Fracture of the lower leg
definition
The term Lower leg medically describes the field of lower extremity, which continues from knee is removed and until foot goes. This area is made up of two bones, the Schienbein (Tibia) and the Fibula (Fibula). These bony structures are made up of ligaments and Musculature held together, with the largest proportion of Musculature can be found on the back of the extremity and enables people to walk upright, among other things.
Various causes, mostly with considerable ones mechanical forces can cause these bony structures to break and thus reproduce the medical image of a lower leg fracture. A fracture of the lower leg often results in combined fractures of the tibia and fibula, whereby a fracture of just one of the bones is also possible. The localization of the lower leg fracture is very variable. One speaks of lower leg shaft fractures when the shin and fibula are equally affected. A distinction is made between three different lower leg shaft fractures: The simple, complex and the wedge fracture. Therapy may need to be adjusted depending on the type of fracture.
Tibial head fractures must be differentiated from the lower leg shaft fracture. The part of the shin (tibia head) belonging to the knee joint is affected.
causes
Lower leg fractures usually have a trauma as the cause. This means that large mechanical forces are exerted on the bone act until these forces die resistance of the bone and the bone eventually breaks. One distinguishes two forms of traumaA distinction is made whether the forces act directly or frontally on the bone, or, for example, a rotation is the cause of the break. At Sports injuriesassociated with a lower leg fracture is usually an indirect trauma in which the leg is moved so that large Rotational or flexion forces act on the bones. Are predestined for this type of lower leg fracture sports like soccer, or skiing and snowboarding.
Direct trauma In most cases, they arise in traffic accidents in which strong forces act frontally on the lower leg bones and these break under the heavy load. Motorcyclists in particular are with you because of their poorer protection accident often affected by this injury after an accident.
A distinction is also made between whether the lower leg fracture is open or closed. An open lower leg fracture means that either the tibia or fibula penetrate the skin of the lower leg and are exposed. Closed breaks can be a so-called Compartment syndrome bleeding, which increases the pressure in the lower leg so much that some muscle tissue can be lost. Compartment syndrome after a lower leg fracture is a surgical emergency and requires immediate treatment.
Tibial head fractures, i.e. a fracture of the tibia head, are more common in people with existing osteoporosis. In this disease, the bone structures are so weakened that only slight trauma can be responsible for the fracture of the bone.
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diagnosis
If after a accident if a lower leg fracture is suspected, should in any case, consulted a doctor become. This can confirm or refute the suspicion using certain methods. It is important to first show the course of the accident. From this the first relevant information for the safe diagnosis be collected.
The final diagnosis of a lower leg fracture is usually ensured with the help of an imaging procedure, with usually a X-ray machine is used. Recordings from at least two different angles on the lower leg are usually sufficient for a reliable diagnosis of a lower leg fracture and enable the type of fracture to be classified. To rule out further injuries, other procedures, such as a Ultrasound examination, used to prevent a violation of the Vessels of the lower leg to be able to exclude. Another exam measures the pressure in the soft tissues of the lower leg. This examination is important because bleeding after a fracture in the lower leg area is the clinical picture of the Compartment syndrome can occur, which requires immediate medical attention.
In some cases you can certain movement tests confirm or rule out a suspicion of a lower leg fracture. To be absolutely sure, however, you can rely on the use of a X-ray machine not be waived.
If there is an open fracture, either or both bone partially protruding from the skin, the diagnosis of a fracture of the lower leg is clear. In most cases, it is still necessary to take an X-ray of the injured area for further treatment.
Frequency distribution
Estimating the frequency of lower leg fractures is not easy due to the various causes. In general one can say that with Lower leg shaft fractures usually both bones, so Shin and Fibula, are affected. Very rarely, however, it can happen that only the shin is affected.
Most of the lower leg fractures are due to traffic accidents. Only then do sports injuries and other accidents join.
Lower leg fracture in a child or toddler
In the case of children, the Bone healing works even better for them than in adults, so the Healing phases usually shorter than the usual six weeks for adults. This also applies to the lower leg fracture.
That's because in children Cells are built up and broken down faster and the repair mechanisms can apply to them more quickly.
Especially with Babies and toddlers applies that it less likely to break bones comesthan in adults as their Bones more flexible are and so usually do not break. It happens often, especially in babies Broken tibia, this is also known as a learning break.
Usually it is only a small one Hairline crackwhich usually does not need further treatment.
The children spare because of the Pain the leg a little by itself.
In these cases, children then start crawling again, although they have actually already learned to walk.
If such a hairline crack is diagnosed by a doctor, it will Shin in plaster. Surgery is definitive for these minor fractures not necessary.
If there is an undisplaced or only slightly displaced lower leg fracture, in children conservatively with the help of a plaster of paris treated. Both the Lower leg as well as thigh in plaster.
How long the cast has to be worn depends on the age of the child. In children under the age of five, a fracture usually heals within two to three weeks. In children between five and ten years of age, fracture healing takes approximately between three and four weeks.
In the course of healing, does one develop shift the lower leg fracture, this must be treated surgically, but this happens very rarely in children.
Also occurs in children after successful plaster therapy then a physiotherapy therapy to strengthen the Musculature.
If the deformity of the fracture exceeds a certain extent, surgery must also be performed on children. In children are mostly used for surgical care Titanium pins or so-called Kirschner wires used.
The general rule for children is that three quarters of all hernias can be treated conservatively without surgery.
In adults, on the other hand, three quarters of all fractures have to be operated on.
Symptoms
The Symptoms After a lower leg fracture, the severity of the fracture varies depending on the type of fracture. Typically, affected people complain of strong Pain in the injured area. Associated movement restrictions of the leg as well as an inability to exercise can also be observed in almost all lower leg fractures. A common symptom of lower leg fractures is also the occurrence of one Bruisecaused by the rupture of vessels near the break. The break is also accompanied by swelling. Depending on the severity, a Misalignment of the lower leg indicate a fracture. Sensory disturbances in foot are also often seen with a lower leg fracture.
A visible piece of bone that penetrates the skin is an unmistakable sign of the break at least one bone. Such an open fracture can be divided into four different grades:
Grade I - Part of the Bone protrudes from the inside out onto the surface, whereby only small parts of the tissue are destroyed and only a small part bacterial contamination can be assumed.
Grade II - The skin is severed from the outside in by force. The surrounding structures are partially damaged. It is from moderate bacterial contamination of the wound to go out.
Grade III - the surrounding soft structures are severely injured. annoy such as Vessels are involved, the bone is shattered and it can be assumed that the wound is highly bacterial.
Grade IV - ¾ of the soft structures are no longer intact, important nerves and blood vessels have been severed Blood supply some tissue structures are no longer guaranteed. The consequence of such an injury is usually one amputation.
Pain in a fracture of the lower leg
Obviously, pain, along with swelling or visible bone fragments, is one of the absolute best Main symptoms a lower leg fracture. They occur to a relatively limited extent on the lower leg, so they normally do not radiate from the buttock and thigh region into the lower leg, which enables them to be differentiated from a disc problem. Since a fracture of the lower leg is usually accompanied by severe swelling and often - especially with an open fracture - also with an inflammatory reaction, most patients experience this pain not only when they are exerted, but also when they are at rest.
The severe pain in the affected lower leg moves the patient to relieve the leg. This relieving posture can give an indication of a fracture of the lower leg or a similar injury in the leg area, especially for small children who may not yet be able to specifically report pain or an accident (e.g. a fall).
After the surgical treatment, almost every patient complains of pain in the area of the affected lower leg. These are treated with pain reliever and anti-inflammatory drugs such as ibuprofen immediately after the operation and usually over several days. As part of wound healing and rehabilitation, this pain should gradually decrease, but can of course reappear when the load is increased. The alarm bells should only ring and the surgeon should be informed of this if the pain is severe or if there is no improvement over a long period of time. Otherwise, moderate pain when exercising the leg and a halt in pain reduction for several days after the operation are initially not all too alarming signals.
therapy
A Fracture of the lower leg is usually, with a few exceptions, surgically provided. The conservative, non-surgical treatment after a fracture of the lower leg is associated with some serious possible complications, so that this type of therapy can usually no longer be recommended. Thrombosis, Joint immobility, Misalignments and slow healing are just a few of the possible complications that should be mentioned after non-surgical treatment. If there is a clean break and the two pieces of bone are not displaced against each other, the injury could be treated with immobilization using a plaster of paris without surgical intervention. However, due to the complications listed above, this type of treatment has taken a back seat.
The surgical treatment of a lower leg fracture mainly depends on the location of the injury. When the break is close to Knee joint so-called plate osteosynthesis is usually used. Here, the bone pieces are brought into their correct anatomical shape and screwed together using a plate that is adapted to the bone. For breaks that are in the middle range and the Ankle joint are closer, so-called intramedullary nails or locking nails are used. Long metal pins are pushed lengthways through the bone and ensure stability there. The advantage of this method of treatment is that the leg can quickly bear weight after the operation. In the case of complicated comminuted fractures, in which there are many fragments of bone, an operation may be necessary to immobilize the leg from the outside (External fixator).
In any case, due to the restricted movement of the leg after the operation, a blood-thinning drug (usually Heparin) are taken to Thrombosis to prevent.
After the operation, the rehabilitation phase begins, which can last different lengths depending on the severity of the lower leg fracture. It is important to learn to walk with crutches as soon as possible and to slowly put weight on the leg again. Intensive treatment and training through physiotherapy exercises can be helpful here. Attention should always be paid to complications and infections of the wound sutures and the bone should be identified and corrected quickly.
plaster
If a plaster cast used for therapy depends on the type of lower leg fracture. Is it a open fracture, this must be operated on immediately and it often becomes a so-called External fixator where the fracture of the lower leg is stabilized by rods and screws and no plaster of paris is required.
In the case of fractures that are located in the part of the Lower leg and where there is only one slight misalignment has come and the bone ends caused by the fracture of the lower leg have not shifted against each other, becomes a plaster cast used.
Also with one Fracture of the fibula (Fibula) a plaster cast is used for healing. Not only is the lower leg cast in plaster, but the cast is applied up to the thigh. The plaster cast then remains for four to six weeks on the leg until the fracture has healed.
Sometimes there is also a plaster cast only in the further course of the healing process for use. For example, a wire or a nail by the Heel bone be shot, a weight can then exert a pull over the nail via a rope construction.
In this case, a thigh cast is only applied after about four weeks.
In the further course of healing, the thigh cast can be changed to a lower leg cast be reduced.
Even if on the leg Circulatory disorders present or a local inflammation the conservative method of treatment using plaster of paris is preferred, since surgery can worsen the situation. If the leg has to be immobilized in a cast for a long time, there is an increased risk of a Blood clotwhich can seal vessels (thrombosis). Therefore need preventative anticoagulant syringes are given.
forecast
The prognosis after a Fracture of the lower leg is generally relatively good. However, depending on the severity, it can take a relatively long time for the leg can be fully charged again. Open lower leg fractures in particular usually heal much worse than closed fractures.
It should always be open, especially with open fractures Infections be respected. If intramedullary nails were used as a treatment method, an infection is particularly feared and should be treated as soon as possible.
The most common complications after a surgery of a lower leg fracture are permanent misalignments and joint instabilities. Even after interventions that are objectively optimal, such damage cannot be ruled out. Especially with complicated ones Fractions Several operations may be necessary before a satisfactory result can be achieved.
Healing, healing time, healing time
The Duration of treatment of the lower leg fracture depends on the Type of break and how the fracture is treated therapeutically.
Typically, adult bone healing time is six weeks. It takes average between two and twelve weeks until that leg can be fully charged again. Is the lower leg fracture by means of Screws and plates surgically supplied, the earliest after one year, but usually after about 18 months Materials are removed again.
This is again carried out as part of a small surgical procedure, so that another hospital stay is necessary.
Is the Lower leg fracture healed and can be loaded again, regardless of whether the lower leg fracture heals conservative or operative has taken place, physiotherapy will take place afterwards.
Physiotherapy serves to relieve the weakened Musculature of Lower leg to strengthen again in a targeted manner and to restore mobility.
If the lower leg fracture was treated surgically, the physiotherapy take place shortly after the fracture has been restored. Initially, the leg is then partially loaded with around 20kg. In the Plaster supply, physiotherapy can only take place after the cast has been removed.
Rehabilitation after a lower leg fracture
The Rehabilitation (rehab) represents an important component in the follow-up treatment of a lower leg fracture operation. If carried out appropriately, it can shorten the overall treatment time considerably and help bring the patient back to the level of health at which he was before the lower leg fracture as quickly as possible. In addition, it is essential for maintaining therapeutic success: Once successes have been achieved - e.g. Freedom from pain or resumption of sporting activities are not always permanently achieved per se. Only a consistent and long-term continuation of the exercise of the affected leg can keep the risk of relapses or permanent loss of movement or strength low.
In a broader sense, the rehab of a lower leg fracture begins on the first day after the operation. The physiotherapists and, if necessary, occupational therapists working in the hospital can, for example, go through Lymphatic drainage Accelerate the outflow of lymph fluid from the surgical area while the nursing staff and surgeons are entrusted with treating the surgical scars. Both the quickest possible subsidence of the swelling and the uncomplicated healing of the wounds are important first steps in rehabilitation of the lower leg fracture. Subsequently, under certain circumstances, the hospital can submit an application for inpatient or outpatient rehab.
In this rehab in the narrower sense, the focus is initially on promoting the decongestion of the leg and on monitoring wound healing. Depending on the type of lower leg fracture, light strength training can be started for the affected leg after 1-3 weeks - but this always happens without stress on the leg! The appropriate exercises are taught to the patient by the physiotherapist present. The point in time from which the first partial load can be exerted on the leg again using crutches varies, depending on the type of lower leg fracture, between 2 weeks and up to 3 months. While the load on the leg is steadily increasing, the physiotherapist should focus on adequate gait training to prevent malpositions from creeping in.
