Fracture of the lower limb is a fairly common injury. This violates the integrity of the bone structures and adjacent tissues, so that damage is widespread.
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 form of the fracture, the severity and location.
Classification
Depending on the damage line 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 located along the length of the bone structure.
- Helical. In this case, the fracture line has the shape of a spiral (this happens with a sharp twisting of the limbs).
Depending on the number of fragments emit:
- Polyfocal. There are more than 2 large fragments of bone.
- Comminuted. Separates several fragments.
- Fragmented. A large number of small fragments are present.
Depending on the nature of the injury, there are:
- Compression. The bone is compressed, cracked, flattened, deformed.
- Driven 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 fracture on the lower limb, there are:
- Fracture of the bones of the 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 tarsus, metatarsal bone, and phalanges of the fingers are also damaged.
- Fracture of the femur. This also applies to the head and neck of the thigh.
Damage to the distal and proximal endings of bone structures are intraarticular and periarticular. In the first case, the ligaments, capsule, and cartilage are also damaged. In parallel, there may be a dislocation or a subluxation. Periarticular fractures are usually located in the area between the end of the articular joint and the diaphysis.
ICD-10 code
Fracture of the lower limb, according to the classification of ICD-10, adopted in 2016, belongs to the general class “Injuries, poisoning and some other consequences of external causes (S00-T98)”. But in the lower limb there is a large number of bones, so there are several subclasses.
Fracture of the femur combined with some injuries of the hip joint. He is part of the subclass "Injuries to the hip and hip." In this block, the fracture has the code S72.
The ICD-10 code for ankle fracture is S82. He is part of the knee and lower leg injury. In addition to such fractures, joint injuries also apply.
Fractures of the foot are code S92. They belong to the large block "Injuries to the ankle and foot."
All these blocks have many subcategories, which include injuries of various bone structures.
Symptoms
With 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 dull character, does not go away;
- pain, if a person tries to step on his leg, there is a sharp and throbbing;
- limitation of mobility;
- blue skin at the site of injury, swelling, hematoma symptoms;
- crepitus, which occurs due to the fact that the debris rub against each other;
- a 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, femoral, tibial and metatarsal;
- a bone is visible if there is an open fracture;
- the ability to probe the wreckage, if there is a displacement;
- unnatural position of the legs;
- increase in body temperature;
In addition, the length of the affected limb may be reduced compared to a healthy one. With a fracture of the patella without displacement, swelling occurs. A complete disruption of the functioning of the articular joint also occurs. If there is a fracture of the toes or the whole of this zone, then the functions will be impaired only partially, and the leg will slightly swell.
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 say about such symptoms to a traumatologist.
As for the closed fracture of the bones of the lower extremities, the characteristic symptoms are as follows:
- the shape of the leg varies greatly;
- on palpation, a crunch is heard;
- mobility is unnatural;
- blackening of the skin at the site of injury after some time (caused by stagnation of blood).
Usually, it is 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, since there is a chance of infection in the wound. The skin in this place is very hot. The integrity of the tissues is broken. Trauma 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).
Causes
The following causes of the mechanical type of damage are distinguished:
- hit with a heavy object;
- falling from a great height;
- traffic accident;
- accident of any kind;
- during sports activities;
- when injured by a firearm;
- in case of violation of safety rules during childbirth (trauma in a newborn).
There is another group of factors that reduce the density of bone structures, which increases the likelihood of a fracture:
- osteomyelitis;
- bone tuberculosis;
- cancerous diseases;
- fibrotic dysplasia;
- genetic pathologies;
- polyarthritis;
- osteoporosis.
Most diseases that can lead to a violation of the integrity of bone tissue usually develop with age.
First aid
First aid is an important stage of pre-medical treatment. The following actions must be performed if the injured leg is injured:
- If there is severe bleeding (that is, blood vessels are damaged), then a tourniquet is required. But you need to keep it no more than 2 hours. It is always necessary to detect time.
- If respiratory or heart failure is observed, 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 steps must be completed as soon 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:
- Raise leg before applying tourniquet. Just 5 minutes is enough. This is required for the outflow of blood in the veins.
- Place a gauze bandage or bandage under the tourniquet itself. You can put it on clothes.
- A tourniquet is required in the middle of the thigh.
- The first 2 times you need to wrap the tourniquet very strongly.
- In warm weather, keep the tourniquet no more than 1.5 hours, and in cold weather - up to an hour. After this time, you need to loosen it, but hold the artery with your fingers. Enough 15 minutes. If after this 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, then the bleeding stops. The skin below the tourniquet will be lighter and cooler, and the pulse will not work out. The leg may go numb.
Rules for fixing the leg in a fracture
In case of a broken leg, it must be fixed. To do this, it is necessary to accurately determine the place of 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 pain medication. A person needs to be reassured and explained. Do not take off his clothes or shoes. If the trousers are too narrow and interfere with the examination of the affected limb, then the material will have to be cut.
To fix the legs, the Diterichs technique is used. But before all actions, it is required to overlay the limb with soft material, cotton wool. This will prevent bedsores. With an open type of fracture, a tourniquet is imposed, but so that it does not interfere with laying the tire, and it would not be necessary to disassemble the entire structure.
To fix the legs using a frame made of metal or wood. If the fracture is received in the cold season, then the limb needs to be additionally insulated. With a fracture of the lower leg, fixation is performed according to the Cramer method. This fixes the back of the leg.
Diagnostics
Diagnostics includes the following:
- interrogation (determine the situation in which the injury was received);
- palpation of the affected area;
- x-ray diffraction;
- 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. Medication is not included in the therapy, but the doctor may prescribe painkillers as well as vitamin preparations with a high calcium content.
The treatment methods are as follows:
- closed reposition of bones;
- surgery with minimal tissue incisions;
- gypsum overlay.
Gypsum with a fracture of a toe or any other bone structure of the lower limb is superimposed with any type of open or closed injury. The wearing time for 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 attending doctor. With a calcaneus fracture, the orthosis ideally helps to relieve the affected 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.
Surgical intervention is prescribed in the following cases:
- open fracture;
- comminuted fracture ;
- failed hood and closed recovery.
Thanks to the operation, bone fragments are better fixed, therefore, recovery will be faster.
Hip fracture
Fracture of the femur is a serious injury that is accompanied by bleeding. Of the complications, bedsores and congestive pneumonia are distinguished. In addition, fat embolism is possible in the first 3 days.
Fracture of the femoral neck refers to intraarticular. Most often, it occurs in old age in people with osteoporosis. Fracture appears in the fall. The limb will be deployed outward. In the supine position, the patient will not be able to raise the heel.
A damaged limb looks shorter than a healthy one. Puffiness is small. The thigh neck will grow together poorly due to insufficient blood flow. As a rule, a surgical operation is performed - bone autoplasty, osteosynthesis, or endoprosthetics.
Spit fracture belongs to the group of extra-articular. Usually occurs in people of working age. Symptoms will be the same as with a violation of the integrity of the femoral neck, but they are more pronounced.
Swelling is very strong, as is 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.
A diaphyseal hip fracture is usually caused by an accident, a fall, or an accident at work. Typically, with such an injury, there will be a displacement due to the fact that the muscles pull and deploy fragments. You feel severe pain, swelling, bruising. The leg is shortened, and the thigh has a deformed shape.
A strong painkiller is required first to prevent shock. After that, an extract or osteosynthesis is used.
Condylar fractures are intraarticular. Usually they appear in the elderly. The reason most often is a fall or a blow. There is sharp pain in the knee and lower thigh. The movement is limited, it is not possible to rely on a limb. The knee area swells, hemarthrosis develops. If there is an offset, then the shin is rejected.
For treatment, traction or gypsum is used. If it is not possible to combine the fragments, then osteosynthesis is performed.
Shin fractures
Shin fractures are one of the most common. They arise due to an accident, a strong and energetic effect on the bone, or a fall from a great height. An exception is only an ankle fracture, which usually occurs when a leg is tucked. In this case, ligament rupture is also observed.
Fractures of the condyles of the tibial bone structure are intraarticular. They occur in most cases due to a fall from a height. It can be damaged as a single condyle (external or internal), and both at once.
Hemarthrosis develops in the knee, swelling appears. The movement is difficult. For treatment, puncture and anesthesia are performed. Then gypsum is applied, and if there is an offset, then traction, osteosynthesis or the Ilizarov apparatus is 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 an offset, which requires surgical intervention. After reposition, gypsum is applied.
Fractures of the foot
Calcaneus fractures usually occur when falling from a great height. You must know where the talus is located. This is one of the bone structures of the tarsus. It connects to the calcaneus.
A fracture can be either intraarticular or extraarticular, with displacement of fragments and without it. In the place where the talus and calcaneal structures are located, puffiness and severe pain appear. It’s impossible to lean. The heel expands greatly. If there are no displacements, then apply gypsum. Otherwise, carry out a closed reposition. In severe cases, they can mount the Ilizarov apparatus.
The sphenoid bones of the foot are 2 tarsal structures. Their fractures are a very rare occurrence. It can occur with a direct hit, fall, tuck. Tissues in the area of the sphenoid bones of the foot swell, pain appears, problems with movements and support. Have to wear gypsum for up to 1.5 months.
In fractures of the metatarsus and fingers, which is a fairly common injury, the appearance of confusion is often. The distal area of the foot swells, pain appears. Leaning on the foot is very difficult.
Treatment involves the use of a plaster cast. If there is an offset, then reposition is first performed. Knitting is carried out in the case when it is impossible to fix the breaks in the right position.
In any case, the help of specialists is indispensable.