Medial condyle of the tibia. Tibial condyle injury

Fractures of the medial epicondyle of the humerus are avulsion in nature and account for 35% of all fractures of the distal part of this bone. They are the result of an indirect mechanism of injury and occur during a fall with an emphasis on the hand of an extended arm with a deviation of the forearm outward. Muscles attached to the medial epicondyle tear it off.

In this case, a significant rupture of the capsule of the elbow joint occurs. The mechanism of occurrence of a fracture of the medial epicondyle corresponds to the mechanism of dislocation of the bones of the forearm. Quite often at dislocation of a forearm there is an infringement of this epicondyle in an elbow joint. According to our statistics, 62% of dislocations of both bones of the forearm were accompanied by detachment of the medial epicondyle.

There are the following types of fractures of the medial epicondyle of the humerus:

fractures without displacement;

fractures with displacement in width;

fractures with rotation;

fractures with infringement in the elbow joint;

fractures with nerve damage;

fractures in combination with dislocation of the forearm;

repeated breaks.

Clinical and radiological diagnostics

Limited tissue swelling along the anteromedial surface of the elbow joint, extensive bruising, and local pain are expressed. On palpation, a mobile epicondyle can be determined. This resembles the symptoms of a transcondylar fracture with displacement of the distal fragment to the lateral side. However, with the latter, the swelling extends to the entire elbow joint, and the sharp edge of the central fragment is determined on the medial side of the elbow joint. When the medial epicondyle is torn off, extension in the elbow joint with the deviation of the extended fingers to the back causes pain in the projection of this epicondyle, fluid is determined in the cavity of the elbow joint, and signs of nerve damage are detected. With a dislocation of the bones of the forearm, deformation of the elbow joint is observed. The nature of the deformation is determined by the type of dislocation. With repeated detachments of the medial epicondyle, which occur with fibrous fusion of the false joints, the symptoms are “blurred”, the swelling is small and limited, there is no bruising, on the anteromedial surface of the elbow joint, soft tissue compaction associated with the humerus is palpated.

Difficulties in X-ray diagnosis arise mainly in children under 6 years of age, in whom the ossification nucleus has not yet appeared, and in the absence of displacement of the epicondyle.

The combination of separation of the medial epicondyle and dislocation of both bones of the forearm is characteristic, therefore, when studying radiographs, it is necessary to pay attention to the area of ​​the medial epicondyle. Sometimes it is difficult to distinguish a repeated fracture from a primary one. Only the presence of ossification indicates re-injury.

In children, avulsion of the medial epicondyle occurs as apophyseolysis or osteoapophyseolisis. There are detachments of only part of the apophysis. Sometimes it is a cartilage plate that is not radiopaque. Separations of a muscular leg with a periosteum are observed. The muscle leg is sometimes infringed in the elbow joint, dragging the ulnar nerve with it, and signs of damage to it are determined. The latter cases are rare and difficult to recognize, but should always be kept in mind. There are detachments at the same time and the lateral epicondyle of the humerus. Separation of the medial epicondyle is often combined with other fractures in the elbow joint.

The fragment under the influence of muscle traction is displaced downward and to the radial side. Infringement of the epicondyle in the elbow joint is of two types:

when it is all in the joint cavity;

when only its edge is infringed.

The joint space is expanded from the medial side. With a cartilaginous epicondyle, this x-ray sign becomes especially valuable. Be sure to pay attention to the degree of rotation of the fragment, the shape and size of the ossification nucleus. In children 6-7 years old, the ossification nucleus has a rounded shape and at first its shadow appears in the form of a dot.

Treatment

If there is no displacement of the bone fragment, then treatment is limited to immobilization of the posterior plaster splint for 15-20 days. With a displacement of more than 5 mm, rotational displacement, infringement of the epicondyle, surgical treatment is indicated. In case of dislocation of the bones of the forearm, the dislocation is first reduced and only then the question of surgical treatment is decided. The operation is technically simple and, if performed correctly, leads to a complete recovery.

Open reduction is sought to be performed as soon as possible after injury. In the first 1-3 days, the operation is performed with minimal soft tissue trauma, and it is not associated with any difficulties. The skin incision is made along the anteromedial surface of the elbow joint. Stupidly separate the soft tissues and approach the fracture site. This removes blood clots. The wound surface of the humerus is freed from the soft tissues covering it, which are retracted medially along with the ulnar nerve. Determine the position of the epicondyle, the degree of damage to the capsule and joint. If a fragment is infringed in the joint cavity, it is removed. Be sure to evacuate blood clots from the joint cavity. To compare the fragment, it must be shifted upwards and slightly backwards. In the center of the epicondyle, a needle with a thrust platform or an awl with a removable handle is injected so that it runs perpendicular to the plane of the fracture. The end of the needle is brought out above the wound surface by 0.5-1 cm. With the help of a needle, the epicondyle is pulled up. Then the end of the spoke is placed in the center of the facet on the humerus and, acting on the principle of a lever, reposition is achieved. The needle is introduced into the condyle of the humerus, pressing the epicondyle against it with a persistent platform. This technique greatly facilitates reduction, especially with stale fractures. Visually check the accuracy of the reduction. The wound is sewn up tightly. Be sure to produce x-ray control, bearing in mind that when the epicondyle is torn off, there is a tendency to dislocation of the forearm. Impose a back plaster bandage from the bases of the fingers to the upper third of the shoulder. The elbow joint is immobilized at an angle of 140°. Practice shows that from this position of the joint, its function is restored faster. In order to avoid the formation of conflicts, the edges of the splint are bent. In the postoperative period, a UHF field is prescribed. Immobilization is continued for at least 3 weeks. The fixing needle is removed and exercise therapy is prescribed. Movements in the elbow joint are carried out within the amplitude that does not cause pain. Forced restoration of function, violent movements lead to a reflex closure of the elbow joint, the formation of ossifications and, ultimately, to a prolongation of the restoration of the function of the elbow joint. Massage of the elbow joint area, warming it up also have a negative effect.

During the first week, the first signs of recovery of movements are already noted. During this period, the child and his parents master the basic principles of exercise therapy quite well and, after discharge from the hospital, carry it out at home under the supervision of an exercise therapy methodologist.

The most common complication is the formation of a false joint. With non-surgical treatment, this complication is observed in 40% of cases, which is mainly associated with soft tissue interposition. In surgical treatment, it is rare and is associated with errors in the surgical technique, as well as in the treatment of stale fractures.

Avulsion fractures of the lateral epicondyle of the humerus are very rare. Usually, only its outer plate is torn off, to which the radial collateral ligament of the elbow joint and muscle is attached. The displacement is usually insignificant and easily eliminated. Fixation of the lateral epicondyle is carried out with a thin needle. Outcomes are favorable. Indications for surgical treatment are very rare.

Fractures of the head of the condyle of the humerus

Among all fractures of the bones that make up the elbow joint, fractures of the head of the condyle of the humerus occupy the first place in terms of the frequency of adverse outcomes. This is a violation of the function of the elbow joint, delayed consolidation, the formation of pseudarthrosis and other complications. These fractures account for 8.2% of all fractures in the elbow joint. They arise from an indirect mechanism of injury, when falling on an outstretched, slightly bent arm; more often occur in children aged 5-7 years.

There are several types of these fractures:

epimetaphyseal fracture of the outer part of the condyle;

osteoepiphyseolysis;

pure epiphyseolysis;

fracture of the nucleus of ossification of the head of the condyle;

subchondral fractures;

fracture or epiphysiolysis in combination with dislocation in the elbow joint.

Fractures of the head of the condyle of the humerus are sometimes combined with fractures of the medial epicondyle, olecranon, and neck of the radius. Fractures of the head of the condyle of the humerus in combination with dislocations in the elbow joint occur in 2% of cases. Anterior-medial dislocation predominates, posterior-medial dislocation is less common.

Clinical and radiological characterization

There is swelling of the lateral side of the elbow joint, sharp pain on palpation of the lateral surface of the distal part of the humerus. In the cavity of the joint fluid, hemarthrosis are determined. Sometimes the mobility of a broken bone fragment is determined. Difficulties in radiographic diagnosis may arise in the absence of displacement. Usually, a broken bone fragment is displaced laterally and downward, anteriorly or posteriorly, as well as at an angle open posteriorly or anteriorly. Quite often, rotation of the fragment is observed, due to the traction of the muscles attached to it. Typically, rotation occurs in more than one plane and is often quite significant. In such cases, the articular surface of the head of the condyle may be directed towards the wound surface of the humerus. It loses contact with the head of the radius and is in a position of subluxation or dislocation.

In osteoepiphysiolysis, a fragment of the metaphysis can be of various sizes and shapes. Its crescent shape is characteristic. It occurs at the time of injury with displacement laterally and posteriorly. In this case, only a compact plate breaks off from the lateral or posterior surface of the metaphysis of the humerus. On radiographs, it is defined as a sickle, which at one end approaches the lateral surface of the nucleus of ossification of the head of the condyle of the humerus.

By the nature of the fracture plane and the degree of displacement, the depth of the blood supply disturbance of the broken fragment is determined with a sufficient degree of certainty. To the greatest extent, it suffers from pure epiphysiolysis. The state of blood supply largely determines the choice of treatment tactics.

Treatment

The method of treatment is chosen on the basis of studying all the features of the fracture. In the absence of displacement, a posterior plaster splint is applied from the bases of the fingers to the upper part of the shoulder. If there is a slight displacement, then it is preferable to fix the fragment with knitting needles. This eliminates the possibility of slow consolidation.

When the fragment is displaced along the width, at an angle and slightly rotated, a closed reposition is used. It is carried out with very careful movements. At the same time, the direction of displacement and the localization of unbroken soft tissues that bind the fragments and give them a certain stabilization are taken into account. When the fragment is displaced laterally and downwards, the forearm is deflected medially and by pressing the fingers on the fragment from the outside up and inward, it is brought closer to the humerus, introducing it between the condyle of the humerus and the head of the radius. When displaced backwards, they press on the fragment from behind and bend the limb at the elbow joint. Then the fragment is percutaneously fixed with pins with thrust pads to the humerus. Produce x-ray control. The terms of immobilization are 4-5 weeks.

Fractures of the head of the condyle of the humerus in combination with dislocation in the shoulder joint

The study of such injuries showed that at the time of injury, the head of the condyle of the humerus is fractured, then dislocation occurs. As a result, the broken fragment retains its connection with a part of the epicondyle of the humerus through soft tissues. There is a displacement in one ligament of the forearm with the head of the condyle of the humerus. This explains the possibility of bloodless reduction in such injuries. In the course of surgical interventions, it was found that in children with similar fracture-dislocations, there was an infringement of soft tissues in the humeroulnar joint or there was a significant rupture of the articular capsule and other soft tissues. After elimination of the infringement of soft tissues in the joint cavity, free reduction of the bone fragment occurred.

Treatment options

Based on the clinical and radiological study of patients, as well as the analysis of surgical findings, a technique for bloodless reduction of fractures of the head of the condyle of the humerus in combination with dislocation in the glenohumeral joint was developed. Its principle is that the fracture and dislocation are reduced simultaneously. At the same time, all manipulations should be reasonable, purposeful and as sparing as possible in order to avoid additional rupture of soft tissues. Otherwise, the reduction becomes ineffective. The result of reduction is controlled by radiography, osteosynthesis is carried out with pins with thrust pads.

In children, as a rule, there are many cartilaginous elements in the elbow joint, so the correct assessment of the position of the broken fragment can be difficult. It is especially difficult to determine the degree of rotation. Therefore, in doubtful cases, open reposition is preferred.

Of fundamental importance is the question of the timing of immobilization for all fractures of the head of the condyle of the humerus. Experience convinces us that the reduction of terms, even in the absence of displacement, unacceptably showed that the complication was often in those in whom the displacement was either absent at all, or was insignificant. Guided by this, doctors stopped immobilization in patients of this category already 2 weeks after the injury, which was the reason for nonunion of the bone.

The period of immobilization depends on a number of factors and, especially, on the age of the patient, the degree of adaptation of the fragments and the violation of the blood supply to the broken fragment. With epiphysiolysis, in connection with this, the fixation time should be large. On average, rest of the fracture area should last at least 4-5 weeks. Of decisive importance in deciding whether to remove the plaster cast are the data of the control radiographs. The fear of the occurrence of post-immobilization contractures in children is not justified. With delayed consolidation, immobilization is extended until the fracture heals.

With a significant rotational displacement, an open reduction is resorted to without attempting a closed reduction. The operation is performed with gentle techniques. Fixation is carried out with spokes with thrust pads, which create a certain compression between the fragments.

Due to the peculiarities of the blood supply to the distal end of the humerus in its fractures, especially the lateral part, often there is a delayed consolidation, a false joint of the head of the condyle, the phenomena of its avascular necrosis. These complications are facilitated by ineffective and short-term immobilization. Delayed consolidation and false joints often occur with non-displaced fractures. In such cases, doctors erroneously shorten the immobilization period, which is the cause of the noted complications. For their treatment, closed fixation of fragments is used using a specially designed screw that allows it to be inserted using a removable handle. If the fragment is displaced simultaneously with the movements of the forearm, then the latter is set in the position in which the head of the condyle of the shoulder is set in the correct position. Fragments are fixed with a needle. Then, with a scalpel, an incision is made up to 5 mm in the direction of the head of the condyle of the humerus. A canal is made through the incision with an awl through the head of the condyle into another fragment. A screw is passed through the channel using a removable handle. The screw creates compression between fragments. Apply a plaster cast. After healing the fracture with a removable handle, the screw is removed on an outpatient basis.

Subchondral fractures of the head of the condyle of the humerus.

A special group of fractures of the head of the condyle are subchondral fractures. We are talking about the separation of articular cartilage with areas of bone substance. They are not so rare, but, as a rule, are not diagnosed. They are usually referred to the group of epiphyseolysis. Subchondral fractures are observed only in children 12-14 years old. Displacement only anteriorly is characteristic. They are unfamiliar to practitioners, since the mention of them is very rare. Meanwhile, they require a special approach in the diagnosis and choice of treatment.

Clinical and radiological signs

The clinical manifestations of subchondral fractures depend on the time elapsed since the injury and the degree of displacement. In recent cases, marked pain in the elbow joint, aggravated by movement. The contours of the joint are smoothed, local pain is detected with pressure on the head of the condyle. In the cavity of the elbow joint in fresh and stale cases, fluid is determined.

X-ray examination is of decisive diagnostic value. The radiological picture of the damage depends on the size of the broken articular cartilage and bone plates, as well as on the steppes and its displacement. In most cases, the fracture extends only to the head of the condyle, but it often passes to the lateral surface of the shaft of the block. In one patient, articular cartilage was removed from the entire distal epiphysis of the shoulder.

Since plates of bone substance of various sizes break off with articular cartilage, the contours of the separated fragment are quite clearly visible on radiographs.

It should be noted that in a number of patients, the cortical plate and bone substance break off from the outer surface of the head of the condyle of the humerus. Further, the fracture plane goes inward, separating only the articular cartilage. Therefore, on the lateral radiograph, when the fragment is displaced anteriorly, a picture of the displacement of the entire epiphysis of the humerus in the form of a hemisphere is revealed.

In practice, it is advisable to distinguish 5 groups of subchondral fractures:

fractures without displacement and with slight displacement; they are visible only on the lateral radiograph; at the same time doubling of a contour of a head of a condyle comes to light; treatment consists in immobilization of the elbow joint for 3-4 weeks;

fractures with displacement, but only at an angle open anteriorly; reposition consists in pressure on the head of the condyle from front to back and full extension in the elbow joint; in this position, a plaster splint is applied; as a rule, reposition leads to the desired result;

fractures with displacement not only at an angle, but also in width anteriorly; at the same time, the wound surfaces of the fragments from behind are still in contact; reposition is also carried out by the same methods as for fractures of the previous group;

complete displacement of the fragment anteriorly; while its wound surface is adjacent to the anterior surface of the distal part of the humerus; closed reduction fails, surgical treatment is indicated;

displacement of the fragment into the anterior torsion of the elbow joint; in such cases, movements in the elbow joint are restored completely without eliminating the displacement; with uncorrected displacements of the 3rd and 4th groups, the function of the elbow joint is sharply disturbed, primarily extension suffers.

With stale fractures without displacement, clinical symptoms are not very pronounced. Patients complain of moderate pain in the elbow joint, extension in it is limited. There is fluid in the joint cavity.

Palpation is not painful. On the lateral radiograph, fragmentation of one of the contours of the head of the condyle of the humerus is sometimes revealed. Treatment begins with immobilization of the joint. Then use exercise therapy, FTL.

Humeral block fractures

Fractures of the block of the humerus in children are very rare and arise from an indirect mechanism of injury, when falling on an adducted and slightly bent arm at the elbow joint. They are typical for children of the older age group. There are metaepiphyseal fractures of the medial part of the condyle of the humerus, vertical fractures of the medial edge of the block with the medial epicondyle, and epiphysiolysis.

Clinical and radiological picture

A fracture of the block of the humerus is characterized by swelling of the elbow joint, sometimes significant, but more localized on its medial side. With full extension of the fingers and in the wrist joint, pain also appears on the medial side of the joint.

On palpation, a sharp pain is detected here, sometimes the mobility of a bone fragment. In the joint cavity, fluid is determined, which is regarded as hemarthrosis.

On radiographs, a block fracture of a different nature is detected. Difficulties in interpreting radiographs may arise in children in whom the block is represented by several ossification nuclei. The fragment is displaced inwards and downwards. Quite often, rotation of the fragment is observed, sometimes it is significant, due to the traction of the muscles attached to the medial epicondyle.

Treatment

Treatment of block fractures without displacement is limited to immobilization of the posterior plaster splint for 3 weeks.

Displacement of fractures of the block of the humerus leads to restriction of movements in the elbow joint, so they must be eliminated. When offset in width, an accurate comparison is usually possible in a closed way by direct pressure with fingers on the fragment. In order to avoid secondary displacement, osteosynthesis with wires is used. Fragment rotation, as a rule, cannot be eliminated closed, therefore an open reduction is used.

Apply medial access to the fracture site. The ulnar nerve is isolated and retracted medially. Under the control of the eye, an accurate comparison of the fragments is achieved. They are fixed with knitting needles with persistent platforms. After layer-by-layer suturing of the wound, the arm is fixed with a posterior plaster splint for 4 weeks. The spokes are removed and the movement in the elbow joint is restored according to the principles outlined earlier. Proper use of exercise therapy guarantees complete restoration of the functions of the elbow joint.

The structure of a healthy knee joint

The joint is formed by three bones: the femur, tibia and patella. Above the femur, two condyles form the articular surface: the outer or lateral and the inner or medial. Below is the articular surface of the tibia, and on the side is the patella. From the inside, the joints are covered with smooth cartilage tissue, for better glide and greater range of motion. Features of the histological structure of the condyles of the femur and tibia suggest the receipt of depressed and impacted fractures, since its structure is plastic and easily bent.
Quite often, fractures of the condyles of the tibia pass with displacement of the fragments and a violation of the biomechanics of the joint. This entails a violation of the distribution of forces acting on the joint during walking and other physical activities. And after healing, if it happened incorrectly, inflammation of the articular bag may occur, since the deviated parts of the bone will constantly “scratch” the inner surface of the joint or, under the weight of the body, the articular surfaces will become incongruent to each other.

Fracture of the lateral condyle of the tibia

It occurs most often as a result of violent actions, or excessive abduction of the leg to the side below the knee joint (occurs with sports injuries or accidents). X-ray shows a displacement of the lateral condyle by more than four millimeters, the fault line runs obliquely or vertically. If the traumatic agent continues to act on the leg, then the fragments are displaced, otherwise (provided that the limb is immobilized during transportation), the fracture passes without displacement.

Fracture of the lateral condyle of the tibia

This type of fracture occurs if the lower leg is brought to the hip or the knee is bent more than forty-five degrees at the time of injury. It is equally common in everyday life, sports and accidents. It is also possible to localize the fracture by the pictures in frontal and lateral projection, a vertical picture of the articular area. If nothing strange is found during standard X-rays, and the symptoms persist, it makes sense to take an x-ray in an oblique projection.

Fracture symptoms

The patient will most often complain of pain in the knee at rest and at the slightest movement, an inflammatory reaction with accumulation of exudate is objectively visible, a violation of the integrity of the skin over the site of impact, a decrease in the volume of active and passive movements in the joint. The characteristic external deformation and defiguration of the joint is expressed. The patient is forced to take the position that is the least painful for him - the knee is slightly bent to reduce the tension of the ligaments, the muscles are relaxed. Most often, condylar fractures are not isolated, they are combined with rupture of the anterior or posterior cruciate ligaments, lateral ligaments, discs, menisci. Damage to blood vessels and nerves that feed the joint. The latter is manifested in a decrease in the temperature of the lower leg and foot, a violation of sensitivity.

Treatment

There are four most common ways to treat a knee fracture and their combinations:
1. Pressure bandage (holding fragments from displacement).
2. Plaster cast and closed comparison of fragments.
3. Skeletal traction.
4. Open reposition, connection of fragments with fixing material (pins, plates).
How the injury will heal depends on the nature of the fracture, its type, the presence of additional pathologies and complications, as well as on the method used by the traumatologist.

The first two methods are conservative treatment, involving cold therapy, immobilization and a gradual increase in the load on the leg in general and the joint in particular. During the entire treatment, images of the healing leg are taken to monitor the process and prevent displacement of fragments or shortening of the limb. Plus, the patient is prescribed exercise therapy to prevent contractures and reduce the range of motion in the joints. Such therapy is more suitable for older people who will not run, swim, or otherwise put a lot of stress on the leg in the future.
The last two methods are operational, when, one way or another, invasive methods of treatment are involved. It is important that the operation is performed by an experienced specialist, since it depends on him how accurately the fragments will fall into place and grow together again. You can fix them with screws, or add a metal plate to them. Often during the operation it is required to examine the inner surface of the joint, then arthroscopy or arthrotomy is used, depending on the clinical situation and the complexity of the fracture. The entire process of the operation is controlled radiologically, pictures are taken directly on the operating table, which are filed into the medical history for further comparison and tracking of the dynamics of bone restoration.

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The knee and foot are connected to each other by the tibia and fibula of the lower leg. In appearance, this is a long tubular bone, which consists of 3 parts: the proximal, distal epiphysis (pineal body) and the body of the bone. Fracture of the lower leg in the tibia is a common injury that patients of all ages face.

The tibia fractures under traumatic force. The degree of fracture depends on the number of fragments, their placement, and the severity of damage to the soft tissues around the bone. The consequences of an injury can be the most dangerous. That is why it is important to provide first aid to the victim in time, and transport him to a medical facility.

Classification of fractures of the tibia

Depending on the mechanism of injury, fractures are:

• Inertial - the bone broke due to inertia due to impact;
• Compression - the injury occurred due to prolonged compression of the bone body;
• Impression - a crack as a result of indentation.

By type, fractures are divided into the following:

• Comminuted - a fracture with the formation of 2 or more fragments;
• Stable - there is a slight displacement of bone fragments;
• Helical - the line of pereshib covers the bone in a spiral;
• Transverse - the line of injury is perpendicular to the axis of the bone;
• Oblique - the line of injury is beveled;
• Displaced - bone fragments are displaced relative to each other.

A tibial fracture can be closed - the skin is not damaged, and open - the integrity of the muscles and skin is violated.

Depending on the structure of the tibia, fractures are divided into medial (middle), intra-articular (trauma to the bone inside the joint) and compression.

Depending on the location of the fracture line, the following types of tibial injuries are distinguished:

Fissures of the upper and lower parts of the bone are divided into intraarticular and periarticular.

Fracture of the intercondylar eminence

This is a rare injury that is preceded by overstretching of the ligaments. Even after a successful comparison of fragments, the ligamentous apparatus of the knee cannot function as before.

A fracture of the intercondylar eminence of the tibia is referred to as an avulsion fracture, that is, a fragment of the bone is torn off at the site of attachment of the tendon of the muscle. The line of injury passes through the upper end, and most of the articular surface is torn off the bone (in whole or in part), and sometimes chafed. Often, the injury affects the epiphyseal plate (cartilaginous growth plate).

Causes of injury

Due to the immaturity of the musculoskeletal system in children, a fracture of the intercondylar eminence is more common than in adults.

According to statistics, more than 65% of injuries of the intercondylar eminence of the tibia are provoked by non-contact sports.

Typically, a fracture occurs when the lower limb abruptly changes direction, stops, or lands from a height with a nearly extended knee.

During contact sports, there is an increased likelihood of injury at the time of forcible bending or turning inward. Most often, football players, basketball players, volleyball players, and skiers get injured.

Symptoms

It is possible to identify a fracture of the intercondylar eminence by the following symptoms:

• Strong pain;
• The victim cannot lean on the injured leg;
• Hemorrhage into the joint due to rupture of intra-articular vessels;
• Excessive looseness of the joint;
• Inflammation of the synovial (inner) membrane of the joint.

Similar articles

With a fracture of the tibia without displacement, passive movements are possible, but they are accompanied by pain.

Treatment

After reposition, a plaster bandage is applied to the injured leg, which fixes it from the ankle to the buttock in the overextension position. If the bone fragments are in the correct position, then the bandage is left for a period of 6 to 8 weeks.

Severe fractures require surgery. In this case, an arthroscopic operation is performed to compare the fragments, but this is not so easy to do because of the strong hemorrhage into the joint.

Non-crushed fragments are fixed with metal or absorbable screws. With a comminuted fracture, the fragments are fixed with thick suture material or wire.

Regardless of the method of therapy, the leg should be rested for 6 weeks. The cast is then removed and the joint is protected with a long articulated bandage that is placed over the knee.

Fracture of the condyle of the tibia

This is an intra-articular injury, during which the lateral sections of the superior pineal body of the tibia are damaged. Such a fracture is not uncommon, but not all injuries in this area can be attributed specifically to fractures. When damaged, the condyles are displaced by more than 4 mm.

Hidden fractures are more often diagnosed in older patients, which can be identified using x-rays. If a person complains of pain in the region of the condyles, then a diagnosis should be made.

Fracture of the condyles is complete and incomplete. In the first case, the condyle is completely or partially separated, and in the second, the cartilage is crushed, impressions or cracks appear.

During a condyle fracture, there is a risk of damage to the ligaments of the knee, the cartilage lining. In addition, this injury is combined with a fracture of the fibula and intercondylar eminence.

Causes of damage

Fracture of the condyles occurs under the influence of force with compression, which occurs along the axis with a turn. When the traumatic force exceeds the bone strength, a fracture occurs. In most cases, the injury occurs under the influence of a direct mechanism.

A condylar fracture is the result of a fall from a height. Often, an injury occurs as a result of a traffic accident, after hitting the middle (median) part of the bone with a car bumper.

Other fractures are caused by a combination of rotational stress and axial compression. The structure of the condyles is spongy, and therefore they are crushed during pressure. As a result, depressed fractures occur.

With a violent fracture of the leg, the lateral (middle) condyle of the tibia suffers. If the knee is extended at the time of injury, an anterior fracture occurs. Late condylar injuries form when the knee is bent.

Symptoms of injury

A fracture of the condyles of the tibia is determined by the following signs:

• Pain in the damaged area;
• Deformity of the leg in the region of the condyles;
• Hemorrhage in the joint;
• The functionality of the knee joint is impaired;
• Pathological lateral movements in the knee.

Pain depends on the severity of the injury. During palpation, the patient feels pain in the region of the condyles. Bleeding into the joint can be large, often because of it, the knee joint expands and blood flow is disturbed. In this case, it is important to pierce the articular bag and remove the contents. In order for the blood to resolve faster, you can perform early active movements in the joint (after the permission of the doctor).

A specific sign of injury is a deformity in the area of ​​the knee joint, which occurs due to the displacement of fragments.

The patient can only perform passive movements that are accompanied by painful sensations. In addition, there is lateral mobility in the knee area.

Diagnostic Measures

To determine the nature of the injury and the severity of the damage, x-rays are prescribed. This is the main method of instrumental diagnostics in this case. X-ray of the lower limb is performed in two projections. So the doctor will be able not only to clarify the presence of injury, but also to determine the nature of the displacement of the fragments.

If the results of the x-ray are ambiguous, then the victim is sent for a computed tomography of the knee. If the doctor suspects that soft tissues are damaged (ligaments, cartilage pads of the knee), then there is a need for magnetic resonance imaging.

Sometimes nerves and blood vessels are pinched during injury. If the doctor suspects that the neurovascular bundle is damaged, then it is necessary to consult with a vascular surgeon and a neurosurgeon.

Methods of treatment

With a fracture of the condyle of the tibia, the treatment is divided into several stages:

• Early reposition of bone fragments to restore the congruence of joint surfaces;
• Fixation of the lower limb in the damaged area until the fragments grow together;
• Late active exercise of the injured lower limb.

The terms of treatment for a fracture of the condyle of the tibia, depending on the damage, can reach several weeks or even months. In case of a marginal fracture without displacement, an incomplete fracture or a crack, the injured leg is immobilized and a plaster splint is applied to it for 3-4 weeks. For 3-5 days after the injury, it is important to ensure the rest of the injured limb. The patient can then move around with crutches. During the day, the splint can be removed and active movements in the area of ​​the knee joint can be performed. You need to start with a minimum load, which is increased over time.

In case of a fracture of the condyle with a displacement, the method of adhesive traction for the lower leg is used when the leg is extended. In addition, side adjusting loops are used.

With a fracture of the lateral condyle of the tibia, the lateral loop is applied so that it is directed outward. The loop, which is placed above the ankles, is directed inwards. This method allows you to get rid of the deformation, set the bones and fix them in the desired position.

If both condyles are damaged, skeletal traction with lateral loops is used.. In some cases, manual reduction of fragments is carried out. During the procedure, general or local anesthesia is used.

After skeletal traction, exercises are performed after a few days if the patient does not have acute pain. Traction is eliminated after a month, after which the patient can move on crutches, but in such a way as not to burden the injured leg.

Surgical intervention is necessary if fragments in the joint cavity are infringed and movement is impaired, as well as when damaged by bone fragments of vessels and nerves. In addition, surgery is needed if conservative methods are ineffective and with strong compression of the condyles.

Complications

After a condyle fracture, there is a possibility of the following complications:

To avoid the above complications, treatment should be carried out on time, and the recommendations of the doctor should be followed. This is the only way to accelerate the restoration of motor activity of the knee joint.

Tibia body injury

The tibia is a long tubular bone that is often injured. The body of the tibia captures the area between the knee and ankle.

A fracture of a long bone provokes a large traumatic force, and therefore it is often combined with other injuries.

The lower leg consists of the tibia and fibula. The dimensions of the tibia exceed the dimensions of the small bone. It is a support for the body during the load, in addition. Between the upper and lower parts of the tibia is its body.

The severity of the injury depends on the traumatic impact on the bone. Often the tibia and fibula are fractured at the same time. A fracture of the body of the bone can be stable, displaced, transverse, oblique. Often diagnosed with a spiral, comminuted, open and closed type of damage.

Causes of the fracture

A fracture of the body of the tibia occurs as a result of a strong blow to the front of the lower leg. In most cases, this happens as a result of traffic accidents when a person collides with a car.

Often, after an accident, multi-comminuted fractures are diagnosed when the body of the bone splits into 2 or more fragments.

Injury to the lower leg is possible when practicing low-energy contact sports, such as football. That is, a fracture can occur even as a result of a collision between players. Also, such injuries occur under the action of a twisting force and are usually oblique or spiral.

Damage symptoms

To identify a fracture of the body of the tibia is quite simple, for this you should pay attention to the characteristic signs:

• Pain in the anterior part of the leg;
• The victim cannot lean on the injured limb and actively move it;
• Deformation appears on the middle part of the lower leg;
• The injured leg becomes unstable;
• A fragment of bone bulges under the skin or breaks it and comes out;
• In some cases, sensitivity in the foot area is disturbed.

After the onset of such symptoms, first aid should be given to the victim and transported to a medical facility.

Diagnostics

Upon arrival at the hospital, the patient should tell the doctor about how the injury occurred. If he fell from a height, then the approximate distance should be called. If the victim was previously injured, then this is also worth mentioning. This applies to serious diseases, such as diabetes. In addition, the patient should tell about what medications he is taking.

After collecting an anamnesis, the doctor conducts a visual examination of the injured limb in the shin area. If the victim is conscious, then his sensitivity and muscle strength are checked, for this he is offered to move his toes.

To clarify the diagnosis, the patient is sent for x-rays. This diagnostic method confirms or refutes a fracture of the bone body, allows you to see a displaced fracture and the number of bone fragments.

If the doctor suspects that the fracture has spread to the knee or ankle joint, then the patient is prescribed a CT scan.

Treatment Methods

During the preparation of treatment tactics, the orthopedist takes into account the cause of the injury, the general condition of the victim, the severity of the injury and the amount of damage to the soft tissue structures. The terms of treatment of a fracture of the tibia directly depend on these factors.

Conservative therapy is indicated in the following cases:

Bone fragments are fixed with a splint or plaster splint. Only in the first case, the bandage can be tightened or loosened, which guarantees the safe disappearance of puffiness. The plaster is removed after a few weeks, and then it is replaced with a functional plastic splint with a fastening mechanism. It supports the bones until they are completely fused. During washing or physical education, the tire is allowed to be removed

Surgery for a fracture of the body of the tibia is prescribed in the following cases:

• open fractures;
• Unstable injuries with the presence of highly displaced bone fragments;
• If conservative treatment was ineffective and the bones do not grow together.

In such cases, intraosseous osteosynthesis is often prescribed. During this operation, bone fragments are fixed with a metal rod (pin). Also for this purpose, special screws, screws and metal plates are used.

To speed up recovery, doctors advise to do physical exercises.

Complications

A fracture of the body of the tibia is a dangerous injury that provokes the following complications:

In the latter case, antibiotics are needed.

The operation can also provoke complications:

• It is impossible to combine bone fragments and restore its integrity;
• Penetration of infection into the damaged area;
• Damage to nerves, blood vessels;
• thrombus formation;
• Slow fusion of bones;
• Curvature of the injured leg.

The likelihood of leg curvature is possible when using an external fixation device.

First aid for a fracture of the tibia

With a fracture of the tibia, it is very important to provide competent first aid to the patient in time.

Instructions for first aid for a fracture of the tibia:

After providing prehospital care, the victim is transported to the hospital or an ambulance is called.

Injury diagnosis

Differential diagnosis will help the doctor determine the type of damage and prescribe competent treatment.

With a fracture of the condyles of the tibia, the doctor first of all conducts a thorough visual examination.

To determine the type of injury and severity, x-rays are prescribed. In addition, a diagnostic puncture of the joint is performed.

To confirm a tuberosity fracture, an x-ray of the tibia in lateral protection is taken. If soft tissue damage is suspected, magnetic resonance or computed tomography is prescribed.

Thus, a fracture of the tibia is a serious injury that requires timely detection and competent treatment.

Fractures of the condyles of the tibia are intra-articular injuries and occur most often when falling on straight legs or when the lower leg deviates outward or inward. There are fractures of the external condyle, internal condyle, as well as T- and Y-shaped fractures of both condyles. Fractures of the condyles can be impression and chipping type. They may be accompanied by damage to the meniscus, the ligamentous apparatus of the knee joint, fractures of the intercondylar eminence of the tibia, fractures of the head of the fibula, etc.

Clinical picture in fractures of the condyles of the tibia, it corresponds to intra-articular damage: the joint is enlarged in volume, the leg is slightly bent, hemarthrosis is detected by the symptom of balloting the patella. The tibia is deflected outwards in case of a fracture of the external condyle or inwardly in case of a fracture of the internal condyle. The transverse size of the tibia in the area of ​​the condyles is increased in comparison with the healthy leg, especially in T- and Y-shaped fractures. On palpation of the fracture area is sharply painful. Characterized by lateral mobility in the knee joint with unbent lower leg. There are no active movements in the joint, passive movements cause sharp pain. The patient cannot raise the straightened leg. Sometimes damage to the external condyle is accompanied by a fracture of the head or neck of the fibula. In this case, the peroneal nerve can be damaged, which is recognized by a violation of sensitivity, as well as motor disorders of the foot.

X-ray examination allows you to clarify the diagnosis and identify the features of the fracture.

Treatment. In case of fractures of the condyles of the lower leg without displacement, a joint is punctured for aspiration of blood and the introduction of 20-40 ml of a 1% solution of novocaine. The injured limb is fixed with a circular plaster cast. From the 2nd day, exercises for the quadriceps femoris are recommended. Walking with crutches without weight on the affected leg is allowed after a week. The plaster bandage is removed after 6 weeks. Loading of the leg is allowed 4-4.5 months after the fracture. With early loading, impression of the damaged condyle may occur.

In case of a displaced condyle fracture, both conservative and surgical treatment is used.

In some cases, fractures with displacement, especially comminuted, T and V-shaped fractures, permanent skeletal traction can be applied. At the same time, the patient's limb is placed on the Beler splint, the needle is passed through the calcaneus, the load along the axis of the lower leg is 4-5 kg. The duration of treatment with this method is 4-5 weeks, after which the limb is fixed with a gypsum bandage. Further treatment is the same as for a fracture of the condyles without displacement of the fragments.

Surgical treatment is indicated for unsuccessful conservative treatment. The operation is performed 4-5 days after the injury: open reposition of the fracture and osteosynthesis with metal structures. The sutures are removed on the 12-14th day, and further management of the patient, as in case of fractures of the condyles without displacement.

Diaphyseal fractures of the leg bones

Diagnostics isolated fractures of the diaphysis of the tibia does not cause difficulties. Visible deformity of the damaged segment, impaired limb support, and other symptoms characteristic of diaphyseal fractures of any localization make it possible to make a diagnosis before X-ray examination. X-ray of the leg allows you to clarify the nature of the fracture.

Treatment isolated fractures of the tibia without displacement of fragments is carried out with a circular plaster cast (Fig. 83) for 2-4 months. With severe swelling of the lower leg, a path is opened along the front surface. After the edema subsides, the bandage turns into a deaf circular one.

Isolated fractures of the tibia with displacement are treated promptly due to the fact that they are irreducible due to the whole fibula.

Fractures of both bones of the lower leg are much more common than isolated ones. The mechanism of injury can be direct or indirect. The direct mechanism leads to transverse and comminuted fractures. An indirect mechanism (flexion, twisting) leads to fractures with an oblique fracture plane, spiral, helical. The tibia and fibula often fracture at different levels. The displacement of fragments depends both on the strength and direction of external violence, and on the action of the muscles attached to the fragments.

Clinic fracture is clear. Symptoms of diaphyseal fractures of any localization are characteristic (pain, swelling, dysfunction, deformity, crepitus, pathological mobility, anatomical shortening of the lower leg). In addition, a funnel-shaped retraction (umbilization) of the skin over the fracture site is possible, which indicates soft tissue interposition. X-ray in two projections clarifies the diagnosis.

The following groups of fractures of the diaphysis of the lower leg are distinguished:

fractures without displacement of fragments of the tibia;

repairable and easily retained fractures;

repairable fractures, but unretainable without additional traction;

non-repairable fractures.

A plaster cast is used to treat non-displaced fractures, as well as reduced and easily retained fractures.

The plaster bandage does not prevent secondary displacement, so it should not be used for oblique and helical fractures. In case of fractures in the upper third of the lower leg, a plaster cast is applied from the gluteal fold, in the middle third - from the middle of the thigh to the tips of the toes. In the presence of edema of the lower leg, the plaster cast is cut along the anterior surface.

Treatment the method of permanent skeletal traction (Fig. 84) is the main one for closed fractures of both bones of the lower leg of any localization. The traction pin is passed either over the ankle or over the calcaneus. The leg is placed on the Beler splint. The initial reducing load along the axis of the lower leg is 10% of the mass of the victim. Then, according to the control radiograph, which is made no earlier than after 24-48 hours, an individual load is selected. The duration of bed rest is 4 weeks. A reliable clinical criterion for the sufficiency of the treatment period is the absence of pathological mobility in the fracture zone, which is an indication for the next X-ray examination of the fracture site. After dismantling the skeletal traction, the limb is fixed with a gypsum bandage for 2-3 months. Ability to work is restored after 4-6 months from the date of injury.

Surgical treatment of closed diaphyseal fractures is indicated for interposition of soft tissues in the fracture zone, open and complicated fractures, non-repairable fractures. In case of fractures of the diaphysis of both bones, only the tibia is osteosynthesised.

In diaphyseal fractures of the lower leg, unlike diaphyseal fractures of other localizations, osteosynthesis of the tibia can be successfully performed with all currently existing fixators: extramedullary (screws, bolts, plates), intramedullary (rods, pins), transosseous devices (Ilizarov). This is facilitated by the simplicity of operational approaches and the relative ease of reduction of bone fragments due to the absence of a muscle layer on the anterior medial surface of the tibia.