Fractures are injuries to bones in which their integrity is compromised. Fractures are divided into congenital and acquired. Congenital fractures are quite rare, they are formed either as a result of trauma received during pregnancy, or as a consequence of disease of the fetal skeleton. As for acquired fractures, the vast majority of them are traumatic fractures that occur as a result of the immediate impact of excessive mechanical force during transport, industrial, combat and other injuries. As a result of traumatic fractures, there is (to a greater or lesser extent) damage to the soft tissues that surround the bone. A fracture can be open if the integrity of the skin is disrupted as a result of a traumatic object or a sharp bone fragment. If the skin at the fracture site remains intact, the fracture is closed. Depending on the direction in which the fracture lines are located, fractures are distinguished as transverse, oblique and longitudinal.
a) fractures of the femur
b) patella fractures
c) fractures of the leg bones
d) ankle fractures
d) fractures of the foot bones
All hip fractures are treated in a hospital setting; the doctor must make a timely diagnosis, organize immobilization of the fracture and evacuation of the patient to a surgical hospital.
Depending on the location of the fracture, hip fractures are divided into fractures of the upper end of the femur, the diaphysis and the lower end. Fractures of the upper end of the femur are divided into intra-articular (medial femoral neck fractures), extra-articular (lateral femoral neck fractures) and isolated fractures of the greater and lesser trochanter. A femur fracture can occur due to direct as well as indirect trauma.
Also, depending on the location of the damage, femur fractures are divided into fractures of the proximal end (cervical fractures, fractures of the trochanteric region - pertrochanteric, intertrochanteric, isolated fractures of the greater and lesser trochanters), fractures of the diaphysis (upper, middle and lower third) and fractures of the distal end (condylar fractures). There are also hip fractures: closed, open and gunshot.
As for the clinical course, treatment and outcome of the types of femur fractures described above, they are different in each case.
This fracture is an intra-articular fracture of the knee joint and, according to statistics, occurs in 1-2% of cases in relation to all limb fractures. A patellar fracture most often occurs due to a direct mechanism of injury, for example, a fall on a bent knee, a blow to the patella with a hard object, etc. Quite rarely, a patellar fracture occurs as a result of an indirect mechanism of injury, such as a sharp contraction of the quadriceps femoris muscle.
In 80% of cases, the patellar fracture line is located transversely, in other cases it is in the middle of the patella or slightly distal. It is very rare to encounter patellar fractures with a longitudinal fracture plane. Displacement of fragments during a fracture of the patella occurs depending on the extent to which the lateral extensor apparatus was damaged. In the event that the lateral extensor apparatus does not rupture due to injury, the fragments of the patella do not diverge, as a result of which there is no dysfunction of the lower limb, namely, extension of the lower leg. Therefore, the patient can easily lift the straightened leg and keep it suspended.
However, if the lateral extensor apparatus is torn, the proximal fragment is displaced superiorly by the action of the quadriceps femoris muscle. As a consequence, there is a violation of the extensor function of the leg. The victim cannot lift his leg, straightened at the knee joint, and keep it suspended. Trying to bend or straighten the leg, the patient pulls it up, and the heel slides along the plane of the bed (the so-called positive symptom of a stuck heel).
A patellar fracture can be identified by the presence of local tenderness on palpation. This fracture is also characterized by the presence of gaps between the fragments of the patella, hemarthrosis, and the impossibility of active extension movements. In this case, passive extension of the leg is painless, but flexion of the leg, on the contrary, is very painful. With this pathology, there is a smoothing of the contours of the joint, and the diverging fragments of the patella are balling out. If its fragments are not displaced, then voting of the patella as a whole may occur.
The final confirmation of the diagnosis depends on the results of the radiograph, which is performed in two projections.
Fractures of the lower leg bones account for 10 to 30% of all bone fractures. Very often, these fractures occur as a result of the influence of a direct mechanism, that is, with the direct application of traumatic force. And in some cases, shin bone fractures can occur as a result of an indirect mechanism of injury when force is applied away from the fracture.
There are fractures of the proximal parts of the bones of the leg (which includes fractures of the condyles of the tibia, fractures of the head of the fibula), diaphyseal fractures (these are fractures of both bones, isolated fractures of one of the bones of the leg) and fractures of the ankles (the ankle joint area).
The listed locations of tibia fractures differ in the mechanogenesis of their occurrence, clinical course and methods of possible treatment. Particular attention should be paid to fractures of the proximal and distal ends of the tibia, which are severe intra-articular injuries.
The most common traumatic injury to the lower leg is an ankle fracture. These fractures account for 40-60% of all tibia fractures.
In most cases, ankle fractures occur as a result of an indirect mechanism of injury: tucking the foot outward or inward, excessive plantar or dorsal flexion of the foot, rotation, and as a result of various combinations of the mentioned mechanisms of injury.
Often ankle fractures are accompanied by ruptures of the tibiofibular syndesmosis ligaments, which causes the foot to shift outward and widen the ankle joint.
When an ankle is fractured, the following phenomena are observed: swelling, hemorrhage, local pain along the ankle fracture line and in the area of the deltoid ligament, which is also damaged, and there is also limited mobility in the ankle joint. After analyzing the x-rays, it can be determined whether there is displacement of ankle fracture fragments and subluxation of the foot. Fractures of one ankle (especially displaced ones) are sometimes mistaken for ligamentous tears. And fractures of two ankles at the same time occur more often. These fractures (like fractures of one ankle) are divided into supination (adduction) and pronation (abduction). Supination fractures of the ankles are formed due to the sudden turning of the foot inward with continued load of the entire weight of the body, because of this, the external ligaments are sharply strained and break off the lateral malleolus.
Fractures of the bones of the foot are divided into fractures of the talus, calcaneus, navicular, cuboid, wedge-shaped, metatarsal bones and phalanges.
A leg fracture is a violation of the integrity of the bone when a load or mechanical impact is applied that exceeds its strength. The occurrence of fractures is caused by both injury to a certain area and the presence of various pathologies and diseases that can reduce the strength of bone tissue and make it more vulnerable. The severity of a leg bone fracture is determined by the number and nature of the damaged areas. With multiple fractures, traumatic shock and blood loss are possible. The recovery process in such cases occurs rather slowly and depends on the nature of the damage, the course of the disease and the general condition of the victim, including the ability of bone tissue to heal.
In fact, bone fractures are by no means a rare phenomenon in wildlife, and methods of treatment and recovery have been well studied and are successfully applied in practice. These diseases, judging by historical data, were cured even in primitive society. As for the present time, traumatologists and surgeons have honed their skills with the help of modern medical equipment that allows them to see improperly fused bone tissue. In medical practice, there are several types of fractures, each of which is characterized by the area of localization, the nature of the damage and the final presence of altered tissue. Among all types, the most common are:
As for the structure of the leg, each of them consists of bones:
The occurrence of fractures due to injuries of various origins is characterized by the following relative symptoms and signs:
Depending on the severity, in addition to the relative signs of fractures, absolute ones are added:
The causes of leg fractures can be very different, but they all characterize the receipt of bone injuries with their visible damage and violation of the integrity of the structure. Factors in the occurrence of fractures include gunshot wounds, various household and industrial injuries, as well as injuries received as a result of playing sports.
Treatment of leg fractures is usually prescribed after diagnosis of the disease. At the present stage, under normal circumstances, radiography is prescribed in almost every case. When receiving images in frontal and lateral projections, the likelihood of making an incorrect diagnosis is minimized, since they allow you to visually see the presence and nature of the fracture and determine what measures to take.
Treatment involves bringing the damaged leg bones into the correct position with mandatory subsequent fixation. In most cases, first aid is to take painkillers through an IV or an inhalation mask, as well as immobilize the limb with a splint. After determining the nature of the fracture, doctors are given the opportunity to take further measures. In the case where there is a fracture without displacement or swelling, treatment is limited to the application of a plaster cast.
When the leg swells greatly, a splint is applied.
If the bones are displaced, they must be put in place before fixation. This procedure is called closed reduction. During this procedure, the patient may be given local or general anesthesia, during which there will be no pain at all. After the bones are brought into the correct position, the patient must be given a plaster cast.
Some serious leg fractures require surgery followed by internal fixation of the bone using pins, plates, screws or rods. Metal structures can be subsequently removed or left in the leg if they do not cause discomfort and are the main fixators and substitutes for lost or broken areas of bone tissue. In very rare cases, an external frame is used with the ability to secure the bones in the desired position using bolts, which must be removed after fusion. The surgical operation necessarily requires the subsequent application of a plaster cast to enable proper fusion of the leg bones.
The fusion process will take place under the periodic supervision of an orthopedic traumatologist. Typically, the first examination is scheduled for patients one or two weeks after the application of the cast. The most complex fractures in the usual scenario are subject to healing in a period of 3 months to six months. However, after removal of the bandage, many patients require follow-up examinations with follow-up X-rays for some time.
During treatment, patients are advised to strictly follow all medical advice and recommendations.
Many will be advised to use crutches or a wheelchair to move around until leg fractures heal. Support equipment must be used in compliance with safety regulations. The duration of treatment varies in each specific case. Small closed fractures without displacement usually heal within 7 months. However, more complex injuries may require more time to achieve full recovery.
The rehabilitation process includes a number of physiotherapeutic procedures and therapeutic exercises, which can be indicated for the patient before and after the removal of the cast. It is very important to strictly follow the instructions of your doctor and contact him immediately if you have any questions related to the condition of your leg. These measures are aimed at restoring muscle activity, flexibility and mobility of the injured limb.
A leg fracture is a disruption of the integrity of one or more bones of the lower limb as a result of trauma. It is an extremely widespread injury. The severity, timing and methods of treatment, as well as long-term consequences, can vary significantly depending on the level and characteristics of the fracture. Common signs of leg fractures are swelling, pain, and loss of support and movement. Pathological mobility and crepitus are often detected. To clarify the diagnosis, radiography and CT are used; in some cases, MRI and arthroscopy are prescribed. Both conservative and surgical treatment are possible.
A broken leg is an extremely common injury. According to statistics, 45% of the total number of skeletal injuries are fractures of the lower extremities. More often they are the result of accidents at home (for example, falls on a slippery surface). The second and third places in prevalence are occupied by leg fractures due to road accidents and falls from a height. In addition, the cause of injury can be criminal incidents, as well as industrial or natural disasters.
A leg fracture can be isolated or multiple, or observed as part of a combined injury (polytrauma). Possible combinations with fractures of the upper limbs, pelvic fractures, chest injuries, TBI, kidney damage, spinal fractures and blunt abdominal trauma. Treatment of leg fractures is carried out by traumatologists. Depending on the severity of the injury, both outpatient observation and hospitalization are possible. Both conservative methods and various surgical treatment methods are used.
Leg fractures can be complete or incomplete (cracks). Fractures of the legs that communicate with the external environment through a wound on the skin are called open. If there is no wound, the fracture is closed.
Depending on the characteristics of the fracture line and the nature of the fragments in traumatology, the following types of leg fractures are distinguished:
Taking into account the level of leg fracture, the following are distinguished:
Injuries to the proximal and distal ends of the bone can be intra-articular (epiphyseal) or periarticular (metaphyseal). With intra-articular leg fractures, concomitant damage to various articular structures is observed, including cartilage, capsule and ligaments. Possible combination with subluxation or dislocation. Periarticular leg fractures form in the transition zone between the articular end and the diaphysis and are often impacted. Diaphyseal fractures occur in the middle part of the bone and are usually accompanied by displacement of fragments.
A hip fracture is a serious injury, accompanied by severe pain and significant blood loss due to bleeding from fragments. The severity of the damage and the need to fix the fragments using skeletal traction or a massive plaster cast causes a sharp decrease in the mobility of patients, which, especially in the presence of other injuries or concomitant diseases, can cause the development of dangerous complications, including bedsores and congestive pneumonia. In the first three days after injury, fat embolism is possible.
Femoral neck fractures are intra-articular and occur more often in older patients with osteoporosis. A leg fracture occurs as a result of a fall at home or on the street; with a significant decrease in the strength of the bone, its integrity can be disrupted even with an awkward turn in bed. The patient complains of moderate pain in the joint area, the pain intensifies with movement. The leg is turned outward; in the supine position, the patient cannot independently lift the heel off the bed. When fragments are displaced, shortening of the limb is revealed. Swelling of the injured area is usually minor.
The diagnosis is confirmed by x-ray of the hip joint. Due to insufficient blood supply, the femoral neck heals poorly, a full bone callus, as a rule, is not formed, the fragments are “grabbed” together by connective tissue, which causes a high percentage of disability. Taking into account this circumstance, the preferred method of treatment for such leg fractures is surgery - osteosynthesis with a three-blade nail, endoprosthetics or autologous bone grafting.
If the general condition does not allow surgical intervention, skeletal traction is used. Elderly patients are given a plaster boot with a transverse bar that prevents rotation of the limb. This allows for the formation of fibrous callus while maintaining sufficient physical activity of the patient.
Trochanteric fractures are extra-articular and most often occur in patients of working age. The signs of a leg fracture are the same as for damage to the femoral neck, but the symptoms are more pronounced, there is more severe pain and significant swelling of the injured area. X-rays of the hip joint are also used for diagnosis. Such injuries usually heal well without surgery. The patient is placed in skeletal traction for 8 weeks and then replaced with a plaster cast. For early activation of patients, various surgical techniques can be used, including osteosynthesis with a plate, three-bladed nail or screws.
Diaphyseal femoral fractures occur due to direct or indirect trauma. The immediate cause of a broken leg can be a blow, a fall from a height, an accident or a work injury. People of working age are most often affected. Powerful muscles attached to the femur act on the fragments, “pulling” or turning the fragments, so with such fractures of the leg, in most cases there is a pronounced displacement.
There is sharp pain and significant swelling, and bruising may appear on the skin. The limb is shortened, the femur is deformed, crepitus and pathological mobility are detected. In some cases, traumatic shock is possible. To confirm the diagnosis, an x-ray of the hip is prescribed. Treatment is conservative or surgical. At the admission stage, high-quality pain relief is provided to prevent the development of shock. Then skeletal traction is applied or femoral osteosynthesis is performed with a plate, pin or rod.
Condylar fractures of the femur are intra-articular. They are more common in older people and occur when they fall or get hit on the knee. Accompanied by sharp pain in the knee and lower thigh. Support and movement are limited. The knee joint is swollen and hemarthrosis is detected. In case of displaced condyle fractures, deviation of the tibia inward or outward is observed. To clarify the diagnosis, an x-ray of the knee joint is prescribed. Upon admission, the joint is punctured, then a plaster cast or skeletal traction is applied. If the fragments cannot be compared, an operation is performed - osteosynthesis with screws, a plate or tie bolts.
Tibia fractures are the most common leg fractures. They arise as a result of high-energy exposure, for example, a car accident or a fall from a height. An exception is ankle fractures, which, as a rule, occur when the leg is twisted. They can be detected in people of any age, however, in general, there is a predominance of patients of working age.
Fractures of the tibial condyles are intra-articular and most often occur as a result of a fall from a height. Both isolated fractures of the internal or external condyle, and simultaneous fracture of two condyles are possible. The knee joint is swollen and has hemarthrosis. Movement and support are painful and severely difficult. The diagnosis is clarified on the basis of radiography; less often, MRI of the knee joint is used. Treatment is puncture, anesthesia; for non-displaced leg fractures, immobilization is performed with a plaster cast; for displaced injuries, skeletal traction is applied or surgery is performed (osteosynthesis with plates, screws or an Ilizarov apparatus).
Diaphyseal fractures of the leg bones . Formed as a result of direct or indirect high-energy trauma. A fracture of only the tibia or only the fibula, or a fracture of both tibia bones (the most common) is possible. With fractures of one bone, displacement of the fragments is not observed, or it is less pronounced and easier to correct, since the second bone remains intact and holds the broken one in a relatively correct position. Fractures of both bones are more severe, they are more likely to result in severe displacement and more often require surgical intervention.
The damage is manifested by pain and severe swelling. Pathological mobility and crepitus are observed. Support is impossible, movements are very difficult. The diagnosis is confirmed using radiography. Treatment of fractures of one of the bones of the leg is often conservative - if necessary, a reduction is carried out, then a plaster is applied. Treatment of injuries to both bones of the leg can be conservative or surgical. In the first case, skeletal traction is applied for 4 weeks, and then immobilization is carried out with a plaster cast. In the second, focal osteosynthesis is performed using locked rods, screws, and, less commonly, plates, or extrafocal osteosynthesis with the application of an Ilizarov apparatus.
Ankle fractures are a very common injury. Such leg fractures most often occur when the foot is twisted, less often they are the result of a direct blow to the joint area. Possible fracture of one ankle (inner or outer), fracture of both ankles (bimalleolar fracture) and fracture of both ankles in combination with damage to the posterior or anterior edge of the tibia (trimalleolar fracture). The injury may or may not be accompanied by subluxation, displacement of fragments and rupture of ligaments. In most cases, the more ankles are broken, the higher the likelihood of aggravating moments (subluxation, displacement, etc.).
There is a sharp pain. The joint area is swollen, movements and support are severely difficult or impossible. With subluxation and displacement of fragments, deformation of the damaged area is revealed. The diagnosis is confirmed by x-ray of the ankle joint. Treatment – anesthesia, reposition, plaster. The period of immobilization is determined based on the number of broken ankles (4 weeks for each ankle), that is, 4 weeks for single-ankle fractures, 8 for double-ankle fractures and 12 for trimalleolar fractures. If it is impossible to adequately compare the fragments and eliminate the subluxation, surgical intervention is indicated - osteosynthesis of the ankle with screws, plates or knitting needles.
A calcaneal fracture usually occurs during a fall from a height. It may be intra- or extra-articular, accompanied or not accompanied by displacement of fragments. The heel area is swollen, dilated, sharply painful, support is impossible. To clarify the diagnosis, an x-ray of the heel is performed. In case of leg fractures without displacement, a plaster cast is applied; in case of displacement, closed reduction is performed; in particularly difficult cases, an Ilizarov apparatus is sometimes installed.
Fractures of the tarsal bones - such leg fractures are quite rare and occur as a result of twisting the leg, falling or direct blow. Accompanied by pain, swelling of the foot, difficulty in support and movement. The diagnosis is confirmed by x-ray of the foot. Treatment is conservative - plaster for 1-1.5 months.
Fractures of the metatarsus and toes are fairly common leg fractures. More often they are formed as a result of a blow or fall of a heavy object on the foot. Sometimes there is a shift. The distal part of the foot is swollen, painful, and support is difficult. To clarify the diagnosis, radiography is used. Treatment is usually conservative - a plaster cast (if there is displacement, with preliminary reposition). If it is impossible to hold the fragments in the correct position, fixation is performed with a needle.
jointGangrene of the leg is a very dangerous and insidious disease, which is the complete or partial death of the leg or fingers. Appears as a result of a complete cessation of oxygen flow to the affected area. Unfortunately, even with modern equipment and medical knowledge, the prognosis of the disease is not favorable in all cases.
Gangrene of a finger or toe is necrosis, or death of living tissue, which appears as a result of a pathological process in the body. Under the influence of various factors, oxygen stops flowing to the leg, general blood circulation in the body worsens, which leads to tissue damage in large areas of the skin. If the symptoms are ignored, the affected areas begin to grow and affect neighboring areas of the skin.
As gangrene develops, cells begin to die, which contributes to the further progression of the disease. The exact time of development of gangrene has not yet been established: the disease can develop slowly, gradually, or rapidly. During slow progression, cells gradually die off on the foot or toes, causing intoxication of the entire body and rapidly developing further.
With rapid development, the limb is affected almost instantly, leaving no time to ignore dangerous symptoms. This is the most dangerous manifestation of gangrene: if measures are not taken in time, the rapid development of the disease can end a life in less than a day.
The rapid development of gangrene is observed in cases where insufficient attention is not paid to the disinfection of the injury or its timely elimination.
There are a number of different reasons that can trigger the development of gangrene. Among them there are several main ones:
Previously considered an incurable fatal disease, gangrene has now reduced the risk of death by 34%. According to statistics, about 65% of patients continue to live (albeit with limited physical capabilities).
Gangrene comes in several types and affects different areas of the body. Gangrene of the leg can be dry, wet or gassy. Depending on the type of disease, different symptoms appear:
In order for treatment to proceed as quickly and effectively as possible, it is necessary to seek medical help at the first signs of a developing disease. Some people prefer to treat it with folk remedies - this approach can temporarily mask the symptoms of a dangerous disease, but they will soon appear again.
When the first symptoms appear, which may indicate the development of gangrene of any type, it is necessary to urgently consult a surgeon. The doctor examines the leg and a separate area that is suspicious and interviews the patient. During palpation, the surgeon will be able to determine the thickening of the skin, evaluate the color; when pressing on the affected area, when gas gangrene develops, a specific crunching sound will be heard, occurring due to gas bubbles.
If the fears are confirmed, the doctor may prescribe additional testing: wrap a thread around the affected area to monitor swelling of the foot. As swelling increases, the thread begins to dig into the skin. During the diagnostic process, the following tests must be performed:
Most often, after a preliminary examination, the patient is prescribed a referral to a hospital, where the most effective treatment tactics are selected.
Treatment of the disease is possible with drug therapy or surgery. Drug treatment is possible only at the earliest stages of the disease. Drug therapy consists of several aspects that are important to observe in order to achieve an effective result:
However, if gangrene has already spread to large areas of the body, surgical intervention is necessary. Today, the following types of surgical solutions to the problem are successfully used:
The most favorable prognosis is given in the initial stages of the disease. If you consult a doctor at the first symptoms of gangrene, surgical intervention can be avoided.