Fractures of the bones of the lower leg and foot
Traumatology / / August 12, 2017
causes of injury are: the simultaneous compression of the leg and foot heavy objects falling from a height of victims, avtotravma.On average, each victim of this group accounted for three fractures.Most damaged: tibia, fibula, heel and metatarsal bones.
Symptoms of bone fractures leg and foot
Clinical diagnosis of diaphyseal fractures of the tibia is not difficult, the detection of bone lesions of the foot (especially the heel and talus) is generally difficult due to the large tissue edema and pain of unknown localization.Therefore, it is imperative to carry out a thorough X-ray examination of the lower extremity (not less than 5 X-ray: rear and side view of bones of the lower leg, the profile picture of the bones, heel and axial shot FASD picture forefoot).
First Aid with diphenhydramine, conducted novocaine blockade fractures seats with the addition of "futlyarnoy" shin blockade (the total amount of 0.5% novocaine solution should not exceed 150 mL) fractures of the lower leg and foot
intramuscularly injected Promedolum (analgin).Transport immobilization carried stair rails - back (to the upper third of the thigh) and the V-shaped (to the knee, or the occupation of his).When transporting the foot attach an elevated position.The application of local hypothermia.
treatment of bone fractures leg and foot
The allocation of the affected groups must be based on the principle of unity of tactics and uniformity of the methods of treatment of all (or most) of fractures.From this point of view two major groups of patients it is advisable to select.
Options injury leg and foot
first group consists of the victims with fractures of the shin bone (in the diaphysis) and one or more bones of the foot.Tactics and methods of treating patients in this group are mainly determined by the nature of damage to the tibia.
rarely in patients unable to carry out one-step reduction and fixation of bone fragments circular plaster cast (to the upper third of the thigh).Skeletal traction of calcaneus (as in the case of fracture - abaft) conducted in patients for 5-6 weeks, after which the plaster is applied circular bandage for 3-5 months.More promising active surgical tactics: in the first week of performing osteosynthesis screws with an oblique fracture of the tibia, and for fractures of the calcaneus.External immobilization is carried out circular plaster cast for 3-4 months.
- fractures of the humerus
- Fractures of the shoulder and forearm
- Fractures of the forearm and hand
- Fractures hip and foot
- fracture of the spine combined with fractures of the arms and legs
- Perelomovyvihitalus and forefoot
second group includes victims with fractures of the ankle and one or more bones of the foot.
treatment similar injury earlier provides one-step reposition followed by external immobilization with plaster longetnymi or circular bandages.When repositioning, we usually use simple distraction device, assembled from parts of Ilizarov frame.The dosage distraction and closed the movement of fragments by means of spokes with thrust pads ensures complete reduction of fragments.When "The Expendables" fractures necessarily apply percutaneous fixation of bone fragments with needles (for 2-3 weeks).There must be strict control over the development of edema limb in a cast, since it is easy to appear ischemia and necrosis of the foot.For an objective assessment of the state of blood supply to the feet and use a thermometer pulsografiya fingers.At the slightest suspicion of compression bandage fabric is cut and held active medication and physiotherapy treatment for 2-3 days, before withdrawing injured limb edema.Next, the change of cast.For the prevention of venous disorders of the soft tissues of compression bandages used mainly lining.At sharply expressed edema of the lower third of the leg and ankle area is needed to cut the skin and fascia of the posterior tibial artery.If the latter is damaged (control angiography), the need for urgent revision of the neurovascular bundle and fixation of fractures of metal structures.