A leg fracture is a fairly serious injury that requires long-term treatment and rehabilitation. However, some patients, after being discharged from the hospital, come to see a doctor with questions about how to relieve leg swelling after a fracture.
In our article you will learn why leg swelling occurs after a fracture and how to reduce it.
A leg fracture is a violation of the anatomical integrity of its bones, most often the tibia and femur. As you know, all bone fractures are divided into two main types: open and closed . Closed fractures are characterized by the absence of damage to the skin. With open fractures, not only the integrity of the skin over the site of injury is compromised, very often you can see bone fragments in the wound itself.
You may also see a bruise at the fracture site. If a victim has multiple fractures of the bones of the lower extremities as a result of an injury, he experiences large blood loss and quickly develops a state of shock.
Depending on the etiological factor of development, fractures are distinguished:
The main clinical signs of a fracture of the bones of the lower limb are:
If a victim suffers damage to a large neurovascular bundle as a result of an injury, he or she develops symptoms that require urgent medical attention.
When large nerves are damaged, as a rule, the leg loses its functional activity, and when blood vessels are damaged, the viability of the limb appears threatened.
The main criteria for diagnosing a fracture of the bones of the lower extremity are the presence of injury, the above symptoms and x-ray confirmation of a bone fracture.
The victim must be examined by a doctor or emergency medical technician at the scene of the injury. A splint must be applied to the injured leg in such a way as to prevent movement in the joints above and below the fracture site. If the patient has an open fracture as a result of an injury, before applying a splint, the skin around the wound surface must be treated with iodine and then an aseptic bandage applied.
Swelling of the leg after a fracture is a characteristic complication that occurs in almost all patients and is caused by a violation of the outflow and inflow of blood through the vessels.
In many patients, swelling of the soft tissues of the extremities increases in the late afternoon. A swollen leg makes it difficult to walk and move, and also causes rapid fatigue and paresthesia. In some patients, swelling of the leg may appear several years after the fracture and, as a rule, is associated with an increase in the patient’s body weight and progressive venous insufficiency.
What measures should be taken to reduce leg swelling after a fracture?
If swelling of the lower limb occurs after a fracture, the patient should urgently consult a doctor. The cause of leg swelling may be early complications when applying plaster casts within 24-48 hours.
The main reason for compression of the lower limb is an increase in its volume due to swelling of the soft tissues, which can be observed both during damage and during various inflammatory processes.
If the patient has no signs of compression of the lower limb in the plaster cast, then the initial pain in the area of the leg injury quickly decreases or completely subsides.
Every traumatologist must know that a prerequisite for applying a plaster cast for a broken leg is that the peripheral parts of the fingers are free.
The patient and the traumatologist should always monitor them to ensure that they are warm, mobile, pink and remain sensitive.
If the patient experiences compression of the arteries of the lower extremities, the toes become cold and pale, the pulse in the peripheral arteries cannot be felt or becomes weak and tense. Very often, skin sensitivity on the injured leg disappears.
If the victim has compression of the veins, one can observe cyanotic fingers, swollen and inactive. The patient complains of pain over the entire surface of the leg.
Some patients may experience compression of the nerve trunks in the lower limb. The patient complains that the mobility of his toes has disappeared, although their color has not changed. Most often, the peroneal nerve is compressed in the area of the head of the fibula.
In order to identify the cause of leg swelling, it is necessary to do a control x-ray and ultrasound of the vessels of the lower extremities.
If the above symptoms appear, the doctor should immediately remove compression of the lower limb . If the lower limb is fixed with a circular bandage, the doctor dissects it along its entire length, and carefully separates the edges with forceps. If the patient has had a splint bandage applied, it should be cut with forceps or the edges of the splint should be spread apart. After the manipulations, the patient’s signs of circulatory disorders disappear.
Many people are interested in whether there can be a temperature during a fracture. Since an inflammatory process occurs with any damage, it often happens that a person experiences fever during a fracture.
If, some time after receiving an injury, the general body temperature rises, then you must immediately consult a doctor, because the temperature during fractures can be either a normal reaction of the body to the injury received or indicate the development of an infectious process and the occurrence of pathology.
If a person is injured due to a mechanical force that exceeds the strength of his bones, then a fracture of the limbs or bones in other parts of the human body occurs. In this case, the integrity of the bone tissue is disrupted, and surrounding tissues can also be damaged - nerve endings, tendons, muscles, blood vessels, and skin.
A fracture can occur for the following reasons:
Regardless of the cause of the injury, a bone fracture may cause fever, which can be caused by a number of factors.
When a fracture occurs, a person will experience certain symptoms that indicate possible injury. Some of these signs absolutely indicate a bone fracture, while others can only suggest a violation of the integrity of the bone tissue. The main symptoms are:
Also a common sign present during a fracture is local and general hyperemia. It is impossible to make an accurate diagnosis based on the clinical picture alone; it is necessary to undergo an examination, an X-ray, and, if necessary, a magnetic resonance or computed tomography scan.
The temperature after a fracture is largely due to the fact that when an injury occurs, a reaction occurs not only in the damaged area, but throughout the entire body. Nerve-reflex reactions are triggered, the functioning of the functions and systems of the body changes. If the injury is very severe, the victim often develops traumatic shock. Due to severe pain, basic life processes are inhibited. When the victim is in shock, regulatory systems such as the nervous and reflex systems stop working normally. Later, the heartbeat worsens and breathing becomes impaired.
If the tubular bone is damaged, the temperature rises due to blood absorption, destruction of muscles and bone marrow. The temperature during a fracture of the arm, in which the tubular bones are located, can last up to three days and does not rise to 38.1 degrees. Because trauma is stressful to the body, the temperature of a broken leg or arm increases due to the immune system's reaction to the injury. People who have a weak immune system, are weakened and sick, or are addicted to alcohol or drugs are more susceptible to fever. If a person with good immunity breaks a limb, then this occurs with an open type of fracture.
In addition to the state of the victim's immune system, the local temperature near a broken arm or leg may increase due to the absorption of the emerging hematoma. If hyperemia lasts no more than three days, then there is no cause for concern. This is a normal reaction of the body to damage. When a child's ribs, legs, arms, or other bones are broken, the temperature almost always rises. Thus, interferon, produced at a temperature of 38 degrees, fights potential infection. Sometimes temperature indicates chronic inflammation, so you should consult your doctor if hyperemia occurs.
The most dangerous causes of hyperemia are:
A fracture of large bones is characterized by a rise in temperature to higher levels and, as a rule, it can last a little longer, while with a fracture, for example, of a finger, hyperemia may be completely absent. Pregnant and breastfeeding patients are also at risk. When a woman carries a child or produces milk, the body spends more energy maintaining these conditions, and only then fighting toxins from the absorbed hematoma. Naturally, such patients experience more severe intoxication and, as a result, a higher temperature than a non-pregnant or non-lactating woman would have.
With an open fracture of a limb, which was accompanied by displacement, a person could receive treatment untimely or undergo incorrect therapy, after which a complication such as osteomyelitis arose. This pathology is a purulent inflammatory process in the bone marrow, which appears due to bacterial infection. Bacteria can travel to the bone marrow and adjacent tissues through the bloodstream. The course of this disease is severe, there is a pronounced clinical picture. Among the signs of osteomyelitis:
If you do not consult a doctor, osteomyelitis very often leads to sepsis and gangrene, which can lead to amputation of the injured limb and even death.
When large long bones are fractured, a condition called fat embolism can develop, in which fat cells enter the bloodstream. In this case, small vessels become clogged, the temperature rises to forty degrees, the patient feels weak and feels nauseous. In this case, the patient does not experience pain, although the level of toxins in the body increases significantly. Hyperemia occurs immediately or a few days after the pathological process begins. There is no result from antipyretic drugs.
After a person has suffered a fracture, the temperature does not appear immediately, but on the second day or every other day. If no complications are observed, then the hyperemia lasts no longer than three to five days and goes away on its own after the patient is relieved of pain and the state of shock is completely eliminated. Until the patient undergoes a full examination and the doctor finds out why the temperature is rising, antipyretic drugs should not be taken. Hyperemia may indicate the presence of serious complications, and in order to diagnose them, the doctor must see all the symptoms.
If the body temperature does not normalize after the fifth day, and even more so, it increases, even if the patient is given antipyretic drugs, you need to be examined again. If the temperature does not settle for a long period of time, this may indicate the presence of serious pathologies that require immediate treatment with other drugs, such as antibiotics. In extreme cases, surgery may even be required.
If the temperature rises during treatment of a fracture, you should call medical workers or take the patient to the hospital yourself. Before a medical examination and examination, there is no need to take antipyretic drugs, so as not to blur the clinical picture. After diagnosis, the patient is prescribed drugs based on Ibuprofen or Paracetamol. Aspirin is not prescribed because it interferes with blood clotting and can cause the development of a large hematoma at the fracture site.
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An arm fracture is an injury to one or more bones of a limb. Arm fractures include fractures of the humerus, forearm, elbow, hand, and fingers.
A broken arm is a very common injury. Many of us have encountered this problem. In severe cases, it is not at all difficult to record the signs of a broken arm, but there are situations when you cannot immediately tell that the arm is broken. However, the symptoms are quite obvious.
Not everyone knows what to do if their arm is broken, so it is important for anyone to understand what to do in such a situation.
Fractures of the arm correspond to general signs.
Pain at the site of injury. In this case, the pain radiates to neighboring areas: for example, pain from a fracture in the elbow joint moves to the forearm and shoulder. The pain syndrome is quite strong, and its intensity increases sharply depending on movement and axial load on the limb.
There is swelling and bruising at the site of injury. These symptoms occur with any hand injury. The hand swells, mainly when the hand, fingers, or fracture in the elbow joint are broken.
The damaged area is deformed and shortened. This happens with displaced fractures.
Near the location of the injury, movement in the joints is limited. For example, if the radius is broken, movement will be limited in the wrist joint.
Bone fragments crunch. Such symptoms occur with fractures of the shoulder and olecranon.
If the injury damages the nerves, then symptoms of paralysis of the hand and fingers and impaired sensitivity are possible.
The temperature rises. The temperature rises, as a rule, due to overflow of blood in the vessels of the broken arm.
Knowing the signs of a broken arm can help you identify a bruise. In any case, a doctor must determine whether it is a bruise or a fracture using an X-ray. A bruise and a fracture are very similar in symptoms and signs, so it is extremely important to see a doctor for a correct diagnosis.
However, there are certain differences by which a bruise can be identified. Naturally, it is impossible to confuse a simple bruise and an open fracture. The situation is different with a closed-type broken arm.
A bruise is characterized by not very strong swelling and swelling at the location of the injury. In addition, the bruise does not cause subsequent severe pain after the injury. Also, a deep bruise can form a hematoma only after 2-3 days, while a fracture immediately causes extensive inflammation.
There is such a thing as a symptom of axial load. Using this symptom, you can independently distinguish a bruise from a crack or a broken arm. To do this, you need to press on the limb in the longitudinal direction. If it is a bruise, then there will be no sharp pain.
There is a certain differentiation of arm fractures.
Depending on the type of injury, arm fractures are divided into open arm fracture (skin, soft tissue is damaged, bone is visible) and closed arm fracture, which, in turn, is divided into absolute bone fracture and incomplete (for example, bone crack).
Depending on the number of injured bones: multiple and isolated.
Classification according to the location of the break line. Diaphyseal (line located on the body of the bone), periarticular (line between the end of the bone and its body) and extra-articular (break line at the end of the bone).
Classification depending on the presence of bias. Displaced fractures can be primary (formed at the time of injury due to the force applied to the limb) and secondary (displacement appears as a result of the impact of muscle tissue attached to the broken bones). The displacement can also be rotational, angular, along the width of the limb or along its length.
Separation in accordance with the possibility of movement of fragments. There are stable (the fragments remain in the same place) and unstable (secondary displacement of the resulting fragments occurs).
Depending on the complications. Complicated (fracture accompanied by bleeding, fat embolism, infection, blood poisoning, osteomyelitis).
Another subtype stands out separately - a combination of bone dislocation with a fracture. In this case, a complication most often occurs, leading to damage to nerves and blood vessels.
First aid for a broken arm does not require special knowledge in the field of medicine.
Before the ambulance arrives, it is necessary to calm the victim and immobilize the injured limb with a splint.
The splint can be sticks that fix the hand and are wrapped with a bandage or any other fabric.
With the closed type, fixing the hand is simply a necessary measure, because unnecessary movements can result in an open fracture, especially if the bones are displaced. If this is not a fracture in the elbow joint, then the arm is bent at the elbow for better immobilization. Fixing the arm in the elbow joint is a mandatory measure to restore the function of the limb.
If you have an open arm fracture, you may need to apply a tourniquet to stop the bleeding. The tourniquet is placed above the site of injury at a distance of 10-15 cm. A tourniquet is especially relevant for arterial bleeding, when the blood is bright red. It is important to remember the time of application of the tourniquet and loosen it 1.5 hours after application to avoid necrosis of the arm tissue. A regular belt can be defined as a harness.
To relieve pain, you should take painkillers. As a rule, painkillers are used in the form of injections and must be administered by doctors when transporting the patient to the hospital.
With a fracture, the temperature may rise. The temperature increases due to infectious processes, blood absorption, destruction of soft tissue and bone marrow. Fever does not occur in all people and often does not persist for more than a week. Temperature appears, as a rule, when the fracture is open.
How much the temperature rises depends on the person’s immune system. Basically, it reaches 37-38 degrees. Hospitalization depends on the time of onset of fever. If the temperature occurs on the first day after the injury, then urgent hospitalization is necessary with suspected fat embolism. If on the second or third day, then the patient’s life is not in danger and he simply needs to see a doctor for a prescription of anti-inflammatory drugs and analgesics.
At the hospital, traumatologists will set the bones. A plaster cast is applied for fixation. The condition of the fragments is monitored using X-rays. If the displacement recurs, doctors send the patient for surgery.
For a broken arm, all patients must wear a cast. Gypsum is successfully used in medical practice and is one of the best treatment methods. The cast should not be short and tight. It should not be replaced prematurely. Before applying the plaster, an x-ray inspection must be performed.
Many people are interested in how long it is necessary to wear a cast. A standard non-displaced injury usually heals within 30 days. Any doctor, when asked how long to wear a cast, will tell you that the bandage is not removed for at least 3 weeks.
If a plaster cast is applied, rehabilitation is prolonged, as it becomes necessary to develop the limb due to its prolonged immobility. Exercise therapy after a broken arm and physiotherapy are mandatory. A broken arm in a child usually heals faster due to the high rate of muscle rehabilitation.
After the cast is removed, the arm usually hurts a lot. How long the pain syndrome will last depends on the speed of muscle tissue recovery. Therefore, it is important to know how to develop a hand after a fracture. There are a number of exercises for warming up the arm if the injury is of a closed type. This includes unclenching and squeezing various objects, moving the hand in different directions.
If there are no serious situations in the form of fractures with displacement, which affects the surrounding tissues, increasing the size of their damage, then rehabilitation should be successful, and the arm will return to its previous state. Rehabilitation consists of: physiotherapy, physical therapy, gymnastics, occupational therapy, and also includes massage after a broken arm. Once the cast is removed, the doctor determines how long and how to recover. This process can take a time frame of 1 to 6 months.
A foot fracture is a fairly common injury and accounts for up to 20% of all bone fractures. This should not be taken lightly; the consequences can be very negative, including the inability to move without assistance.
If you sharply twist your foot in any direction, jump from a height with emphasis on your legs, or if you are hit by a heavy object, this injury can occur.
Fractures of the metatarsal bones occur as a result of unexpected strong impact on the leg, excessive stress and overexertion.
Swelling of the injured area and pain are the very first symptoms that indicate that you may have a foot fracture. The photo below shows what a sore leg looks like.
The pain can be so severe that the person cannot move. Bruising may also occur in the area of injury. A displaced fracture is characterized by a change in the shape of the foot.
Sometimes a person does not realize that he has a broken foot. Signs may not be pronounced; pain occurs only when putting weight on the affected leg. Therefore, to clarify the diagnosis, it is necessary to contact a traumatologist.
If a fracture of the foot bones is suspected, the injured limb must be immobilized. You can use an improvised splint made from planks, ski poles or rods, which is attached to the leg with bandages. If you don’t have anything at hand, you can bandage the damaged limb to the healthy one using a scarf, shirt or towel.
If there is an open fracture, you should not try to set the bone yourself; first of all, you need to stop the bleeding. To do this, you need to treat the skin around the wound with iodine or hydrogen peroxide. Then you need to carefully apply a sterile dressing. After first aid has been provided, the victim must be taken to a medical facility.
First of all, the traumatologist must carefully examine the sore leg. Having discovered symptoms of a foot fracture in a victim, the doctor takes an x-ray to determine the type and location of the injury. Very rarely there is a need for computed tomography or magnetic resonance imaging.
Once a fracture has been diagnosed, treatment is prescribed, which depends on its type and which bone is broken.
This bone has some special features. There is no muscle attached to the talus. In addition, it transfers body weight to the entire foot.
A fracture of the talus is possible as a result of indirect trauma, is uncommon and is considered a severe injury to the bones of the foot. Accompanied by other injuries, such as a fracture, dislocation of the ankle or other bones of the foot.
When an injury occurs, sharp pain is felt, swelling of the foot and ankle occurs, and hemorrhages are noticeable on the skin. If the fragments are displaced, you may notice that the foot is deformed.
To confirm the fracture, determine its location, type and degree of bone displacement, an X-ray examination is performed in two projections.
If a displaced foot fracture is diagnosed, bone fragments are immediately compared. The fact is that the later you see a doctor, the more difficult it will be to restore their correct position, sometimes even impossible.
The plaster is applied for a month and a half. Starting from the third week, you need to release the injured limb from the splint and make active movements of the ankle joint.
Somewhat later, physical therapy, massage, and physiotherapy are prescribed. It takes two to three months to restore working capacity.
Occurs as a consequence of direct exposure. Often a fracture of this foot bone is accompanied by injuries to other bones.
A person cannot lean on a limb due to severe pain. Swelling and hemorrhages appear. When palpating and trying to turn the foot in and out, a person feels a sharp pain. To confirm a fracture of the navicular bone of the foot, X-ray examination is recommended.
If no displacement is detected, the doctor applies a circular plaster cast to the damaged area. For displaced fractures of the scaphoid, bone fragments are compared; in some cases, open reduction may be necessary. The foot is fixed in plaster for a period of four to five weeks.
It is quite difficult to treat such a foot fracture in combination with a dislocation. If the dislocated fragment is not set back into place, traumatic flatfoot may develop. Displaced fragments are realigned using a special traction apparatus. Sometimes it is necessary to resort to open reduction and securing the reduced fragment with a silk suture. After such a procedure, immobilization of the injured limb should continue for up to 10-12 weeks. In the future, it is necessary to wear orthopedic shoes.
Most often, the injury occurs when a weight falls on the back of the foot and is accompanied by swelling of the soft tissues in the area of injury, pain on palpation and turning the foot in any direction. An X-ray is required to confirm the fracture. After this, the leg is fixed in a plaster cast for a month and a half. It is recommended to wear an instep support for a year after such a fracture.
This injury is the most common among all foot fractures. There are two types of metatarsal fractures: traumatic and stress.
It is the result of external mechanical influence. This could be a heavy weight falling on the leg, squeezing the foot, or a strong blow.
A traumatic fracture of the foot manifests itself with a characteristic crunch and pain at the time of injury; you may notice a shortening of the toe or its deviation to the side. The pain is very strong at first, but weakens over time, although it does not go away completely. Swelling or bruising occurs at the site of injury.
Such injuries, which include a fracture of the 5th metatarsal bone of the foot, are usually found in athletes and those who lead an active lifestyle. They appear as a result of excessive and prolonged stress on the foot. Essentially, such a fracture is a crack in the bone, and it is very difficult to notice.
If a person suffers from various underlying diseases, such as osteoporosis or foot deformities, his condition may worsen significantly. A stress fracture of the metatarsal bone also occurs in those who constantly walk in uncomfortable and tight shoes.
The first symptom that should alert you is pain that occurs in the foot after prolonged intense exercise and disappears in a calm state. Over time, it intensifies to such an extent that any action becomes impossible. The pain persists even at rest. Swelling appears at the site of injury.
The danger is that most people with such an injury are in no hurry to see a doctor; often the person does not even suspect that he has a foot fracture. The signs in this case are not as pronounced as with other fractures; the patient walks and steps on his leg. Therefore, to avoid complications, you must consult a doctor immediately.
A fracture of the fifth metatarsal bone of the foot is an injury that occurs more often than any other.
When the foot is turned inward, an avulsion fracture may occur. In this case, the metatarsal bone is separated and displaced. Fusion is very long, so you need to contact a traumatologist as soon as possible. If not treated in a timely manner, the bone may not heal properly, in which case surgical intervention will be required.
The base of the 5th metatarsal is an area with poor blood supply. This is where the Jones fracture occurs. It occurs against the background of stress and grows together very slowly.
The doctor carefully examines the victim, examining not only the foot, but also the ankle joint, determining the presence of swelling, hemorrhage and characteristic deformation. Then a radiograph is taken in frontal, lateral and semi-lateral projections. After determining the fracture and its type, the necessary treatment is prescribed.
If a minor fracture of the foot is detected, treatment is simply a splint. In this case, the injured limb must remain motionless for several weeks in order for the damaged bone tissue to heal completely.
When the bone is severely damaged, internal fixation is necessary. This is done using special screws.
The severity and nature of the damage determines further treatment. Any non-displaced metatarsal fracture requires immobilization. The applied plaster will reliably protect the bone from possible displacement. Due to the fact that the foot is completely motionless, the fusion of bone tissue will occur faster.
If the fragments are displaced during an injury, surgical intervention cannot be avoided. During the operation, the doctor opens the area of the fracture and compares the resulting fragments, after which he fixes them with special knitting needles or screws. A cast is then applied for up to six weeks. The patient is prohibited from stepping on the injured leg. After six weeks you can start walking. The knitting needles are removed after three months, the screws after four. The patient is recommended to wear orthopedic shoes or insoles.
For a Jones fracture, a plaster cast is applied from the toes to the middle third of the leg for up to two months. Do not step on the injured leg.
To reduce the load on the injured limb while walking, you need to use crutches. The patient must be observed by a doctor who will select the correct rehabilitation course to restore impaired functionality in the injured foot.
The recovery period for a metatarsal fracture is quite long and includes physical therapy, massage, use of arch supports, and physiotherapy.
If such an injury is not treated or treated incorrectly, complications such as arthrosis, deformity, constant pain and non-union of the fracture may occur.
This type of fracture of the bones of the foot is possible as a result of direct impact on the toes (for example, from a strong blow or a fall from a heavy object). If the main phalanges do not fuse properly, the function of the foot may be impaired. In addition, pain may occur when walking and limited mobility of the injured limb. As a result of a fracture of the middle and nail phalanges, such consequences do not arise.
There is cyanosis of the broken finger, swelling, and pronounced pain during movement. With such injuries, a subungual hematoma sometimes forms. To confirm the diagnosis, it is recommended to conduct an x-ray examination in two projections.
For non-displaced fractures, a posterior plaster splint is applied to the affected finger. If there is displacement, there is a need for closed reduction. Bone fragments are fixed with knitting needles.
Fractures of the nail phalanges do not require special treatment; fixation with an adhesive bandage is usually sufficient. The immobilization period ranges from 4 to 6 weeks.
If you treat a foot fracture correctly and strictly follow all the doctor’s recommendations, it is possible not only to shorten the recovery period, but also to prevent possible complications.
X-ray of bones is the basis of modern traumatology. Bone tissue is clearly visible on an x-ray, as it is saturated with calcium salts that reflect x-rays.
A large complex of syndromes makes it difficult to understand the description of the radiograph. Sometimes the interpretation of a bone image is full of specific terms that are difficult to understand even for a qualified outpatient doctor.
When reading an x-ray of a bone, the radiologist pays attention to the size, shape, and position of the structures shown. Describes the offset.
In the second step, the structure of the external, internal contours of the cortical layer along the entire length is analyzed in order not to miss the “greenstick” fractures found in children. Pathological periostitis (inflammation of the periosteum) can occur with cancerous tumors. Based on the results of the x-ray, osteomyelitis is established - purulent melting of the bone.
If a photograph of the upper or lower extremity is taken on a child, an assessment of the state of the ossification nuclei is required.
These structures appear at a certain time. Caused by the transformation of cartilage tissue into bone. The absence of a focus of bone ossification at the required time indicates developmental delay and genetic diseases.
It is important to evaluate the timing of ossification and the symmetry of the appearance of ossifications on both sides.
When analyzing a joint, certain structures are described:
1. Outlines of the epiphyses;
2. Condition of the endplate;
3. The size of the joint space;
4. Location, external contours of the articular ends of the bones.
The description of the bone image by the radiologist contains information about all the criteria described above - changes in contours, volume, size, surrounding soft tissues.
X-ray of the forearm bones is normal: Koval’s scheme
An X-ray of a fused bone may be no different from the norm or show excess callus or improper fusion of fragments.
When a bone is fractured, a linear clearing can be seen on the radiograph along the site of bone trauma. The rest of the structure is white - darkened.
A fracture line is not always present. Impacted fractures due to the projectional overlap of fragments have an intense white line on the x-ray.
Divergence of fragments occurs with longitudinal, transverse, oblique fractures of large bones, when the muscular-ligamentous force “stretches” the fragments to the sides or at a certain angle.
More often in practice, traumatologists encounter longitudinal displacements of bone fragments. They are formed during falls or impacts on the outer part of the limb with an elastic object.
In X-ray images of the vertebrae, there are types of fractures that are unique to other structures of the body - compression, luxation. Luxation is a flexion-extension effect. When a sharp deflection of the vertebral region forwards or backwards (for example, during emergency braking of a car), wedge-shaped compression of the vertebral body occurs (luxation fracture).
A compression fracture is characterized in the image by flattening of the vertebral body. Formed when falling from a height, pressure from above.
Osteoporosis is a decrease in the density of calcium salts in bone tissue. The condition causes dark areas of the bone structure to appear on x-rays. With severe osteoporosis, the structure easily transmits rays, so in places where an intense white color is normally visible on an x-ray, black areas appear.
Synonyms for osteoporosis that a radiologist can use in describing an image are rarefaction, rarefaction, osteoporotic restructuring.
With nosology, the number of bone beams decreases, therefore the volume of the bone marrow canal increases. The overall length of the bone remains unchanged.
X-ray signs of osteoporosis:
1. Large-loop pattern – can be seen in the image due to a decrease in the number of bone beams;
2. Thinning of the cortical (peripheral) layer;
3. Strong emphasis of the periosteum;
4. Expansion of the medullary canal.
When analyzing a radiograph, a differential diagnosis of osteoporosis with destruction is required. With the latter nosology, the bone beams are not visible in the image. At the site of bone destruction, a looping pattern is not visualized on the radiograph.
When describing osteoporosis, the type is indicated - uniform, uneven, focal. In the description you can find the definitions “piebald” or “loopy” - these are symptoms of an uneven variant.
A uniform appearance may be interpreted by radiologists as “diffuse.” The interpretation of definitions depends on the university the specialist graduated from, practical experience, and the amount of relevant literature read.
There are no unified standards in radiology, so each radiologist describes X-ray syndromes in his own terms.
Uneven osteoporosis is a decrease in the thickness of bone tissue due to a burn, phlegmon, neuritis, fracture - acute conditions that affect locally. Destruction of the bone structure during osteomyelitis on an x-ray is also manifested by osteoporotic restructuring around the focus of fusion.
Uniform osteoporosis is observed in chronic diseases that develop over a long period of time.
The last thing I would like to draw your attention to is that the picture shows the type of osteoporotic changes by location:
1. Local – directly at the site of the lesion;
2. Regional – affects the whole joint;
3. Common osteoporosis – the entire limb is affected;
4. Systemic – osteoporotic restructuring of many parts of the skeleton.
Character reification for older people. In children with fractures, local forms are visualized, which disappear after healing of the destruction.
Subperiosteal fracture of both forearm bones in a 7-year-old child
With atrophy, the volume of the entire bone decreases. This symptom distinguishes this syndrome from osteoporosis and destruction.
Types of atrophy due to:
Some radiologists, representatives of the Soviet school of radiology, describe the type of atrophic changes in their conclusions. One photo alone cannot suggest a reason. Only by analyzing the medical history and interviewing the patient can one indirectly assume the etiological factor of atrophy. Such problems should be solved by the attending physician after a full diagnosis of the patient’s condition.
Destruction differs from atrophy in the destruction of bone beams against the background of trauma, inflammation, and burns. There are no bone beams at the site of the destructive lesion. Differential diagnosis of these nosologies using radiographs is not difficult.
Osteolysis is bone resorption, in which tissue disappears without the presence of reactive, inflammatory, destructive changes around the pathological focus. Occurs in some diseases of the peripheral and central nervous system - tabes, syringomyelia, Raynaud's disease, traumatic injuries of the spinal cord.
Osteomalacia is a softening of the bones that occurs due to insufficient mineral balance of the bones. It is formed during bone restructuring, when osteoid structures are not saturated with calcium due to hormonal disorders, impaired calcium intake from food, and vitamin D deficiency.
X-rays against the background of the disease reveal pronounced, increasing osteoporosis in the bones of the extremities and pelvis. The condition is accompanied by an arched curvature of the bone, limiting the muscle force that is applied to the damaged area.
In conclusion, let us highlight the radiological syndromes in which the volume of bone tissue decreases:
Any of the described symptoms is shown by an x-ray. You just need to correctly analyze the image so as not to miss local areas of decreased bone density.
The following bone thickening syndromes are visualized on x-ray:
3. Periosteal overlays (layers);
Verification of symptoms is not difficult if a high-quality radiograph of the bone is taken.
The most common bone thickening syndrome is osteosclerosis. It manifests itself as active proliferation of connective tissue, leading to thickening of the bone structure. Per unit volume of tissue, the size of one or more bone beams increases.
The morphological basis of pathology is an increase in the space between individual units of the bone structure. There are more beams, the space between them decreases. There may be no bone pattern on the image.
What is osteosclerosis in a joint:
1. Finely looped structure of the pattern or complete disappearance;
2. Increase in cortical standing due to growths in the projection of the medullary canal;
3. Narrowing of the medullary canal.
Conditions with the presence of bone osteosclerosis - tumors, hormonal imbalance, inflammation, callus, intense physical activity on the limbs. Osteosclerosis, like osteoporosis, is a reversible condition.
Periosteal overlays (periostoses, periostitis) are the formation of additional tissue along the periphery of the periosteum. The syndrome is caused by inflammation, injury, and tumors.
Linear periostitis can be seen on an x-ray in the form of a thin strip, which is separated from the periosteum. Appears during inflammatory processes. The most common cause is hematogenous osteomyelitis.
Layered periostosis can be seen on an x-ray in the form of layers of dark and light stripes outward from the periosteum. The most common cause of pathology is Ewing's sarcoma. With inflammation, the disease is observed less frequently.
Assimilated periostitis is a certain phase of linear periosteal bedding, in which articulation of calcium deposits with the underlying bone appears. It is necessary to differentiate the nosology from excess callus in a healed fracture.
Needle periostosis is characterized on a radiograph by the appearance of needle-like layers on top of the periosteum. The “needles” grow at a certain angle to the diaphysis of the bone. Appears in osteogenic sarcoma.
Ossifying periostosis is a unique form in which a “visor” is formed along the cortical layer, which experts call Codman’s triangle.
The mechanism of occurrence is the growth of a tumor from the inner part of the bone with moving away of the periosteum and calcification. If the formation grows quickly, then ossification may not be observed.
Bone hypertrophy is the opposite of atrophy. With pathology, an increase in bone volume is observed throughout the entire length.
Osteolysis for Ewing's tumor of the tibia
Parostosis is a syndrome caused by bone formations located near the main part of the bone. It develops not from the periosteum, but from the surrounding tissues. Damage to fascia, ligaments, and tendons leads to the formation of hematomas in which calcium salts are deposited, so the pathology is verified in the image. The causes of the condition are varied - dystrophy (malnutrition, blood supply), trauma, physical activity.
Osteonecrosis is the death of a section of bone tissue due to increased nutrition. The pathomorphological basis of osteonecrosis is the death of bone cells. In the area of necrosis, the mineral skeleton is preserved.
The intermediate substance does not create intense shadows on the radiograph. Around the site of osteonecrosis, connective tissue grows intensively, which leads to a clear limitation of the pathological focus from the surrounding tissue.
A soft tissue layer separates the “living” and “dead” tissue.
Based on morphology, aseptic and septic necrosis are distinguished. The first type occurs with osteochondropathy, the second - with deforming arthrosis, embolism, thrombosis.
The consequence of inflammation is septic osteonecrosis.
X-ray signs of bone necrosis:
• High intensity of necrotic tissue;
• A clearing strip between healthy and necrotic tissue;
• Osteoporotic changes in surrounding tissue.
It is difficult to distinguish between septic and aseptic variants by analyzing radiographs of a patient with bone necrosis. The diagnostic criterion for the disease is the width of the border strip.
It is difficult to distinguish between the intensive structure of bone substance during osteosclerotic and osteonecrotic changes. The differential feature is an intense band of clearing due to the limitation of the area of death due to necrosis.
When a free area is separated, a sequester is formed. This symptom is characteristic of chronic osteomyelitis - purulent melting of bone tissue.
Serious fractures are visualized well on X-rays, but for minor injuries (“cracks”), the radiologist’s description does not always include the classical interpretation—a line of clearing and displacement of fragments. In doubtful cases, dynamic monitoring is carried out using repeated images after some time, or additional examinations are prescribed - computed tomography.
With arthrosis of the joints, even in the initial stages, a narrowing of the joint space can be observed. The sign occurs due to the destruction of the cartilage plate laid between the articular surfaces of the bones. At the second stage of osteoarthritis, bone osteophytes and subchondral osteosclerosis of the endplates appear, which indicates the destruction of the distal parts of the bones.
To determine the rate of further progression, an analysis of the uniformity of joint spaces is recommended. Deformation indicates the possible addition of a bacterial infection. In such a situation, radiologists make a conclusion about the presence of arthrosis-arthritis of the joint.
X-ray of fused bone, X-ray of the skeleton, X-ray diagnosis of fractures - these topics are familiar to our radiologists, who are ready to give a second opinion after analyzing your X-ray.
Age-related features of the formation of ossification nuclei in a child immediately after birth and up to 4 years
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