Fracture of the tibia in a child. Rehabilitation after childhood fractures

Children, due to their activity, are very susceptible to domestic injuries. According to statistics, 15-18% of all injuries received by a child while playing on the street are fractures.

Due to the fact that the skeletal system at an early age differs from that of an adult, pediatric fractures have a number of specific features, so parents need to have at least a rough idea of this type of injury.

Features of childhood fractures

No one is immune from falls and injuries, and in adults, almost every second case of injury is a fracture. And if adults more often break their limbs and femoral neck, then in children there are two, the most “vulnerable” places - a fracture in the child’s elbow joint and the forearm.

The child’s skeletal system is much more active and better supplied with blood, since it is in a constant process of growth and contains a large amount of organic protein. Traumatologists confidently state the fact that in most cases a broken bone in children is a so-called “green stick”. For example, on an x-ray, a child’s arm fracture looks like a broken green tree branch, slightly bent after the injury.

Sometimes, people who suffered arm or leg injuries in childhood suffer greatly from their consequences throughout their lives. For example, a fracture of the radius in a child heals precisely in the area where active growth of bone tissue is observed. If there is no displacement or fragments, and the healing process is only the application of plaster, then there is no reason to worry.

However, there are cases of severe trauma when the formation of callus and bone fusion proceeds slower than its growth. The consequence of this process is shortening or curvature of the limb.

Classification and nature of fractures in children

Most often, injuries affect the limbs. A fracture of a leg or arm in a child can be pathological or physiological. The first occur against the background of chronic or acquired diseases, during which the skeletal system is destroyed or subject to deformation. The second are spontaneous traumatic injuries.

Physiological ones are divided into open (with damage to the skin) and closed, with and without bone displacement.

Broken arm

Hand injuries are classified according to the characteristics of the bone damage and the line along which it occurred. A displaced fracture of the arm in a child can be oblique, longitudinal, helical or transverse. Displacement is a problematic injury to tubular bones, and the damage itself can be single, double (the bone is broken in two places), or multiple.

Signs of a displaced arm fracture in a child are swelling, swelling and severe pain in the area of injury, and in many cases – deformation of the arm and a hematoma forming on the skin. In the first days after injury, the child may experience a fever, which is associated with tissue ruptures and internal bruising.

Fracture of the clavicle and humerus

This type of injury is classified as serious, occurring mainly when falling on an outstretched arm, elbow or shoulder. When a fracture of the forearm with displacement occurs in children, uncharacteristic mobility of the shoulder joint, swelling, crunching and deformation is observed. The arm dangles arbitrarily along the body, the baby cannot move it, any attempt causes severe pain.

But if this happens in the lower part of the humerus, the consequences can be unpredictable, since the fragments begin to move over long distances, damaging blood vessels and tendons along the way. In the event of a displaced fracture of the collarbone, parents should immediately apply cold to the bruised area and take the child to the nearest clinic.

Tibia fracture

Even those who do not have sufficient knowledge in the field of medicine, but know where the tibia is located, understand that this type of injury is also very dangerous. But, fortunately, this bone does not break so often in children. In this case, the symptoms are obvious - the child has a clear displacement of one of the tibia bones (small or large). Sharp pain, quickly swollen leg and the appearance of a hematoma are the first signs of a fracture of the tibia. The baby has difficulty moving and practically cannot lean on his leg, as this causes unbearable pain.

If the fibula is damaged, then in some cases the child can move. An interesting fact, but a fracture of the tibia in a child 4 years of age or younger can go unnoticed, since it does not have pronounced symptoms, and is very often justified only by the child’s complaints of periodic aching pain.

Fracture of the nose and parietal bone

Signs of a broken nose in a child are, first of all, curvature. After an injury, the first thing parents should do is remove the curvature. As soon as swelling and hematoma begin, this symptom will go away and the fracture may be determined only by an X-ray.

As a rule, at the first visit to the clinic, the specialist is able to put the nose together like a “puzzle”. In children, such fractures heal within 2-3 weeks and do not require additional treatment or surgery. If the bone is crushed, aesthetic facial correction will definitely be required, which is carried out in the clinic in the departments of maxillofacial therapy.

Doctor Komarovsky: a fracture in a child

A fracture of the parietal bone in a child is observed in 70% of cases with strong head impacts, falls from a height, or mechanical trauma. This is a very rare type of fracture, since the bone itself in young children has an increased strength coefficient. A fracture of the parietal bone in an infant is fraught with unpleasant consequences.

Since tissue that has not yet matured is exposed to trauma, this can lead to loss of consciousness and mental disorders.

Whatever the nature of the fracture, parents need to remember that a quick response, going to the clinic and taking urgent action can minimize both the physical pain and moral trauma of the baby. In a specialized clinic, the child will be given an x-ray, a cast will be applied, and first aid will be provided.

Tibia fractures in children account for more than half of the total number of all fractures of the lower extremities. They occur during a fall (including from a height), a traffic injury, a direct blow, or a twisted foot. Clinical manifestations are determined by the level of the fracture. If the upper metaepiphysis is damaged, the symptoms are mild; in some cases, the child can lean on the affected leg. With fractures in the middle third, sharp pain and swelling are observed, support is impossible, noticeable deformation often occurs, and pathological mobility is noted. Damage to the distal metaepiphysis is accompanied by swelling and intense pain. Diagnosis is carried out based on the results of radiography and examination data. Treatment is conservative. If necessary, reposition is performed, a cast or skeletal traction is applied, and physical therapy is prescribed. Surgery is rarely required.

General information

Tibia fractures in children are a common injury. Both isolated damage to the tibia and disruption of the integrity of both bones of the leg can be observed. Isolated injury to the fibula occurs extremely rarely.

The severity of the injury can vary significantly and depends on the level and type of fracture. In a normal fall on the street or while playing, fractures of the tibia in children are usually isolated. In case of road traffic injury and falls from a significant height, a combination with damage to other skeletal bones, head injury, spinal cord injury, blunt abdominal trauma, pelvic organ injury and chest injuries is possible.

Classification of tibia fractures in children

Taking into account the level, they distinguish:

Damage to the upper metaepiphysis of the tibia.
Diaphyseal fractures of one or both leg bones.
Damage to the lower metaepiphysis of the leg bones.

The rarest (4.7%) are injuries to the upper part of the tibia, the most common are diaphyseal fractures.

Fractures of the upper metaepiphysis of the tibia

There are two types of such injuries: fractures of the intercondylar eminence and fractures of the metaepiphysis.

The patient is hospitalized for several days in the children's trauma department and then discharged for further treatment as an outpatient. Upon admission, immobilization is performed with a plaster or plastic splint. The leg is fixed at a slight angle. If necessary, a puncture of the knee joint is performed. The cast must be worn for 3 weeks. Then the child is prescribed exercise therapy.

Treatment is inpatient and then outpatient at the emergency room. The child is put in a cast for 2-3 weeks. Upon completion of immobilization, the patient is referred to exercise therapy.

The prognosis is favorable. Movements are restored in full, limb growth is usually not impaired.

Diaphyseal fractures of the tibia in children

In 60% of cases, there is a fracture of one bone (tibia). In 40%, both bones are broken. As a rule, the damage is localized in the middle third. The fracture line is usually located obliquely, spirally or transversely; comminuted fractures are less common.

The clinical manifestations are clear, so making a diagnosis is not difficult. After a fall or blow to the leg, sharp pain occurs. The child cannot step on his foot. There is swelling in the area of damage, and a hematoma is possible. Deformation is revealed, crepitus and mobility of fragments are determined.

Inpatient treatment is carried out by a pediatric traumatologist. For cracks and fractures without displacement, a deep cast is applied to the slightly bent shin for 2-3 weeks.

For spiral, transverse and oblique fractures with slight displacement, a one-stage reposition of the leg bones under anesthesia is possible, followed by fixation with a plaster cast for 4-5 weeks.

Significant displacement and an unsuccessful attempt at reposition is an indication for skeletal traction for 2-3 weeks. Then a cast is applied for another 2-3 weeks.

The prognosis for diaphyseal fractures of the tibia in children is favorable. The union is good. Even if after reposition there is a slight displacement in width (up to 1/3 of the diameter of the bone), it is eliminated as the child grows.

Fractures of the lower metaepiphyses of the leg bones

As a rule, in childhood, osteoepiphysiolysis of the lower end of the tibia occurs in combination with a fracture of the lower third of the fibula. Ankle avulsions are less common. The injury is usually caused by a twisted foot.

With osteoepiphysiolysis, the child complains of pain when trying to move or feel. Support is impossible. The ankle joint is swollen, and sometimes the skin in this area becomes bluish or purple. With pronounced displacement, there is deformation of the joint area and some outward rotation of the foot.

If there is no displacement, a cast is applied to the knee for 3 weeks. In case of osteoepiphysiolysis with displacement in combination with damage to the fibula, reposition is performed under general anesthesia. Then the fracture is fixed with a plaster cast and X-ray control is performed. A repeat control image is prescribed after 4-6 days. Fixation period is 3-4 weeks.

Children with non-displaced fractures are observed on an outpatient basis by a pediatric traumatologist. If there is displacement, hospitalization is possible.

Ankle fractures are more common in teenagers. There is usually no displacement of fragments. The clinic for fractures without displacement is erased. There is slight swelling and moderate pain, support is somewhat limited.

With displacement injuries, significant swelling and more or less noticeable deformation are observed. The pain is intense. Support is impossible.

X-ray examination makes it possible not only to confirm the diagnosis, but also to assess the amount of displacement of fragments. CT or MRI of the joint is required very rarely, usually for non-displaced fractures.

Treatment of non-displaced injuries is carried out in the emergency room. The child is put in a cast for 2-3 weeks, then physiotherapy and exercise therapy are prescribed.

In case of isolated injuries of the inner or outer ankle with displacement, reposition is carried out. After applying the plaster and 4-5 days later, a control photograph is taken. Immobilization lasts 3-4 weeks. Then it is recommended to use special insoles for 2-3 months. Paraffin or ozokerite and exercise therapy are prescribed.

Displaced bimalleolar fractures are an indication for hospitalization in the pediatric trauma department. Reposition is performed under anesthesia, then a bandage is applied and X-ray control is performed. Immobilization period is 4-5 weeks. Then physical therapy and physiotherapy are prescribed.

Surgical treatment is required extremely rarely, mainly for open injuries.

When the displacement is eliminated and the congruence of the articular surfaces is restored, the prognosis is favorable.

The most common limb injury in humans is a fracture of the tibia. Medical statistics claim that fractures of the tibia and fibula occur with equal frequency, and the lower leg is also often injured.

These injuries occur most often during road traffic accidents. A fracture of the tibia is a complex injury accompanied by complications.

General information

The tibia consists of two tibia bones – the tibia and the tibia. They carry a lot of load when walking. Therefore, fractures involving them occur frequently.

The tibia is located inwardly, towards the middle of the body and consists of a long tubular bone and a tibia.
The fibula is located laterally, that is, on the side, closer to the outer part of the leg. It is also tubular and long, but is inferior in volume to the tibia.

Tibial fractures most often occur in the winter and in older people because their bone structure has become weak. Fractures can be either the tibia or the tibia, but a fracture of both bones at once is considered complex.

Causes of fracture

To fracture the tibia, a force is required that exceeds the strength of bone tissue in intensity. The reasons for receiving this bone injury are as follows:

Road accident - a strong blow to the shin area.
Falling or jumping from a height - if you land unsuccessfully on straight legs, a fracture of the tibia and fibula occurs, with or without displacement, causing harm to health.
Skateboard, skates or skis - when riding on the listed objects, excessive rotation of the lower leg occurs with a fixed foot, which leads to injury to the limbs.
A strong blow to the knee or a fall on it.
Sports injuries, car accident - compression of the lower leg bones.
The leg is twisted at the ankle joint.
blow to the ankle with a blunt object.

Important! Another reason for fractures in this area are diseases that affect the strength of bone tissue.

Types of damage to the tibia

A shin injury occurs in the middle part of the tibia in the diaphysis area. When fractures of the fibula together with a fracture of the tibia, the prognosis of the pathology worsens significantly and leads to complications. With such an injury, therapy and rehabilitation require a long time.

Fractures of the fibula and tibia can be closed or open. With a closed fracture, the bones remain inside, under the skin, while an open fracture is fraught with bone fragments coming out through the dermis.

Closed injuries may be complete or have "grapevine" bone fractures. In turn, there is a complete fracture of the bones with displacement or without bone fragments.

The severity of harm to a person’s health due to leg fractures depends on the type of injury:

Partial.
Full.
Open.
Closed.
With offset.

Fractures

Fibula fracture

The fibula fracture represents an injury that was received due to a blow. The result of such an injury is directly related to the fact that the bone structures lose their integrity.

The injury can occur after a person falls or in a traffic accident. Violation of safety precautions in the workplace can also cause this fracture, causing harm to the health of the victim. The shin bones can be injured due to bad weather.

In medicine, there are several types of fibula injury in children and adults:

Fracture of the fibula with displacement of fragments.
Fracture of the fibula without displacement of fragments.
Transverse injury.
Trauma with oblique fracture.
Spiral fracture of the limb.
The leg has a fragmentary fracture.

What are the main symptoms of a fibula fracture?

The limb deviates from the axis;
Sharp pain and swelling appears.
One limb becomes shorter than the other.
There may be numbness in the leg.

Important! Treatment for this fracture depends entirely on the nature of the injury and the degree of harm to health.

Tibia fracture

A tibia fracture occurs when the load on the limb exceeds the strength of the bone itself and the bone structure is damaged. This type of fracture is the result of a direct blow to the bone, which can occur as a result of a fall or being hit by a car.

The main types of fracture of the tibia:

Displaced fracture of the tibia - damaged bones are displaced from their axis. The severity of the harm to health is high. This injury cannot be treated conservatively; surgical intervention is necessary.
A break or small crack in a bone. Can be placed vertically on the leg or horizontally.
Comminuted fracture.
Closed fractures. The tibia did not violate the integrity of the soft tissues on the victim’s leg and the fracture is not visible, only palpable.
Open fractures. There is a violation of the skin with open fractures. The broken tibia is visible from the outside. Refers to common fractures.

Main signs of a fracture:

Dull, aching pain. A person cannot step on the injured limb, and if he tries to lean on the surface, in order to stand up, he experiences severe pain, which in some cases causes a leg cramp.
Swelling and hematoma appear in the area of injury.
The leg is deformed.

Important! If the tibia is fractured, the victim cannot move independently; he must be provided with first aid. If a child receives such an injury, he should be immediately taken to a specialist.

First aid

The most important thing for the victim is timely and correct assistance. People often ask what to do in case of a fracture, is it possible to somehow help the patient? It is not only possible, but also necessary to provide first aid, but only if you know how. Until the ambulance arrives or the victim is taken to the hospital, a number of actions must be taken. Algorithm of actions:

It is necessary to relieve pain with analgesics. This is not suitable for small children. In the absence of a wound, you can apply a cold compress, which will not only relieve pain, but also stop the development of swelling and hematoma.
In order to prevent the bone fragments from moving and causing harm to the tissues surrounding them, it is necessary to fix the damaged leg and make it immobile. This is especially important for screw fractures that consist of bone fragments. To do this, take two large boards or thick sticks. One of them needs to be secured with a bandage to the inside of the leg, and the second to the outside. A homemade splint must be applied from heel to hip, firmly fixing it in the area of the knee and ankle joint.
In case of an open fracture, first clean the wound of contaminants, being careful not to touch the bone. After this, you should treat the wound with an antiseptic and apply a dry sterile bandage. Ointments and other products cannot be used.
If there is blood loss, then a tourniquet is applied to the femoral part of the leg and the time when the procedure was performed is remembered, since it cannot be kept on the leg for more than two hours. If the limb has lost color and become cold, the tourniquet must be removed.

An injured child or adult should only be transported in a supine position. This is necessary in order to avoid causing harm to health.

Diagnostics

After a person has damaged the fibula or tibia and has been taken to the clinic, the doctor orders a detailed examination. This is necessary for further treatment and positive restoration of all functions of the damaged limb. At the first stage, the specialist collects an anamnesis, followed by a visual examination to identify leg deformities, bleeding, the presence of edema and hematoma, and protrusion under the skin.

After this, the patient is sent for radiography. This method helps determine the nature of the damage to the tibia and diagnose a fracture. Also, using an x-ray, you can determine the condition of the fibula and whether there is a displaced fracture. If there are symptoms of a more severe injury, a CT scan is prescribed. Using this method, it is possible to see a cross section of tissue, identify an oblique fracture and obtain a more accurate picture of the severity of the injury.

After the diagnosis is announced, the victim will be sent to a surgical or orthopedic department.

Fracture treatment

Treatment and rehabilitation of a tibia fracture depends on the type of injury and associated complications, as well as how long to walk in a cast with certain fractures.

No offset

When treating a non-displaced injury, the doctor administers local anesthesia and applies a plaster cast. A plaster cast is applied from the heel bone to the middle of the thigh. After this, a repeat x-ray is taken to make sure that the bones are anatomically correct and that no fragments could be displaced.

A week after immobilization, a repeat x-ray is taken. The plaster is removed two and a half months after the injury, then a rehabilitation course is carried out for a month. If no complications arise during therapy, the bones heal normally, then complete restoration of all functions of the limb occurs after four months.

With offset

If there are obvious displacements of bone fragments, the treatment tactics are somewhat different from the previous one, and the treatment time for the fracture increases.

After the patient has been taken to the hospital, the injured limb is anesthetized, after which the patient is placed in traction. During treatment, the muscles are stretched and the bone segments are not displaced. The patient remains in this state until the callus grows, and this depends on the number of damaged bones and how long they will heal.

Throughout the entire period while bone fusion occurs, the patient is given an x-ray, in which the doctor observes the formation of callus. If the bone heals normally and the patient’s condition is satisfactory, then traction is canceled after about a month and a half. After this, the bones are fixed using a plaster splint. After 2-4 months, a control x-ray is carried out, and if it shows that there is no need for a plaster fixation, the fused bone fragment looks normal, then the splint is removed.

Surgical intervention

Surgical intervention for fractures of the tibia is resorted to in the following cases:

An open fracture and there is a need to monitor wound healing.
An unstable fracture with a health hazard or the presence of more than three bone fragments.
Conservative treatment did not give a positive result - the bone heals incorrectly or slowly.

Doctors use the following devices to treat a fracture with surgery:

Illizarov apparatus

This method is the most reliable for quick and effective treatment, since the needles, which are inserted into the bone fragments and brought out, form a frame. The bones are fixed rigidly, so that the fragment does not move under the skin, even if its edges are oblique. The doctor has the ability to change the position of the segments during therapy.

Screws

Fixation of the tibia using an external method gives positive results, but doctors resort to it in extreme cases. During the operation, special screws are inserted into the bone, which are brought out and secured with a metal structure that holds the fragments well in the desired position and prevents them from moving during the fusion process. But this method has contraindications - it is not suitable for children with long-term rehabilitation.

Kernel

An incision is made on the victim's skin. A special steel rod is inserted through it into the bone canal, which is removed when the bone heals completely.

Plate

Holes are made in the skin through which a plate is attached to the bone using special screws. This operation is not performed when treating a fracture in children, since it can damage the periosteum, which will negatively affect bone growth in the future.

Drug treatment

Regardless of the type of fracture and treatment method, the patient is prescribed medications that help with recovery. These products improve microcirculation and saturate the patient’s body with essential vitamins. If necessary, the patient is prescribed painkillers.

Rehabilitation

Rehabilitation after a tibia injury, unless there are complications, should begin almost immediately after the cast has been applied. To develop a leg after a fracture, the patient is advised to start moving his toes and carefully turning his foot.

It is necessary to work out the leg after an injury so that all its functions are restored. The doctor draws up a rehabilitation plan, which includes therapeutic massage, physiotherapy and certain exercises for the leg. But when working out your leg, you should be extremely careful - not to overexert it, so as not to cause adverse side effects.

Full recovery, provided all doctor's instructions are followed, occurs six months after the injury.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!

The support of the entire human body lies on the legs. The leg skeleton consists of different bones, damage to which disrupts normal human movement. The shin bones are the main structures of the leg, which can be injured under excessive loads.

A fracture of the tibia (tibia), as well as a fracture of the fibula, are quite common occurrences. Typically, out of 100 types of fracture, 10% are tibial fractures. As a rule, such damage is dangerous. Injuries are usually recorded in the central region of the bone, but there are also situations in which the intercondyles of the tubercle of the tibia are also noted.

The tibia consists of two fragments: the tibia and fibula. The tibia is long and bulky. It includes the body and two ends of the joint. The tibia takes part in the formation of the knee and ankle joints. In this case, the knee joint is formed due to the participation of the proximal end, and the ankle joint – due to the distal part of the bone.

The fibula is located near the tibia, at its ends there are 2 heads, which are connected to each other using almost flat joints. Due to this, sliding in the area of the bone head is limited. Both the proximal and distal heads of the bone contain articular surfaces, which are represented by narrow slit-like spaces.

The tibia and fibula are no longer fused with each other; the fibula is somewhat free in its movements. But for strength, a fibrous membrane is stretched between these bones, which is also called the interosseous membrane. Unlike the tibia, the fibula does not participate in the formation.

Classification

Fractures of the tibia and fibula occur as often as injuries to other bones. However, there are a number of differences between both fragments and reasons why injury occurs.

Fractures of the tibia are usually classified:

Stable, in which the fracture of the tibia occurs without displacement, or it is not significant. As a rule, such injuries are localized along the axis and the fragments do not move during the fusion process.
Transverse, in which the line of damage is perpendicular to the axis.
Displaced fractures are characterized by damage in which the bone axis is disrupted and bone fragments are separated. As a rule, such fractures do not heal on their own; as a result, surgical intervention is required.
Oblique, in which the line of injury is at an oblique angle. The victim as a result of such a fracture experiences progressive instability. Damage often occurs in combination with the fibula.
Comminuted, in which there are 2 or more fragments.
Spiral, screw, helical fractures of the tibia, in which the damage is marked in a spiral, etc.
Closed fractures, which are characterized by the integrity of the skin and the absence of visible debris and wounds outside the skin. Often the injury is localized, has severe swelling, and hematoma. If help is not provided in a timely manner, blood circulation in the localized area will be impaired, as a result of which muscle cells will die. In severe cases, limb amputation is required.
Open fractures, which are characterized by the presence of an open wound and debris extending beyond its boundaries. With open fractures, bleeding and damage to muscle tissue, ligaments and tendons often occur. Complications often develop and recovery takes a long time.

It is also common to distinguish:

intra-articular and extra-articular fractures of the tibia;
fractures of the head of the fibula without displacement;
fracture of the tibial tuberosity;
fracture of the tibial diaphysis;
fractures of the distal metaepiphysis of the tibia;
marching fractures, stress fractures, compression fractures.

Fractures of the fibula are mostly classified according to the same characteristics, therefore they are distinguished:

Fractures of the fibula with and without displacement.
Fractures of the head (neck or body) of the fibula;
Isolated fractures of the fibular diaphysis;
Transverse fractures;
Splintered or fragmented;
Spiral fractures.

General characteristics include:

March fractures.
Avulsion fractures.
Fractures of the lower third of the bone.
Fractures of the upper third of the bone.
A double fracture in which both bones are broken (occurs frequently).
Figurative fractures.

Trauma code according to ICD 10

Fracture of the tibia code according to ICD 10 in combination with a fracture of the fibula (with ankle joint)

Causes

The causes of damage to the shin bones have some similarities and differences. In both cases, the injury occurs as a result of strong pressure on the bone, which can occur during a fall or blow. As a result of the impact, if there is still an additional load, the bone will become mixed and a fracture will occur.

Such injuries are usually multiple and dangerous due to complications. The greatest danger is posed by open fractures with numerous injuries and blood loss.

The tibia bone tissue is injured more often, and damage to both tibia bones at once also often occurs.

The tibia, fractures of which occur more often, is injured for the following reasons:

Falling from height.
Technogenic disasters.
Natural disasters.

As a rule, damage to the tibia due to these factors is not isolated and is combined with multiple other injuries.

A fibula fracture occurs as a result of:

Falls from heights.
Impact of a direct ramming blow to the outer part of the shin (in case of an accident).
A “screwing” movement, at the moment when the shin is tightly fixed.

Most often, injury occurs to the epiphysis or neck of the bone. As an example, a model with a pin is often used. With a talus impact, the pin opens, causing one part of it to move to the side; the same thing happens when the fibula is damaged. The damage may be at the back or at the top. The interosseous membrane is also damaged.

Symptoms

The signs of a tibia fracture are similar to injuries to other limb bones.

In both cases, pain occurs in a localized area.
It is almost impossible to step on your foot, causing severe pain and discomfort.
The lower leg itself is swollen, and a hematoma forms in the affected area.
Limb deformity occurs.
Numbness in the lower part of the leg, sometimes bluish skin.
If the fracture is open, there is blood loss and damage to tissues located near the wound.

With a fracture of the fibula, the same basic symptoms of a fracture are present. However, the pain may not be as pronounced, or the victim may not feel it at all. This is primarily due to the fact that the blood vessels are damaged, the leg goes numb, and the pain does not fully manifest itself. Signs may be accompanying.

Additional symptoms of a fibula fracture are often identified:

edema;
bleeding;
with an open fracture - a protruding piece of bone;
with avulsion – a hanging limb.

First aid

has its own similarities.

If a fracture of the fibula or a fracture of the tibia occurs, you must:

Reduce the severity of pain to avoid painful shock in the victim.
In case of blood loss, consult an emergency specialist and try to stop the bleeding. To do this, the edges of the wound are treated with an antiseptic, and the damaged area is covered with a sterile, loose bandage.
After this, immobilization is carried out to prevent further displacement. To do this, the injured limb must be raised and secured; if you have shoes, it is advisable to remove them. The injured leg is immobilized and a splint is applied. For this purpose, you can use any items that are at hand (plywood, board, sticks). It is important to apply the splint in such a way that the lower part covers the ankle, and the upper part reaches the upper thigh.

After providing first aid, the victim must wait for the ambulance to arrive and, if possible, go to the emergency room with him. This is necessary in order to testify about what happened and inform the doctor what was taken prematurely, what

Note!

The relevance of the problem of first aid requires knowledge that can be put into practice.

Diagnostics

Fractures of the tibia and fibula are diagnosed using x-rays. In some cases, a CT, MRI or ultrasound result may be needed. The doctor will inform you about a specific type of diagnosis as necessary.

Diagnosis and treatment tactics for all fractures of the tibia are as follows:

Inspection and interview of the victim.
Determining the nature of the damage (whether the articular surface of the tibia and fibula is broken, identifying the edge of the fracture, determining a closed or open fracture).
Performing radiography. This type of study is carried out in two projections, and thanks to the image you can find out which bone is broken - the tibia or fibula, as well as identify the number of bone injuries and their location.

Treatment

When treating fractures of the tibia, use:

Conservative therapy
Surgical intervention.

Conservative treatment of a non-displaced fracture of the tibia is carried out using pain blockade and the application of a plaster cast. The plaster should fix the knee, lower leg and foot. If the displacement was minor, local closed reduction is performed using local anesthesia. The immobilization period for normally located fragments is 1.5-4 months. If the injury is complex, it may take longer - 4-6 months. They usually wear a cast for the same amount of time.

Note!

For fractures of the tibia, the time frame for treatment and recovery varies. In some cases, when the fracture is not significant, without displacement and multiple fragments, the doctor may apply a plaster cast and, after a control image at 21 days, remove it if the bones have fused. Sometimes it may take longer because the healing time, for example, is longer in older people.

What is fracture consolidation?

Consolidation (or fusion) is a process by which damaged bone fragments grow together. Consolidation takes place in 4 stages:

The first stage - 3 days - multiple penetration of leukocytes to the site of the lesion and resorption of dead tissue occurs.
The second stage is multiple reproduction of cells of the skeletal system, mineralization of bone, filling of cartilage tissue.
The third stage is the restoration of blood supply to the affected area.
The fourth stage is the fusion of the bone, the creation of the periosteum, and its penetration with blood vessels.

The period of consolidation for the tibia and the small fibula is 60-120 days, depending on the location of the lesion.

For the purpose of fixation and immobilization, a tight bandage or orthosis is used. A splint is applied that will fix the leg until the fragments are completely fused.

What to do if you have a displaced tibia fracture

If a displaced tibia fracture occurs, the following is indicated:

Anesthetize the localization of the injury using painkillers.
Perform skeletal traction. To do this, it is fixed with a special knitting needle, which is secured to the side and a load is hung on it. Due to this, the muscles are stretched and the bone fragments cannot fit together. In a state of skeletal traction, reposition is performed, after which the patient must continue to be in traction until the moment when a callus growth does not form.
The growth of callus is checked from time to time using a photograph, and if everything goes well, the traction is removed after 5-6 weeks. Then a plaster cast is applied, which fixes the position of the aligned bones.
The plaster is worn for 2-4 months, after which, when the plaster splint is removed, the recovery period begins.

Surgical treatment

The operation is indicated in cases where bone fusion does not occur for a long time; when injuries are numerous and nerves and blood vessels are affected, as well as when we are talking about an open fracture of the proximal tibia.

The operation for a fracture of the proximal tibia, as well as other parts of the tibia, is carried out in several stages:

Stage 1– pain relief with potent local anesthetics or.

Stage 2– open osteosynthesis. For fractures in the epimetaphysis or proximal metaepiphysis of the tibia, osteosynthesis must be carried out carefully, paying attention to soft tissues, since the course of further treatment depends on the degree of their damage. For fractures of the proximal tibia, minimally invasive closed osteosynthesis is also used.

Stage 3– fixation of bone fragments with rods. Screws, pins, plates, and an Ilizarov apparatus can also be used.

Fixation using rods: it is inserted into the bone canal, after making an incision in the skin, so that one end is outside the canal. With this, reliable fixation of bone fragments is achieved. Then, when the bones grow together, the rod is removed.

Fixation using a plate: if the patient who is injured is an elderly person, plates are used. They are inserted through pre-prepared holes, after which they are screwed to the bones with self-tapping screws. Thanks to this, the position of the fragments is recorded until they are completely fused.

This method of fixation cannot be used by children, and those for whom the method will damage the periosteum and disrupt the growth of bone tissue.

Fixation using self-tapping screws: if an angular injury to the longitudinal bone occurs with displacement, bone fragments are fixed using self-tapping screws. As soon as the fragments grow together, the screws are removed.

Fixation using an Ilizarov device: the device itself is a rigid frame that is fixed over the leg. It is assembled on knitting needles, which are inserted into the holes of the bone fragments themselves and brought out. Thanks to this device, the fixation is rigid, and the position of the fragments themselves can be adjusted.

Stage 4– limb immobilization, regular photographs during the immobilization process.

As a rule, in case of a displaced fracture of the tibia and fibula, surgery is performed immediately. Because every minute counts. If help is not provided in time, the limb may be cut off due to necrosis of damaged tissue and possible sepsis.

Rehabilitation

Rehabilitation after fractures of the tibia and displaced fractures of the fibula is carried out after the fragments have healed and the plaster or other fixation has been removed. As a rule, doctors select a set of rehabilitation exercises on their own, and recommend wearing an elastic bandage.

How to develop a leg after a fracture

Rehabilitation after fractures of the tibia is long and includes:

Developing the leg after a fracture of the tibia. In this case, the leg needs to be developed as early as possible (only after medical confirmation), since during the process of wearing a plaster boot, the muscle tissue gradually begins to atrophy. But you should understand that exercises with maximum loads cannot be performed so as not to cause repeated displacement, since the bone has not yet become stronger. Loads should be carried out gradually.
Another effective and useful method of rehabilitation after a fracture of the tibia is massage. It helps to warm up muscle tissue and improve blood circulation, resulting in a faster recovery process. The duration of recovery procedures should be determined by a doctor. As a rule, it is 7-10 days. Sometimes it may take longer.
You can also use physiotherapeutic agents, which improve the nutrition of injured tissues and cells, and regeneration processes occur faster.
A set of physical exercises is determined by a rehabilitation doctor, who takes into account the condition at the time of injury and the condition at the time of recovery. At the same time, special rehabilitation techniques are selected, thanks to which the restoration of the limb will proceed faster. Therapeutic exercise is performed from the initial development of the lower leg, after which the patient must gradually rise to his feet without outside help and squat.

In addition to all the measures described above, it is important to get rid of bad habits and excess weight. According to medical prescriptions, it is necessary to carry out the entire range of rehabilitation measures and take medications.

Massage

As mentioned above, massage has a beneficial effect on the recovery process, so it must be carried out as carefully as possible. If the tibia hurts a little after a fracture, massage will help relieve some of the pain.

Complications and consequences

Complications of a fracture of the tibia and fibula are different. The most dangerous thing is amputation of a limb as a result of necrosis of damaged tissues and the onset of sepsis, after an infected hematoma. But this can be avoided if assistance is provided to the victim in a timely and correct manner. Also, if the patient does not self-medicate and does not resort to traditional medicine, esotericism, etc. to treat a fracture.

What else could happen? Consequences of a fracture:

The bone fragments did not heal properly, and immediate surgery with six months of immobilization was required.
Arthritis and osteoarthritis developed.
The fracture damaged the peroneal nerve.
An open wound became infected.
A vascular complication has occurred.

Prevention

In order to prevent a fracture of the posterior edge of the tibia or both tibias, you need to watch what you are stepping on, in other words, “look at your feet.” You should take care of your health, monitor your weight and eliminate unhealthy foods and habits. It is recommended to treat any illnesses in a timely manner and take care of yourself.

Buy shoes of the right size. This rule also applies to the choice of rollers, skates, etc. It is not recommended to overuse heels. If you pay attention to yourself in time, you will be able to avoid many problems, including fractures of the tibia and fibula. Be healthy!

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

Author of the article:| Orthopedic doctor Education: Diploma in General Medicine received in 2001 from the Medical Academy named after. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty “Traumatology and Orthopedics” at the City Clinical Hospital No. 29 named after. N.E. Bauman.

The children's skeletal system differs from the adult skeletal system not only in physiological, but also in biomechanical and anatomical characteristics. Therefore, methods for diagnosing and treating fractures in children have their own peculiarities.

A child's bones contain cartilage tissue. The periosteum in children is stronger than in adults, so it forms callus faster. A child's skeletal system absorbs more energy; children's bones have lower mineral density and more porosity than adults'. The increased density is ensured by the presence of a large number of Haversian channels. Therefore, children's bones are less elastic and less strong than those of adults. Approximately 10-15% of all injuries in children result in bone fractures. With age, bones become less porous, their cortical layer thickens and becomes stronger.

Features of fractures in children

When the limbs are injured, damage to the growth plates is possible, since the ligaments are often attached to the epiphyses of the bones. But their strength is increased by the perichondral rings and intertwined mastoid bodies. Ligaments and metaphyses are stronger than growth zones: they are more resistant to stretching. The severity of the fracture (whether it will be displaced) largely depends on the periosteum: if the periosteum is thick, this prevents closed reduction of bone fragments.

Healing of fractures

The healing of a fracture is influenced, first of all, by the age of the child, as well as how close the injury is to the joint and whether there are obstacles to the movement of the joint. Anatomical reposition of fragments in fractures in children is not always necessary. During healing, bone remodeling occurs due to the resorption of old bone tissue and the formation of new one.

The younger the child, the greater the potential for remodeling. If the bone deformation is close to the growth zone in the plane of motion of the joint axis, then the fracture will heal faster. Intra-articular fractures with displacement, rotational fractures that impair movement in the joint, and fractures of the diaphysis heal less well.

Excessive growth

As a fracture heals, the growth plates of the bones are further stimulated by blood flow, so long bones (such as the femur) may begin to grow excessively. Thus, in children under 10 years of age, a fracture of the femur and its subsequent healing can provoke a lengthening of this bone by 1-3 cm over the next two years. To prevent this from happening, bone fragments are connected with a bayonet. Children over 10 years old undergo simple repositioning of fragments, since their excessive growth is not so pronounced.

Progressive deformity

Shortening of the bone or its angular deformation can occur when the epiphyseal zones are damaged (due to their complete or partial closure). In different bones, such deformation is possible to varying degrees, which depends on the possibilities for further growth of these bones.

Fast healing

Fractures in children heal much faster than in adults. This is due to the thick periosteum and the ability of children's bones to grow. Every year, the rate of fracture healing decreases and gradually approaches the rate of bone healing in adults. Most fractures in children are treated closed. The nature of bone fractures in children is determined by the physiological, biomechanical and anatomical characteristics of their skeletal system.

Most often in children:

Complete fractures (when the bone breaks on both sides). Complete fractures can be transverse, oblique, helical, or impacted (however, an impacted fracture is not typical for children).

Compression fractures occur when there is compression along the long axis of a long bone. In children, compression fractures are often localized in the metaphysis and distal radius. Such a fracture heals with simple immobilization in 3 weeks.

A “greenstick” bone fracture in children occurs in cases where the bending of the bone greatly exceeds its plastic capabilities: a complete fracture does not occur, but damage occurs.

Plastic deformation, or bending - most often these fractures occur in the knee and elbow joints when there is insufficient pressure to fracture the bone.

Epiphyseal fractures in children are divided into five types:

a fracture in the growth zone occurs against the background of degeneration of the cell columns of cartilage or against the background of hypertrophy;

fracture of the growth plate (part of it) – extends to the metaphysis;

fracture of part of the growth plate, which extends to the joint through the epiphysis;

fracture of the metaphysis, epiphysis and growth plate;

crushing of the growth plate.

This classification allows you to choose a treatment method and predict the risk of premature closure of epiphyseal growth zones. When treating type 1 and type 2 fractures, closed reduction is used, i.e. complete alignment of the fragments is not required (only in case of a type 2 fracture of the distal part of the femur, complete alignment of the fragments is required in an open or closed manner, otherwise an unfavorable outcome is possible). With types 3 and 4 fractures, the growth plate and articular surface are displaced, so when treating these fractures, reposition is necessary. A type 5 fracture is most often recognized by its consequences - premature closure of the epiphyseal growth zone.

Child abuse

It happens that bone injuries in children are caused by intentional trauma. Injuries to the ribs, shoulder blades, metaphyses of long bones, or processes of the vertebrae and sternum may indicate child abuse. The fact that the child has experienced abuse is evidenced by multiple fractures, which may be at different stages of healing, fractures of the vertebral bodies, separation of the epiphysis, and fractures of the fingers. A screw-shaped or non-supracondylar fracture of the femur may indicate an intentional injury to a small child who does not yet know how to walk.

A fracture of the clavicle between its middle and lateral parts is often observed in childhood. Such a fracture can be caused by a birth injury, be the result of a direct blow or a fall on an outstretched arm. A clavicle fracture usually does not cause vascular or nerve damage, and the diagnosis is easily made by clinical signs and x-ray (superior or anteroposterior view). The fragments are displaced and are located 1-2 cm on top of each other.

To treat such a fracture, a bandage is applied that covers the shoulders and prevents displacement of the fragments. Complete alignment of fragments is not necessary when treating a clavicle fracture. The fracture heals in 3-6 weeks. The callus can be felt after 6-12 months.

Proximal humerus fracture

Type 2 proximal humerus fractures in children are caused by falling backwards while leaning on a straight arm. Such a fracture may be accompanied by damage to nerves and blood vessels. Diagnosis is carried out using an x-ray of the shoulder girdle and humerus in the lateral and anteroposterior projections.

Simple immobilization is used to treat a proximal humerus fracture. Sometimes it becomes necessary to perform a closed reduction of fragments. But it is not necessary to completely eliminate the deformity: wearing a scarf or splint will be enough. Closed reposition of fragments and immobilization of the limb is necessary in case of sudden displacement of fragments.

Distal humerus fracture

One of the most common fractures is the distal humerus fracture. This fracture may be epiphyseal, supracondylar, or transcondylar. Epiphyseal and supracondylar fractures can be caused by a fall on an outstretched arm, and a transcondylar fracture can be caused by child abuse.

The diagnosis is established using an x-ray of the limb in the posterolateral and anterior direct projections. Disruption of the connection of the shoulder with the ulna and radius bones or the appearance of swelling on the posterior surface of the elbow indicates the presence of a transcondylar or radiologically non-reducible fracture. With such fractures, attempting to move the arm causes pain and swelling. Neurological disorders may also appear: if the injury is localized near the median, radial or ulnar nerves.

To treat a distal humerus fracture, repositioning of the fragments is important. Only careful reduction can prevent deformation of the humerus and ensure its normal growth. Reduction is carried out using a closed method or using internal fixation of fragments; in extreme cases, open reduction is performed.

Distal fracture of the radius and ulna

Compression fractures of the metaphysis of the radius are also common in children. It is caused by falling on an arm with an extended hand. Sometimes such a fracture can be mistaken for a bruise, so people with such fractures go to the hospital only 1-2 days after receiving the injury.

The diagnosis is made by X-ray of the hand in the lateral and anteroposterior projections. For treatment, a cast is applied to the wrist joint and forearm. It grows together in 3-4 weeks.

Fracture of the phalanges of the fingers

The cause of fractures of the phalanges in children is most often the fingers being pinched by a door. With such a fracture, hematomas may form under the nails, requiring drainage. When there is bleeding from under the nail bed or when the nail is partially detached, an open fracture can be diagnosed. In this case, it is necessary to carry out tetanus prophylaxis and use antibiotics.

The diagnosis is made by X-ray of the finger in the lateral and anterior direct projections. During treatment, a plaster cast is applied. Closed reduction of fragments is needed only when the phalanx is rotated or when it is bent.

Fractures in children starting to walk

A helical fracture of the tibia (its distal third) occurs in children 2-4 years old. This type of fracture can occur when you trip over something or fall while playing. As a result, soft tissue swelling appears, the child feels pain and finds it difficult to walk.

The diagnosis is made by X-ray in the lateral and anterior direct projections. In some cases, it is additionally necessary to do an oblique X-ray or bone scintigraphy. Treatment consists of applying a high plaster boot. After 1-2 weeks, subperiosteal formation of bone tissue occurs, and bone fusion occurs after 3 weeks.

Lateral ankle fracture

Avulsion of the fibular epiphysis has symptoms of sprain: pain and swelling appear in the lateral area of the ankle. The diagnosis is confirmed by x-ray under stress (conventional x-ray does not reveal the fracture).

Treatment of a lateral ankle fracture is performed by immobilizing the fibula with a plaster boot. Treatment lasts 4-6 weeks.

Metatarsus fracture

A metatarsal fracture can be caused by trauma to the dorsum of the foot. In this case, the child’s soft tissues swell and bruise appears. The diagnosis is established by x-ray of the foot in the lateral and anteroposterior projection.

As treatment, a plaster cast that looks like a plaster boot is used. When the diaphysis of the fifth metatarsal bone is fractured, the fracture may not heal. In this case, you can lean on your leg only after X-ray confirmation of the presence of signs of bone fusion.

Fracture of the phalanges of the toes

Such a fracture in a child can occur due to trauma while walking barefoot. In this case, bruises appear on the fingers, they become swollen and painful. The diagnosis is made using x-rays. The presence of bleeding indicates an open fracture.

In the absence of strong displacement, closed reduction of fragments is not performed. Treatment consists of taping the sore finger to the healthy one for several days until the swelling subsides.

Surgical treatment of fractures in children

Surgical treatment of fractures in children is performed in 2-5% of cases. Surgical stabilization is carried out for unstable fractures, multiple or open fractures, intra-articular fractures or fractures of the epiphyses with displacement of fragments.

When treating fractures in children, three main surgical methods are used:

open reduction with internal fixation;

closed reduction with internal fixation;

external fixation.

Open reduction with internal fixation is used for intra-articular fractures, displaced fractures of the epiphyses, unstable fractures, damage to blood vessels and nerves, as well as open fractures of the tibia or femur.

Closed reduction with internal fixation is used for metaphyseal or diaphyseal fractures, intra-articular or epiphyseal fractures, and fractures of the femoral neck, phalanges, or distal humerus.

External fixation (complete immobilization of the fracture site) is done for fractures accompanied by a severe burn, for an unstable pelvic fracture, for an open fracture of the 2nd or 3rd degree, for a fracture accompanied by damage to nerves and blood vessels.