A broken leg can greatly change the rhythm of a person’s life. If the victim has one leg injured, he will not be able to walk freely or do his normal work activities.
The diagnosis is made based on:
An X-ray examination is carried out (using this method it is possible to clarify the location and nature of the fracture, the location of fragments and foreign bodies);
Treatment of a broken leg is carried out in two ways:
Conservative treatment is carried out by skeletal traction. A metal pin is passed through the bone. The victim's lower limb is then placed on a therapeutic splint and a weight is attached.
Skeletal traction in the patient continues for 2-2.5 months. After removing the skeletal traction, the doctor allows the patient to walk with the help of crutches and prescribes a set of rehabilitation measures: physical therapy, physiotherapy, massage.
The doctor allows full weight bearing on the lower limb no earlier than 3 months after the injury.
A leg fracture in children and people with good immunity usually heals in 2-3 months; weakened and sick people may need six months for this.
Advantages of surgical treatment:
There are two methods of surgical intervention for a broken leg:
With an open surgical procedure, the surgeon exposes the site of the bone fracture and inserts a metal nail into the fragment. This type of treatment is used very rarely in traumatology, since the operation is poorly tolerated by the patient and is accompanied by significant damage to soft tissues.
The type of operation for each patient admitted to the hospital very often depends on the type of bone damage, the severity of the fracture and displacement of the fragments.
Elderly patients are given a pin or plate when a leg is broken, but it is not subsequently removed and remains in the bone for the rest of their lives.
Surgical treatment is indicated if there is:
Advantages of open reduction:
Typically, a week after surgery, the patient is allowed to get out of bed on crutches, and then gradually expand their physical activity.
Complications of a displaced leg fracture:
The period of physiological function of the lower limb usually lasts 6-12 months.
The rehabilitation program for a broken leg includes:
During the rehabilitation period, great importance is given to learning to walk on crutches . If there is an incorrect distribution of physical load on the leg and non-compliance with the rules of walking, then the patient may “unsuccessfully” fall and injure the leg a second time.
First, the patient must, under the guidance of a rehabilitation therapist, learn to walk along a hospital corridor with two crutches, and only after he has acquired this skill and feels confident in his abilities can he carefully go up and down the stairs. If a person has learned to walk with the help of two crutches, you can gradually switch to a cane or walking stick.
All physical exercises during the recovery period for a patient with a broken leg should be performed under the guidance of an instructor.
In order for the fracture to heal faster, the patient is recommended to take calcium supplements, as well as Teroflex and Osteogenon.
After the cast is removed, some patients come to the traumatologist with complaints: “My leg is swollen after the cast is removed,” or “My leg hurts after the fracture,” “After the fracture, my toes are numb.”
After prolonged immobilization of a broken leg with a plaster cast, the patient's functionality of large joints is significantly reduced and swelling of the soft tissues occurs and limited mobility of the leg.
Drugs that are used to reduce pain and swelling of soft tissues after a fracture:
Pain in the leg after removing a cast or after surgery is very often due to the fact that the leg is not yet fully developed.
In case of severe pain, the traumatologist prescribes the patient a short course of non-steroidal anti-inflammatory drugs or non-narcotic analgesics; it is also recommended to rub the leg with ointments and take warm baths.
In victims with a broken leg, an increase in temperature is usually associated with blood absorption processes, destruction of soft tissue and bone marrow. Fever is not observed in all patients after injury and usually lasts no more than 7 days.
A fracture of the leg bones is a stress for the whole body, so an increase in body temperature is directly related to the type of reactivity of the body and immune defense.
An increase in temperature to subfebrile and febrile levels is most often observed in people with weak immunity, the elderly and patients with severe somatic diseases.
Victims with a broken leg, who have a strong immune system and are physically well developed, as a rule, have a temperature of about 37-38 ° C. The body's temperature reaction is pronounced in patients with open leg fractures. At the appointment, the doctor should always carefully examine the leg, pay attention to the color of the skin and the condition of the stitches. In some cases, temperature can be caused by purulent-septic and infectious complications (osteomyelitis, gangrene, sepsis). In these cases, the patient is indicated for urgent hospitalization in a hospital and the appointment of powerful antibacterial therapy and infusions.
In most patients, the temperature after a leg fracture usually lasts for three days and does not tend to increase subsequently.
To reduce pain and swelling of the leg during a fracture, the patient is recommended to wear an orthopedic bandage.
Benefits of wearing a brace for a broken leg:
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The professional sports field is accompanied not only by high-profile victories and achievements, but also by frequent injuries and fractures. Fractures occupy a special place in sports. In this area, you can observe almost all types of bone injuries, from the simplest to the complex, with various complications. These are, of course, both avulsion fractures and open fractures.
An avulsion fracture of a bone in athletes ranks high among other bone injuries. This type of bone damage has this name because of its mechanism of occurrence. If a muscle contracts strongly at the site of its tendon attachment, damage or tearing of the bone area may occur. This deformation of bone tissue can also occur due to uncoordinated movement of the limb, for example due to missing a ball or excessive tension when throwing a throwing projectile. It should be taken into account that avulsion fractures are more likely to occur in places where there is already a degenerative process and the area of avulsion is weakened. Also, the location of the injury depends on the type of sport in which the athlete practices. The most common avulsion fractures are:
Avulsion fractures of the greater tubercle of the humerus are often observed in gymnasts and people involved in throwing sports. The site of injury in this case is the greater tubercle, to which the strong supraspinatus and infraspinatus muscles are attached. When a fragment is torn off, it is often displaced towards muscle contraction. In some cases, with direct damage to the shoulder area, there may be no displacement. As with other types of fractures, an inflammatory process begins, which is accompanied by pain. With this injury, abduction of the limb from the body and internal rotation is limited or impossible, and any attempts will cause severe pain. Treatment in this case consists of pain relief and application of a Deso retaining bandage. If displacement is detected during a fracture, it is necessary to compare the bone fragments and apply a plaster cast to immobilize the limb. Quite rarely, this type of fracture requires surgical intervention due to the inability to compare the fragments, then they are fastened with a medical screw.
Also, often with rapid contraction of the triceps brachii, a tear or avulsion fracture of the radial process of the ulna . This fracture is observed when throwing projectiles, in hockey, and diving from a springboard. The athlete experiences swelling at the site of injury; upon palpation, the tear site can be felt. Deformation and hemorrhage in the joint (gamoarthrosis) may occur, movement becomes severely limited, and extension is impossible. The treatment process in this case will take about three weeks. Using a splint, the arm is immobilized at the required angle until complete recovery.
In people who are professionally involved in throwing or weightlifting, avulsion fractures of the epicondyles of the humerus . This damage results in limited mobility in the elbow joint and severe pain. Treatment will consist of immobilization of the limb and alignment of the fragments.
Extremely rare, but no less dangerous are fractures of the spinous processes of the vertebrae . The most common site of this type of injury is avulsion of the spinous process of the seventh cervical vertebra. Such an injury can occur after a fall in motorsports, horse riding, or while exercising on gymnastic apparatus. You also need to know that with significant muscle tension, the transverse processes of the lumbar vertebrae can also be torn off, for example when rowing. Treatment in this case consists of reducing or completely removing the load on the muscles in the area of injury.
In sports such as handball, football, rugby, volleyball, sudden movements of the hand under the force of the extensor muscle tendons can cause avulsion fractures in the terminal phalanges of the fingers . It is quite clear that this injury impairs the functioning of the fingers. The recommended treatment for these fractures is surgery to restore and strengthen the damaged phalanges and tendons with fixation of the bone fragment using a knitting needle.
All of the above types of avulsion fractures are encountered much less frequently than in the pelvic area. Probably due to the fact that the muscles of the lower extremities have greater contractile force. When skiing downhill or dismounting from a height, the integrity of the anterosuperior iliac spine , since it is in this area that the sartorius muscle and the tensor fascia lata are attached. These muscles displace the fragment downwards and outwards. With this injury, a symptom of reversal . When walking forward, a sharp painful sensation occurs, but movement to the rear remains accessible and pain-free, so during recovery, patients walk only backwards. For treatment, a Baler splint is used, and the limb is moved slightly to the side to reduce pain. Surgical intervention is required only for additional fixation of the fragment.
a separation of the lesser trochanter of the iliopsoas muscle to the femur is often observed at the site of tendon attachment This injury is possible due to a sudden miss when hitting the ball, or during sudden acceleration during acceleration in a luge sport. This muscle works during sharp flexion and extension of the femur. When the lesser trochanter is fractured, pain appears on the inner surface of the thigh. To reduce pain, the patient holds the hip in a flexed position at an angle of 90 degrees. During treatment, the patient is in a horizontal position, and a splint is applied to the injured limb for at least three weeks.
The most rare fractures with avulsion of a bone area are fractures of the greater trochanter , which are often found in skiing, a fracture of the ischium during running and long jumping, and an avulsion fracture in the area of the foot , namely the calcaneal tubercle, which is more common among athletes in skiing.
Open fractures are also common in professional sports. Open fractures differ from closed ones by the appearance of a violation of the integrity of the surrounding soft tissues. Damage to soft tissue is a serious complication that can lead to disastrous consequences. This type of fracture is typical for athletes whose bones endure high compressive or impact loads, often occurring during ski jumping, weightlifting, and contact sports. The most common fractures in athletes are:
In weightlifting, athletes often experience a fracture of the spine and displacement of the vertebral body in front - true spondylolisthesis . This injury is more common in the lumbar spine. There is limited mobility and high pain when moving. The recommended treatment in this case is surgery to strengthen the bone structures using metal plates and screws.
In addition to the above bone injuries, athletes are also susceptible to compression fractures of the thoracic spine , as well as compression fractures of the lumbar spine . The main cause of this injury is the force that acts on the spine, compressing the vertebral bodies. Damage can damage several adjacent vertebrae at once. Compression fractures can occur in different parts of the spine, but are most common in the thoracic and lumbar regions. Also, with these spinal injuries, the adjacent intervertebral discs are affected, their height decreases, which leads to pain and limited mobility. Such fractures are increasingly common among athletes in weightlifting, gymnastics, and after ski jumping. Treatment is classic - as with other fractures, in some cases vertebroplasty may be used.
Professional athletes retire quite early, as their body is subjected to physical overload, which wears out bones, muscles and other organs and tissues of the human body. Sports injuries include sprains, sprains, sports fractures and other types of injuries.
Bone fractures are divided into several types:
Damage to bones can occur both in the limbs and, for example, in the vertebrae. Sports injuries, and fractures in particular, are the subject of an entire medical field - sports trauma, which develops various methods of treatment and recovery after injury.
Avulsion fractures are the most common osseous extremity injury in sports. This happens due to sudden movement. For example, athletes who throw a shot or throw a javelin are susceptible to such fractures. And also for football players - if you miss the ball, the muscle can tear off the bone along with a bone fragment.
It is worth considering that avulsion fractures most often occur in an already weakened area, that is, it all starts with small muscle tears and bone microcracks, which over time lead to serious injury.
By location, the most common avulsion fractures are:
This type of fracture occurs in athletes who throw. The location of the injury is the attachment point of the infraspinatus and supraspinatus muscles, the tubercle of the humerus. The injury is accompanied by displacement of a bone fragment. With direct damage there may be no displacement. Severe pain occurs when trying to rotate the arm inward.
If there is no displacement, then it is enough to numb the area of the shoulder joint and fix the arm with a Deso bandage. If there is displacement of bone fragments, they need to be realigned and an immobilizing plaster cast applied. In exceptional cases, when reduction using a closed method is impossible, surgical intervention is recommended, during which the bone fragment is fixed with a screw.
Separation of the olecranon process is quite common among hockey players and during diving. This injury is characterized by local swelling in the area of the elbow joint; extension of the joint is impossible; palpation reveals a moving part of the bone.
After the fragment has been reduced, the arm is fixed in a bent position with a plaster splint. If reduction is not possible, then a Weber operation (two wires and a figure eight wire) is indicated. Complete recovery of the elbow joint occurs after 3 weeks.
This type of injury is common among professional weightlifters. Such a fracture is also accompanied by severe pain, limited mobility and swelling. Treatment is reduction of fragments and immobilization until the fracture heals completely.
Quite rare, but the injury is quite dangerous. Most often, avulsion fractures occur in the cervical and lumbar vertebrae. A fracture of the vertebral processes occurs as a result of a fall (horse riding, rowing, motorsports, gymnastics on the apparatus). Treatment mainly consists of complete rest, that is, immobility until the processes fuse with the vertebra.
Vertebral fractures occur when jumping from high heights or under heavy loads in weightlifting:
This spinal injury is characterized by a fracture of the lumbar vertebra. In this case, the victim feels acute pain, and mobility is very limited. Treatment involves surgery to fix the vertebra using a plate and screws.
Compression fractures are compression of the spine in which one of the vertebrae cracks. This can cause damage to the spinal canal, which can lead to partial or even complete paralysis. This injury is also accompanied by compression of the intervertebral discs. Surgery to restore the integrity of a vertebra is called vertebroplasty.
As strange as it may sound, fractures of the pelvic bones in athletes are more common than injuries to the limbs. This is due to the fact that the muscles that are attached to the pelvic bones are an order of magnitude more powerful than those on the limbs.
Skiers are susceptible to this type of injury, and you can also get an avulsion fracture of the iliac spine if you land poorly during a jump from a height.
A feature of this fracture is the symptom of “posterior gait,” that is, the patient moves backwards, since normal walking is accompanied by severe pain. Such a fracture is treated by immobilizing the pelvic area with slight abduction using a Baler splint.
If the mixture cannot be straightened in a closed way, then surgery and fixation of the fragments with metal structures is necessary.
Injuries to the upper part of the femur often occur in skiing athletes, as well as runners with a sharp start, and in track and field athletes who engage in long jumps. A characteristic symptom is pain relief when the leg is bent at the hip joint at a right angle.
In case of a non-displaced fracture, the patient will have to spend about 20 days in a supine position with a plaster splint in the joint area.
An open fracture is characterized by damage to the skin at the site of injury. In this case, bone fragments may even be visible in areas of the body where the bones are located superficially (lower leg, forearm). Open fractures occur with high compression loads on the lower extremities (jumping, weightlifting).
In case of fractures with damage to the integrity of soft tissues and skin, primary surgical treatment is carried out first in order to cleanse the wound of contamination. When reducing such a fracture, it is necessary to clear the bone canal of formed blood clots and muscles that may interfere with reduction. The bone fragments are fixed using a metal structure.
Bone fractures cause quite severe pain, but open fractures also add pain from the wound. The pain syndrome is relieved with painkillers, the dosage of which is determined by the doctor. The instructions for the drug must correspond to the chosen dosage.
Is it possible to play sports with a fracture? After the integrity of the bone has been completely restored, it is necessary to devote some time to developing the limb, since during the time spent in the cast, the muscles have weakened, and the joint, which was fixed in one position, also needs to be developed.
How long after a fracture can you play sports? During the rehabilitation process, loads should be increased gradually so as not to damage the still weakened limb. You can begin to engage in intensive sports only after completing a full course of rehabilitation. Depending on the severity and location of the fracture, you can start training after 3 months to 1 year. The rehabilitation period is determined by the doctor, and only he gives permission to resume training.
Advice! The price of a sports career is quite high, but health is more expensive, so you should not neglect the prescriptions and recommendations of your doctor. Increasing the load on your own can be a disservice and it will take even longer to recover
The video for this article will help you learn more about sports fractures and rehabilitation methods.
Fractures of the tibial condyles are a common sports injury if the direction of the traumatic force passes through the axis of the bone, that is, from top to bottom, for example, when landing unsuccessfully on straight legs during a long jump or falling from a sports motorcycle. But this could be the consequences of an accident, a fall from a height or on ice. There are options for a fracture of the internal or external condyle, or both at once, as well as intra- and extra-articular fractures, depending on the location of the fault line.
The joint is formed by three bones: the femur, tibia and patella. Above the femur, two condyles form the articular surface: the outer or lateral and the inner or medial. The articular surface of the tibia is located below, and the patella is located on the side. The inside of the joints is covered with smooth cartilage tissue, for better gliding and greater range of motion. Features of the histological structure of the condyles of the femur and tibia suggest the occurrence of depressed and impacted fractures, since its structure is plastic and easily bent.
Often, fractures of the tibial condyles occur with displacement of fragments and disruption of the biomechanics of the joint. This entails a violation of the distribution of forces acting on the joint during walking and other physical activities. And after healing, if it does not happen correctly, inflammation of the joint capsule may occur, since the deviated parts of the bone will constantly “scratch” the inner surface of the joint or, under the weight of the body, the articular surfaces will become incongruent with each other.
1. Pressure bandage (to keep fragments from moving).
2. Plaster cast and closed comparison of fragments.
3. Skeletal traction.
4. Open reduction, connection of fragments with fixing material (pins, plates).
How the injury will heal depends on the nature of the fracture, its type, the presence of additional pathologies and complications, as well as on the method used by the traumatologist.
The last two methods are surgical, when, one way or another, invasive methods of treatment are involved. It is important that the operation is performed by an experienced specialist, since it depends on him how accurately the fragments will fall into place and grow together again. You can secure them with screws, or add a metal plate to them. Often during surgery it is necessary to examine the inner surface of the joint, then arthroscopy or arthrotomy is used, depending on the clinical situation and the complexity of the fracture. The entire operation process is controlled radiographically; pictures are taken directly on the operating table, which are filed in the medical history for further comparison and tracking of the dynamics of bone restoration.
A broken leg is not a rare injury. Often the reasons for receiving it are different (fall, accident, etc.), but it may also turn out that the bone in the leg was “prepared” for this in advance. The fact is that there are a number of diseases that contribute to the development of bone fragility, for example, osteochondrosis. Therefore, not only a child, but also an adult should be more careful in outdoor activities.
Depending on the severity of the injury, there may be:
According to the direction of injury, leg fractures are divided into:
In fact, it is very important to determine the type of fracture, since treatment will depend on this, whether to make a splint or still wait for the doctors to arrive. Under no circumstances should you treat your leg yourself without any skills in this matter, especially if it is an open fracture of the leg.
After all, if a displaced injury is received, then there is a high risk of moving the fragment in such a way that it cuts the tendon or seriously injures the muscle. And then the person may remain disabled for life.
In fact, any fracture has fairly clear symptoms. The same goes for the legs. Although, if the fracture is partial and closed, then it can be mistaken for an ordinary muscle strain, especially for injuries to the tibia or ankle.
In addition to the fact that the fractures themselves have their own types, each type can also have its own individual symptoms. Therefore, there is also a gradation here:
This category includes: severe pain when the victim tries to move the injured leg, the place itself will swell, and hemorrhages will form under the skin in this area. It is not possible to make any movements with the leg, and it is impossible to do so.
In this case, the leg has an unnatural shape, and with an open injury, the bones will peek out. This category includes high mobility, which should not exist in this area, and a possible crunch in the leg. Although the latter symptom does not always accompany fractures.
Since the leg consists of several segments, therefore, injuries can be different. Of course, medical attention is most often sought for fractures in the ankle area, since it is the most mobile part. But nevertheless, it is necessary to know the symptoms of other parts of the leg:
In most cases, pathological mobility is present at the affected area, with the injured leg becoming somewhat shorter than the healthy one. If a person tries to put weight on the sore leg, he will feel severe pain, which can lead to painful shock.
In this case, the area above the kneecap will begin to swell greatly as hemorrhage forms under the skin. If you ask a person to bend or straighten his leg, he will not be able to do this, and in addition, such attempts will be accompanied by severe pain. If the fracture is complete and fragmented, and the distance between the fragments exceeds 5 mm, then the patient will no longer be able to even lean on such a leg.
Such an injury is accompanied by very severe pain, since the area with the periosteum has a large number of nerve endings. Even slight palpation brings severe pain to the victim. With such an injury, swelling of the soft tissues of the ankle does not occur immediately, but after some time.
Damage to the foot makes itself felt first of all by severe pain. If you try to lean on your injured leg, the sensation will only intensify. The heel will become bright red, as the main hemorrhage will occur in this area, and all nearby soft tissues will begin to swell.
Trauma to the fingers of the lower extremity is also a type of leg fracture. As for the symptoms, the first thing you should pay attention to is the location of the damage. If the phalanx is damaged, this will be accompanied by a fairly loud crunch, and if pressure is applied, the finger will deviate unnaturally to one side. But the most dangerous thing is that even if there is a complete fracture of the finger, then visible signs may not be detected, and the pain itself will be tolerable, which is why a person may consider that such an injury may not be treated.
All these symptoms are quite easy to identify yourself, without the help of a specialist. But treatment should be carried out in a medical facility, and not at home. The fact is that if there is a comminuted fracture, then it is important to remove all the fragments, because otherwise, in addition to the risk of damaging adjacent tissues, there is a risk of inflammatory processes. We should not forget about improper bone fusion, which is why surgery is necessary.
To help a victim after an injury, you should first call an ambulance. While they are getting to the scene of the incident, the patient should be given a splint, which will allow the limb to be fixed in a stationary position. Also, so that the victim does not experience severe pain, it is permissible to give him an anesthetic, but if the person is conscious, you should first find out if he is allergic to any substances. Otherwise, in addition to a fracture, an allergic reaction will also occur.
After the patient is taken to the hospital, doctors will analyze the injury.
Here not only the type, but the severity of the fracture will be assessed. The issue will be resolved in two ways - either they will apply a plaster cast, or they will perform an operation. The second method is used in cases where it is necessary to combine existing fragments. For this, a knitting needle, metal plate or screw is used. Such things help to fix the limb in the correct position so that the bone heals as needed. An operation such as traction can be performed when it is necessary to straighten the leg not only in shape, but also in length. After the surgery is completed, the patient is also given a cast.
As for drug treatment, the patient is not prescribed anything other than analgesics, since in this case there is no need for intensive care. The only thing worth mentioning is that the patient is prescribed to take vitamin complexes with a high calcium content. This substance helps bones heal faster.
If the assistance was provided correctly, and the doctors were highly qualified specialists, then after a complete recovery, the leg will return to its functions. Typically, this process takes 1.5-2 months, depending on the severity of the injury. Rehabilitation of a child requires special attention, since due to his age he is very mobile, which means such a concept as peace is alien to him. And this can just affect the correct fusion of the bone, so parents need to monitor the activity of their baby with renewed attention.
The femur is one of the largest and strongest bones in the body. The upper or proximal part of the femur forms the hip joint. The lower or distal portion of the femur forms the knee joint. The middle part of the bone is called the diaphysis. It takes a lot of force to fracture the femur
In young patients, the most common cause of hip fractures is high-energy trauma (road traffic accidents, falls from height). The bone in elderly patients is mainly weakened by osteoporosis, and therefore a hip fracture in this group of patients may even be caused by a minor injury or a fall from a height.
Femur fractures are usually divided into three broad groups.
Fractures of the proximal femur are localized at the upper end of the femur in close proximity to the hip joint and include fractures of the head and neck of the femur, as well as trochanteric fractures.
Fractures in the middle part of the bone are called diaphyseal . Fractures of the femoral shaft are the result of very severe trauma, often multiple or combined.
Femoral condyle fractures are fractures in the distal femur, just above the knee joint. These fractures are often intra-articular and are associated with damage to the cartilage of the knee joint.
The femur is the largest and strongest bone in the human body. The middle or central part of the femur is called the diaphysis. The diaphysis of the femur provides the main supporting function for the entire human body.
In order for a fracture of the femoral shaft , a very large force is required. In young patients, the most common cause of a fracture is a traffic accident or a fall from a height. The bone in older patients is mostly weakened by osteoporosis or tumors, so a fracture can be caused by even minor trauma.
A femoral shaft fracture is a very severe injury that impairs the function of the entire lower limb. Treatment for femur fractures is almost always surgical. Approaches to surgical treatment of femoral shaft fractures have changed significantly in recent years.
Minimally invasive methods of hip surgery have become widespread , when during the operation a closed reposition of bones and fragments is performed in the correct position, and their connection is carried out by introducing fixators through small punctures of the skin. This ensures that the integrity and relationship of the soft tissues in the fracture area is not compromised, an earlier recovery from injury is achieved, the length of stay in the hospital is reduced, and the risk of complications is reduced.
The operation allows the patient to get back on his feet the very next day and does not require additional immobilization in a cast in the postoperative period.
Various types of fixators are used to treat fractures. For example, locking intramedullary nails are used for femoral shaft fractures and will achieve stable fixation with minimal soft tissue trauma. The scars after such operations are so small that even a specialist cannot always notice them.
Plates are most often used for fractures near joints. Modern plates can also be inserted into the fracture zone without large incisions, subcutaneously.
The absolute indication for surgery is open fractures . In such cases, in the first stage we stabilize the femoral fractures using external fixation devices. After the wounds have healed, in the second stage we remove the device and perform final fixation with an intramedullary rod.
With this minimally invasive approach, nutrition in the fracture zone is not disrupted, thereby significantly reducing the likelihood of complications, and, importantly, achieving an excellent cosmetic effect.
Fusion of the bone diaphysis in an adult takes a long time. After six weeks, the first signs of callus can be seen on x-rays. After 3 months, the bone strength in the fracture area reaches up to 80 percent of the original. Complete consolidation and remodeling of the bone can take up to several years. Fractures in the knee and hip joint heal faster.
Once the fracture has healed, you can consider removing the metal fixator, although this is not necessary. In some cases, the metal fixator can cause discomfort and a feeling of pain. Typically, rods and plates from the femur are removed no earlier than after 2 years, if there are radiological signs of fracture consolidation.
In our clinic, we can offer you specially designed metal structures for fixing femur fractures, made from various materials, and also select the most suitable one in your particular case. The result of the operation largely depends not only on the quality of the implant, but also on the skill and experience of the surgeon. The specialist at our clinic has experience in treating several hundred fractures of this location for more than 10 years.
We use only minimally invasive hip surgery techniques . Patients who underwent surgery in our clinic return to physical activity the very next day after surgery.
A fracture is a complete or partial disruption of the integrity of a bone resulting from an impact that exceeds the strength characteristics of bone tissue. The cause of development may be a blow, a fall, an industrial or natural disaster, a car accident, etc. Signs of a fracture are pathological mobility, crepitus (bone crunch), external deformation, swelling, limited function and severe pain, while one or more symptoms may absent. The diagnosis is made on the basis of anamnesis, complaints, examination data and X-ray results. Treatment can be conservative or surgical.
A fracture is a violation of the integrity of a bone as a result of traumatic impact. Is a widespread injury. Most people experience one or more fractures during their lifetime. About 80% of the total number of injuries are fractures of long bones. Along with the bone, surrounding tissues also suffer during injury. More often there is a violation of the integrity of nearby muscles, less often compression or rupture of nerves and blood vessels occurs.
Fractures can be single or multiple, complicated or uncomplicated by damage to various anatomical structures and internal organs. There are certain combinations of injuries that are common in traumatology. Thus, with fractures of the ribs, damage to the pleura and lungs is often observed with the development of hemothorax or pneumothorax; if the integrity of the skull bones is damaged, the formation of an intracerebral hematoma, damage to the meninges and brain matter, etc. Treatment of fractures is carried out by traumatologists.
Depending on the initial structure of the bone, all fractures are divided into two large groups: traumatic and pathological. Traumatic fractures occur on a healthy, unchanged bone, while pathological fractures occur on a bone affected by some pathological process and, as a result, partially lost its strength. To form a traumatic fracture, a significant impact is necessary: a strong blow, a fall from a fairly high height, etc. Pathological fractures develop with minor impacts: a small impact, a fall from a height of one’s own height, muscle strain, or even turning over in bed.
Taking into account the presence or absence of communication between the area of damage and the external environment, all fractures are divided into closed (without damage to the skin and mucous membranes) and open (with a violation of the integrity of the skin or mucous membranes). Simply put, with open fractures there is a wound on the skin or mucous membrane, but with closed fractures there is no wound. Open fractures, in turn, are divided into primary open, in which the wound occurs at the time of traumatic impact, and secondary open, in which the wound is formed some time after the injury as a result of secondary displacement and damage to the skin by one of the fragments.
Depending on the level of damage, the following fractures are distinguished:
Taking into account the nature of the fracture, transverse, oblique, longitudinal, helical, comminuted, polyfocal, crushed, compression, impacted and avulsion fractures are distinguished. V- and T-shaped injuries occur more often in the metaphyseal and epiphyseal zones. When the integrity of the cancellous bone is violated, the penetration of one fragment into another and compression of the bone tissue are usually observed, in which the bone substance is destroyed and crushed. In simple fractures, the bone is divided into two fragments: distal (peripheral) and proximal (central). With polyfocal (double, triple, etc.) injuries, two or more large fragments form along the bone.
Comminuted fractures are also characterized by the formation of several fragments, but located “more closely” in one zone of the bone (the distinction between polyfocal and comminuted injuries is quite arbitrary, therefore in clinical practice the general term “comminuted” fractures is usually used to refer to them). In cases where the bone is destroyed and turns into a mass of fragments over a significant length, the fractures are called comminuted.
Taking into account the mechanism of injury, fractures from compression or crushing, twisting and flexion, damage due to shear and avulsion fractures are distinguished. Damage from compression or compression occurs in the area of the metaphyses of long bones and vertebral bodies. Flexion fractures can occur due to indirect or direct forces; Such injuries are characterized by the formation of a transverse bone rupture on one side and a triangular fragment on the other.
Damage from torsion occurs when an attempt is made to forcefully rotate a bone around its longitudinal axis (a typical example is a “police fracture” of the shoulder when twisting the arm); the fracture line runs spirally or helically. The cause of avulsion fractures is severe muscle tension, as a result of which a small fragment is torn from the bone in the area of muscle attachment; Such injuries can occur in the ankles, patella, and epicondyles of the shoulder. Shear damage occurs when subjected to direct force; They are characterized by a transverse fracture plane.
Depending on the degree of bone damage, complete and incomplete fractures are distinguished. Incomplete include violations of the integrity of the bone such as a fracture (the fracture extends to less than half the diameter of the bone), crack (the fracture occupies more than half the diameter), cracking or depression. In case of incomplete bone damage, displacement of fragments is not observed. With complete fractures, displacement (fracture with displacement) is possible along the length, at an angle, along the periphery, along the width and along the axis (rotational).
There are also multiple and isolated fractures. In isolated cases, there is a violation of the integrity of one anatomical and functional formation (fracture of the femoral diaphysis, fracture of the ankles), in multiple cases - damage to several bones or one bone in several places (simultaneous fracture of the diaphysis and neck of the femur; fracture of both legs; fracture of the shoulder and forearm). If a bone fragment causes damage to internal organs, it is called a complicated fracture (for example, a spinal fracture with damage to the spinal cord).
All fractures are accompanied by more or less pronounced destruction of soft tissue, which is caused both by direct traumatic effects and by displacement of bone fragments. Typically, hemorrhages, soft tissue bruises, local muscle ruptures and ruptures of small vessels occur in the area of injury. All of the above in combination with bleeding from bone fragments causes the formation of a hematoma. In some cases, displaced bone fragments damage nerves and great vessels. Compression of nerves, blood vessels and muscles between fragments is also possible.
There are absolute and relative signs of a fracture. Absolute signs are deformation of the limb, crepitus (bone crunch, which can be detected by the ear or detected under the doctor’s fingers during palpation), pathological mobility, and in open injuries, bone fragments visible in the wound. Relative signs include pain, swelling, hematoma, dysfunction and hemarthrosis (only for intra-articular fractures). The pain intensifies with attempted movements and axial load. Swelling and hematoma usually occur some time after the injury and gradually increase. Dysfunction is expressed in limited mobility, impossibility or difficulty in support. Depending on the location and type of damage, some of the absolute or relative signs may be absent.
Along with local symptoms, large and multiple fractures are characterized by general manifestations caused by traumatic shock and blood loss due to bleeding from bone fragments and damaged nearby vessels. At the initial stage, there is excitement, underestimation of the severity of one’s own condition, tachycardia, tachypnea, pallor, cold sticky sweat. Depending on the predominance of certain factors, blood pressure may be reduced, or less often, slightly increased. Subsequently, the patient becomes lethargic, lethargic, blood pressure decreases, the amount of urine excreted decreases, thirst and dry mouth are observed, and in severe cases, loss of consciousness and respiratory disorders are possible.
Early complications include skin necrosis due to direct damage or pressure from bone fragments from the inside. When blood accumulates in the subfascial space, subfascial hypertension syndrome occurs, caused by compression of the neurovascular bundle and accompanied by impaired blood supply and innervation of the peripheral parts of the limb. In some cases, as a result of this syndrome or concomitant damage to the main artery, insufficient blood supply to the limb, gangrene of the limb, and thrombosis of the arteries and veins may develop. Damage or compression of the nerve can lead to paresis or paralysis. Very rarely, closed bone injuries are complicated by suppuration of the hematoma. The most common early complications of open fractures are wound suppuration and osteomyelitis. With multiple and combined injuries, fat embolism is possible.
Late complications of fractures are improper and delayed fusion of fragments, lack of fusion, and pseudarthrosis. With intra-articular and periarticular injuries, heterotopic para-articular ossifications often form, and post-traumatic arthrosis develops. Post-traumatic contractures can form with all types of fractures, both intra- and extra-articular. Their cause is prolonged immobilization of the limb or incongruence of the articular surfaces due to improper fusion of fragments.
Since the clinical picture of such injuries is very diverse, and some signs are absent in some cases, when making a diagnosis, much attention is paid not only to the clinical picture, but also to clarifying the circumstances of the traumatic impact. Most fractures are characterized by a typical mechanism, for example, when falling with emphasis on the palm, a fracture of the radius often occurs in a typical place; when a leg is twisted, a fracture of the ankles occurs; when falling on the legs or buttocks from a height, a compression fracture of the vertebrae occurs.
The patient's examination includes a thorough examination for possible complications. If the bones of the extremities are damaged, the pulse and sensitivity in the distal parts must be checked; in case of fractures of the spine and skull, reflexes and skin sensitivity are assessed; if the ribs are damaged, auscultation of the lungs is performed, etc. Particular attention is paid to patients who are unconscious or in a state of severe alcohol intoxication . If a complicated fracture is suspected, consultations with relevant specialists (neurosurgeon, vascular surgeon) and additional studies (for example, angiography or echoEG) are prescribed.
The final diagnosis is made on the basis of radiography. X-ray signs of a fracture include a line of clearing in the area of damage, displacement of fragments, a break in the cortical layer, bone deformations and changes in bone structure (clearing with displacement of fragments of flat bones, compaction with compression and impacted fractures). In children, in addition to the listed radiological symptoms, with epiphysiolysis, deformation of the cartilaginous plate of the growth zone may be observed, and with greenstick fractures, limited protrusion of the cortical layer.
Treatment can be carried out in an emergency room or in a trauma department, and can be conservative or surgical. The goal of treatment is the most accurate comparison of fragments for subsequent adequate fusion and restoration of function of the damaged segment. Along with this, in case of shock, measures are taken to normalize the activity of all organs and systems; in case of damage to internal organs or important anatomical formations, operations or manipulations are carried out to restore their integrity and normal function.
At the first aid stage, pain relief and temporary immobilization are carried out using special splints or improvised objects (for example, boards). For open fractures, remove contamination around the wound if possible, and cover the wound with a sterile bandage. In case of intense bleeding, apply a tourniquet. Measures are taken to combat shock and blood loss. Upon admission to the hospital, the injury site is blocked and repositioned under local anesthesia or general anesthesia. Reposition can be closed or open, that is, through the surgical incision. Then the fragments are fixed using plaster casts, skeletal traction, as well as external or internal metal structures: plates, pins, screws, knitting needles, staples and compression-distraction devices.
Conservative treatment methods are divided into immobilization, functional and traction. Immobilization techniques (plaster casts) are usually used for non-displaced or slightly displaced fractures. In some cases, plaster is also used for complex injuries at the final stage, after removal of skeletal traction or surgical treatment. Functional techniques are indicated mainly for vertebral compression fractures. Skeletal traction is usually used in the treatment of unstable fractures: comminuted, helical, oblique, etc.
Along with conservative methods, there are a huge number of surgical methods for treating fractures. The absolute indications for surgery are a significant discrepancy between the fragments, excluding the possibility of fusion (for example, a fracture of the patella or olecranon); damage to nerves and great vessels; interposition of a fragment into the joint cavity during intra-articular fractures; the threat of a secondary open fracture with closed injuries. Relative indications include interposition of soft tissues, secondary displacement of bone fragments, the possibility of early activation of the patient, reducing treatment time and facilitating patient care.
Exercise therapy and physiotherapy are widely used as additional treatment methods. At the initial stage, UHF, inductothermy and ultrasound are prescribed to combat pain, improve blood circulation and reduce swelling. Subsequently, electrical stimulation of muscles, UV irradiation, electrophoresis or phonophoresis are used. To stimulate fusion, laser therapy, remote and application magnetic therapy, alternating and direct currents are used.
Therapeutic exercise is one of the most important components of treatment and rehabilitation for fractures. At the initial stage, exercises are used to prevent hypostatic complications; subsequently, the main task of exercise therapy becomes the stimulation of reparative metabolic processes, as well as the prevention of contractures. Physical therapy doctors or rehabilitation specialists draw up an exercise program individually, taking into account the nature and period of injury, age and general condition of the patient. In the early stages, breathing exercises, exercises for isometric muscle tension and active movements in healthy limb segments are used. Then the patient is taught to walk on crutches (without load or with load on the injured limb), and subsequently the load is gradually increased. After removing the plaster cast, measures are taken to restore complexly coordinated movements, muscle strength and joint mobility.
When using functional methods (for example, for compression fractures of the spine), exercise therapy is the leading treatment technique. The patient is taught special exercises aimed at strengthening the muscle corset, decompressing the spine and developing motor patterns that prevent aggravation of the injury. First, the exercises are performed lying down, then on your knees, and then in a standing position.
In addition, for all types of fractures, massage is used to improve blood circulation and activate metabolic processes in the area of damage. At the final stage, patients are sent to sanatorium-resort treatment, prescribed iodine-bromine, radon, sodium chloride, pine-salt and pine therapeutic baths, and also carry out rehabilitation measures in specialized rehabilitation centers.