognized with the naked eye, with the exception of cracks and minor shifts in bone fragments. About the fracture of the tibiawith displacement will indicate an unnatural twist of the foot and a noticeable shortening of the damaged limb due to the convergence of the fragments with each other.
Rules for first aid for fractures of the lower leg
Timely assistance to the victim plays a huge role in his further recovery. The likelihood of complications and the rate of recovery of the patient depend on whether therapeutic measures were provided correctly or not.
First of all, you need to call an ambulance and give the victim an anesthetic. In order to prevent pain shock, you can use any analgesic that is at hand, in tablets (Dolaren, Ibuprofen, Ketorol, Nimesil) or injections (Analgin, Lidocaine, etc.).
You need to be careful with an open fracture. The edges of the tibia may stick out of the wound, but they should not be touched or attempted to be set. Any careless movement can lead to additional bone breakage, which will significantly aggravate an already unenviable situation.
If the victim has bleeding, a tourniquet is applied to the injured limb. The best place to apply it is the middle of the thigh. As soon as the blood stops, all visible contamination must be carefully removed, and the wound should be carefully treated with disinfectant solutions. After applying antiseptic agents, a tight, but not pressing, sterile bandage is applied.
Next, using any material at hand, you need to fixinjured limb in a static position and save him even from the minimum load. In case of displacement of the lateral or fracture of the medial condyle of the tibia, the patient is placed on a flat surface, and the splint is fixed with a bandage or other improvised materials to the injured leg from the side opposite to the injury. Ice should be applied if fracture is likely.
Waiting for the arrival of the ambulance, the patient is placed on a hard surface. It is especially important to eliminate the tension in the foot resulting from swelling, so shoes must be removed. If for some reason the arrival of specialists is impossible and the victim will have to be transported on his own, it is important to ensure complete immobility of the leg from the ankle joint to the middle of the femur. An alternative option is to bandage the injured limb to a he althy one. It is possible to transport the victim in a car only in the supine position.
Diagnosis of a fracture
To make an accurate diagnosis and prescribe treatment, the doctor must conduct a detailed examination, during which:
- examines the site of damage for the presence of a wound, hematoma, edema, deformity;
- specifies with the victim the circumstances of the injury;
- finds out the direction of the impact force (this indicator is necessary to study the properties of injury);
- prescribes an X-ray examination, the result of which will help to conclude the type of fracture, and computed tomography, which will assesscondition of ligaments, muscles, blood vessels, tendons.
After clarifying the diagnosis, the victim is sent to the inpatient department of surgery. A fracture of the tibia can be easily seen on an X-ray image made in two projections. The study will determine the amount of damage and their exact localization. CT scans are usually ordered if damage to adjacent joints is suspected.
Principles of treatment
The recovery technique is selected individually in each case. The choice of treatment tactics depends on the complexity of the tibial fracture. Doctors give the most favorable prognosis for the recovery of patients with trauma without displacement. The victim is put in a plaster cast from the fingertips to the lower leg, and it is difficult to give an unambiguous answer about how long the victim will have to wear it.
If damage to the bone caused the debris to move, it is first important to determine in which direction the shift occurred.
- In case of an oblique fracture, reduction is required by traction, thanks to which the bones will eventually fall into place. The essence of this treatment is the implantation of a special needle into the bone. Hanging weights are attached to this spoke.
- In case of a transverse fracture, a metal plate is installed, and plaster is applied on top of it. And in the future, treatment will be carried out according to the standard algorithm for the treatment of fractures with a typical displacement.
- When the posterior edge is fracturedtibia, a plaster cast is applied to the middle of the thigh.
Uncomplicated fracture of the tibia is extremely rare. This is one of the few cases where, with such a serious injury to the lower limb, surgical treatment can be dispensed with. Most often, bone fusion requires the use of the skeletal traction method, which was described earlier. The needle is inserted through the calcaneus, and the injured limb is placed on the splint. The value of the suspended load depends on the body weight, the degree of development of the muscular apparatus, as well as the type of displacement of bone fragments and averages 4-7 kg. After 3-4 weeks, the weight of the suspended load can be increased or reduced. The pulling needle is removed after the signs of callus formation are confirmed on the X-ray image, after which the plaster is applied for another 2.5 months. During this period, the patient is recommended to undergo a course of physiotherapy and exercise therapy.
Surgery
There is no alternative to surgery for a fractured tibia. Thanks to the timely operation, it is possible to prevent the development of post-traumatic contracture. In some cases, the intervention is carried out a few days after the victim's admission to the inpatient department. In the preoperative period, the patient should be in an immobilized lying position with a pull-out pin.
Surgical treatment of tibial fractures involves the use of various metal structures, including metal blocking plates, intramedullary pins and rods. When choosing a methodosteosynthesis for the speedy fusion of bones, the severity and localization of the fracture are taken into account.
Fracture of the leg bones is a direct indication for the use of the Ilizarov apparatus - this method of extrafocal osteosynthesis helps to restore the anatomically correct relative position of the fragments. In modern traumatology, the device is used to treat complicated injuries, including bone crushing. Despite the effectiveness of the use of the Ilizarov apparatus, it is a massive and uncomfortable metal structure that cannot be removed during the entire period of fusion, and it averages from 4 to 10 months.
If the victim is diagnosed with a fracture of the tibia with displacement on the tuberosity, the limb is fixed with a screw, and the tendon is sutured. The load on the lower leg is limited during the entire splicing period.
Dangerous consequences of a fracture
The most unfavorable complication of a shin injury can be its amputation, the decision on which doctors make in case of tissue necrosis and developing sepsis. This can be avoided through the timely provision of first aid. Other consequences of a tibial fracture are also possible. The tenth revision of the ICD has defined separate codes for pathological conditions that are complications of a shin injury:
- mal-union fracture (M84.0);
- nonunion fractures or false joint (M84.1);
- other consequences of tibia fracture (T93.2);
- complications due to use of implants or grafts (T84.0).
An unpleasant and problematic reminder of a fracture can be:
- arthritis or osteoarthritis;
- peroneal nerve injury;
- infection of a wound with an open type of fracture;
- vascular aneurysms.
The term of complete rehabilitation of the patient depends not only on the severity of the injury, but also on the individual characteristics of the organism. In most cases, complete fusion of the bone and restoration of limb functions require at least six months. But even after this period, not all patients experience pain and swelling. Also, the possibility of impaired mobility of the ankle or knee joint is not ruled out.
Testimonials from patients who survived a broken leg
All the responses of the victims come down to one thing: it will take a lot of time to return to full-fledged physical activity. According to reviews, the rehabilitation period after fractures of the bones of the lower leg usually lasts about 2-3 weeks. In order to restore the motor functions of the limb as soon as possible, patients are recommended to develop the leg.
People confirm that due to prolonged wearing of the cast, the muscles of their limbs became weaker and partially atrophied. In order to literally get on their feet, they had to carefully develop a limb for some time. Doctors focus on the fact that a large load at first is completely contraindicated. Exhausting exercise, long walking or liftingweights can lead to re-displacement. In order to strengthen the formed callus, it may take several more months, so the load is increased in stages.
Many patients speak positively about rehabilitation massage - this is the second effective method of recovery after a fracture of the bones of the lower leg. This is a great way to warm up your muscles and improve circulation, which will help you recover faster. The duration of the massage course is determined by a specialist. According to patients, it usually takes 10-14 days to recover.
All users confirm that the complex of physical exercises exercise therapy was made for them personally by a rehabilitation doctor. The specialist always takes into account the patient's condition both at the time of damage to the limb and after recovery. At the same time, individual techniques and sets of exercises are selected for each, which must necessarily be preceded by the stage of initial development of the calf muscles. As soon as the muscles of the leg acquire a satisfactory tone, patients are allowed to stand up, squat, and move independently.
In addition to performing therapeutic exercises, rehabilitation after a tibial injury may include physiotherapy procedures that improve the trophism of damaged tissues and cells, and start regenerative processes. It is equally important to make appropriate adjustments to the diet and take calcium-containing vitamin-mineral complexes, eliminate bad habits, and lose weight.
Can a fracture be prevented
There is no special prevention of lower extremity injuries. All recommendations of trauma surgeons boil down to the following:
- When walking, you must carefully look under your feet.
- Prevent obesity, take steps to lose weight.
- Cure infectious diseases to the end.
- Eat foods fortified with calcium.
- Wear comfortable shoes with low heels.
- Observe safety precautions during sports training, work activities, etc.
- Avoid jumping from significant heights.
