- Anatomical features of the shin bones
- Causes and types of fractures in the shin area
- Clinical picture
- First aid delivery
- Diagnosis and treatment tactics
Anatomical features of the shin bones
Structure of the bones of the shin
The shin consists of two tubular bones. The larger bone is located medially or on the inner side of the tibia, called the tibia. Lateral or external side of the tibia is a small fibular bone. Tibia bones at the top are attached to the patella and femur, forming the knee joint. At the bottom they participate in the formation of the ankle and connect with the talus bone.
The tibia in the upper part has a head with a wide plateau. It contains the medial and lateral condyles, with which the bone connects to the thigh. Between the condyles is the intercondylar elevation, to which the internal ligaments of the knee joint are attached. The bone has a triangular shape, the sharp edge lies under the skin and is not covered by subcutaneous fatty tissue. Therefore, shocks in the shin area cause intense pain. At the bottom, the tibia forms the medial malleolus, which forms the ankle joint.
The fibula is less massive than the tibia. At the top it is attached to the tibia, and below it passes into the lateral ankle and limits the ankle. Isolated fractures of the diaphysis( middle part) of the fibula are less common and often accompany injuries of the tibia. In most clinical cases, a fracture of the lateral malleolus is recorded. In the tibia region, there are large vessels and nerves, with the damage of which severe complications develop due to excessive blood loss and paralysis of the lower limbs.
Causes and types of fractures in the region of the shin
Fracture of the tibia occurs when exposed to a traumatic force, which in intensity exceeds the strength of bone tissue. Causes of trauma to the bones of the lower leg:
- high impact in the shin area( road accident);
- landing on straightened legs from a great height( unsuccessful jump, fall from height);
- excessive turn of the shin with a fixed foot( skating, skiing, skateboarding);
- falling on the knee or a strong blow to the kneecap;
- compression of the leg bones( occupational injuries, car accidents);
- turning the leg in the ankle inwards or outwards;
- blow an obtuse subject on the ankle.
When the fracture is open, the ends of the damaged bone always move.
Shin injury usually occurs in the middle part of the region of the tibia diaphysis. Fracture of the fibula in combination with a fracture of the tibia worsens the prognosis of the disease, often causes the development of complications, requires prolonged therapy and rehabilitation.
Bone injury can be closed and open. With closed fractures tibia do not communicate with the external environment, and when open, bone fragments form a skin defect and come out. Closed fractures can be complete or a crack type. In turn, complete fractures occur with displacement and without displacement of bone fragments.
Localization of the lesion is distinguished:
- fracture of the tibia in the condyles and intercondylar space;
- fracture of the tibia and tibia in the diaphysis( body) region;
- fracture of the medial and lateral ankle.
In case of damage to the bones of the lower leg, single or multiple fragments can form which aggravate the course of the trauma and require an operative intervention.
Clinical manifestations of trauma to the bones of the shin depend on the localization of the fracture. The location of the lesion affects the severity of the condition and the characteristics of the therapy.
Fracture in the area of the tibial plateau
Damage of condyles and intercondylar space refers to intra-articular fracture of the knee joint, which determines the complexity of diagnosis, the frequency of complications and the characteristics of treatment. After trauma, intense pain arises in the knee region, which limits the motor activity of the leg. Such damage often occurs when you fall on your knees, awkward movements during active rest( skating, roller skis, skis).
Knee edema and subcutaneous hematoma with intraarticular fracture
- pain when trying to move in the knee joint and support the lower limb;
- knee edema;
- subcutaneous hematomas in the knee region;
- with passive movement, the tibia freely moves relative to the knee( symptom of the drawer);
- with pressure on the knee determine its looseness( a symptom of fluctuations);
- heeling on the heel strengthens the pain in the knee;
- unnatural shin shin outward or inward.
For the diagnosis of intraarticular fractures and ligament injuries, endoscopic examination of the knee cavity - arthroscopy is additionally performed.
Fracture in the region of the tibia of the tibia
Fracture of the tibia and tibia often occurs with a strong impact on the shin, for example, when the car hits a pedestrian.
Clinical manifestations of trauma:
- intense pain syndrome in the area of injury;
- pain is worse when the injured leg moves;
- inability of motor activity in the ankle and knee;
- edema and hematomas in the area of trauma;
- deformation or shortening of the lower limb;
- crepitation of bone fragments with palpation;
- defective bone can protrude under the skin.
Isolated fibula injury usually manifests as a pain after trauma and swelling of the shin. In children, such trauma usually has weak clinical signs. Fractures in the child due to the high elasticity of the bones and periosteum appear as a "green twig", which masks the classic symptoms of damage.
Fracture in the ankle area
Ankle swelling with ankle injury
Ankle injury occurs when the foot is turned inward or outward, hitting the ankle with a heavy blunt object. Injury of the inner ankle is associated with the tibia, and the outer one with the fibula.
- intense pain in the ankle, intensified by movement and palpation;
- ankle swelling;
- subcutaneous hemorrhage in the area of injury;
- crunching bone fragments while moving or feeling the ankle;
- the deviation of the foot outward or inward.
Ankle injury is the most common injury for shin fractures.
First Aid Assistance
After injury, the injured person should be immediately taken to the hospital for diagnosis and treatment. The patient should be transported to the emergency room by an ambulance. If it is impossible to call the medics, the victim is taken to a medical institution on his own.
An improvised tire on the shank for transportation to the hospital
For this, a tire is placed on the injured leg, which should fix the knee and ankle joint. Improvised tires can be made from boards, branches, thick cardboard. They are tightly bandaged to the leg, which prevents bone displacement and trauma to soft tissues during transportation. You can bind a sick leg to a healthy lower limb.
Place the ice pack on the injury site and deliver the patient to the trauma department in the supine position. To reduce the intensity of pain, you can give an anesthetic drug( analgin, diclofenac, nimesil).With an open fracture to the wound, a sterile bandage should be applied and bleeding stopped by applying a tourniquet above the site of the vessel damage.
Diagnosis and treatment tactic
To confirm fracture of the bones of the lower leg, X-rays are taken in a straight and a side projection. When intraarticular injuries are additionally prescribed arthroscopy, so as not to miss damage to the intraarticular ligament. X-ray examination helps to establish the nature and severity of the fracture of the lower leg bones.
With closed trauma without displacement, conservative treatment is prescribed by applying a cast bandage that fixes the knee, ankle and foot. With a slight displacement of the bone fragments, a closed reposition of the bones under local anesthesia( lidocaine) is performed. Restoration of the normal position of the bones with a significant displacement of the fragments is achieved with the help of bone extension. The inability to correctly correlate fragments in a closed way, the formation of fragments and subluxations in the joints require an operation.
Radiography in the fracture of the tibia diaphysis before treatment and after osteosynthesis
During the surgical procedure, the bones are returned anatomically correct position, fastened with screws, plates, knitting needles. This method of therapy is called open osteosynthesis. With complex fractures, a closed osteosynthesis is prescribed with the help of the Ilizarov apparatus. It consists of metal spokes and hemispheres, serves to stretch the leg, compare the fragments and form the bone callus in the area of damage.
How much to walk in a cast, to be stretched or to wear an Ilizarov apparatus, is determined by a trauma doctor. The therapeutic immobilization of the limb is prescribed for a period of 1.5-4 months, depending on the severity of the injury. During the rehabilitation period, massage, physiotherapy, physical therapy exercises are used to restore blood flow to the injured leg and to train weakened muscles. Return to normal motor activity and work activity occurs within 3-6 months.
In case of untimely contact with a doctor and incorrect treatment, complications occur:
- non-growth of the fracture;
- fat embolism of blood vessels with impaired blood supply to internal organs;
- contracture( complete immobility) of the knee or ankle joint;
- deforming osteoarthrosis of the knee or ankle;
- false joint in violation of bone defect healing;
- improper bone fusion and deformity of the lower limb.
Fracture of the shin bones refers to common types of trauma, which often cause the formation of complications. Timely diagnosis and therapy improve the prognosis for recovery and complete recovery of the motor function of the injured limb.