tibia and fibula fracture
Introduction
Introduction to tibia fracture Tibial shaft fractures (calculus fractures) are most common in systemic fractures, especially in children under 10 years of age. Among them, the humeral shaft has the most single fracture, the humeral shaft is double-folded, and the humeral shaft has the least fracture. The humerus is the main skeleton that supports the weight of the underside of the femur. The humerus is an important bone that attaches to the calf muscle and bears 1/6 of the weight. The morphological changes of the lower third of the humerus are prone to fracture. The upper third of the fracture is displaced, and the radial artery is easily compressed, causing severe ischemic gangrene in the lower leg. The 1/3 of the humerus can be closed in the calf bone. In the fascia room, increasing the pressure in the room causes the ischemic muscle contracture to become gangrene. The lower third of the humerus fracture causes the trophoblast to break, which is easy to cause fracture and delay healing. Children sometimes see the "green branch fracture" of the tibia, and long-distance runners can also see the "fatigue fracture" of the tibia. basic knowledge The proportion of illness: 0.052% Susceptible people: children under 10 are especially common Mode of infection: non-infectious Complications: Traumatic arthritis Vascular injury
Cause
Cause of humeral fracture
Most of the disease is caused by direct violence. Direct violence is often seen as crushing, colliding, and hitting the wound. The fracture line is transverse or crushed; sometimes the two calves are broken in the same plane, and the soft tissue damage is often serious, which is easy to cause open fracture. Sometimes the skin is not broken, but the contusion is serious, the blood is bad, and the secondary necrosis occurs. The bone is exposed and the infection becomes osteomyelitis. Indirect violence is often caused by a high position falling, a sprain or slip due to running. Fracture; the fracture line is often oblique or spiral, and the tibia and tibia are not in the same plane.
Prevention
Prevention of tibia fracture
Prevention of direct or indirect violence can reduce the incidence rate. If a fracture occurs, different complications should be actively prevented for different fracture sites to prevent ischemia, gangrene, and function. After the patient has a fracture, in order to restore the weight function of the calf as soon as possible, it must be The angular deformity and rotational displacement of the fracture and the limb shortening should be completely corrected, so as to avoid affecting the weight-bearing function of the knee joint. Immediately after fixation, the dorsiflexion of the ankle joint and the quadriceps contraction exercise should be guided. After 2 weeks of stable fracture fixation, under the guidance of a doctor, the leg is raised and the knee joint is flexed. After 3 weeks, the splint continues to be fixed, and the patient can walk away from the bed without weight-bearing walking. activity.
Complication
Coma bone fracture complications Complications, traumatic arthritis, vascular injury
Fracture of the tibia, prone to delayed healing or non-healing, especially unstable fractures are easily displaced, local external fixation often fails, re-determination is not ideal, due to changes in force lines, can cause walking pain and complicated with traumatic arthritis.
In traumatic tibial fractures, it is mainly easy to combine with major vascular injuries, because most of them are injuries caused by major violence, so the injury is usually heavier, and often combined with other parts of the injury and internal organ damage, humeral fracture combined After vascular injury, muscle-rich calf muscle tissue is extremely susceptible, because skeletal muscle is more sensitive to ischemia. It is generally believed that limb muscle tissue can be degenerated and necrotic after 6-8 hours of ischemia; if there is soft tissue itself The safety of the injury is more transient, and the severe soft tissue injury and sepsis caused by postoperative wound infection also greatly increase the risk of amputation.
Symptom
Symptoms of humeral fractures Common symptoms Tibial tenderness, humeral pain, calf swelling, pain, gastrointestinal muscle tear, external sputum, depression, crush, injury, thigh, local swelling, deformation, cyanosis
Local calf pain, swelling, deformity is more significant, showing angular and overlapping displacement, should pay attention to whether it is accompanied by common peroneal nerve injury, anterior tibial, posterior tibial artery injury, tension in the anterior tibial region and gastrocnemius muscle area, often caused by fracture The consequences of complications in the fracture itself are more serious.
Examine
Examination of the fracture of the tibia
X-ray examination is used in the auxiliary examination of this disease. The plain film has limited bone rupture on the tibia. The cortical bone is discontinuous and has a notch. The bone density is increased and the periosteal thickening is basically in all cases. Now, the trabecular bones are not arranged neatly, and the fuzzy incomplete fracture line can be seen. In severe cases, the bone deformation of the signature book and the surrounding soft tissue damage can be recorded.
For cases suspected of having arterial injury, vascular ultrasonography should be performed in time, because Doppler ultrasound vascular examination is a non-invasive examination, can be carried out at the bedside, easy and fast operation, and can clarify the blood flow velocity in each part of the blood vessel And the direction, the blood supply range of the limbs and the vascular injury can be roughly understood, which is of great significance for the timely development of emergency surgery.
For patients who are still unable to make a definite diagnosis, DSA examination is feasible if necessary, but the clinical application of DSA examination still has many limitations, such as: invasive examination means; it is necessary to repeatedly move the patient, which is inconvenient for patients with multiple injuries. Danger; time-consuming, may delay the timing of treatment.
Diagnosis
Diagnosis and diagnosis of tibia fracture
diagnosis
Because the position of the humerus is superficial, the general diagnosis is not difficult. It is often possible to remove the displaced bone end in the painful and swollen part. It is important to find the injury of the arteriovenous and common peroneal nerve before and after the fracture. During the examination, the pulsation of the dorsal artery of the foot, the feeling of the foot, the ankle joint and the dorsiflexion of the big toe should be recorded as routine records, the crush injury with severe local injury, the open fracture and the longer time to stop the blood. And the wounded and tightly wounded, especially pay attention to observe whether the injured limb has progressive swelling, especially in the muscles, such as skin tension, shiny, cold, blisters, muscles, and dorsal artery Can not tell, limb hair color or pale, etc., that is, the performance of fascial compartment syndrome, should be urgently treated in a timely manner.
Differential diagnosis
Combined with clinical and X-ray findings can be diagnosed, but fatigue fractures of the tibia sometimes need to be differentiated from osteoid osteoma and green branch fractures, local bone infections, early bone tumors.
1. Although osteoid osteoma has thickening of the cortex and periosteal reaction, it has a typical tumor nest.
2, the green branch fracture occurs mostly in children, with a history of exact trauma.
3, local bone infection with periosteal reaction cortical thickening, no trabecular trabecular fracture and cortical bone notch sign, and clinical epithelial temperature is higher.
4, early bone tumors with lace-like or onion-like periosteal reaction, gradually bone destruction, tumor bone and soft tissue mass.
Fatigue fractures and various bone diseases have the same local periosteal reaction, thickening and cortical cortex, but it still has its own characteristics. As long as the X-ray features and clinical history are grasped, the fatigue fracture can be made correctly. Diagnosis.
