Femoral Distal Fracture

　　1. Etiology

　　High longitudinal compressive violence causes injury to the distal end of the tibia.

　　2. Pathogenesis

　　When falling from a height, the foot lands, and the distal end of the tibia impacts on the articular surface of the talus, causing a fracture.

　　Complicated with traumatic arthritis of the ankle joint. Traumatic arthritis, also known as traumatic arthritis or traumatic osteoarthritis, is a disease caused by trauma, mainly characterized by degeneration and atrophy of joint cartilage, secondary cartilage hyperplasia and ossification, and mainly manifested by joint pain and functional disorders. If the bone and joint is fractured, cartilage damage, joint foreign body retention, etc., caused by falling, collision, etc., the joint surface is uneven, thus suffering from abnormal wear and damage.

　　Due to the longitudinal violence, the fracture fragments burst outward, the local skin is subjected to tremendous tension, forming blisters, and even skin rupture, with bone fragments piercing the skin to become open fractures, and can be accompanied by fibula fractures and limb shortening.

　　With the aging of the body, bone metabolism function decreases, the level of female estrogen decreases, calcium absorption ability gradually decreases, and osteoporosis is prone to occur in the elderly. In addition, long-term high-salt, high-protein diet, smoking, drinking, lack of exercise, less sun exposure, long-term illness of liver and kidney diseases, hypertension, diabetes, long-term use of corticosteroids, anticancer drugs, diuretics, and other factors will lead to calcium loss in the human body, causing osteoporosis. In daily life, minor collisions or falls can cause fractures, known as osteoporotic fractures. The fracture site is often located at the proximal femur, spine, and distal radius.

　　At the time of diagnosis, in addition to relying on clinical manifestations, auxiliary examinations are also needed. The X-ray film of this disease can be diagnosed, and CT scan is necessary when necessary to judge the fragmentation of the fracture. This disease seriously affects the daily life of patients, so it should be actively prevented.

　　What foods are good for the body when suffering from a distal rib burst fracture?

　　1. In the early stage of fracture (1-2 weeks after injury):Diet should be mainly light, easy to digest, and easy to absorb foods, such as vegetables, eggs, soy products, fruits, light fish soup, lean meat, etc. The preparation should be mainly steamed, stewed, and boiled, and fried and baked should be avoided. It is worth noting that the commonly used soybean 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.

　　Animal livers, seafood, soybeans, sunflower seeds, and mushrooms contain a lot of zinc; animal livers, eggs, legumes, green vegetables, and wheat flour contain a lot of iron; oatmeal, kale, egg yolks, and cheese contain a lot of manganese, and fracture patients can eat more of these. Animal livers and pork blood have a hematinic effect, which plays a particularly important role in timely blood supplementation after bleeding caused by trauma, so they can be eaten regularly.

　　2. In the middle stage of fracture (2-4 weeks after injury):Diet should shift from light to moderate high-nutrient supplementation to meet the needs of bone growth. Foods such as bone soup, Cordyceps chicken, fish, eggs, dairy products, and animal livers can be added to the initial diet. It is appropriate to eat more vegetables rich in vitamin C, such as green peppers, tomatoes, amaranth, and radishes.

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

　　(The above information is for reference only; for details, please consult a doctor.)

　　First, treatment

　　According to the skin condition after injury, the range of fracture, and other injuries, choose one of the following methods: ①Closed reduction followed by cast immobilization. ②Open reduction and internal fixation. ③Percutaneous pin fixation. ④Bone traction (i.e., calcaneal traction). ⑤Combination of two pins with cast immobilization. ⑥External fixation frame. ⑦Internal fixation methods using pins through the calcaneus, ankle joint, and tibia.

　　The following points should be noted during treatment:

　　If there are no blisters, no damage, closed reduction fails, and the bone fragments are comminuted but still fixable with screws, the fracture should be opened for reduction and internal fixation. Attention should be paid to restoring the anatomical relationship of the tibial weight-bearing surface and using multiple Kirschner wires for fixation to maintain the reduction. Radiographs are needed during surgery to observe the reduction. If the reduction is satisfactory, the gaps between the bone fragments can be filled with cancellous bone from the ilium and fixed with screws. A silicone tube is placed in the wound for continuous drainage, and finally, the cast is applied with the administration of broad-spectrum antibiotics.

　　If there is skin abrasion,破损, blisters, or cracks, strict debridement should be performed first, followed by skin trimming and suture, and antibiotics should be administered intravenously immediately. At this time, the proximal tibia and fibula can be pierced with Smith's pins, and correctors can be placed. Then, the fractured ends are separated to realign the fracture surface. Radiographs are taken to check the reduction; if satisfactory, the femur can be immobilized with a cast, with the two Smith's pins fixed within the cast. The Smith's pins are removed after 6 weeks and replaced with a cast on the lower leg for continued immobilization for 4 more weeks. This method is also applicable to cases with no significant skin injury, but severe comminution of bone fragments, and where internal fixation cannot be used.

　　3. When diagnosing explosive fractures, attention must be paid to fractures above the joint (i.e., distal tibia bone fragments). The main fracture line is located near the joint surface, but the fracture line can affect the lower joint surface of the tibia. It can also be caused by displacement of the proximal joint surface fracture fragments, although the fracture has not invaded the tibial joint surface, it can still cause the tibial joint surface to be inclined, thus affecting the ankle joint. Fractures of the distal tibia are usually accompanied by fibula fractures, so the limbs often have a shortening deformity. Treatment should first restore the length of the fibula and perform open reduction and internal fixation. If it is an open fracture or a severe comminuted fracture, external fixation frames can be used for treatment to maintain the length of the tibia and the level of the tibiofibular joint surface. This method is convenient for postoperative dressing changes and can maintain fracture fixation. After 6 weeks, the thigh cast is used to fix the limb until the fracture heals.

　　4. Some distal tibia fractures or explosive fractures, although treated actively, cannot maintain the integrity of the joint surface, and will produce traumatic arthritis, leading to postoperative pain. Ankle joint fusion can be performed, which has little impact on lower limb function.

　　5. Some comminuted open fractures of the distal tibia and fibula are extremely unstable and can still be勉强缝合 skin after debridement. Since the fracture is in a comminuted state, and the ankle joint surface is inclined, it is not suitable to fix the tibia with plates and screws, but plates can be used to fix the fibula, and a screw can be used to fix the distal tibia and fibula, keeping the distal tibia joint surface in a horizontal position, and then using plates and two screws to fix the proximal fibula, and the distal end of the plate is used to fix the plate, fibula and tibia at the same time with a screw. In this way, the proximal end of the fibula has two screws fixed, and there are also two screws fixed between the distal ends of the tibia and fibula, so the tibia and fibula can be fixed better. Finally, plaster cast fixation is used, even if the cast is opened to change the wound dressing, it will not cause displacement of the fracture.

　　Secondly, prognosis

　　Injuries are severe, often呈粉碎性, and the prognosis is poor.