A fracture of the tibia is a common violation of the integrity of long tubular bones. Together with this injury, as a rule, damage to the fibula also occurs. In most cases, the cause of a leg fracture is an accident and falls from a great height. Understanding that a person has broken a leg is not difficult, especially when it comes to a fracture of the open tibia. You will learn about the classification of lower leg injuries, methods of their treatment and possible complications from this article.
The anatomical structure of the lower leg
The bone about which we will speak today is tubular. In comparison with other fragments of the skeleton, it has a significant length and volume. The tibia includes the 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 - due to the participation of the proximal end.
The tibia is located next to the tibia. It is located in the back of the limb and has similar heads at the two ends (proximal and distal) connected by flat joints, due to which gliding in this part of the lower leg is limited.
The tibia and tibia are not fused to each other, while the latter is less mobile, since it does not participate in the formation of the knee joint. The fibrous membrane stretched between two bones guarantees high strength and protection against light impacts and damage.
Fractures of the tibia in the ICD of the tenth revision
Injuries of the lower leg in the current edition of the International Classification of Diseases are indicated by the common code S82. This subsection includes various types of damage, each of which is marked by an additional figure. 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 intraarticular joints.
The subheadings of section S82 are necessary for optional use in the presence of additional state characteristics when it is impossible or inappropriate to conduct multiple coding. To accurately identify the type of tibial fracture, ICD-10 clearly distinguishes between open and closed shin injuries.
Each patient in a personal medical history or disability sheet can see a record with a code. The injury coding system allows statistics and analysis of cases of recovery or complications, including after fractures of the tibia. ICD-10 is used by all countries participating in the World Health Organization.
Types of injuries
ICD established the official classification of tibial fractures. Code S82.0 gives damage to the patella. The code S82.4 is intended solely to indicate fractures of the fibula. Code S82.1 is attached to proximal fractures of the tibia, including damage to the condyles, head, tuberosity, plateau. To clarify the diagnosis, S82.5 is used, which indicates damage to the internal bones of the ankle or ankle, and S82.7 - to identify 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 leg:
- partial, in which there is no significant harm to health and well-being;
- complete - in this case, a fracture of the bone structure occurs, affecting muscle tissue and ligaments.
In addition, an open and closed fracture of the tibia is distinguished. In the first case, the injury is isolated, in the second - there is a displacement. A closed fracture is more dangerous for the patient’s health and life, because when broken, sharp bone fragments can damage not only the surrounding soft tissues, but also blood vessels.
Other types of damage are distinguished depending on the vector of the force acting on the shin:
- stable - this is a fracture of the tibia without displacement, that is, the fragmented parts remain in their original position, without provoking ruptures of muscle fibers, tendons and ligaments;
- oblique - in this case, the fault passes obliquely;
- longitudinal - the damage line is visible to the naked eye;
- helical - a rather rare type of injury, in which a fragment of a fragment turns 180 ° from its natural position.
Fractures of the legs are diagnosed with the same frequency as damage 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, 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 syndrome is not the only symptom of a fracture of the tibia. Patients describe their condition as follows:
- the inability to step on the foot;
- visually noticeable deformation and shortening of the damaged leg in relation to a healthy limb;
- shortening of a damaged limb in relation to a healthy one;
- violation of tissue sensitivity.
With an open type of leg injury, hemorrhage occurs, and bone fragments can stick out of the wound. Evidence of a distal fracture of the tibia is a strong swelling of the limb.
Pain syndrome with a fracture of the leg will increase dramatically when trying to lean on the leg. Due to increasing pressure on the heel in a standing position, mobility of the limb is minimized. A fracture can also be recognized by the unnaturally arched position of the limb.
Signs of damage in a child
If there is no doubt in the diagnosis with an open leg injury, then an examination cannot be done to confirm a closed fracture of the tibia. Compared to adults, injuries in children are 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, like an adult, to step on an injured leg.
Moreover, pain 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 weakly expressed, be aching and dull. As soon as the victim makes a new attempt to lean on his foot, the sharp pain will return.
In children, a hematoma is quickly formed around the site of bone fracture. The leg itself may look deformed, and in the area of the scrape, atypical tissue mobility occurs. In childhood, the sensitivity of the foot disappears extremely rarely. The loss of innervation, in which the limb becomes pale and cold, may be a confirmation of the rupture of blood vessels. If a person receives an open injury, there is no doubt in its nature.
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. When practicing active sports and martial arts, a leg injury is also a common injury. A fracture can also occur in people suffering from bone tissue pathologies (osteomyelitis, bone tuberculosis, osteoporosis, and cancer).
Complicated Injuries
An intercondylar fracture of the tibia is a relatively rare case in the practice of traumatologists. Often, such damage is not independent, but is associated with other damage to the lower leg. In this case, patients feel acute pain in 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.
With a fracture of the lateral condyle of the tibia, the ankle swells, support on the limb becomes impossible, a noticeable deviation of the foot inward is observed. To confirm the diagnosis, the injured patient is sent for radiography, which is performed in several projections.
In complicated fractures of the lower leg, as a rule, they resort to surgical treatment using the Ilizarov apparatus, implanting 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 of bone fragments. An unnatural turn of the foot and a noticeable shortening of the damaged limb due to the convergence of the fragments with each other will testify to a fracture of the tibia with displacement.
First Aid Rules for Shin Fractures
Timely assistance to the victim plays a huge role in his further recovery. The probability of developing complications and the rate of recovery of the patient depends on whether the therapeutic measures were correctly rendered or not.
First of all, it is necessary 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.).
Care must be taken when an open fracture occurs. The edges of the tibia can stick out of the wound, but they should not be touched or tried to set. Any careless movement can lead to additional bone fracture, which will significantly exacerbate the already unenviable position.
If the victim has bleeding, a tourniquet is applied to the injured limb. The optimal place for its overlay is the middle of the thigh. As soon as the blood stops, all visible impurities must be carefully removed and the wound carefully treated with disinfectant solutions. After applying antiseptic agents, a dense, but not pressing, sterile dressing is applied.
Next, using any material at hand, you need to fix the damaged limb in a static position and rid it of even the minimum load. When the lateral displacement or fracture of the medial condyle of the tibia of the patient is placed on a flat surface, and the tire is fixed with a bandage or other improvised materials to the injured leg from the side opposite to the damage. With a high probability of a fracture, ice should be applied.
Waiting for the arrival of the ambulance crew, the patient is laid on a hard surface. It is especially important to eliminate the stress in the foot that has arisen as a result of edema, so the shoes must be removed. If for some reason the arrival of specialists is impossible and the victim will have to be transported on their own, it is important to ensure complete immobility of the leg from the ankle to the middle of the femur. An alternative is to bandage the injured limb to a healthy one. It is possible to transport the injured person in a passenger car only when lying down.
Fracture Diagnosis
In order 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, deformation;
- clarifies the circumstances of the injury to the victim;
- ascertains the direction of the impact force (this indicator is necessary to study the properties of the injury);
- appoints an X-ray examination, the result of which will help to make a conclusion about the type of fracture, and computed tomography, which will assess the condition of ligaments, muscles, blood vessels, tendons.
After clarifying the diagnosis, the victim is sent to the inpatient surgery department. A fracture of the tibia can be easily seen on an x-ray taken in two projections. The study will determine the number of lesions and their exact location. CT is usually prescribed for suspected damage to neighboring joints.
Treatment principles
The recovery technique is selected individually in each case. The choice of treatment tactics depends on the complexity of the fracture of the tibia. Doctors give the most favorable prognosis for the recovery of patients with injury without bias. The victim is given a plaster bandage from the tips of the fingers to the lower leg, while it is difficult to give an unambiguous answer about how long the victim will have to wear it.
If the damage to the bone entailed the displacement of the debris, it is first of all important to determine in which direction the shift occurred.
- With an oblique fracture, reduction is required by the traction method, due to which the bones will eventually fall into place. The essence of this treatment is the implantation of a special needle into the bone. A suspended load is mounted on this spoke.
- In the case of a fracture of the transverse type, a metal plate is installed, and gypsum is placed on top of it. And in the future, the treatment will take place according to the standard fracture treatment algorithm with a typical displacement.
- In case of fracture of the posterior edge of the tibia, a plaster cast is applied to the middle of the thigh.
Uncomplicated shin bone fracture is extremely rare. This is one of the few cases when with such serious damage 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 damaged limb is placed on the tire. The size of the suspended load depends on 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 may increase or decrease. The exhaust needle is removed after confirmation on the X-ray image of signs of bone marrow formation, after which the gypsum is applied for another 2.5 months. During this period, the patient is recommended to undergo a course of physiotherapy and exercise therapy.
Surgical intervention
There is no alternative to surgical treatment for a fracture of the 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 several days after the victim arrives at the inpatient unit. In the preoperative period, the patient should be in an immobilized lying position with an exhaust needle.
Surgical treatment of shin bone fractures involves the use of various metal structures, including metal blocking plates, intramedullary pins and rods. When choosing a method of osteosynthesis for the speediest bone fusion, the severity and location of the fracture are taken into account.
Fracture of the leg bones is a direct indication for using the Ilizarov apparatus - this method of extra focal osteosynthesis helps to restore the anatomically correct position of the fragments. In modern traumatology, the device is used to treat complicated injuries, including bone fragmentation. Despite the efficiency of using 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 an offset by tuberosity, the limb is fixed with a screw, and the tendon is sutured. The load on the shin is limited throughout the entire splicing period.
The dangerous consequences of a fracture
The most unfavorable complication of a leg injury can be its amputation, a decision that doctors make when tissue necrosis and sepsis develops. This can be avoided by the timely provision of first aid. There are other possible consequences of a fracture of the tibia. The ICD of the tenth revision has identified separate codes for pathological conditions that are complications of a leg injury:
- improperly fused fracture (M84.0);
- conglomerates or the occurrence of a false joint (M84.1);
- other consequences of a leg fracture (T93.2);
- complications caused by the use of implants or grafts (T84.0).
An unpleasant and problematic reminder of a fracture may be:
- arthritis or osteoarthrosis;
- peroneal nerve damage;
- wound infection with an open type of fracture;
- vascular aneurysms.
The term of the patient’s full rehabilitation depends not only on the severity of the injury, but also on the individual characteristics of the body. In most cases, at least six months are required for complete bone fusion and restoration of limb functions. But even after this period, not all patients experience pain, swelling. Also, the probability of impaired mobility of the ankle or knee joint is not excluded.
Testimonials of patients who survived a shin fracture
All the responses of the victims boil down to one thing: to return to full-fledged physical activity, it will take a lot of time. According to reviews, the rehabilitation period after fractures of the lower leg bones usually lasts about 2-3 weeks. In order to restore the limb motor functions as soon as possible, patients are recommended to develop a leg.
People confirm that due to prolonged wearing of a plaster cast, the muscles of their limbs became weaker and partially atrophied. To literally get to 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 heavy lifting can lead to repeated displacement. In order for the formed bone marrow to grow stronger, it may take several more months, so the load is increased in stages.
Many patients respond positively to rehabilitation massage - this is the second effective method of recovery after fracture of the lower leg bones. This is a great way to warm up muscles and improve blood circulation, which will contribute to faster recovery. 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 set of physical exercises for exercise therapy was for them personally a rehabilitologist. The specialist always takes into account the patient’s condition both at the time of limb damage and after recovery. At the same time, each individual is selected individual techniques and sets of exercises, which must necessarily be preceded by the initial stage of development of the muscles of the leg. As soon as the leg muscles acquire a satisfactory tone, patients are allowed to stand up, squat, and move around on their own.
In addition to performing therapeutic exercises, rehabilitation after a tibial injury can include physiotherapeutic procedures that improve trophism of damaged tissues and cells, and triggers 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
Special prevention of lower limb injuries does not exist. All recommendations of trauma surgeons are as follows:
- When walking, look carefully under your feet.
- Avoid obesity, take measures for weight loss.
- To cure infectious diseases to the end.
- Consume calcium fortified foods.
- Wear comfortable low-heeled shoes.
- Observe safety precautions during sports training, work, etc.
- Avoid jumping from considerable heights.