Therapy
A lower leg fracture is usually, with a few exceptions, treated surgically. The conservative, non-surgical treatment after a lower leg fracture is accompanied by some serious potential complications, so that this type of therapy can usually no longer be recommended. Thromboses, joint immobility, malalignment and slow healing are only a few of the possible complications after non-surgical treatment.
If there is a clean fracture and the two pieces of bone are not displaced against each other, the injury could be treated without surgery by immobilizing them with a plaster cast. However, due to the complications listed above, this type of treatment has receded into the background. The surgical treatment of a lower leg fracture depends mainly on the location of the injury.
If the fracture is close to the knee joint, a so-called plate osteosynthesis is usually used. Here, the bone pieces are brought into their correct anatomical shape and screwed together using a plate that is adapted to the bone. In the case of fractures that are located in the middle area and closer to the ankle joint, so-called medullary nails or locking nails are used.
Long metal pins are inserted lengthwise through the bone to provide stability. The advantage of this treatment method is the fast loading capacity of the leg after the operation. In complicated comminuted fractures, where there are many bone splinters, a surgical procedure may be necessary to immobilize the leg from the outside (external fixator).
In any case, due to the limited mobility of the leg after the operation, a blood-thinning medication (usually heparin) should be taken to prevent thrombosis. After the operation, the rehabilitation phase begins, which can last for varying lengths of time depending on the severity of the lower leg fracture. It is important, as soon as possible, to learn to walk with walking aids and to slowly put weight on the leg again.
Intensive treatment and training through physiotherapy exercises can be helpful here. Attention should always be paid to complications and infections of the suture and bone should be quickly recognized and remedied. Whether a plaster cast is used for therapy depends on the type of lower leg fracture.If it is an open fracture, it must be operated on immediately and a so-called external fixator is often attached, in which the lower leg fracture is stabilized with rods and screws and no plaster is necessary.
A plaster cast is used for fractures that are located in the part of the lower leg close to the joint, however, and where there has been only a slight malposition and the bone ends resulting from the fracture of the lower leg have not shifted against each other. A plaster cast is also used to heal a fracture of the fibula. Not only the lower leg is put in a cast, but the cast is applied up to the thigh.
The cast then remains on the leg for four to six weeks until the fracture has healed. In some cases, a plaster cast is only used in the further course of the healing process. For example, a wire or nail can be shot through the heel bone, and a weight can then exert a pull on the nail via a rope construction.
In this case, a thigh cast is only applied after about four weeks. In the further course of healing, the thigh cast can be reduced to a lower leg cast. Even if there are circulatory problems in the leg or a local inflammation, the conservative method of treatment with a plaster cast is preferred, since the conditions can be made even worse by an operation. If the leg has to be immobilized for a long time with a plaster cast, there is an increased risk of a blood clot forming, which can block vessels (thrombosis). Therefore, preventive anticoagulant injections must be given.
