كسور الساق عند البالغين - كسر قصبة الساق - كسر الظنبوب Tibial Shaft Fractures In adults (subtitled)

tibial shaft fracture are the most common long bone fracture. In the event of a tibia fracture, the fibula is often broken as well. Tibial shaft fractures are often caused by some type of high-energy collision, such as a motor vehicle or motorcycle crash. Sports injuries, such as a fall while skiing or a collision with another player during soccer, are lower-energy injuries that can cause tibial shaft fractures. sports that involve repeated impact to the shinbones, such as long-distance running. The presence of significant osteoporosis increases the risk for compound or more complex fractures associated with higher morbidity and mortality. Types of tibia shaft fractures. The type of tibia fracture greatly depends on the initial force that causes the break. Direct trauma leads to transverse and comminuted fractures. In Transverse fracture, the break is a straight horizontal line going across the tibial shaft. Rotational (twisting) forces lead to oblique, or spiral fractures. in Spiral fracture, the fracture line encircles the shaft like the stripes on a barber shop sign. Oblique fracture has an angled line across the shaft. A stable fracture involves a crack in the bone that leaves most of the bone intact and in its normal position. This is called a non-displaced fracture. With a displaced fracture, a crack in the bone moves part of the bone so that it is no longer aligned. Stress fractures, also called hairline fractures, are common overuse injuries. These fractures are small, thin cracks in the bone. I will discuss this type of fractures later. When the bone fractures into three or more pieces, this is called a comminuted fracture. Open fractures are fractures where the bone breaks through the skin and can be seen, or a deep wound exposes the bone through the skin. in closed fracture, the bone is broken, but the skin is intact. Symptoms and diagnosis. A tibial shaft fracture usually causes immediate, severe pain. lower leg swelling. Inability to walk or bear weight on the leg. Significantly displaced fractures can lead to a Deformity or instability of the leg. Bone "tenting" over the skin at the fracture site or bone protruding through a break in the skin. To diagnose a fractured tibia, a doctor will ask about a person’s medical history and how the injury happened. then he will perform a careful examination. Open fractures are common and overlying skin should be carefully examined for small lacerations. Severe fractures from high velocity trauma can be associated with neurovascular injury. Therefore, it is important to examine distal pulses and lower extremity motor and sensory function. Definitive diagnosis of a tibial shaft fracture is made by plain radiograph. The radiographic features help to determine whether conservative or operative treatment is preferred. The anteroposterior and lateral radiographs obtained should include the entire length of the lower leg from knee to ankle. sometimes the fracture lines can be very thin and hard to see on an x-ray. A CT scan can help your doctor see the lines more clearly. MRI examination is the only method to identify early symptoms of stress injuries, even when a fracture line is not visible. Initial treatment. Initial treatment is stabilization of the fracture is accomplished with a long leg posterior splint. Ice and elevation minimize swelling and, along with analgesics, help to control pain. These treatments continue for 48 to 72 hours, or until definitive management begins. Close monitoring during the initial treatment phase must allow doctors to detect any emerging compartment syndrome or change in neurovascular status. immediate antibiotics should be administered within 3 hours for all open tibia fractures. in addition, tetanus vaccination status should be confirmed and appropriate prophylaxis should be administered if necessary. all open tibia fractures require an emergent surgical debridement within 12-24 hours of injury. definitive treatment. Closed, well-aligned, nondisplaced tibial shaft fractures may be definitively treated with a long leg cast. certain patients who may be non-ambulatory, or those unfit for surgery can also be treated nonsurgically. the acceptable alignment criteria are: Most fractures cause some swelling for the first few weeks. Your doctor may initially apply a splint to provide comfort and support. Once the swelling goes down, your doctor will change the splint to a full cast. a long-leg cast is applied that incorporates the knee and ankle joint, Surgery : Intramedullary nailing . internal fixation with plates and screws. External fixation. Complications. acute compartment syndrome (ACS), Fat embolism syndrome . Bone infection . malunion . Delayed union Nonunion knee pain, leg swelling, reduced ankle mobility, and thigh and calf muscle atrophy.