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).
prognosis and prevention
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S82 Fracture of leg including ankle
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.
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
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.
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.
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.
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.
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.
- 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
- Association of Orthopedic Traumatology. Fracture and Dislocation Classification Compendium - 2018 // Journal of Orthopedic Trauma. — 2018. — № 1. — 173 p.shortcut
What are the causes of tibial fracture? ›
It is caused by a rotational or twisting force such as a sports injury or a fall. Treatment includes setting the bone without surgery and a long-leg cast with the knee bent. Unstable displaced fractures may require surgery.What is the treatment for tibial fracture? ›
Intramedullary nailing—This is the most common approach for tibia fractures. A rod is inserted into the canal that runs down the center of the bone; the rod passes through the fracture to keep the pieces in alignment and stable during healing. Screws above and below the fracture secure the rod in place.What are the most common causes of tibial plateau fracture? ›
Causes of Tibial Plateau Fracture
Both low-energy injuries (fall from a height and sports-related trauma) and high-energy injuries (motor vehicle accidents) can cause tibial plateau fractures. Additionally, these fractures may result in improper limb alignment.
A tibia fracture refers to any crack or breaks in the tibia bone. The tibia is one of two bones that make up the lower leg, the other being the fibula. The tibia is the larger of these two bones.What are the 5 causes of fracture? ›
- Fall from a height.
- Motor vehicle accidents.
- Direct blow.
- Child abuse.
- Repetitive forces, such as those caused by running, can cause stress fractures of the foot, ankle, tibia, or hip.
- pain and tenderness in just one specific area of the leg.
- worsening pain that develops over a period of weeks to months.
- pain increases with impact activity (running or jumping)
The most common way to evaluate a fracture is with x-rays, which provide clear images of bones. X-rays can show whether the tibia is broken or intact. They can also show the type of fracture and where it is located within the tibia.Can you still walk with a fractured tibia? ›
Can you still walk with a fractured tibia? In most cases, the answer is no. Walking after a tibia fracture can make your injury worse and may cause further damage to the surrounding muscles, ligaments and skin. Walking on a fractured tibia is also likely to be extremely painful.Do tibial stress fractures need surgery? ›
Although most tibial stress fractures heal with nonoperative treatment, some may require surgical management. Surgical treatment options include intramedullary nailing, tension band or compression plating, and drilling with debridement and bone grafting.Can you bend your knee with a fractured tibia? ›
Yes, bending the knee can start immediately after tibial plateau fracture if you did not have surgery. If you had surgery then you can start bending the knee to 90 degrees 1 week after surgery. Once the incision is fully healed (10-14 days) you can go past 90 degrees of knee bend.
How long is recovery from cracked tibia? ›
What is the recovery process for a tibia fracture? Recovery time for a tibia fracture typically takes 4-6 months to heal completely. If the fracture is open or comminuted, healing time may take longer. Your doctor will often prescribe medications for pain-relief for a short period of time after the injury or surgery.What are the complications of tibia fracture? ›
Gangrene. Osteomyelitis. Delayed union, nonunion, or malunion. Amputation or skin loss.Is a tibial stress fracture serious? ›
Stress fractures are the most serious of all running injuries. Many runners will wave off shin pain and continue to train, Dr. Goldberg says. This is dangerous with stress fractures, however, because your bones can't repair themselves while you're increasing the duration, intensity or frequency of your training.What are the 3 most common causes of fractures? ›
Bone fractures are often caused by falls, trauma, or as a result of a direct blow or kick to the body. Overuse or repetitive motions can cause stress fractures. Fractures can also be caused by diseases that weaken the bone.What causes fractures without trauma? ›
Among the most common causes of spontaneous fracture are osteoporosis (calcium deficiency and corticosteroid-induced), malignancy, overexposure to vitamin A, periprosthetic weakening, Brucellosis, cerebral palsy (especially in children), and osteodystrophy because of chronic renal failure.Do tibial stress fractures show up on xrays? ›
Stress fractures often can't be seen on regular X-rays taken shortly after your pain begins. It can take several weeks — and sometimes longer than a month — for evidence of stress fractures to show on X-rays. Bone scan.What happens if shin stress fracture goes untreated? ›
If a stress fracture is not treated, the fracture may get worse. It can heal improperly, lead to arthritis or may even need surgery. Definitely do not ignore the pain. Ignoring the pain can lead to serious problems in the future, so it is important to see your doctor when you start feeling the pain.Can a broken tibia heal without a cast? ›
Technically speaking, the answer to the question “can broken bones heal without a cast?” is yes. Assuming conditions are just right, a broken bone can heal without a cast. However, (and very importantly) it doesn't work in all cases. Likewise, a broken bone left to heal without a cast may heal improperly.How do you tell if a tibia bone is fractured or bruised? ›
there may be swelling, bruising or tenderness around the injured area. you may feel pain when you put weight on the injury, touch it, press it, or move it. the injured part may look deformed – in severe breaks, the broken bone may be poking through the skin.What does a hairline fracture in the tibia feel like? ›
A tibial stress fracture is a hairline fracture of the tibia bone in the lower leg caused by overuse or repetitive stress. Symptoms are very similar to 'shin splints' with gradual onset pain on the inside of the shin.
Can you weight bear on a broken tibia? ›
Patients with tibial plateau fractures will be instructed to touch down (toe touch or foot flat) weight bear (approximately 10% of body weight) for at least 6 weeks. After the 6 week post op visit, patients may begin weight bearing as tolerated until full weight bearing is achieved.Will a knee brace help a stress fracture? ›
Treatment for Knee Stress Fractures
Instead, most physicians will recommend rest and a mechanism for bone and joint support. Treatment for knee stress fractures may involve a knee brace or sleeve that supports your knee for limited walking.
Wearing an ankle brace such as the Aircast Air-Stirrup may also help you heal more quickly from a stress fracture and prevent re-injury. For lower leg stress fractures products such as the Aircast Leg Brace have been recommended by physicians and medical professionals.How can you tell if a bone is stress fracture? ›
At first, you might barely notice the pain associated with a stress fracture, but it tends to worsen with time. The tenderness usually starts at a specific spot and decreases during rest. You might have swelling around the painful area.Why do I keep getting tibial stress fractures? ›
They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also develop from normal use of a bone that's weakened by a condition such as osteoporosis.How common are tibia fractures? ›
A large-scale study of tibial shaft fractures from a trauma databank found an incidence of 16.9/100,000 population with a bimodal distribution of peaks at ages 20 and 50 . The risk is somewhat higher in males (males 21.5/100,000 and females 12.3/100,000 incidence per year) .What is the fastest way to heal a tibial stress fracture? ›
Most stress fractures will heal if you reduce your level of activity and wear protective footwear for 2 to 4 weeks. Your doctor may recommend that you wear a stiff-soled shoe, a wooden-soled sandal, or a removable short-leg fracture brace shoe.Do you need surgery for a tibia stress fracture? ›
To reduce stress on your leg, protective footwear or crutches may be necessary. Surgery is also an option. In most cases, it takes 6 to 8 weeks for a stress fracture to heal, when surgery is not required. More serious stress fractures can take longer.Is a fractured tibia serious? ›
A broken tibia-fibula is a fracture in the lower leg that happens when a fall or blow places more pressure on the bones than they can withstand. A tibia-fibula fracture is a serious injury that requires prompt immediate medical attention. With timely and proper treatment, a broken tibia-fibula can heal completely.What are the complications of a tibial fracture? ›
Late complications, e.g., delayed union, nonunion, and chronic infection, tend to be more serious than early complications. The most complicated tibial shaft fractures are open fractures. Closed methods offer a better chance of avoiding severe complications.
What does a fractured tibia feel like? ›
A tibial shaft fracture usually causes immediate, severe pain. Other symptoms may include: Inability to walk or bear weight on the leg. Deformity or instability of the leg.How do you know if your tibia is fractured? ›
- Inability to walk or bear weight on the leg.
- Deformity or instability of the leg.
- Bone "tenting" over the skin at the fracture site or bone protruding through a break in the skin.
- Occasional loss of feeling in the foot.