If movement restrictions with swelling in the area of the lower leg occur after a traffic accident or an accident during sports, a lower leg fracture may have occurred. Far more often, however, this injury occurs as an open fracture. Skiers and motorcyclists are very often affected.
What is a lower leg fracture
A lower leg fracture is a fracture of one or both long bones of the lower leg. A distinction is made between the tibia and the fibula. These two bones ensure the stability of the lower leg, with the tibia bearing most of the body’s weight and the fibula providing support. Fractures of the lower leg occur as a result of direct or indirect force, which can frequently occur in accidents in sports, at home or in road traffic. Depending on the type of fracture, an additional distinction is made between compression fracture, bending fracture, and torsion and segmental fracture. All types of fractures can occur as either open or closed fractures of the lower leg, but open fractures are far more common. In closed fractures, in addition to a restriction of movement with pronounced pain, there is also a deformity as well as swelling of the lower leg. An open fracture is an emergency that requires immediate medical attention.
Causes
The cause of a lower leg fracture is always an impact of force on the affected area of the lower leg. A distinction is made between fractures to the shaft of the lower leg bones and fractures distal to the body. The shaft of the bone is stronger than its structure in sections distal to the body. While the forces acting on the bone in a traffic accident can be even more pronounced than in sports, fractures on the shaft of the bone therefore occur mainly after traffic accidents, while fractures distal to the body occur more often after sports accidents. This type of lower leg fracture is a classic injury in skiing.
Symptoms, complaints and signs
A fracture of the lower leg is usually always associated with symptoms and signs that can be self-diagnosed by the affected person. In most cases, there is severe swelling associated with a lower leg fracture, which can be seen immediately at the affected area. If it is an open fracture of the lower leg, then of course the fracture is visible to the naked eye. Usually there is an audible crunching sound, provided the leg can be moved. Of course, with such a fracture, the entire range of motion is severely restricted, so that a normal gait is not possible at all. Even the smallest movements cause severe pain. For this reason, medical or inpatient treatment is essential to eliminate the symptoms described. Anyone who forgoes medical and surgical treatment at this point is taking a great risk. In such a case, the individual symptoms will worsen considerably. The pain will become more severe, so that even at rest a stabbing pain will persist. If you do not put off going to the doctor, you will feel an improvement within a short time. The symptoms that occur subside and thus nothing stands in the way of a full recovery.
Diagnosis and course
In the case of an open lower leg fracture, the diagnosis is confirmed by X-rays in two planes. This also allows other injuries to be ruled out or detected. It is possible that blood vessels have been injured by the lower leg fracture. These can be examined by so-called Doppler sonography. This is a painless ultrasound examination. Vessels can also be visualized with the so-called angiography. For this purpose, a contrast medium is injected into the affected blood vessels so that they are visible in a subsequent X-ray image. If injury to tendons and ligaments is suspected, an MRI (magnetic resonance imaging) must provide information about the severity of the additional injuries. If there is severe swelling of the lower leg, a compartment pressure measurement is often taken. Any increase in pressure in the patient’s muscle tissue can lead to damage in the tissue and even death of the area affected by the lower leg fracture.
Complications
First and foremost, those affected by a lower leg fracture suffer from very severe pain. These can be so severe that the affected person loses consciousness and possibly injures himself again during another fall. Furthermore, the pain not infrequently spreads to the neighboring regions of the body. There are considerable restrictions in movement, so that the affected person is usually always dependent on the help of other people in his daily life. In most cases, the lower leg fracture is an open fracture, so that infections or inflammations can also occur. The affected regions are severely swollen and there is significant redness and bruising. In most cases, complications only occur with a lower leg fracture if no treatment of the fracture takes place. In this case, the bone may grow together incorrectly. Complications do not occur during the treatment itself. By immobilizing the region, the discomfort is alleviated. This results in a positive course of the disease. Also, the life expectancy of the patient is usually not negatively affected by the lower leg fracture.
When should one go to the doctor?
If severe pain occurs in the leg area after a fall, force, or accident, it should be monitored further. If the pain increases in intensity and magnitude or remains unchanged for an extended period of time, a visit to the doctor is advised. If the foot cannot be placed on the ground without pain after the triggering event, this is unusual. The affected person should be examined and treated. Disturbances in locomotion, restriction of freedom of movement as well as a sudden decrease in physical performance are signs of a present disease. A doctor is needed, since spontaneous healing is not to be expected in the case of a lower leg fracture. If there are visual changes of the bones in the area of the lower leg or if there are abnormalities of the skin appearance, this is a sign of a health irregularity. In the case of the formation of bruises or a sensitivity to pressure, further tests are necessary to clarify the cause and establish the diagnosis. If the affected person can no longer shift his own weight to one of his legs without discomfort, he needs help. If physical activities can no longer be carried out as usual and sensory disturbances of the leg or feet become apparent, a doctor should be consulted. Circulatory problems and a tingling sensation on the skin are other signs of an existing irregularity.
Treatment and therapy
Treatment of a lower leg fracture depends on the severity of the injury and other associated injuries to tendons, ligaments, or vessels. In this regard, all open fractures are treated surgically. This also applies to displaced fractures in the tibia and fractures with additional injuries to the ankle joint. The fractured bone can be stabilized with an intramedullary nail. The use of plates and screws is also possible. An external fixator, called an external fixator, provides stability to the fracture site with externally placed screws and rods. If the muscles and connective tissue are injured, multiple surgeries are necessary to reconstruct the damaged soft tissue mantle. Open fractures often require the patient to take an antibiotic. Physical therapy exercises must be started after healing to restore mobility to the fractured lower leg. Simpler fractures of the tibia, whose bone ends have not shifted against each other, as well as fractures of the fibula, can be treated with a plaster cast, in which the lower leg fracture can heal in four to six weeks without further consequences for the patient.
Prevention
Since a lower leg fracture usually occurs due to an external force, there are no direct measures to prevent this injury. By selecting the appropriate sports equipment for skiing and appropriate motorcycle clothing, concomitant injuries of the lower leg fracture, such as involvement of the ankle joint or injuries to tendons and ligaments, can at best be reduced.
Aftercare
Regular checks of the lower leg by X-ray are an indispensable measure to assess bone healing.Complications such as malpositions or delays in fracture healing can thus be detected at an early stage. Otherwise, the follow-up care of patients depends on whether the lower leg fracture was treated conservatively (without surgery) or surgically. With the conservative procedure, a plaster cast must usually be worn for four to six weeks. During immobilization, anticoagulant medication is administered to prevent thrombosis (blockage of blood vessels by blood clots). Physical therapy can begin only after the cast is removed. If the fracture was treated surgically with nails, screws or plates, physiotherapy measures can begin a few days after the operation. Through a second operation, the inserted materials must be surgically removed after 12 to 18 months. This requires another hospital stay. In the case of complicated fractures, additional surgical interventions may be necessary due to malpositions or joint instabilities. The basis for effective recovery is rehabilitation (rehab). After the bone has healed, physiotherapy is used to continuously increase the leg’s ability to bear weight. Systematic gait training is designed to prevent malpositions when walking. Other goals of rehab are to strengthen the muscles of the lower leg and promote mobility.
Here’s what you can do yourself
An uncomplicated fracture of the thigh usually heals quickly. The patient must take it easy and perform physiotherapy according to the doctor’s instructions. An active lifestyle is optimal, and the injured limb must be excluded from sports and stretching activities. Smokers should stop consuming cigarettes, and stimulants such as alcohol and caffeine should be largely avoided. After a fracture, a change in diet is recommended. A diet rich in vitamins and fiber is important. In addition, calcium and vitamin D supplements as well as omega-3 fatty acids and curcumin contribute to fracture healing. Proven remedies include flaxseed oil, krill oil, and various types of fish, eggs, and gently prepared fruits and vegetables. Shock wave therapy, magnetic therapy, and laser irradiation stimulate blood flow to the fracture zone and thus recovery. If these measures are followed, the lower leg fracture should heal quickly. The doctor must be informed about the state of health and any complaints so that the therapy can be adapted and the healing process optimally supported. If complications such as pain or numbness occur, the responsible physician must be informed. Self-care also includes taking the prescribed painkillers and anti-inflammatories properly. Certain medications, such as diclofenac or ibuprofen, interfere with bone metabolism and should be taken only after consultation with a physician.
