Multiple fractures of the shin bone
Traumatology / / May 08, 2016
Multiple fractures of the tibia are typical of the lower limbs, their causes were street injuries (53.6%), transport (24.7%), falls from height (21.7%).
extensive damage to the skin, muscles and major vessels, particularly in the distal fracture level and below.In double and multiple fractures of the tibia are most violated innervation and blood supply of the intermediate diaphyseal fragment as broken upper feeding arteries in the proximal fracture.As a result, in the distal fracture metaepiphysis periosteum broken vessels associated with the internal network malleolar - main power supply of the lower third of the tibia.
Blood disorders intermediate fragment is even more pronounced in open injuries, which are often localized in the lower fracture of the tibia, and often accompanied by detachment from the bone not only the surrounding soft tissues and periosteum.This is the main reason for delayed consolidation and development of osteomyelitis in open and double fractures of the tibia.
severity was affected, as a rule, it corresponds to the shock I-II degree.Affected intravenous analgin (4 ml of a 50% solution) or promedol (1 ml of 2% solution), diphenhydramine (1 ml of 1% solution), produce novocaine block fractures "futlyarnoy" sites or "cross-section" (for crushing soft tissue oropen polifrakturah).
transport immobilization at polifrakturah shin.
and - preparation of the tire;b - after immobilization (first rail is fixed to the thigh and shin then after stretching - all the way to the toes).
transport immobilization carried stair rails.Anti-shock therapy may be limited to intravenous transfusion (jet, rapid drops) - 500 ml glyukozonovokainovoy mixture (laktasol, ringerlaktat).The application of local hypothermia to +10 ... + 15 ° C
Principles of treatment
Treatment of open tibia polifraktur consists of three sequentially executed actions:
1) struggle with shock and blood loss,
2) primary surgical treatment andwound closure,
3) specialized treatment of fractures.
- Multiple rib fractures
- Multiple fractures pelvis
- Multiple fractures of the bones and the bones of segments
- Multiple fractures of the forearm bones
- Multiple fractures wrist
- Multiple fractures of femur
- multiple fractures of foot
- multiple fractures ankle
- multiple fractures of the bones of the knee joint
Timely (early) and the correct surgical treatment of lower leg injuries in open fractures should pursue the goal of not only the prevention of wound infection and easily ariseshere osteomyelitis, but also the recovery of the skin necessary for the healing of the fracture.
Recently, the method of choice in the treatment of lower leg became polifraktur Transosseous osteosynthesis with external fixation.When conservative treatment periods of fracture healing is 5-7 months, and in the distal fracture consolidation occurs later.The formation of callus in the fracture of the proximal tibia occurs in an average of 5 months, in the area of the distal fracture - after 7.5 months.The average bed-day in the treatment of patients with polifrakturami tibia is in the conservative treatment of 42.7 days, while the operational - 92.8.Full recovery of limb function and disability of patients observed in 76.2% of all treated, persistent disability group II remains at 9.5%.