Tibial Fracture - Causes, Symptoms, Diagnosis and Treatment (2023)

tibial fractureit is a violation of the integrity of a larger spine. In most cases, the fibula fractures along with the tibia. The damage is manifested by acute pain, swelling, deformation, crepitus and pathological mobility in the shin area. Supporting the feet is impossible. To clarify the diagnosis, an X-ray is prescribed. Treatment can be surgical (fixation of the fragments with rods, plates and external fixation devices) or conservative (skeletal traction followed by plaster application).

CIE10

S82 Fracture of leg including ankle

Meaning

Tibial fracture is a common and extremely important injury, both because of its prevalence and the possible negative consequences. In the absolute majority of cases, it is accompanied by displacement of fragments (longitudinal, angular, rotational). Tibial fractures are often combined with other injuries: pelvic fractures, fractures of other bones of the extremities, rib fractures, chest injuries, blunt abdominal injuries, etc. Treatment of fractures of the bones of the leg is carried out by traumatologists.

causes

The cause of tibial fractures is usually high-energy injuries (car accidents, falls from heights, industrial injuries, natural and man-made disasters). Damage is caused by significant direct, flexural, and torsional forces, resulting in a high proportion of complex injuries (open, comminuted, oblique, and spiral fractures). All this leads to unfavorable results in some cases: shortening and curvature of the limb due to insufficient fusion, lack of fusion and formation ofwrong joints, etc

pathanatomy

The tibia is made up of two bones: the fibula and tibia. Cinnamon is larger, more massive. It bears the main load on the limb, participates in the formation of the ankle and knee joints. The fibula has an auxiliary value and is the starting point of the muscles. In lower leg injuries, both bones are usually fractured, but maintenance of limb function depends primarily on restoring the integrity and shape of the tibia.

classification

Fractures of the body of the tibia are almost always unstable and accompanied by a more or less pronounced displacement of the fragments. Depending on the position of the fracture line and the number of fragments, the following types of injuries are distinguished in traumatology and orthopedics:

• Querbruch.The fracture line is perpendicular to the axis of the bone. With simultaneous violation of the integrity of the fibula, as a rule, instability of the fragments is observed. If the fibula is not damaged, relatively stable damage is possible without significant displacement of the fragments.
• oblique fracture. The break line is oblique. The fracture is unstable, there is a tendency to progressive displacement.
• a spiral fracture. Occurs when a torque force is applied. The fracture line is spiral. Damage is usually unstable.
• debris fracture. Under the influence of traumatic force, three or more bone fragments are formed. A comminuted fracture is characterized by extreme instability.

In addition, there are open and closed injuries of the tibia. Withclosed fractures, the skin is not damaged, with open fractures, the integrity of the skin is violated, the fracture area communicates with the external environment. Open fractures are often accompanied by severe soft tissue injuries, such injuries have an increased risk of complications: wound suppuration,osteomyelitis, incorrect welding, missing welding, etc.

symptoms

The patient complains of severe pain. The leg is deformed: shortened, twisted (the foot is turned in or out in relation to the knee joint), angularly bent. In the area of ​​\u200b\u200bdamage, crepitus and pathological mobility are determined. Support and movement are impossible. Swelling increases over time: soon after the injury, the swelling may disappear, then the pimple increases in volume, bruises appear on the skin. With open wounds on the lower leg there is a wound in which bone fragments can be seen.

To diagnose

The diagnosis is confirmed by an x-ray of the tibia. Examination of the images allows us to determine the number of fragments and the nature of the displacement, the presence or absence of an accompanying fracture of the fibula, and the involvement of the ankle and knee joints. In some cases (usually with joint damage), the patient may be referred for a CT scan of the joint. If nerve and vascular damage is suspected, consultation with a vascular surgeon, neurologist or neurosurgeon is mandatory.

Treatment

At the preclinical stage, the victim is given painkillers, immobilization of the leg is carried out using a special hoop or improvised means (for example, two boards). It is necessary that the lower part of the arch "captures" the ankle, and the upper part reaches the upper third of the thigh. For compound fractures, foreign bodies and larger debris are removed from the skin around the wound and the wound is closed with a sterile dressing. If the bleeding is heavy, a tourniquet is placed on the thigh. In the presence of traumatic shock (it can develop with multiple and combined injuries), anti-shock measures are carried out.

Hospital treatment tactics depend on the level and type of damage and can be conservative or surgical. In the case of a stable, non-displaced fracture of the tibia (extremely rare), immobilization with a plaster cast is possible. In other cases it is necessary to apply skeletal traction. The ray is passed through the heel bone, the leg is placed in an arc. The average value of the initial load for an adult is from 4 to 7 kg and depends on body weight, the degree of muscle development, the type and nature of displacement of the fragments. Later, if necessary, the load weight can be reduced or increased.

Two options are possible in the future. With conservative treatment, skeletal traction is maintained for 4 weeks, achieving correct remodeling of the fragments. After the appearance of radiological signs of a callus, the traction is removed, the leg is put in a cast for another 2.5 months. At the initial stage, the patient is given painkillers. Physiotherapy and physiotherapy are indicated throughout the treatment period. After removing the plaster, hygiene measures are carried out.

Indications for surgical treatment are multifractures, in which it is not possible to restore the normal position of the fragments using conservative methods. In addition, surgical treatment serves to activate and prevent the development of post-traumatic contractures at an early stage. In most cases, surgeries are performed a week or more after the patient's admission. By this time, the patient's condition usually normalizes, the swelling of the limb subsides, and doctors have time to conduct a full examination to determine contraindications to surgery. In the preoperative phase, the patient is in skeletal extension.

Several metallic structures are used in the surgical treatment of tibial fractures, including intramedullary pins, plates and locking nails. The choice of osteosynthesis method is made taking into account the type and level of the fracture. In most cases, intramedullary (intraosseous) fixation of the tibia is preferred. Also, for such injuries, non-focal fixation with Ilizarov devices is often used; This method allows you to restore the normal interposition of the fragments not only at the same time (during the operation), but also in the postoperative period. It can be used to treat the most complex injuries, including fractures with bone defect formation. The disadvantage of the technique is the presence of a massive and uncomfortable external metal structure.

prognosis and prevention

The average fusion time for an uncomplicated tibial fracture is 4 months. For comminuted fractures, open wounds, and severe compound injuries, this period can be extended to six months or more. A prerequisite for the complete restoration of limb function is the implementation of the doctor's recommendations, including early exercise, regular exercise therapy and limiting the load on the injured leg. Prevention includes measures to avoid injuries at home and at work.

literature

1. Busse J.W., Morton E., Lacchetti C. et al. Current management of tibial shaft fractures: a survey of 450 Canadian orthopedic trauma surgeons // Acta Orthop. — 2008. — № 5. — Р. 689-694.shortcut
2. Association of Orthopedic Traumatology. Fracture and Dislocation Classification Compendium - 2018 // Journal of Orthopedic Trauma. — 2018. — № 1. — 173 p.shortcut