Principles of treatment of concurrent fractures of the femur and tibia
Traumatology / / August 12, 2017
extremely conservative treatment combined with fractures of femur and tibia is undesirable.Treatment of big hip plaster cast can be applied only in fractures without displacement of both segments, with a combination of ankle fractures with impacted fracture of the femoral neck in the elderly, malnourished and weak, with physical or mental disabilities.
Skeletal traction is applied widely, but its success is possible under the following rules:
1) the use of double or triple skeletal traction of the metaphysis of the femur and the calcaneus and protivotyagi in the upper part of the thigh;
2) applying sufficient to stretch the muscles of goods (8-12 kg on the thigh and shin 4-6 kg);
3) application to relax the muscles in the first 5-6 days every day or two local novocaine blockade on the thigh and lower leg (in the fracture hematoma and surrounding muscles);
4) elimination via the lateral traction external rotation of the intermediate fragment of femur and tibia, as well as shifts in width and angle;
5) sufficient length of skeletal traction until a clear callus in both fractures while the intensive use of therapeutic exercises of the knee joint.
- Conservative treatment for multiple fractures of extremities
- First aid for multiple fractures pelvis
- skeletal traction
- spinal cord injuries and cauda equina
- Diagnostics and first aid forwhile bone fractures of femur and tibia
- damage to abdominal organs and limbs
intramedullary femoral stems primarily used for leg bones - the Ilizarov apparatus.
intramedullary hip should strive to use such structures, which create maximum fixation strength (for example, 2 rod or nail-screw), will make it possible to dispense with the external plaster immobilization and early to start developing the knee joint, which is located between the two fractures.The most common complication of this fracture is a combination of stiffness of the knee joint, due not only to the proximity of the two fractures, and prolonged immobilization.
development of callus on the tibia (even with closed fractures) lags behind the timing of consolidation on the thigh of the same leg (1-3 months), and this difference is stored as the conservative and the surgical treatment.The average time of consolidation of the femur - 5-6 months, the tibia - 6-9 months.Delayed fusion of fragments of the tibia associated with more severe injuries of soft tissues, weak development in this segment of the muscle layer (especially in the lower third), a marked trophic disorders in the "distal" injury.
Treatment of patients in this group averaged 115 bed days.The use of osteosynthesis and hip plaster bandage used to periodically treat the patient as an outpatient.But we should not prescribe patients with plaster imposed only on the shin, in the absence of a strong consolidation of the femur.Disabled restored within 1-2 years.