1 phalanx of the toe. Fracture of the marginal base of the nail phalanx of the hand

Fingers play very important role in our Everyday life, because they help to grab and hold objects. With them, a person touches things and interacts with the outside world in many ways, which makes this part of the body vulnerable to injury. Finger injuries range from minor bruises or bruises to serious injuries such as a dislocation or fracture. The latter is quite common in sports or extreme sports such as skiing, skateboarding, etc.

Fracture of the finger on the hand - description of the injury

For understanding anatomical structure and the work of the finger, you need to know that it is controlled by the tendons responsible for attaching the bone to the muscle. The bones in the fingers are called phalanges, they are connected to each other by ligaments. There are no separate muscles in this part of the hand. In fact, the muscles of the forearm are attached to the fingers by tendons, which allows them to move.

Each finger has three phalanges, and only the thumb has two.

There are three bones in the finger, called the proximal (main), middle and distal (nail) phalanx, they are located in series. The thumb is an exception because it consists of two phalanges.

It is noteworthy that the thumb is the least prone to injury. Often it is the little finger that suffers from fractures - due to its extreme location on the hand and thin bone, it is especially vulnerable to different kind damage.

The term "broken finger" is used when any of the three bones in the finger is broken. In the case of a simple fracture, the treatment is quite simple, and healing occurs quickly. Complications occur when cracks and fractures occur near the joints, making therapy difficult. Intra-articular fissures provoke hemorrhage into the joint cavity, and it becomes inflamed. In this regard, around the damage strongly swell soft tissues. If the cartilage is also injured, the joint may undergo degenerative changes in the future.

With regards to some types of fractures, it is difficult to understand: only the phalanx was affected, or also the intra-articular surface. Failure to recognize and properly treat these injuries in time threatens with the prospect of partial or complete loss of function.

What are fractures

The following are the different types of finger fractures:

detachable - occurs when the tendon or ligament attached to it is excessively stressed;
longitudinal - due to impact (applied force) - when the broken ends of the digital bone are located in one line;
with a break - if, under the action of an applied force, the finger bone is divided into two differently directed parts, which can be located perpendicular or at an angle to each other;
comminuted - when the bone is broken into three or more parts;
shattered - when destroyed big square bones, with the formation of many fragments;
open fracture - the bone breaks through the skin;
closed fracture - the skin remains intact, the bone is not visible from the outside;
undisplaced or stable fracture - the finger bone breaks, but without divergence of the fragments;
displaced fracture - the bone breaks into separate pieces that do not align themselves, they must be "collected".

The main types are listed above, but there are also combinations. various kinds fractures among themselves.

The most common types of finger fractures

There are typical, often found in clinical practice, types of fractures. It is useful to have a clear idea about them.

Comminuted fracture of the fingertip

A comminuted fingertip fracture is the most common type of distal phalanx fracture.

X-ray of a comminuted fracture (shown by arrow), the most common type of fracture nail phalanx

These fractures are stable and are treated with a simple splint around the DIP joint (distal interphalangeal joint). In this case, you need to immobilize the injured finger for about 2-4 weeks. This type of fracture is often combined with soft tissue and nail injuries - subungual hematomas, ruptures of the nail bed, etc. They must be treated separately by a doctor.

It is necessary to know that fingertip fractures are often complicated by hyperesthesia - hypersensitivity to irritants, pain and numbness for up to six months after the injury.

Avulsion intra-articular fracture of the nail phalanx

Two tendons are attached to the nail phalanx of each of the four fingers - the extensor at the back surface, and the flexor at the palmar surface. This type of fracture is also called a "hammer finger" or "baseball player's finger" because it often occurs as a result of a ball hitting the tip of a straightened finger. And the finger itself is broken at the joint, shaped like a hammer. Such an injury is characterized by a detachment of the extensor tendon and a bone fragment at the back of the finger.

Avulsion intra-articular fracture - a fragment of the bone is closer to the dorsal surface

Treatment of an avulsion intra-articular fracture involves splinting the DMF joint for eight weeks. It is extremely important that the splint is constantly on the finger, since any careless bending can affect healing, prolong the treatment period. After using the splint, an x-ray should be taken to confirm the correct fit of the bone fragments.

Some doctors believe that it is necessary to treat this type of fracture with surgery if more than 30 percent of the joint surface is damaged. However, during the research it was found that conservative therapy(splinting) in this case is optimal, because the result is not inferior to the outcome of a similar injury after surgery.

Such a fracture usually occurs due to forced bending of the fingertip in the joint back (in an unnatural direction for it). The flexor tendon is torn off with a bone fragment at the palmar surface of the nail phalanx.

Avulsion fracture of the deep flexor - the bone fragment is closer to the palmar surface

With this type of injury, the finger temporarily loses the ability to bend in the damaged joint. Due to the risk of contraction (retraction) of the tendon, surgical treatment of the injury is necessary.

Fractures of the middle and proximal phalanx

Fractures of the middle and proximal phalanx are often associated with trauma. Such damage is characterized by gross external deformation when examining these phalanges. These fractures are usually classified as either intra- or extra-articular. Intra-articular lesions are often complex and unstable and must be treated surgically. Extra-articular fractures are either non-displaced or displaced. Stable non-displaced fractures can be treated conservatively with splinting and early immobilization. But they should be observed to ensure proper fusion. Displaced, oblique, or spiral fractures are inherently unstable and require surgical treatment.

Causes and factors

Common causes of finger fractures:

Direct trauma or a fall directly on the finger is the main cause of fractures.
An instinctive desire to prevent a fall by stretching the arms forward - a blow to the ground or other object in front falls on the brush.
Contact sports are the most common cause of fingertip fractures.
Intentional twisting of the finger backwards with the application of force.
an accident at work, or occupational injury when using a heavy tool such as a drill or chainsaw.
Finger pinched by a door or heavy object.

Osteoporosis and bone calcium deficiency are major risk factors.

People with osteoporosis are more likely to fracture the middle of the finger than the tip.

Symptoms and first signs

The main symptoms of a broken finger are:

Diagnostics

The basis for diagnosing finger fractures is x-rays. The type of damage will determine the treatment. Each clinical picture has specific characteristics to be discovered by the doctor. Diagnosis in the office of a surgeon or orthopedist includes:

physical examination - during it, the doctor assesses the injury and determines the severity of the fracture. The doctor takes into account the range of motion of the victim's finger, asking him to clench his hand into a fist. The surgeon will also evaluate visual signs such as swelling, bruising, and deformity. With the help of palpation, he will look for signs of a decrease in blood circulation and determine possible area nerve damage;
hardware methods - are used to confirm the diagnosis or make a diagnosis in the case when the physical traumatologist could not accurately determine the presence of a fracture. These include:
- radiography is the main method for diagnosing fractures. The doctor will place the injured finger between the x-ray source and the detector to create an image. The procedure takes only a few minutes and is painless;
- a CT scan, or computed tomography, is done by combining x-rays, which scan different angles of damage. The physician may decide to use CT if the results of the initial X-ray are not informative enough, or when it is suspected that there is also soft tissue injury associated with the fracture;
- An MRI will be required when there is suspicion of microfractures, a hairline fracture, or a stress fracture that occurs after repeated injuries over time. MRI allows you to see finer details, including soft tissue injuries.

Treatment

The sooner first aid is provided in case of injury, the better and more efficiently the fracture will heal. Therefore, it is important to know the algorithm of actions and perform it confidently step by step, but rather quickly, since the result also depends on the speed of response. It should be noted that in the case of adequate treatment, the first signs of fusion of bone fragments are noticeable 3 weeks after the injury, but the bone will finally recover in about 2 months.

First aid

The basis of first aid is ice, a soft compressive bandage and raising the limb to a height. These measures will help control swelling. You should also make sure that the finger is immobilized. The sequence of actions should be like this:

Don't use your finger for normal daily activities until your doctor has examined it.

Basic treatment

After the doctor examines the fracture and makes a diagnosis, you will need a special splint for fixation. A temporary splint - until a visit to the doctor - can be made from a popsicle stick and a loose bandage. The bandage itself is needed to immobilize the broken finger to prevent further damage.

Splinting

The type of splint needed depends on which toe is broken. For the treatment of minor fractures, a “friendly bandage” will suffice, when the injured finger is tied to the adjacent one, thus immobilizing it.

A long splint for the flexor-extensor ligaments will help the injured finger not to break back.

A long splint for the flexor-extensor ligaments will prevent the finger from breaking

A soft splint is needed to keep the injured finger slightly curved towards the palm, it is held in place by soft fasteners.

Aluminum U-shaped splint holds the finger firmly

Aluminum U-shaped splint - flexible and fixes a damaged finger. It is attached to the back of the finger to keep it motionless.

In more severe cases, the doctor may use a rigid fiberglass splint that runs from the finger to the wrist. Outwardly, it resembles a mini-gypsum.

Rigid fiberglass tire resembles plaster

Medical treatment

To help the patient cope with the pain of the fracture, the doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs). They work by reducing the negative effects of long-term inflammation, pain, and pressure on nerves and other soft tissues. NSAIDs do not interfere with the healing process. Common non-prescription non-steroidal anti-inflammatory drugs used to treat fractures include ibuprofen and naproxen. Paracetamol can also be used, but is not part of the NSAID group and does not reduce inflammation.

If the patient is in severe pain, the doctor will write a prescription for codeine-containing drugs (Pentalgin, Nurofen Plus, Sedalgin) for short-term treatment. Discomfort is likely to be quite strong in the early days, but will gradually decrease. Thus, potent analgesics may be needed only at the beginning of treatment.

In general, you must strictly adhere to the doctor's instructions. Sometimes he appoints a re-examination after a few weeks from the start of treatment. May additionally refer to X-ray to control healing, usually 1–2 weeks after injury.

Surgery

Surgery is needed to cure difficult cases when immobilization and time cannot effectively repair the damage. Surgery indicated for such types of fractures as:

combined;
unstable;
with fragmented bone fragments;
with joint involvement.

These injuries require surgical intervention because the individual fragments need to be put back in place so that the bone can heal in the correct configuration. Surgery may also be required if the bone does not heal properly.

The operation to restore the bone is called osteosynthesis (osteo - bone, synthesis - to create, restore). During surgery, the doctor compares the broken fragments and fixes them with special metal structures. The fixing of individual parts or fragments occurs with the use of metal plates, knitting needles or screws. Sometimes different combinations of these fixing structures are needed.

If for some reason the operation is impossible, then there is another way to fasten the fragments - percutaneous introduction of millimeter titanium wires.

Folk remedies

Some folk remedies can help speed up the healing of fractures. However, they are not a method of treatment, but only have an auxiliary effect, along with the use of complex medical therapy.

Rehabilitation

Immobilization of the finger joint after injury may have ill effects, For example:

softening of the articular cartilage;
shortening and atrophy of muscles and tendons;
deterioration of microcirculation;
impaired motor function;
muscle weakness.

Goals physical rehabilitation after a fracture - optimal loading and restoration of normal tissue connections to improve movement, strength and ability to perform functional activities in everyday life.

But undesirable consequences can be avoided by timely application of such methods of physiotherapy as:

Apply these methods to reduce pain, improve mobility and eliminate inflammation of the fingers and surrounding muscles and tendons.

The home rehabilitation program includes exercises to strengthen and stretch the muscles and ligaments and stabilize the joints. The doctor gives the patient instructions to help the person perform everyday tasks and move to the next functional level.

Restoring the function of an injured finger after treatment: video

Prognosis and possible complications

In general, broken fingers heal fairly well with a doctor's consultation and a 4 to 6 week treatment period. The risks for complications after a broken toe are minimal, but it's still good to be aware of them. It can be:

contracture (tightening and limitation of mobility) of the joint, may occur as a result of the formation of scar tissue around the fracture site. The solution is to develop the hand with physical therapy to strengthen the muscles of the fingers and reduce scar tissue;
displacement of the bone during the healing process, resulting in bone deformity (malunion), which may require a surgical solution;
lack of proper connection of two bone fragments, which leads to permanent instability at the fracture site. This is called "nonunion";
accession of an infection - it is possible if there are lacerations at the fracture site, and they are not treated properly before surgery.

Prevention

How can finger injury be prevented? Some guidelines must be followed.

Any fracture that severely interferes with movement and deforms the hand is likely to require surgery to restore joint mobility. You may be surprised at how difficult it is to complete everyday tasks without full use of all your fingers. A person needs to fully master the motor skills of the fingers in order to properly perform their work. Thus, taking care of proper fracture healing is vital for everyone.

Anyone can get a broken toe. It is enough to hit a stone, a corner of furniture or get under a bicycle wheel. Limbs are always more vulnerable to injury, and you don't have to play extreme sports to earn damage. Most often, the big toe gets hit, a fracture of the little toe on the leg is a little less common. Each injury has its own specifics and special methods of treatment.

The most common are closed fractures. In this case, the integrity is preserved skin. The injury that occurs as a result of compression is often accompanied by displacement. A comminuted open fracture is difficult to repair. But much is determined by the localization of damage. In this regard, there are:

thumb fracture legs - often accompanied by a fracture of the sesamoid bone. The most difficult to treat are intra-articular lesions;
index finger fracture- involves damage to one or more phalanges of the fingers;
middle finger fracture- the nail phalanx suffers more often, and along the fault line, the fracture can be oblique, longitudinal or transverse;
ring finger fracture- a single injury is rare, very often the damage affects the little finger. There are also simultaneous injuries of 1.2 and 4.5 fingers;
little toe fracture One of the most common injuries is a fracture of the proximal phalanx.

Damage without displacement heals faster and medical reposition is not required. Much harder to have in the case of significant deformations. In this case, there are several types of displacements:

with divergence and entry;
with lateral and angular displacement;
with broken fragments.

In case of damage to the middle and distal phalanx, the treatment tactics will be the same, although the damage itself occurs different ways. Only an impacted toe fracture can cause a fracture of the middle phalanx. It is quite difficult to damage it when dropped or hit.

Fractures of the phalanges

A blow to the entire foot leads to injuries of the phalanges. The first two fingers are often subjected to mechanical stress, and therefore fractures of this kind are found in them. The axial load on the broken phalanges is impossible, the damaged finger is not able to bend. Injuries are also open and closed, and wounds on protruding fingers are much more common.

Swelling occurs at the site of injury. A blow to the big toe causes similar impairments as with an injury to the big toe, which is associated with the presence of only two phalanges. Phalangeal fractures are divided into T-shaped, oblique and transverse. A direct blow to the fifth toe causes multiple injuries due to the small size of the phalanges. The affected little finger instantly swells up and becomes cyanotic.

ICD 10 injury code

Everything is hidden under the S92 code. With an injury such as a fracture of the little finger, a separate code is not assigned, but with an injury to the thumb, the code S92 is prescribed in the card. 4. In case of a complex fracture with multiple injuries of the foot, the disease is designated by the code S92.7. All fractures of any finger other than the thumb are covered by code S92.5.

Causes

You can get a broken toe as a result hard hit. Football players are familiar with such injuries, and even reinforced boots do not always protect the foot from injury. More often goes to the first finger, because it has the largest dimensions. Traumatic injuries arise due to the fall of a heavy object, accidents, falling feet under the weight. A person can stumble and earn a crack, but in a normal state musculoskeletal system just happens. Fracture with minimal impact occurs simply because of the fragility of the bones. Diseases such as osteoporosis and tuberculosis lead to weakening of the tissue.

Injuries caused by bone pathologies occur only in 5% of total fractures. As a result of this injury, the integrity of the group of bones is violated, and recovery is extremely difficult. So, when the phalanx of the little finger is damaged, it is often observed. summon similar pathologies maybe a slight impact on another object. It is enough to step on a person's foot to provoke an injury.

Symptoms

Due to a fracture of the big toe, the foot takes a forced position. This is immediately evident, and there are no problems with the diagnosis. Symptoms of a fracture of the little toe on the leg are less pronounced. The leg can swell and turn blue both with a fracture and with a bruise.

What are the first signs of a broken toe? First of all, it's a lot of pain. It is aggravated by tapping or palpation. Pain shock does not occur. Even in the case of a serious injury, pain can be tolerated. A hematoma in the area of the fracture indicates a rupture of the vessels. In some cases, the leg becomes literally purple. Swelling after a fracture often occurs with severe bruising and damage to soft tissues.

If there are wounds, then we are talking about open injury. Skin lesions often accompany symptoms of a broken or cracked big toe. Other signs of a broken toe are:

redness and local hyperthermia;
an increase in the size of the injured finger;
restriction of mobility or complete immobilization.

Symptoms of a broken toe may include shortening of the injured toe and abnormal movement of the toe. In the event of bone crushing, fragments may be visible to the naked eye. Signs of a broken little toe include deformity of the foot and possible displacement of the fifth toe. TO characteristic symptoms a fracture of the little toe should be attributed to crepitus of the bones or their fragments.

First aid

Absence adequate therapy can lead to irreversible deformations. If it is not possible to quickly deliver the victim to the doctor, then you need to provide first aid for a broken toe.

In this case, the procedure will be as follows:

give the patient an anesthetic;
treat the wound, if any;
fix the injured finger.

If pain syndrome does not decrease, non-narcotic analgesics are offered. It is necessary to do immobilization if displacement is suspected. You can fix your toe with a bandage and splint. The thumb is usually immobilized. It is wrapped together with a pencil or other hard and suitable object. Fixation is not always justified. More often, the patient is simply laid down or seated, and the leg is placed on a dais.

If the main phalanx of the 4th finger is damaged, then you can fix the finger with the adjacent one. It is impossible to tie the phalanges tightly; a cotton pad is placed between them. Cold will help relieve pain and swelling. An ice pack is applied for 5-10 minutes and then a break is taken to avoid frostbite. Cooling will help if there is a fracture of the little toe on the leg, however, with this injury, the first aid will be somewhat different.

What to do with a broken little toe

If the little finger is injured, the leg must be lifted up and placed on a pillow in a relaxed position. This will prevent swelling and swelling of the soft tissues. Immobilization of the little finger is not required, but to bring the victim to the hospital, the foot should be secured. Shoes are not worn, otherwise broken bones may be displaced.

What else to do with a broken toe at home? After conducting analgesic and anti-inflammatory therapy, it remains only to call an ambulance. Without accurate diagnosis difficult to take further action. It is forbidden to set a finger on your own.

Diagnostics

Minor cracks and fractures often do without severe symptoms. It is not always possible to determine the injury by eye. In the case of a fracture of the nail phalanx of the big toe, the deformities are easily visualized. The specialist asks a question about the prescription and causes of the injury. To clarify the diagnosis, an x-ray is taken. The traumatologist prescribes x-rays in two projections, which will accurately localize the violation. Treatment tactics also depend on the accuracy of diagnosis.

If the second and further fingers are damaged, the patient may not suspect a fracture. Often the symptoms are similar to a banal bruise. How to determine a broken toe without x-ray? An experienced doctor will be able to understand the nature of the damage during palpation and percussion. But it is not always possible to recognize complex wounds visually. You can find the crack using CT. But this method looks redundant and unjustified in the case when the damage is obvious.

Treatment

Temporary disability with foot injuries is small. A serious injury is a fracture of the little finger. In this case, a plaster cast is applied and the foot is immobilized.

If the broken little toes on the leg are displaced, then they are set. How to treat a fracture in case of a closed injury? The method of one-stage reposition is usually used. Treatment of a broken toe begins with anesthesia, after which the toe is smoothly pulled out, returning it to its physiological position. After reduction, the functionality of all fingers is checked. If the swelling goes away and the fingers function properly, a retainer is installed. This is usually a cast, but may be a bandage.

The timing of immobilization of the phalanges of the toes is determined by the severity of the injury. With minor injuries, the thumb orthosis allows you to reduce the load and protect the foot from external influences.

If it is not possible to cure a fracture with a single-stage closed reduction, use skeletal traction. This invasive method restoration, which allows you to keep bone fragments in correct position. The damaged little finger (or other finger) is pierced and a nylon thread is inserted. In case of a fracture of the little finger on the leg, fixation can be made with special pins. In adults, fusion takes a few weeks, in children - less. The puncture site is treated with antiseptics, and after removing the retainer, orthotics are placed on the finger.

It does not make sense to use folk remedies for a fracture. The exception is herbal medicines with decongestant, anti-inflammatory and analgesic effects. But they are used for a short-term course of treatment. Products containing gelatin - jellies and aspics - allow accelerating the process of fusion.

Surgical treatment

Open reposition is inevitable if the bone is displaced or there is an open fracture with damage to the cartilage tissue. The most difficult is a fracture with multiple fragments. To match the fragments, knitting needles, metal wire and plates are used. Rules surgical treatment provide for subsequent plastering for up to 8 weeks.

Despite the surgical precision open operation there are many difficulties that arise from the specifics of therapy. Remains high risk infection and suppuration, there may be difficulties with anesthesia.

How much to be treated and wear a cast

How to quickly heal an injured foot and reduce the duration of fracture treatment? Much is determined by the individual characteristics of the patient's body and the specifics of the injuries themselves. After an open reposition, the bones grow together for a rather long time. Whether gypsum is needed after the main treatment is determined by the traumatologist. But not a single reposition can do without additional fixation.

You will have to wear a cast for as long as the broken finger heals. With cracks and minor fractures of the toes, immobilization lasts up to 3 weeks. In case of displacement, you can walk no earlier than after 4 weeks, and sometimes after 6 weeks. finger in case open wound depends on the complexity of the operation. It is usually prescribed to wear a cast for a period of 5-6 weeks. Recovery takes up to 2 months if complications have occurred.

In case of incorrect union, a second operation will be required. It's hard to say how long recovery will take. Typically, the period of incapacity for work is doubled.

Rehabilitation

The development of the foot after removal of the cast should be carried out under the supervision of a physician. The specialist will prescribe gymnastics, massage and select physiotherapy. Rehabilitation after a fracture of the thumb does not take much time. Recovery takes from a few weeks to a month. But this is in the absence of complications.

The patient is recommended to start exercise therapy immediately after removing the cast. One of the most effective exercises is to move small items toes. Such gymnastics will be especially useful if nerves have been damaged due to injury. Overvoltage during training should not be. First, they train for 15-20 minutes, over time, the duration of classes is increased to 40-60 minutes.

Physiotherapy

Exercises after a broken toe include squeezing and straightening all the toes. The injured finger is not used for some time, but then it is also connected to gymnastics. At the first stage, it is better to replace the exercises with self-massage. Light stroking and compression will improve blood flow and prevent atrophy. Unpleasant sensations during gymnastics should not be. The duration of therapy is no more than 10 minutes, the duration of the course is 10-15 procedures.

You can develop a foot on your own, but before doing massage and gymnastics, you should consult a doctor. If the fracture of the toe heals slowly, then physiotherapy is prescribed. Efficiency proven following methods treatment:

UHF-therapy - reduces pain, improves tissue trophism, stimulates metabolism and capillary circulation. One of the reliable methods of recovery after fractures;
magnetotherapy - boosts regeneration, prevents the development of diseases skeletal system, reduces swelling;
interference currents - activate trophic processes, relieve hematomas, normalize blood circulation.

Applications with ozocerite have useful properties. They dilate blood vessels and eliminate pain after a long stay in one position. Salt baths have a similar effect. Baths with soda will prevent complications and. They eliminate local inflammatory reactions and reduce post-traumatic swelling.

Complications and consequences

Negative consequences arise due to the lack of treatment. Many patients simply do not go to the doctor, because the injury does not bother them much. But this is at first. Over time, the deformities become irreversible, and the foot does not function properly.

Complications may arise due to errors in therapy. If a fracture of the phalanx of one of the toes has grown together incorrectly, a callus may form. This pathological tissue at the site of fusion. Its dimensions sometimes exceed the size of the phalanx. The growth of the replacement tissue is due to the weakness of the bone structure. Callus compensates for the lack of strength, but causes great inconvenience to the patient. It causes pain, interferes with walking, complicates the selection of shoes. In addition, it is always an additional source of inflammation and a vulnerable spot in case of injury.

If the callus was formed due to improper reposition, then a second operation is required. In this case, healing will last longer than usual. In the presence of a bone defect, repeated surgery is associated with the risk of developing tissue inflammation.

There are other complications of toe fractures:

false joint - occurs due to shrapnel damage. Disparate fragments are erased and become separate elements of the bone. They are not connected to each other, and the space between them represents the same false joint. Due to the lack of cartilage between the fragments, an inflammatory process occurs. The functionality of the toe and foot as a whole is reduced. If the upper phalanx is damaged, then nail ingrowth is not excluded;
ankylosis - occurs due to inflammation in damaged tissues. Over time, the joints ossify and lose mobility. This is one of the reasons why the toes become numb. Sometimes they are completely immobilized, which leads to tissue death. To get rid of this defect, prosthetics are used;
osteomyelitis is one of the most dangerous complications. Occurs as a result improper treatment open fracture. Pathogenic microorganisms enter the bone and cause inflammation. The infection enters the body through an open wound. Less often - by hematogenous route. Correct primary processing damage will prevent the development of osteomyelitis. If it was not possible to avoid infection, a powerful antibiotic therapy is used. In advanced cases - depressurization of the bone;
shortening of the bone - is the result of improper union. An erroneous reposition followed by immobilization firmly fixes the fragments in the wrong position. The supporting function of the bone is reduced, pain occurs during movement. The risk of re-fracture increases dramatically. The next reposition will correct the situation, but the fragility of the damaged bone still remains.

Prevention

In case of weakening of the skeletal system, it is prescribed. They are recommended to be taken for the prevention of all persons. old age, women during and after menopause, as well as pregnant and lactating women. WITH medical point vision the best prevention is increased caution on the street and at home. It is not difficult to avoid a fracture of the main phalanx if you look under your feet and avoid injury.

Strengthen bones will help foods fortified with calcium, magnesium, vitamin D. This group includes dairy products, egg yolks, nuts, chicken liver, seafood, olive oil. They also prevent diseases such as arthritis and arthrosis. At the same time, the consumption of oxalic and uric acids should be limited.

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

Article author:| orthopedic doctor Education: diploma in the specialty "Medicine" received in 2001 at the Medical Academy. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty "Traumatology and Orthopedics" at the City Clinical Hospital No. N.E. Bauman.

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A fracture of the big toe is a common injury of the lower extremities that changes the structure of the bone in this area and causes not only a number of pathological symptoms, but also a variety of complications.

How to determine a fracture of the big toe, what to do and how long to treat it, and what are the features of rehabilitation after the therapy? You will learn about this and much more below.

Common causes of a broken toe

Mankind invented shoes in ancient times - the main protection of the toes and feet from possible damage. However, in spite of the fact that given element wardrobe is constantly being modified and improved, injuries in the above area are not getting smaller. The main causes of thumb fractures are usually:

Strong and sharp blows to the fingers;
stumbling when walking or running;
Fall on lower limb gravity, moving it with a car wheel;
Accelerated, uneven and sharp bending of the foot;
Occupational, sports or domestic injury associated with compression of the above area (squeezing from 2 sides);
Strong twisting of the foot.

Provoking factors in the formation of a fracture are considered to be problems with the musculoskeletal system, the presence of previous injuries of the ankle, flat feet, osteomyelitis, osteoporosis, bone tuberculosis, hyperparathyroidism, certain types oncological diseases. The above risk factors reduce strength and elasticity bone tissue making her more prone to injury.

Fracture classification

Fractures of the big toe are classified according to a number of criteria. In traumatology, the following types of injuries are usually distinguished.

According to bone fragments:

Open. It is formed with the formation of skin defects, bone elements are in contact with the external environment;
Closed fracture of the big toe. The wreckage does not break the outer coverings.

By location:

No offset. Normal position bone structures does not change;
With offset. Bone structures deviate from their normal position.

By the nature of the destruction:

No shards. Ordinary cracks or breaks;
Single and double sided. At a fracture, 1 or several fragments are formed;
Multifragmented. The most severe type of injury, the bones are severely crushed.

By localization:

Fracture of the main phalanx of the big toe. Fracture closer to the foot;
Fracture of the nail phalanx of the big toe. Fracture closer to the nail plate.

According to the mechanism of education:

Direct. Fractures and defects of bone structures coincide with the place of application of the traumatic force;
Indirect. The localization of traumatic force and bone tissue defects do not coincide.

Symptoms of a broken toe

Symptoms of a fracture of the big toe can be absolute and relative. In the first case, we can talk about a reliably confirmed injury, while the second option is conditionally attributed to a number of pathological acute conditions of the musculoskeletal system.

Reliable symptoms and signs of a fractured big toe:

Abnormal mobility of the thumb;
Visible unnatural curvature of the phalanges;
The formation of open fragmental bone wounds in the affected area;
An audible crunch of bone fragments when moving the thumb.

In most cases, the above symptoms refer to complicated, open and comminuted types of fractures, which is quite rare in patients. That is why additional relative signs acute pathology considered to be:

Pain in the area of the thumb, aggravated by movement of the phalanges;
Swelling of the area of injury and the area around it, which subsequently spreads to the entire foot;
Local redness of the skin;
Formation of subcutaneous and nail hematomas;
Decrease or disappearance of motor activity of the foot.

The above manifestations can also be diagnosed with dislocations, bruises and other injuries, therefore, if a fracture is suspected, it is necessary to undergo a comprehensive diagnosis.

The difference between a fracture and a bruise and the diagnosis of injury

Fracture can form open wounds with visible fragmented phalanges. When trying to move thumb a distinct crunch is heard. In the case of a bruise, there is no unnatural curvature of the phalanges of the thumb, its mobility is reduced.

In the absence of clear symptoms of a fracture or the presence of signs similar to a bruise, it is necessary to contact the hospital for additional diagnostics.

Complex diagnostic measures includes an initial examination by a traumatologist and instrumental research methods.

At the first appointment in the hospital, the doctor will listen to the patient's complaints, examine the injured thumb, and palpate it for the presence of phalanx curvature and other signs of a fracture. After making the primary diagnosis, the victim is sent for x-rays - the image obtained in 2 projections will allow you to assess the general nature of the damage and the complexity of the injury with the degree of displacement of the bone structures.

If necessary, as additional instrumental methods MRI and CT can be used- they are designed to detect soft tissue injuries, as well as to diagnose intra-articular injuries, mainly in complicated forms of fracture.

First aid for a fracture

If you suspect a fracture of the big toe, it is advisable to call an ambulance team, and then proceed to the basic measures:

Thumb fracture treatment

After admission to the hospital and determining the diagnosis, the victim is transferred to the trauma department.

Conservative therapy:

Appointment of painkillers and anti-inflammatory drugs by injection: ketorolac, analgin, nimesulide. IN rare cases- narcotic analgesics.
In the case of a closed fracture without displacement - applying cold to the foot, regularly, in sessions of 10-15 minutes.
Immobilization of the big toe with a splint and bandages. It is made only after the reduction of the finger.
Moderate bed rest. Movement - only on crutches, without relying on a leg with an injured toe.
Closed reposition. The local area of injury is treated with local anesthetics, after which a single finger extension is performed with the return of the phalanges to physiological state. Applicable only for closed fractures without fragments with displacement. If necessary, the procedure is repeated several more times until the physiological movement of the finger joints is normalized. After the control radiography, a splint is applied to the damaged area.
Skeletal traction. It is carried out with the ineffectiveness of a closed reposition. The scheme consists in long-term retention of a bone fragment in a retracted position.

The traumatologist treats the toe with a local anesthetic, threads a nylon thread through the skin or nail, makes a “ring” that is attached to the plaster with a wire hook. In this position, the damaged phalanx is 2 weeks.

Every day, the attachment area is treated with local antiseptics to prevent suppuration. After the specified period, the system is disassembled, a control radiography is performed, and the finger is fixed with a classic splint with props or plaster until the fracture is completely healed.

The operation is usually prescribed in case of open fractures of the finger, as well as fragmentation of the phalanges. and accompanying elements into several or more fragments. The surgeon's job is to restore the physiological anatomy of the finger. Bone fragments are fixed inside with plates, pins, screws and wire using complex osteosynthesis.

After the procedure and cleaning of the wound in the damaged area, a drainage channel is formed, after which a splint is applied, and on top of it - a plaster “boot” on the entire foot.

The area of injury is regularly disinfected to prevent secondary bacterial infection.

After the fusion of all structures and the formation of a sufficient amount of callus, the gypsum is removed, leaving only the supporting bandage - the patient is transferred to the rehabilitation stage.

Rehabilitation after a fracture of the big toe

On average, the rehabilitation of a victim with a fracture of the big toe takes 4-8 weeks. The main activities include:

Massage legs, feet with a damaged toe and areas adjacent to the injury zone;
exercise therapy. General strengthening complex of exercises physiotherapy exercises aimed at maintaining general tone body, restoration of blood circulation and mobility of the lower extremities;
Physiotherapy. The patient is prescribed courses of electrophoresis with novocaine, calcium salts and nicotinic acid, UHF, UVR, magnetotherapy, amplipulse, myostimulation, paraffin-ozocerite applications;
Proper nutrition. Introduction to Diet more protein foods, dairy and dairy products, fruits and vegetables. Exception fried foods, soda, coffee, alcohol and products rich in simple carbohydrates;
Limitation of physical activity. Temporary waiver active species sports, where the predominant loads are distributed on the lower limbs;
Wearing the right orthopedic, comfortable shoes to fit, medium hardness and with good adhesion to surfaces.

Proper rehabilitation is very important to avoid serious complications after injury.

Now you know how to develop a big toe after a fracture.

Complications and consequences

Not proper treatment or the lack of qualified therapy for fractures of the big toe can lead to:

Visible curvature of the finger with limited mobility and functionality;
education false joints, ankylosis;
osteomyelitis;
Gangrene due to secondary bacterial infections.

In most cases, untimely handling of even a normal mild fracture results in improper fusion and bone healing, which even surgical methods pretty hard. In this situation, problems with the musculoskeletal system will remain with you forever.

Moisov Adonis Alexandrovich

Orthopedic surgeon, doctor the highest category

Moscow, Balaklavsky prospect, 5, Chertanovskaya metro station

Moscow, st. Koktebelskaya 2, bldg. 1, metro station "Dmitry Donskoy Boulevard"

Moscow, st. Berzarina 17 bldg. 2, metro station "October field"

Write to us on WhatsApp and Viber

Education and professional activities

Education:

In 2009 he graduated from the Yaroslavl State Medical Academy with a degree in general medicine.

From 2009 to 2011, he completed clinical residency in traumatology and orthopedics at the clinical hospital ambulance medical care them. N.V. Solovyov in Yaroslavl.

Professional activity:

From 2011 to 2012, he worked as a traumatologist-orthopedist at the emergency hospital No. 2 in Rostov-on-Don.

Currently works in a clinic in Moscow.

Internships:

May 27 - 28, 2011 - Moscow- III International Conference "Surgery of the Foot and Ankle" .

2012 - training course in foot surgery, Paris (France). Correction of deformities of the forefoot, minimally invasive surgery for plantar fasciitis(heel spur).

February 13-14, 2014 Moscow - II Congress of traumatologists and orthopedists. “Traumatology and orthopedics of the capital. Present and Future".

June 26-27, 2014 - took part in V All-Russian Congress of the Society of Hand Surgeons, Kazan .

November 2014 - Advanced training "Application of arthroscopy in traumatology and orthopedics"

May 14-15, 2015 Moscow - Scientific and practical conference with international participation. "Modern Traumatology, Orthopedics and Disaster Surgeons".

2015 Moscow - Annual international conference.

May 23-24, 2016 Moscow - All-Russian Congress with international participation. .

Also at this congress he was a speaker on the topic Minimally invasive treatment of plantar fasciitis (heel spurs) .

June 2-3, 2016 G. Nizhny Novgorod - VI All-Russian Congress of the Society of Hand Surgeons .

June 2016 Assigned . Moscow city.

Scientific and practical interests: foot surgery And hand surgery.

Fracture of the phalanx of the finger

Our fingers perform very delicate, coordinated movements and disruption of these movements can have a huge impact on daily and professional activity. To maintain the full function of the hand, it is very important that all finger fractures are evaluated by a doctor to determine the appropriate treatment. If you think that a broken finger is a minor injury, then you are seriously mistaken. Without proper finger fracture treatment hand can cause serious problems: limitation of finger flexion (contracture), pain with minor loads, reduced grip of the hand, whether it is a fracture of the nail or the main phalanx of the finger.

Anatomy of the bones of the hand

The human hand is formed by 27 bones:

8 bones of the wrist;
5 metacarpals;
The 14 bones that make up the fingers are called phalanges. The first finger has only two phalanges: proximal and distal. Unlike the rest of the fingers, which consist of three phalanges: proximal, middle and distal.

Fractures of the metacarpal bones of the hand account for 30% of all hand fractures in adults.

Types of finger fracture

Because of

Traumatic fractures are damage to the bone of the finger due to trauma.
Pathological fracture - a fracture of the finger in the zone of pathological restructuring (affected by any disease - osteoporosis, tumor, osteomyelitis, etc.) Osteoporosis is the most common cause of a pathological fracture.

The nature

Closed fractures (no skin damage)

Incomplete

Full

Open fractures (with skin damage)

Primarily open

Reopened

By the presence of displacement:

Fractures without displacement of fragments
Displaced fractures.

Signs and symptoms of a broken finger

Signs of a broken finger include:

Pain on palpation (touch);
Swelling of the finger;
Restriction of movements;
Subcutaneous hemorrhage;
Finger deformity;

Finger fractures can be associated with injuries such as:

Dislocation of the phalanx, damage to the tendons, damage to the ligaments. This can complicate treatment.

Diagnosis and treatment of a fracture of the phalanx of the finger

If you have symptoms of a fracture of the phalanx of the finger, you should contact the emergency room at the place of residence. Where, after examination, radiography will be performed in two projections of the damaged segment. The doctor must determine not only the location of the fracture, but also the type. The bone can be broken in several directions. A fracture of the phalanx can be transverse, in a spiral, into several fragments, or multi-comminuted, i.e. collapse completely.

Treatment for finger fractures depends on three main factors:

First, is the joint affected?
Second, "stable" or "unstable" fracture?
Third, is the finger deformed?

If the fracture involves a joint (intra-articular fracture), it is important to make sure that the articular surface is not destroyed and the fragments have not separated, i.e. no offset. In this case, you can do without surgery.

Second, it is important to define a "stable" or "unstable" fracture. Fracture stability can be determined by x-ray. A fracture is considered unstable if the fragments are displaced, or the nature of the fracture is such that even after correct reposition (elimination of the displacement), the fragments can move over time and remain in a displaced position. The anatomy will naturally be disturbed, which can affect the function of the finger and hand.

The doctor must determine whether there is a shortening of the segment or whether the distal fragment is rotated (turned about its axis). The fingers on the injured hand should line up and look the same as on the healthy hand.

If articular surfaces fragments are destroyed or fragments are displaced, if the fracture is unstable, if there is a deformity that needs to be corrected, then in this case surgery is necessary to restore normal anatomy of the hand and preservation of function after the fusion of a broken finger.

Conservative treatment

In case of a finger fracture without displacement, the following assistance is provided: the damaged segment of the hand is fixed with a plaster splint or polymer bandage, which is lighter and stronger than plaster.

Sometimes an adjacent finger is used as a splint, firmly fixing them together with a band-aid. This makes it possible to work with a brush, bend fingers without fear that bone fragments will move.

If, after reposition, the fragments have shifted, there is instability of the fracture, a multi-comminuted fracture or deformity cannot technically be eliminated, then an operation is necessary in this case. With the help of metal structures, fragments can be fixed in the correct position until the fracture is completely healed. If the fracture is displaced, the doctor should try to repair the displaced fragments without surgery. This is done under local or conduction anesthesia. If the displacement is not eliminated, then there are indications for surgery. After the displacement is eliminated, the finger is fixed with a plaster splint or polymer bandage to prevent secondary displacement. Fractures of the phalanges grow together in 3-4 weeks. During these three weeks, control (repeated) radiographs are taken after 10 and 21 days to make sure that there is no secondary displacement in the cast. After that, the plaster is removed and the active development of the joints of the hand begins.

Surgery

Depending on the type and severity of the fracture of the phalanx of the finger, an operation may be required - osteosynthesis (osteo - bone, synthesis - create, restore), due to which anatomical restoration of damaged structures is achieved.

During the operation, open reposition of fragments (comparison of broken parts) and fixation with metal structures takes place. And for each fracture, an appropriate metal structure or a combination of them is selected:

plate
screws
Spoke

The advantages of this method: simplicity and short manipulation time, no incision and, as a result, a postoperative scar.

Minuses: one end of the pin remains above the skin so that the pin can be removed after the fracture heals; the risk of infection of the wound and the penetration of infection into the fracture area; prolonged wear plaster cast 1 month; the impossibility of early development of the joints of the hand, resulting in the risk of irreversible contracture (lack of movement in the joint) of the injured finger.

Osteosynthesis with plate and screws:

During the operation, access to the fracture site is performed, the fragments are compared and fixed with a plate and screws. The wound is sutured. A sterile dressing is applied. Dressings are performed every other day. The sutures are removed on the 12-14th day.

The advantages of this method: full recovery phalanx anatomy; the possibility of early development of the joints of the hand; gypsum bandage applied for only 2 weeks.

Cons: as after any operation, a small scar remains.

When deforming the fingers with fractures in the article Dupuytren's contracture.

Do not self-medicate!

Only a doctor can make a diagnosis and prescribe the right treatment. If you have any questions, you can call orask a question on .

A fracture of the bones of the toes is a violation of the integrity of the bone tissue. Treatment tactics depend on which finger is broken. The usual mechanism of injury for such injuries is a direct blow or twisting of the finger.

How to determine a bruise or fracture?

A bruise and a fracture is not always easy to distinguish without an x-ray. Since with both types of injury, swelling of the finger is determined, which can pass to the foot. A hematoma may form, which looks like an ordinary bruise. Both types of damage are accompanied by pain, redness of the skin, local fever. The injury may be accompanied by damage to the nail plate, its separation.

The following signs will help distinguish a broken toe from a bruise:

Pain:
- with an injury, the pain is uniform,
- if the finger is broken, then the pain increases with axial load (pressing the finger along the bone) or pulling on the corresponding toe of the foot;
in case of a fracture of the bones of the phalanges of the finger, signs characteristic of any violation of the integrity of the bone (pathological mobility, crepitus of fragments, shortening of the finger) are determined.

Usually, detection of pain during axial loading is sufficient to suggest a fracture. Determination of pathological mobility, crepitus is not carried out, since checking these symptoms can lead to additional traumatization of tissues, an increase in the displacement of fragments.

An absolute sign of a fracture is the presence of a crunch that occurs when trying to move a finger, during palpation.

With a fracture of the main phalanx, the symptoms are more pronounced, especially the big toe. Sometimes fractures are not noticed and are perceived by the victim as a bruised finger, so he turns to a traumatologist late.

Classification

Types of fractures of the bones of the toes:

By localization:

I, II, III, IV, V fingers;
main, middle, nail phalanx;
damage to the diaphysis marginal fracture, epiphyseolysis.

By the presence or absence of a wound:

open (with violation of the integrity of the skin);
closed (without such violation).

By the presence of displacement:

with offset;
no offset.

Along the fracture line:

transverse;
oblique;
longitudinal;
helical;
splintered.

Diagnostics

When identifying clinical symptoms fracture of the phalanges of the toe with a typical mechanism of injury, the patient is sent for x-rays. With the help of this study, it is possible to confirm or refute the violation of the integrity of the bone. Such a study is sufficient and there is no need for expensive types of examinations, such as MRI or CT.

Features in childhood

In children, the bones of the fingers often break along the growth zone, i.e. usually there is a detachment of the epiphysis of the phalanges of the fingers (epiphyseolysis). The pain is localized in the area of the fold of the fingers. To treat a broken toe in a child, a cast or adhesive bandage is applied.

Treatment

Urgent Care

What first aid is needed if the bone is broken? You should give the victim painkillers from the category of NSAIDs (analgin, ibuprofen, nise, ketorol, diclofenac, movalis, naproxen, voltaren, ketanov).

It is better to give the leg an elevated position ( simplest way- put your foot on a pillow or place a small roller under the heel).

As an immobilization in case of suspected fracture of the thumb (I) toe, you can use improvised means, for example, bandage slippers or a wide ruler to the sole of the foot.

If a fracture of the II-V fingers is suspected, an adhesive bandage is applied - the broken finger is fixed (fixed) to a healthy one with several rounds of the patch. For this, it is enough to overlap 3-4 rounds.

An ice pack can be applied to the foot to reduce swelling and pain. This procedure is performed several times for 15-20 minutes.

The victim must be taken to the trauma center as soon as possible for installation correct diagnosis. This can be done with the help of personal transport or SMP (ambulance).

Providing first aid in the emergency room

The victim is examined and x-rayed. What to do if the bones of the fingers are still broken? In case of a fracture of the finger without displacement, a plaster is applied from the fingertips to lower third shins for the entire width of the foot, with the formation of the arch of the foot. If necessary, the patient is issued a certificate of incapacity for work and the date of the next appearance is set.

Further treatment

You need to walk in a cast on crutches, not leaning on your leg. You can slightly start on the heel, there should be no support on the fingers.

Painkiller

In the first days after the injury, the patient is concerned about pain and swelling of the foot. In order to reduce pain, drugs from the NSAID group are prescribed (see). It is recommended to drink painkillers no more than 3 times a day.

They should be taken after meals, as they irritate the mucous membrane of the digestive organs and, if taken for a long time, can lead to gastritis, peptic ulcer. It is better to drink these drugs under protection (Omez, Ortanol, Ultop, Losek maps, Gastrozol), as well as Emaner, Nexium, etc.

If the pain can be tolerated without taking medication, it is better not to take anything. Usually, by the end of the first week, the intensity of pain decreases significantly.

Edema

After the edema decreases (usually after 5-10 days), the plaster splint becomes looser, “dangling” on the leg. For a better fit, you need to bandage the bandage on top without removing the old bandages.

How long does a fracture heal

How long should a cast be worn for a broken toe? Immobilization, i.e. time of wearing a plaster splint:

with a fracture of the big (I) toe is 3 weeks
with damage to the II-V fingers - 2 weeks

Why are the terms of walking in plaster so different? The phalanx of the thumb performs a supporting function when walking, a large load falls on it. Therefore, the timing of immobilization in case of damage to the thumb is longer than the rest. How much to walk in a cast after a fracture also depends on its nature. In the presence of displacement, multiple injuries, the immobilization period increases by an average of 1 week.

When plaster, when bandage

In case of fractures of III-V fingers without displacement, plaster can be replaced with an adhesive bandage. Such immobilization is quite enough, since the middle (III), ring finger(IV) and the little finger do not perform a supporting function when walking. The duration of wearing the adhesive bandage is 2 weeks. This is the time it takes for the fracture to heal.

The patient comes to the doctor's appointment in a cast or adhesive bandage. After removing the plaster, the traumatologist-orthopedist directs the patient to the pictures to see if the fragments have grown together or not.

Why does it grow poorly

With normal fusion at the fracture site, a forming callus is visible. The fracture line can still be traced, but it becomes barely visible on the picture. Poor adhesion can be observed:

at ,
insufficient amount of calcium in the body,
general exhaustion,
the presence of chronic diseases.

What drugs to take

CalciumD3Nycomed - 50 pcs. 280 rub
Compliment with high content calcium - 100 pcs. 300 rub.
Calcium media and vitamin D - 60 tab. 120 rub.
Colagen ultra + calcium d3 - 30 sachets 800 rubles.
Mountain calcium d3 — 80 pcs. 230 rub
Calcemin — 30 pcs. 320 rub.

For the same purpose, the patient is prescribed calcium.

The opinion was firmly established among the people that for better fusion of fragments, you need to drink mummy. It's a delusion. Scientific research conducted on this occasion, showed that the mummy promotes the resorption of bone tissue, the development of osteoporosis. Therefore, its reception not only has no practical benefit, but is also harmful.

After plaster removal

After the plaster is removed, the ankle joint and fingers are developed, since their stiffness develops due to prolonged immobilization. Pain after a fracture may persist for some time, especially when walking, changing weather. The total period of disability for fractures of the toes is about 1 month.

To see a doctor, if a sick leave is not required, they come immediately after an injury to apply a cast. Then, if there are no special complaints, you can come to remove the cast and conduct a control x-ray.

On the same day, the patient is prescribed:

LFK - physiotherapy exercises
physiotherapy - magnetotherapy, electrophoresis with calcium, ultrasound.

Therapeutic exercise includes the following exercises:

straighten your legs, pull the foot away from you, then towards you;
flexion / extension of the toes;
fan-shaped dilution / reduction of fingers;
circular movements in the ankle joints.

If there was an offset

Basically, the treatment of the fracture is carried out conservatively. Surgical treatment is rarely used. This happens when open fractures with significant displacement of fragments. In this case, the intervention is carried out under local anesthesia (the area of injury is cut off with novocaine, lidocaine). Comparison of fragments is carried out using a thick needle or knitting needle. Then plaster is applied.

Immobilization in this case is carried out for 3-4 weeks. After removing the plaster, they develop ankle joint. After consolidation of the fragments, the pin is removed. Further rehabilitation is carried out according to the same principles as with conservative therapy.

If fused with displacement

If the fusion (consolidation) of the fracture occurred with a slight displacement - do not be discouraged. The fact is that the callus undergoes restructuring and change during the year. During this time, it is smoothed and compacted, so even if there are slight offset, it will not break the function.

What's in the future

Subsequently, the injured leg may make itself felt. There may be aching pain in the area of the fracture. Such symptoms can occur with intensive walking, changing meteorological conditions (before rain, snowstorm, wind).