Fractures of the lower part of leg
Fractures of the lower leg of a very common injury. They make up about 20% of all fractures. The most common fractures of the ankle (60%), but the most severe injury is a fracture of the lower end of the tibia at the ankle.
Fractures of the ankle
The direct mechanism of traumatic ankle is rare. This is a direct blow to the ankle. Most ankle fractures occur in the forced rotation of the foot. Ankle break for podvertyvanii foot outward (pronation fracture), medially (supinatsionny fracture), when you turn the leg inward or outward (rotary break). In many cases, the mechanism of injury can be combined. When tucking the foot outward separation occurs inside the ankle.
Depending on the degree of podvertyvaniya comes off more or less a piece of bone. Possible rupture of the deltoid ligament, tibiofibular ligaments. If the traumatic force acts over a long time, arising flexion of the tibia may cause it to fracture at 5-7 cm above the ankle, where the thickness is less than the tibia. All this is accompanied by a subluxation of the foot outwards. This type of fracture is a fracture Dupuytren.
If the foot slip inside, there is separation of the lateral malleolus fracture. With a significant podvertyvanii for a long time, under the pressure of the talus fracture can occur and the inner ankle. Stop with the tucked inwards – internal subluxation of the foot. This type of fracture is called a fracture Malgenya.
Fractures caused by the rotational movement of the tibia (rotation) produce helical fractures. If the lower leg is rotated outwards – is spiral fracture of the lateral malleolus, and vice versa.
Fractures of the ankle, which is accompanied by dislocation or subluxation of the foot called perelomovyvihami. The patient is worried about the pain in the ankle. Stepping on foot is impossible for perelomovyvihah. But in an isolated ankle fracture is possible to maintain the support function of the foot. In this case, turn the foot inward or outward causes a dramatic increase in pain. On examination revealed swelling and deformity of the foot. The foot is painful during palpation.
The diagnosis of ankle fractures refine X-ray examination. On radiographs pay attention not only on the fracture line, but also on the so-called "plug ankle." Fork ankle formed the lower surface of the tibia, ankle protrusions on the sides and top of the upper part of the talus below.
When extending the forks on the ankle x-rays involve a rupture ankle ligaments or displacement of the lateral malleolus.
Treatment of ankle fracture.
Anesthesia is performed by the fracture of solutions of local anesthetics (procaine, lidocaine). In isolated lateral malleolus fractures superimposed cast from the top third of the leg to the toes of the foot. This is a plaster bandage Sapozhok.
Duration about 3 weeks of immobilization. Then the blindfold is removed. Assigned to physiotherapy (massages, baths, wraps and paraffin ozokerite), therapeutic exercise.
Upon detection of fractures of both ankles and fractures of both ankles, coupled with a fracture of the back of the lower end (epiphysis) of the tibia without displacement of bone fragments and the expansion of the cavity ankle – "fork ankle" in the X-ray plaster cast is applied from the toes to the middle third of the femur, including the the knee joint. A month removed from the plaster of the knee joint, and "plaster Sapozhok" leave of up to 6 weeks.
If the X-ray revealed the displacement of bone fragments, they compare (one-stage reduction). Under local anesthesia, a doctor with the help of an assistant manually assigns fragments with special techniques. After comparing the fragments in the leg cast is applied from the toes to the middle third of the thigh. The position of the foot at the same time depends on the type of fracture. The term immobilization for 6 weeks. One week after repositioning is carried out X-ray control.
Surgical treatment is carried out when it is impossible to compare the fragments, if the repositioning of bone fragments failed to eliminate the extension of the ankle joint fork. For fixation of bone fragments used screws, plates. Typically, the inner ankle strengthening with a screw and an outer – a plate. When the gap appeared between the bundles of the tibia and fibula – the bones connect spongy screw. After surgical treatment is applied Sapozhok plaster for 6 weeks. Then assigned to exercise therapy and physiotherapy.
Fractures of the lower part of the tibia
These fractures are much less common than fractures of the ankle, but is considered the most serious, because this function is affected ankle. Such fractures occur when falling from a height on the legs straight, with a direct hit. Patients complain of pain in the area of injury. Stepping on foot is impossible.
Treatment is carried out using skeletal traction. If we compare the fragments can not be used internal fixation with different types of plates and screws. It is necessary to restore the normal length of the tibia and the ankle joint level surface. Good results are obtained when using transosseous osteosynthesis by Ilizarov.
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