The mechanism of fractures of the shin bone may be direct: a blow to the shin, hit his legs under the wheel of a car. Indirect mechanism of fracture occurs when bending leg at a sharp turn of the body when the foot is fixed in place (helical fractures). The displacement of bone fragments of leg bones depends on the direction of traumatic force during the initial exposure. Then, under the thrust of the muscles attach to bones of the leg fragments are displaced along the length.
At the turn at the top of the upper tibia diaphysis otlomok under the influence of a strong quadriceps muscle is shifted upwards. Fractures of the tibia is a feature of the unfavorable conditions for the fusion of bones in the lower third of the tibia. Here, the blood supply of bone lean.
When the double leg fracture occurs inside the gap feeding artery, due to that supply blood to the shin bone, which further complicates the healing of the fracture. Fusion of the fibula is faster than the tibia, which may hinder the convergence and fusion of fragments of the tibia. Patients complain of pain and swelling in the area of the fracture. Most fractures of the tibia are open and are accompanied by damage to the skin and muscle bone fragments. There may be considerable bleeding.
When fractures of the fibula in the leg movements can be preserved in full, but the peripheral otlomok rotated outwards and can be felt through the skin. When fractures of both bones of leg broken leg configuration, the function is lost legs, walking impossible. Clarify the diagnosis after x-rays.
Treatment of fractures of the tibia diaphysis.
Anesthesia is performed by the fracture of solutions of local anesthetics. If the bias is not found or is a minor, applied cast from the middle third of the thigh to the toes of the foot. The term immobilization for 3 months. When fractures of the fibula without displacement plaster cast is applied for 2-3 weeks. Appointed by the dosage load on the damaged leg in 1-2 weeks. Complete fracture healing occurs within 1.5 months. When fractures of both bones of leg circular cast applied to the middle third of the thigh to the toes for 2 months for fractures in the upper third and at 3 months for fractures in the lower third of the tibia. If there is displacement of bone fragments are compared (reduction). Reduction is carried out manually on an orthopedic table. Then make an X-ray control and put a plaster cast for 3 months.
Skeletal traction is used when the fragments can not hold in the associated position. Shin is placed on a special bus, carried through the needle heel bone. By the needle is hung a weight of 5.10 kg. The term skeletal traction to 1.5 months. Then, on the lower leg cast is applied for 1.5-2 months.
If it is impossible to keep the associated fragments used internal fixation. However, this method of surgical treatment is often accompanied by complications, so it resorted to strict indications. Tibia bare, and perform surgical fixation with screws, plates, intraosseous pins. After fixation plaster cast is applied for the whole seam.
In comminuted, fragmented, complex fractures, the presence of purulent complications of wounds at the site of the fracture is transosseous osteosynthesis with the Ilizarov fixator. This treatment allows you to take care of the wound surface, but also allows early loading on the tibia, which contributes to its better fusion.