Tibial fracture

　　One, External factors

　　1. Direct violence

　　Fractures often occur due to heavy object strikes, kicks, impacts, or wheel碾压 injuries, with violence mostly coming from the outer anterior aspect of the lower leg. Fracture lines are often transverse or short oblique. Fractures caused by great violence or traffic accidents are usually comminuted fractures. Since the front of the tibia is located under the skin, there is a high possibility of the fracture end piercing the skin, and there are more opportunities for muscle contusions.

　　2. Indirect violence

　　Fractures caused by falling from a height, rotational violence扭伤 or slipping, etc., are characterized by the fracture line often being oblique or spiral.

　　Second, internal factors

　　1. Tibial fractures are more common in the thin part of the middle and lower third;

　　2. The anterior medial side of the tibia lacks soft tissue, and fractures are prone to break the skin and form open fractures;

　　3. The tibia is surrounded by a lack of muscle, the nutrition is poor, and in addition, its nutrient vessels mostly come from above downwards. After fracture, the nutrient vessels are damaged, and the downward blood supply is cut off, so it is easy to have delayed fracture healing or non-union after fracture;

　　4. The soft tissue of the lower leg is thin, with little cushioning space, and the ecchymosis after injury is often severe, which is easy to affect blood circulation and cause compartment syndrome between bone and fascia. If not treated in time, serious consequences will occur;

　　5. Due to the lack of muscle on the anterior medial side of the tibia, after tibial fracture, due to unbalanced muscle strength, angular deformity protruding forward and medially often occurs;

　　6. Below the middle and lower third of the lower leg muscle, it often changes to tendinous tissue, making the lower leg obviously thinner, and the tuberosity of the calcaneus is abnormally prominent, so that the posterior muscle belly of the middle segment of the lower leg and the tuberosity of the calcaneus each form a fulcrum, with an empty space in between, making it easy for the lower segment of the tibia to fracture and then to protrude backward and form an angular displacement.

　　The following are the complications that are easily caused by tibial fractures:

　　Fascial compartment syndrome can cause circulatory disorders and lead to fascial compartment syndrome when the pressure within the fascial compartment increases due to hematomas, reactive edema, etc. in the lower leg fractures or soft tissue injuries such as muscles, among which the incidence of anterior compartment syndrome is the highest.

　　The anterior compartment is located on the anterior and lateral aspect of the lower leg, where the anterior tibial muscle, long extensor muscle, extensor hallucis longus muscle, third peroneal muscle, common peroneal nerve, and anterior tibial artery and vein are located. When anterior compartment syndrome occurs, the anterior and lateral aspect of the lower leg becomes hard and there is marked tenderness, and the pain increases when the toes are passively extended or flexed. The pain is related to the degree of compression of the peroneal nerve, and in the early stage

　　There may be decreased sensation between the first and second interdigital spaces, followed by paralysis of the extensor digitorum longus, extensor hallucis longus, and anterior tibial muscles. Since the peroneal artery has communicating branches that connect with the anterior tibial artery, the dorsal artery of the foot can be palpated early.

　　In addition to the anterior fascial compartment, the three compartments at the posterior tibia can also develop this syndrome. Among them, the incidence of posterior deep compartment syndrome is higher than that of posterior superficial compartment and lateral compartment. The characteristics are posterior compartment pain, plantar numbness, weakened toe flexion strength, increased tension and tenderness of the deep fascia at the distal end of the gastrocnemius muscle when the toes are passively extended, and the pain increases. If the symptoms continue to develop without timely treatment, muscle ischemic contracture within the compartment can occur, leading to claw toe. A medial posterior lower leg incision can be made, starting from the origin of the gastrocnemius muscle, and the deep fascia can be longitudinally incised. If necessary, the perimysium can also be incised to achieve decompression.

　　Anterior compartment syndrome is formed by the continuous increase of pressure within the compartment, vasoconstriction, increased tissue osmotic pressure, and tissue ischemia and hypoxia. Especially in cases of closed tibiofibular fractures with obvious soft tissue contusions, there is a possibility of developing fascial compartment syndrome, so early fracture reduction and intravenous infusion of 20% mannitol should be performed to improve microcirculation and reduce edema, and close observation should be made.

　　In addition to the fascial compartment syndrome, the inferior orifice of the anterior tibial compartment near the ankle joint, the anterior tibial muscle, the long extensor muscle, and the digital long extensor tendon are closely attached to the tibia. After the fracture is healed and the callus is formed, the tendons can be worn, causing symptoms. If necessary, the fascia should be surgically incised to relieve pressure.

　　What are the typical symptoms of tibial fractures? Below are the specific symptoms of the disease:

　　Tibial shaft fracture: Swelling and pain in the calf, with possible deformity and abnormal movement.

　　Tibial plateau fracture: Swelling and pain in the knee joint, activity impairment, as it is an intra-articular fracture, there is intra-articular hematoma. Local pain and rapid swelling after injury, with the calf unable to bear weight can suggest a diagnosis of tibial fracture. If there are angular deformities or bone grinding signs and pseudo-activity, the diagnosis can be confirmed. Diagnosis can be made easily based on clinical manifestations and related examinations.

　　For the prevention of tibial fractures, direct prevention of direct or indirect violence can reduce the incidence rate. If a fracture occurs, it is necessary to actively prevent different complications according to different fracture sites, prevent ischemia and gangrene, and avoid affecting function. In addition, paying attention to safety in production and life is the key to preventing this disease. Since the complications of this disease are common, it is more important for patients to prevent the occurrence of complications such as hemorrhagic shock, non-union of bones, and joint stiffness. It is also necessary to pay attention to the early functional exercise of the affected limb to promote fracture healing and functional recovery.

　　What laboratory tests are needed for tibial fractures? Tibial fractures can undergo X-ray and CT examinations

　　Local pain and rapid swelling after injury, with the calf unable to bear weight can suggest a diagnosis of tibial fracture. If there are angular deformities or bone grinding signs and abnormal movement, the diagnosis can be confirmed. X-ray examination is helpful for diagnosing fractures and fracture types.

　　Patients with tibial fractures should focus on light, appetizing, easy-to-digest, and easy-to-absorb foods. These include vegetables, eggs, soy products, fruits, light fish soup, and lean meat. The preparation should mainly be steamed or stewed, avoiding frying. It is worth noting that the commonly used soybean and bone soup in folk is greasy and contains a lot of fat, which is not easy to digest and absorb, so it is best not to eat it at this stage.

　　According to recent research findings, patients with tibial fractures need to supplement trace elements such as zinc, iron, and manganese. Animal liver, seafood, soybeans, sunflower seeds, and mushrooms contain a lot of zinc; animal liver, eggs, legumes, green vegetables, and wheat flour contain more iron; wheat bran, mustard greens, egg yolks, and cheese contain more manganese, and patients with tibial fractures can eat more of these. Animal liver and pork blood have the effect of replenishing blood, which plays a particularly important role in timely blood replenishment after bleeding caused by trauma, so they can be eaten regularly.

　　In the middle stage of tibial fracture (2-4 weeks after injury), dietary intake should shift from light to moderate high-nutrient supplementation to meet the needs of bone growth. Foods such as bone soup, Cordyceps chicken stew, fish, eggs, milk, and animal liver can be added to the initial diet. Eating more vegetables rich in vitamin C, such as green peppers, tomatoes, amaranth, and radishes, can promote callus growth and wound healing.

　　There are no dietary restrictions in the late stage of tibial fracture (more than 5 weeks after injury), and various high-nutrient foods and foods rich in calcium, phosphorus, iron, and other minerals can be eaten. During this period, the diet can be supplemented with chicken soup, pork kidney soup, sheep kidney soup, deer tendons soup, fish soup, and so on.

　　The conventional methods of Western medicine for treating tibial fractures are as follows:

　　The overlap, angular and rotational displacement of the fracture ends should be completely corrected to avoid affecting the loading function of the lower leg and the occurrence of joint fatigue. Fractures without displacement can be fixed with splints until the fracture heals. Stable fractures with displacement can be manually reduced and splinted. Unstable fractures can be manually reduced and splinted, and combined with calcaneal traction. Open fractures should be thoroughly debrided, and fractures should be reduced at the same time, using calcaneal traction to maintain fracture alignment. After the wound heals, splint fixation is added. For old fractures with malunion, manual reduction and splint fixation or combined with traction can be used. For patients with compartment syndrome, deep fascia should be incised and completely decompressed.

　　1. Cast Fixation

　　Transverse fractures with no displacement or stable after reduction, such as short oblique fractures, in which the fractured surface contacts stably without lateral displacement, can be manually reduced and externally fixed with a long leg cast under anesthesia. When the cast is fixed, the knee should be kept in a slight flexion of about 15°.

　　2. Bone Traction

　　Oblique, spiral or slightly comminuted unstable fractures cannot be maintained in good alignment with simple external fixation. Tracing can be performed under local anesthesia, and a spiral traction frame can be used for traction fixation.

　　3. Open Reduction and Internal Fixation

　　Fractures of the tibia and fibula generally have a long bony healing period, long-term plaster cast fixation will inevitably affect the function of the knee and ankle joints, and currently, more and more people are adopting open reduction and internal fixation.

　　4. Surgical Treatment

　　When the articular surface collapse of the platform fracture exceeds 2mm, and the lateral displacement exceeds 5mm; with knee ligament injury and genu varum or genu valgum exceeding 5°.