Fracture of the tibia in a child. Displaced fracture of the tibia, oblique fracture of the tibia

Support of everything human body falls on your feet. The leg skeleton consists of different bones, damage to which disrupts normal human movement. The shin bones are the main structures of the leg, which can be injured under excessive loads.

A fracture of the tibia (tibia), as well as a fracture of the fibula, are quite common occurrences. Typically, out of 100 types of fracture, 10% are fractures tibia. As a rule, such damage is dangerous. Injuries are usually recorded in the central region of the bone, but there are also situations in which the intercondyles of the tubercle of the tibia are also noted.

The tibia consists of two fragments: the tibia and fibula. The tibia is long and bulky. It includes the body and two ends of the joint. The tibia takes part in the formation of the knee and ankle joints. Wherein knee-joint is formed due to the participation of the proximal end, and the ankle – due to the distal part of the bone.

The fibula is located near the tibia, at its ends there are 2 heads, which are connected to each other using almost flat joints. Due to this, sliding in the area of ​​the bone head is limited. Both the proximal and distal heads of the bone contain articular surfaces, which are represented by narrow slit-like spaces.

The tibia and fibula are no longer fused with each other; the fibula is somewhat free in its movements. But for strength, a fibrous membrane is stretched between these bones, which is also called the interosseous membrane. Unlike the tibia, the fibula does not participate in the formation.

Classification

Fractures of the tibia and fibula occur as often as injuries to other bones. However, there are a number of differences between both fragments and reasons why injury occurs.

Fractures of the tibia are usually classified:

• Stable, in which the fracture of the tibia occurs without displacement, or it is not significant. As a rule, such injuries are localized along the axis and the fragments do not move during the fusion process.
• Transverse, in which the line of damage is perpendicular to the axis.
• Displaced fractures are characterized by damage in which the bone axis is disrupted and bone fragments are separated. As a rule, such fractures do not heal on their own and as a result, surgical intervention is required.
• Oblique, in which the line of injury is at an oblique angle. The victim as a result of such a fracture experiences progressive instability. Damage often occurs in combination with the fibula.
• Comminuted, in which there are 2 or more fragments.
• Spiral, screw, helical fractures of the tibia, in which the damage is marked in a spiral, etc.
• Closed fractures, which are characterized by the integrity of the skin and the absence of visible debris and wounds outside the skin. Often the injury is localized, has severe swelling, and hematoma. If help is not provided in a timely manner, blood circulation in the localized area will be impaired, as a result of which muscle cells will die. In severe cases, limb amputation is required.
• Open fractures, which are characterized by the presence of an open wound and debris extending beyond its boundaries. With open fractures, bleeding and damage to muscle tissue, ligaments and tendons often occur. Complications often develop and recovery takes a long time.

It is also common to distinguish:

• intra-articular and extra-articular fractures of the tibia;
• fractures of the head of the fibula without displacement;
• fracture of the tibial tuberosity;
• fracture of the tibial diaphysis;
• fractures of the distal metaepiphysis of the tibia;
• marching fractures, stress fractures, compression fractures.

Fractures of the fibula are mostly classified according to the same characteristics, therefore they are distinguished:

• Fractures of the fibula with and without displacement.
• Fractures of the head (neck or body) of the fibula;
• Isolated fractures of the fibular diaphysis;
• Transverse fractures;
• Splintered or fragmented;
• Spiral fractures.

TO general characteristics include:

• March fractures.
• Avulsion fractures.
• Fractures of the lower third of the bone.
• Fractures of the upper third of the bone.
• A double fracture in which both bones are broken (occurs frequently).
• Figurative fractures.

Trauma code according to ICD 10

Fracture of the tibia code according to ICD 10 in combination with a fracture of the fibula (with ankle joint)

Causes

The causes of damage to the shin bones have some similarities and differences. In both cases, the injury occurs as a result strong pressure on the bone, which can be observed during a fall or impact. As a result of the impact, if there is still an additional load, the bone will become mixed and a fracture will occur.

Such injuries are usually multiple and dangerous due to complications. The greatest danger is posed by open fractures with numerous injuries and blood loss.

The tibia bone tissue is injured more often, and damage to both tibia bones at once also often occurs.

The tibia, fractures of which occur more often, is injured for the following reasons:

• Falling from height.
• Technogenic disasters.
• Natural disasters.

As a rule, damage to the tibia due to these factors is not isolated and is combined with multiple other injuries.

A fibula fracture occurs as a result of:

• Falls from heights.
• Impact of a direct ramming blow to the outer part of the shin (in case of an accident).
• A “screwing” movement, at the moment when the shin is tightly fixed.

Most often, injury occurs to the epiphysis or neck of the bone. As an example, a model with a pin is often used. With a talus impact, the pin opens, causing one part of it to move to the side; the same thing happens when the fibula is damaged. The damage may be at the back or at the top. The interosseous membrane is also damaged.

Symptoms

The signs of a tibia fracture are similar to injuries to other limb bones.

• In both cases, pain occurs in a localized area.
• It is almost impossible to step on your foot, causing severe pain and discomfort.
• The lower leg itself is swollen, and a hematoma forms in the affected area.
• Limb deformity occurs.
• Numbness in the lower part of the leg, sometimes bluish skin.
• If the fracture is open, there is blood loss and damage to tissues located near the wound.

With a fracture of the fibula, the same basic symptoms of a fracture are present. However, the pain may not be as pronounced, or the victim may not feel it at all. This is primarily due to the fact that the blood vessels are damaged, the leg goes numb, and the pain does not fully manifest itself. Signs may be accompanying.

Often isolated additional symptoms fracture of the fibula:

• edema;
• bleeding;
• at open fracture– protruding bone fragment;
• with avulsion – a hanging limb.

First aid

has its own similarities.

If a fracture of the fibula or a fracture of the tibia occurs, you must:

• Reduce the severity of pain to avoid painful shock in the victim.
• In case of blood loss, consult an emergency specialist and try to stop the bleeding. To do this, the edges of the wound are treated with an antiseptic, and the damaged area is covered with a sterile, loose bandage.
• After this, immobilization is carried out to prevent further displacement. To do this, the injured limb must be raised and secured; if you have shoes, it is advisable to remove them. The injured leg is immobilized and a splint is applied. For this purpose, you can use any items that are at hand (plywood, board, sticks). It is important to apply the splint in such a way that the lower part covers the ankle, and the upper part reaches the upper thigh.

After providing first aid, the victim must wait for the ambulance to arrive and, if possible, go to the emergency room with him. This is necessary in order to testify about what happened and inform the doctor what was taken prematurely, what

Note!

The relevance of the problem of first aid requires knowledge that can be put into practice.

Diagnostics

Fractures of the tibia and fibula are diagnosed using x-rays. In some cases, a CT, MRI or ultrasound result may be needed. The doctor will inform you about a specific type of diagnosis as necessary.

Diagnosis and treatment tactics for all fractures of the tibia are as follows:

• Inspection and interview of the victim.
• Determining the nature of the damage (whether articular surface tibia and fibula, identifying the edge of the fracture, determining a closed or open fracture).
• Performing radiography. This type The studies are carried out in two projections, and thanks to the image, you can find out which bone is broken - the tibia or fibula, as well as identify the number of bone injuries and their location.

Treatment

When treating fractures of the tibia, use:

• Conservative therapy
• Surgical intervention.

Conservative treatment of a non-displaced fracture of the tibia is carried out using pain blockade and the application of a plaster cast. The plaster should fix the knee, lower leg and foot. If the displacement was minor, local closed reduction is performed using local anesthesia. The immobilization period for normally located fragments is 1.5-4 months. If the injury is complex, it may take longer - 4-6 months. They usually wear a cast for the same amount of time.

Note!

For fractures of the tibia, the time frame for treatment and recovery varies. In some cases, when the fracture is not significant, without displacement and multiple fragments, the doctor may apply a plaster cast and, after a control image at 21 days, remove it if the bones have fused. Sometimes it may take longer because the healing time, for example, is longer in older people.

What is fracture consolidation?

Consolidation (or fusion) is a process by which damaged bone fragments grow together. Consolidation takes place in 4 stages:

• The first stage - 3 days - multiple penetration of leukocytes to the site of the lesion and resorption of dead tissue occurs.
• The second stage is multiple reproduction of cells of the skeletal system, mineralization of bone, filling of cartilage tissue.
• The third stage is the restoration of blood supply to the affected area.
• The fourth stage is the fusion of the bone, the creation of the periosteum, and its penetration with blood vessels.

The period of consolidation for the tibia and the small fibula is 60-120 days, depending on the location of the lesion.

For the purpose of fixation and immobilization, a tight bandage or orthosis is used. A splint is applied that will fix the leg until the fragments are completely fused.

What to do if you have a displaced tibia fracture

If a displaced tibia fracture occurs, the following is indicated:

• Anesthetize the localization of the injury using painkillers.
• Perform skeletal traction. To do this, it is fixed with a special knitting needle, which is secured to the side and a load is hung on it. Due to this, the muscles are stretched and the bone fragments cannot fit together. Able skeletal traction Reposition is performed, after which the patient must continue to be in traction until a callus buildup is formed.
• The growth of callus is checked from time to time using a photograph, and if everything goes well, the traction is removed after 5-6 weeks. Then a plaster cast is applied, which fixes the position of the aligned bones.
• The plaster is worn for 2-4 months, after which, when the plaster splint is removed, the recovery period begins.

Surgical treatment

The operation is indicated in cases where bone fusion does not occur for a long time; when injuries are numerous and nerves and blood vessels are affected, as well as when we are talking about an open fracture of the proximal tibia.

The operation for a fracture of the proximal tibia, as well as other parts of the tibia, is carried out in several stages:

Stage 1– pain relief with potent drugs for local anesthesia or.

Stage 2– open osteosynthesis. For fractures in the epimetaphysis or proximal metaepiphysis of the tibia, osteosynthesis must be carried out carefully, paying attention soft tissues, since the course of their damage depends on the degree of damage further treatment. For fractures of the proximal tibia, minimally invasive closed osteosynthesis is also used.

Stage 3– fixation of bone fragments with rods. Screws, pins, plates, and an Ilizarov apparatus can also be used.

Fixation using rods: it is inserted into the bone canal, after making an incision in the skin, so that one end is outside the canal. With this, reliable fixation of bone fragments is achieved. Then, when the bones grow together, the rod is removed.

Fixation using a plate: if a patient who has been injured old man, use plates. They are inserted through pre-prepared holes, after which they are screwed to the bones with self-tapping screws. Thanks to this, the position of the fragments is recorded until they are completely fused.

This method of fixation cannot be used by children, and those for whom the method will lead to damage to the periosteum and impaired growth bone tissue.

Fixation using self-tapping screws: if an angular injury to the longitudinal bone occurs with displacement, bone fragments are fixed using self-tapping screws. As soon as the fragments grow together, the screws are removed.

Fixation using an Ilizarov device: the device itself is a rigid frame that is fixed over the leg. It is assembled on knitting needles, which are inserted into the holes of the bone fragments themselves and brought out. Thanks to this device, the fixation is rigid, and the position of the fragments themselves can be adjusted.

Stage 4– limb immobilization, regular photographs during the immobilization process.

As a rule, in case of a displaced fracture of the tibia and fibula, surgery is performed immediately. Because every minute counts. If help is not provided in time, the limb may be cut off due to necrosis of damaged tissue and possible sepsis.

Rehabilitation

Rehabilitation after fractures of the tibia and displaced fractures of the fibula is carried out after the fragments have healed and the plaster or other fixation has been removed. As a rule, doctors select a set of rehabilitation exercises on their own, and recommend wearing an elastic bandage.

How to develop a leg after a fracture

Rehabilitation after fractures of the tibia is long and includes:

• Developing the leg after a fracture of the tibia. In this case, the leg needs to be developed as early as possible (only after medical confirmation), since during the process of wearing a plaster boot, the muscle tissue gradually begins to atrophy. But you should understand that exercises with maximum loads cannot be performed so as not to cause repeated displacement, since the bone has not yet become stronger. Loads should be carried out gradually.
• Another effective and useful method rehabilitation after a fracture of the tibia is massage. It helps to warm up muscle tissue, improve blood circulation, as a result of which the recovery process will go faster. The duration of recovery procedures should be determined by a doctor. As a rule, it is 7-10 days. Sometimes it may take longer.
• You can also use physiotherapeutic agents, which improve the nutrition of injured tissues and cells, and regeneration processes occur faster.
• Complex physical physical therapy exercises determined by a rehabilitation physician who takes into account the condition at the time of injury and the condition at the time of recovery. At the same time, they select special techniques rehabilitation, thanks to which the recovery of the limb will go faster. Physiotherapy is performed from the initial development of the lower leg, after which the patient must gradually rise to his feet without outside help and squat.

In addition to all the measures described above, it is important to get rid of bad habits, excess weight. According to medical prescriptions, it is necessary to carry out the entire range of rehabilitation measures and take medications.

Massage

As mentioned above, massage has a beneficial effect on the recovery process, so it must be carried out as carefully as possible. If the tibia hurts a little after a fracture, massage will help relieve some of the pain.

Complications and consequences

Complications of a fracture of the tibia and fibula are different. The most dangerous thing is amputation of a limb as a result of necrosis of damaged tissues and the onset of sepsis, after an infected hematoma. But this can be avoided if assistance is provided to the victim in a timely and correct manner. Also, if the patient does not self-medicate and does not resort to folk medicine, esotericism, etc. for the purpose of treating a fracture.

What else could happen? Consequences of a fracture:

1. The bone fragments did not heal properly, and immediate surgery with six months of immobilization was required.
2. Arthritis and osteoarthritis developed.
3. The fracture damaged the peroneal nerve.
4. An open wound became infected.
5. A vascular complication has occurred.

Prevention

In order to prevent a fracture of the posterior edge of the tibia or both tibias, you need to watch what you are stepping on, in other words, “look at your feet.” You should take care of your health, monitor your weight and avoid junk food, habits. It is recommended to treat any illnesses in a timely manner and take care of yourself.

Buy shoes of the right size. This rule also applies to the choice of rollers, skates, etc. It is not recommended to overuse heels. If you pay attention to yourself in time, you will be able to avoid many problems, including fractures of the tibia and fibula. Be healthy!

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

Author of the article:| Orthopedic doctor Education: Diploma in General Medicine received in 2001 medical academy them. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty “Traumatology and Orthopedics” at the City clinical hospital No. 29 named after. N.E. Bauman.

A tibia fracture is an injury to the lower leg due to trauma. The lower leg consists of two parts - the tibia and fibula. The shin can be damaged in several places at the same time. When an injury occurs, both bones are often damaged. A fracture of the tibia can be open, closed, displaced or non-displaced. A severe case is considered to be an open or closed fracture with displacement of fragments. Because of this, tissue, blood vessels and skin can be damaged from the inside by fragments and other bones.

Causes

The reasons that can cause a tibia fracture can be different. But in any case, damage to bone tissue occurs due to injury. A fracture of the tibia in a child can occur due to a blow or fall. If children's bones are fragile, even a small injury will cause damage. Fractures vary depending on the position of the leg and foot. If a blow or fall occurs while the leg is immobilized, an oblique fracture may occur. This type of fracture is typical for situations where the leg gets stuck somewhere. If a child falls from high altitude and at the same time stands on straight legs, in addition to a fracture of the tibia, hemorrhage may occur in the kneecap.

Symptoms

• The manifestation of a fracture of the tibia in a child is clearly visible. But if a child’s fibula is damaged, it may not be noticed without a doctor’s examination. It is also difficult to determine complete fracture, that is, a crack or slight displacement.
• In the first seconds after receiving an injury, the child experiences severe pain, which makes it impossible to stand on his leg.
• Because of the strong pain the victim may be in a state of shock.
• Gradually the injured leg begins to swell.
• With a strong blow, a hematoma appears at the site of injury, which increases over time.
• A displaced fracture can be recognized by a shortened or twisted leg in an unnatural way. The fragments are displaced, and because of this they come closer together.
• If the axis of the tibia is displaced, the child will not be able to rotate his leg.
• With an open fracture, a wound occurs, due to which bleeding occurs and fragments and bones are visible.

Diagnosis of a fracture of the tibia in a child

To determine an accurate diagnosis of a fracture of the tibia in a child, the doctor conducts an examination. The victim's complaints are also taken into account. After the examination, the child is sent for an X-ray examination. An X-ray of the injured lower leg is taken in two projections to precise definition nature of the fracture. IN severe cases MRI or CT scan. Tests are necessary if there is a suspicion of a complication or disruption in the functioning of other organs.

Complications

Many parents worry about the dangers of a fracture of the tibia in childhood. Children's bones heal much faster than adults, so most often no consequences from this injury are observed. Complications may occur due to improper bone fusion, but to avoid this, the child undergoes X-ray examination several times during the treatment period. If a lot of time has passed since the fracture and the child complains of pain in the damaged area, a doctor’s consultation is necessary.

Treatment

What can you do

• If you suspect a fracture of the tibia in a child, you must call an ambulance.
• If possible, you need to take the victim to the nearest emergency room or children's hospital. But transportation of the child is possible after first aid is provided.
• To eliminate the possibility of displacement of fragments and damaged bones, it is necessary to immobilize the broken leg. For this you can use a board or sticks.
• The child must be in horizontal position so as not to aggravate the situation.
• For relief, apply ice or a cold object to the damaged area.
• In case of an open fracture, the wound should be disinfected and a sterile bandage applied.
• If a child starts bleeding as a result of an open fracture of the tibia, it should be stopped. It is necessary to use a tourniquet or improvised means and apply it to the area above the injury.
• To relieve pain, the child should be given a painkiller.

What does a doctor do

• After diagnosis, the doctor will prescribe treatment. For non-displaced fractures it is used conservative treatment. A plaster cast is applied to the injured leg.
• For a displaced fracture, treatment will depend on the nature of the injury.
• In case of oblique displacement, the traction method is used. A special knitting needle is inserted into the shin, on which a small load is suspended;
• The metal plate is used for lateral displacement;
• If a child receives a displaced comminuted fracture, surgical intervention is necessary. In this case, the surgeon collects the damaged bone in parts.
• In case of an open fracture, the doctor prescribes the use of an Ilizarov apparatus, which fixes the damaged lower leg.
• After the doctor determines how to treat the injured leg, the child goes through a recovery period. The duration of this period depends on the nature and severity of the fracture. When the damaged bone heals, rehabilitation is necessary. The child can undergo a course of massage or hydromassage, electrophoresis, or engage in physical therapy.

Prevention

Preventing a tibia fracture in a child is not easy. Children move actively, both on the street and at home. They are not protected against accidental drops or impacts. But parents can talk to the child and explain safety rules to him. For the children preschool age constant monitoring is required not only on the street, but also at home. The child also needs to be explained the rules for being on public transport. Children are transported in a car using a restraint device that protects them from impacts in collisions with other cars.

occur as often as in adults. The diaphysis of the lower leg bones is primarily damaged. All types of fractures occur. Of these, more than 60% are oblique and spiral, 20% are transverse and about 10% are epiphysiolysis.

Mechanism of injury mostly indirect. Diagnosing a fractured leg bone in children is not difficult. Clinical signs the same as in adults: pain that intensifies when trying to make active and passive movements, deformation of the lower leg. Some difficulties arise when recognizing non-displaced fractures and cracks. Radiography in two projections is required.

Treatment of fractures of the diaphysis of the lower leg bones mostly conservative. Surgical intervention is used extremely rarely. The basic requirements for treatment are the same as for adults: good reposition and subsequent fixation until consolidation. Manual reduction should be performed under general anesthesia; Local anesthesia is of little use in children. When fragments are displaced, the anesthesia must be deep so that the retracted muscles do not interfere with the comparison of fragments.

When repositioning tibial fragments, certain requirements must be met. It is necessary to eliminate angular displacements, since the fusion of fragments in a vicious position subsequently leads to an increase in the angle and pronounced deformation. In addition, curvature of the tibia axis leads to a violation of statics and, in connection with this, to foot defects.

Length offsets must also be eliminated. It is not necessary to make an exact comparison of fragments that have shifted to the sides. With the correct axis of the tibia, there is no displacement of fragments by half the diameter of great importance, since as the child grows, the tibia is rebuilt and after some time the displacement becomes invisible.

In most cases, manual reposition of fragments is performed. However, if at good anesthesia A two-time attempt to juxtapose the displaced fragments fails and the displacement can lead to severe deformation; the child should be sent to the hospital for treatment using skeletal traction or surgery.

After reposition, the limb is fixed with a plaster cast. Circular bandages should not be applied to children in the first days after injury to avoid compression of soft tissues by increasing swelling and hematoma. Immobilization is carried out using a posterior deep plaster splint, which is fixed with a soft bandage. A few days later, when swelling will subside and the danger of compression of soft tissues has passed, the plaster splint is turned into a circular bandage, for which the soft bandages with which the splint was fixed are removed and replaced with plaster ones. Before this, it is necessary to take an x-ray to ensure that there is no secondary displacement of the fragments.

The duration of fixation with a plaster cast for fractures of the lower leg bones in children is somewhat shorter than in adults; early termination of immobilization is a mistake. There are many cases where this led to repeated displacements. The timing of immobilization in children, as well as in adults, must be established based on data from dynamic, clinical and radiological studies. In any case, in children under 7 years of age, fixation should last at least 4-5 weeks, and in older children - 6-7 weeks.

For fractures of the tibia in the lower third, a plaster cast is applied to the knee, for fractures in the middle and upper third - from the middle third of the thigh to the fingers.

Dubrov Ya.G. Outpatient traumatology, 1986

The most common limb injury in humans is a fracture of the tibia. Medical statistics claim that fractures of the tibia and fibula occur with equal frequency, and the lower leg is also often injured.

These injuries occur most often during road traffic accidents. A fracture of the tibia is a complex injury accompanied by complications.

General information

The tibia consists of two tibia bones – the tibia and the tibia. They carry heavy load when walking. Therefore, fractures involving them occur frequently.

• The tibia is located inwardly, towards the middle of the body and consists of a long tubular bone and a tibia.
• The fibula is located laterally, that is, on the side, closer to the outer part of the leg. It is also tubular and long, but is inferior in volume to the tibia.

Tibial fractures most often occur in winter time, and in older people because their bone structure has become weak. Fractures can be either the tibia or the tibia, but a fracture of both bones at once is considered complex.

Causes of fracture

To fracture the tibia, a force is required that exceeds the strength of bone tissue in intensity. Reasons to get this bone injury are as follows:

• Road accident - a strong blow to the shin area.
• Falling or jumping from a height - if you land unsuccessfully on straight legs, a fracture of the tibia and fibula occurs, with or without displacement, causing harm to health.
• Skateboard, skates or skis - when riding on the listed objects, excessive rotation of the shin occurs when fixed foot, which leads to limb injury.
• A strong blow to the knee or a fall on it.
• Sports injuries, car accident - compression of the lower leg bones.
• The leg is twisted at the ankle joint.
• blow to the ankle with a blunt object.

Important! Another reason for fractures in this area are diseases that affect the strength of bone tissue.

Types of damage to the tibia

A shin injury occurs in the middle part of the tibia in the diaphysis area. When fractures of the fibula together with a fracture of the tibia, the prognosis of the pathology worsens significantly and leads to complications. With such an injury, therapy and rehabilitation require a long time.

Fractures of the fibula and tibia can be closed or open. With a closed fracture, the bones remain inside, under the skin, while an open fracture is fraught with bone fragments coming out through the dermis.

Closed injuries may be complete or have "grapevine" bone fractures. In turn, there is a complete fracture of the bones with displacement or without bone fragments.

The severity of harm to a person’s health due to leg fractures depends on the type of injury:

• Partial.
• Full.
• Open.
• Closed.
• With offset.

Fractures

Fibula fracture

The fibula fracture represents an injury that was received due to a blow. The result of such an injury is directly related to the fact that the bone structures lose their integrity.

The injury can occur after a person falls or in a traffic accident. Violation of safety precautions in the workplace can also cause this fracture, causing harm to the health of the victim. The shin bones can be injured due to bad weather.

In medicine, there are several types of fibula injury in children and adults:

• Fracture of the fibula with displacement of fragments.
• Fracture of the fibula without displacement of fragments.
• Transverse injury.
• Trauma with oblique fracture.
• Spiral fracture of the limb.
• The leg has a fragmentary fracture.

What are the main symptoms of a fibula fracture?

• The limb deviates from the axis;
• Sharp pain and swelling appears.
• One limb becomes shorter than the other.
• There may be numbness in the leg.

Important! Treatment for this fracture depends entirely on the nature of the injury and the degree of harm to health.

Tibia fracture

A tibia fracture occurs when the load on the limb exceeds the strength of the bone itself and the bone structure is damaged. This type of fracture is the result of a direct blow to the bone, which can occur as a result of a fall or being hit by a car.

The main types of fracture of the tibia:

• Displaced fracture of the tibia - damaged bones are displaced from their axis. The severity of the harm to health is high. This injury cannot be treated conservatively; surgical intervention is necessary.
• A break or small crack in a bone. Can be placed vertically on the leg or horizontally.
• Comminuted fracture.
• Closed fractures. The tibia did not violate the integrity of the soft tissues on the victim’s leg and the fracture is not visible, only palpable.
• Open fractures. There is a violation of the skin with open fractures. The broken tibia is visible from the outside. Refers to common fractures.

Main signs of a fracture:

• Dumb, It's a dull pain. A person cannot step on the injured limb, and if he tries to lean on the surface, in order to stand up he has a strong pain syndrome, which in some cases causes leg cramps.
• Swelling and hematoma appear in the area of ​​injury.
• The leg is deformed.

Important! If the tibia is fractured, the victim cannot move independently; he must be assisted first aid. If a child receives such an injury, he should be immediately taken to a specialist.

First aid

The most important thing for the victim is timely and correct assistance. People often ask what to do in case of a fracture, is it possible to somehow help the patient? It is not only possible, but also necessary to provide first aid, but only if you know how. Until the ambulance arrives or the victim is taken to the hospital, a number of actions must be taken. Algorithm of actions:

• It is necessary to relieve pain with analgesics. This is not suitable for small children. In the absence of a wound, you can apply a cold compress, which will not only relieve pain, but also stop the development of swelling and hematoma.
• In order to prevent the bone fragments from moving and causing harm to the tissues surrounding them, it is necessary to fix the damaged leg and make it immobile. This is especially important for screw fractures that consist of bone fragments. To do this, take two large boards or thick sticks. One of them needs to be secured with a bandage to inside legs, and the second to the outside. A homemade splint must be applied from heel to hip, firmly fixing it in the area of ​​the knee and ankle joint.
• In case of an open fracture, first clean the wound of contaminants, being careful not to touch the bone. After this, you should treat the wound with an antiseptic and apply a dry sterile bandage. Ointments and other products cannot be used.
• If there is blood loss, then a tourniquet is applied to the femoral part of the leg and the time when the procedure was performed is remembered, since it cannot be kept on the leg for more than two hours. If the limb has lost color and become cold, the tourniquet must be removed.

An injured child or adult should only be transported in supine position. This is necessary in order to avoid causing harm to health.

Diagnostics

After a person has damaged the fibula or tibia and has been taken to the clinic, the doctor orders a detailed examination. This is necessary for further treatment and positive restoration of all functions of the damaged limb. At the first stage, the specialist collects anamnesis, then proceeds visual inspection to detect leg deformation, bleeding, the presence of edema and hematoma, protrusion under the skin.

After this, the patient is sent for radiography. This method helps determine the nature of the damage to the tibia and diagnose a fracture. Also, using an x-ray, you can determine the condition of the fibula and whether there is a displaced fracture. If there are symptoms of a more severe injury, a CT scan is prescribed. With help this method it is possible to see a cross section of tissue, identify an oblique fracture and get a more accurate picture of the severity of the injury.

After the diagnosis is announced, the victim will be sent to a surgical or orthopedic department.

Fracture treatment

Treatment and rehabilitation of a tibia fracture depends on the type of injury and associated complications, as well as how long to walk in a cast with certain fractures.

No offset

When treating a non-displaced injury, the doctor does local anesthesia and applies a plaster bandage. Superimposed gypsum bandage from the heel bone to the middle of the thigh. After this, a repeat x-ray is taken to make sure that the bones are anatomically correct and that no fragments could be displaced.

A week after immobilization, a repeat x-ray is taken. The plaster is removed two and a half months after the injury, then a rehabilitation course is carried out for a month. If no complications arise during therapy and the bones heal normally, then full recovery all functions of the limb occur after four months.

With offset

If there are obvious displacements of bone fragments, the treatment tactics are somewhat different from the previous one, and the treatment time for the fracture increases.

After the patient has been taken to the hospital, the injured limb is anesthetized, after which the patient is placed in traction. During treatment, the muscles are stretched and the bone segments are not displaced. The patient remains in this state until the callus grows, and this depends on the number of damaged bones and how long they will heal.

Throughout the entire period while bone fusion occurs, the patient is given an x-ray, in which the doctor observes the formation of callus. If the bone heals normally and the patient’s condition is satisfactory, then traction is canceled after about a month and a half. After this, the bones are fixed using a plaster splint. After 2-4 months, a control x-ray is carried out, and if it shows that there is no need for a plaster fixation, the fused bone fragment looks normal, then the splint is removed.

Surgical intervention

Surgical intervention for fractures of the tibia is resorted to in the following cases:

• An open fracture and there is a need to monitor wound healing.
• An unstable fracture with a health hazard or the presence of more than three bone fragments.
• Conservative treatment did not give a positive result - the bone heals incorrectly or slowly.

Doctors to treat a fracture surgical intervention The following devices are used:

Illizarov apparatus

This method is one of the most reliable for quick and effective treatment, since the knitting needles, which are inserted into the bone fragments and brought out, form a frame. The bones are fixed rigidly, so that the fragment does not move under the skin, even if its edges are oblique. The doctor has the ability to change the position of the segments during therapy.

Screws

Fixation of the tibia using the external method gives positive results, but doctors resort to it in extreme cases. During the operation, special screws are inserted into the bone, which are brought out and secured with metal structure, which holds the fragments well in the desired position and prevents them from moving during the fusion process. But this method has contraindications - it is not suitable for children with long-term rehabilitation.

Kernel

An incision is made on the victim's skin. A special steel rod is inserted through it into the bone canal, which is removed when the bone heals completely.

Plate

Holes are made in the skin through which a plate is attached to the bone using special screws. This operation is not performed when treating a fracture in children, since it can damage the periosteum, which will negatively affect bone growth in the future.

Drug treatment

Regardless of the type of fracture and treatment method, the patient is prescribed medications that help with recovery. These products improve microcirculation and nourish the patient’s body. essential vitamins. If necessary, the patient is prescribed painkillers.

Rehabilitation

Rehabilitation after a tibia injury, unless there are complications, should begin almost immediately after the cast has been applied. To develop a leg after a fracture, the patient is advised to start moving his toes and carefully turning his foot.

It is necessary to work out the leg after an injury so that all its functions are restored. The doctor draws up a rehabilitation plan, which includes - massotherapy, physical therapy and specific leg exercises. But when working out your leg, you should be extremely careful - not to overexert it, so as not to cause adverse side effects.

Full recovery, provided all doctor's instructions are followed, occurs six months after the injury.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!

Children, due to their activity, are very susceptible to domestic injuries. According to statistics, 15-18% of all injuries received by a child while playing on the street are fractures.

Due to the fact that skeletal system V early age different from an adult pediatric fractures have a number of specific features, so parents need to have at least a rough idea of ​​this type of injury.

Features of childhood fractures

No one is immune from falls and injuries, and in adults, almost every second case of injury is a fracture. And if adults more often break limbs and the neck of the femur, then in children there are two, the most “vulnerable” places - a fracture in elbow joint in the child and forearm.

The child’s skeletal system is much more active and better supplied with blood, since it is in constant process growth, it contains a large number of organic protein. Traumatologists confidently state the fact that in most cases a broken bone in children is a so-called “green stick”. For example, on x-ray a child's arm fracture looks like a broken green tree branch, slightly bent after the injury.

Sometimes, people who suffered arm or leg injuries in childhood suffer greatly from their consequences throughout their lives. For example, a fracture radius in a child, it grows together precisely in the area where active growth of bone tissue is observed. If there is no displacement or fragments, and the healing process is only the application of plaster, then there is no reason to worry.

However, there are cases of severe trauma when the formation of callus and bone fusion proceeds slower than its growth. The consequence of this process is shortening or curvature of the limb.

Classification and nature of fractures in children

Most often, injuries affect the limbs. A fracture of a leg or arm in a child can be pathological or physiological. The first occur against the background of chronic or acquired diseases, during which the skeletal system is destroyed or subject to deformation. The second are spontaneous traumatic injuries.

Physiological ones are divided into open (with damage to the skin) and closed, with and without bone displacement.

Broken arm

Hand injuries are classified according to the characteristics of the bone damage and the line along which it occurred. A displaced fracture of the arm in a child can be oblique, longitudinal, helical or transverse. Displacement is a problematic injury tubular bones, while the damage itself can be single, double (the bone is broken in two places), or multiple.

Signs of a displaced arm fracture in a child are swelling, swelling and strong pain in the area of ​​injury, in multiple cases - deformation of the hand and formed on skin hematoma. In the first days after injury, the child may experience elevated temperature, which is associated with tissue ruptures and internal bruising.

Fracture of the clavicle and humerus

This type of injury is classified as serious, occurring mainly when falling on an outstretched arm, elbow or shoulder. When a fracture of the forearm is displaced in children, uncharacteristic mobility is observed shoulder joint, swelling, crunching and deformation. The arm dangles arbitrarily along the body, the baby cannot move it, any attempt causes severe pain.

But if this happened at the bottom humerus, the consequences can be unpredictable, as the debris begins to move over long distances, damaging blood vessels and tendons along the way. In the event of a displaced fracture of the collarbone, parents should immediately apply cold to the bruised area and take the child to the nearest clinic.

Tibia fracture

Even those who do not have sufficient knowledge in the field of medicine, but know where the tibia is located, understand that this type of injury is also very dangerous. But, fortunately, this bone does not break so often in children. IN in this case the symptoms are obvious - the child has a clear displacement of one of the tibia bones (small or large). Sharp pain, a quickly swollen leg and the appearance of a hematoma are the first signs of a fracture of the tibia. The baby has difficulty moving and practically cannot lean on his leg, as this causes unbearable pain.

If the fibula is damaged, then in some cases the child can move. Interesting fact, but a fracture of the tibia in a child 4 years of age or younger may go unnoticed, since it does not have pronounced symptoms, and is very often justified only by the child’s complaints of periodic aching pain.

Fracture of the nose and parietal bone

Signs of a broken nose in a child are, first of all, curvature. After an injury, the first thing parents should do is remove the curvature. As soon as swelling and hematoma begin, this symptom will go away and the fracture may be determined only by an x-ray.

As a rule, at the first visit to the clinic, the specialist is able to put the nose together like a “puzzle”. In children, such fractures heal within 2-3 weeks and do not require additional treatment or surgical involvement. If the bone is crushed, aesthetic facial correction will definitely be required, which is carried out in the clinic in the departments of maxillofacial therapy.

Doctor Komarovsky: a fracture in a child

Fracture parietal bone in a child is observed in 70% of cases with strong blows head, falls from height, mechanical injuries. This is a very rare type of fracture, since the bone itself in young children has increased coefficient strength. Parietal bone fracture infant is fraught with unpleasant consequences.

Since tissue that has not yet matured is exposed to trauma, this can lead to loss of consciousness and mental disorders.

Whatever the nature of the fracture, parents need to remember that a quick response, going to the clinic and accepting urgent action are able to minimize both the physical pain and moral trauma of the baby. In a specialized clinic, the child will be given an x-ray, a cast will be applied, and first aid will be provided.