Sacrum fracture

Introduction to tibia fracture Tibial fractures can occur alone or simultaneously with pelvic injuries; the former is less common, while the latter accounts for 30% to 40% of pelvic fractures. Therefore, the absolute incidence is much higher than that of single-shot, and male More common; more complex in treatment, need to be considered together with the treatment of pelvic fractures. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: pelvic fractures, shock

Cause of humeral fracture

(1) Causes of the disease

Both direct violence and indirect violence cause this damage.

(two) pathogenesis

The mechanism of patella fracture associated with pelvic fracture is consistent with pelvic fracture, mostly due to pelvic anterior and posterior compression. Please refer to the pelvic fracture section for a single tibiofibular fracture.

1. Direct violence to fall from a height, it is common to see the ground when it is slid down or rolled down; secondly, it is hit by a heavy object, or it is caused by a direct impact of a vehicle or the like.

2. Indirect violence is more common in the downward conduction from the lower side (the distal end of the appendix), while the chance of violence from the top to the bottom is very small; it can also cause avulsion fractures due to ligament traction.

Among the more common combined injuries, many of the pelvic fractures are caused by direct violence. The common injuries of the tibia fractures mainly involve the rectum and anus.

Prevention of tibia fracture

Should try to avoid violence, the elderly try to avoid strenuous activities, anti-skid, anti-fall, to avoid the sudden landing of the crotch.

Coma bone fracture complications Complications pelvic fracture shock

Such as combined with pelvic fractures can be combined with hemorrhagic shock.

Symptoms of humeral fractures Common symptoms Neuralgia Persistent pain, sensory disturbance, comminuted fracture, shock, persistent pain, humeral fracture

The clinical symptoms of tibiofibular fractures vary greatly depending on the degree of damage. The following points should be noted during the examination:

1. Pain after complaints of persistent pain in the humerus after trauma, should be examined in detail, clear strip tenderness is mostly caused by fractures, and can determine the fracture line along the direction of tenderness; conduction pain is lighter than lumbar fractures, especially It is when the standing position is checked.

2. When sitting in a sitting position, gravity directly acts on the appendix and causes pain. Therefore, the patient likes to take a seat when he comes to the doctor, or the hip is seated on one side.

3. Subcutaneous congestion due to the shallow humerus, deep damage is easy to be exposed under the skin, so in the physical examination can be found in the hematoma at the fracture, subcutaneous congestion or skin contusion, abrasions and so on.

4. Anal examination of the anus can be based on tenderness, displacement of the fracture and bleeding, speculation of the fracture line, whether there is obvious dislocation and whether it is an open fracture.

5. Saddle area sensory dysfunction and pupil fracture can stimulate the sacral nerve branch and appear in the saddle area, such as hyperesthesia, tingling, numbness and sensation.

6. Other fractures involving the 1st and 2nd vertebrae may have symptoms similar to sciatica (1, 2 nerves form part of the sciatic nerve), including sensory, motor and Achilles tendon reflexes. Patients with pelvic fractures should pay attention to General conditions, with or without shock, fat embolism and other complications, and pay attention to the presence of combined rectal, bladder injury.

7. Tibial fractures are generally divided into the following four types.

(1) transverse fracture: transverse fracture can be seen in all planes of the humerus, but it is more common in the middle and lower segments. It happens to be the lower edge of the ankle joint (equivalent to 4 to 5), when the patient falls on the back. The vertebrae touch the ground, so that the lower part of the humerus is easily broken by direct impact of violence. Many of the fractures are fractured, and the length of the crack is different. It extends from one side to the middle, and can also run through the entire humerus. There are few dislocations, but if violence Excessive fierce, it can cause the upper part of the atlas to shift forward with the lumbar vertebrae, or the lower fracture piece can be displaced forward, and the stenosis of the fistula can cause radial nerve injury, resulting in saddle area symptoms, if 2,3 nerve When affected, the function of the bowel movement may be impeded. Sometimes the distal fracture piece may be displaced by the levator ani muscle and may also cause the sacral nerve symptoms. The most serious complication of the disease is rectal rupture, cerebrospinal fluid leakage and Retroperitoneal hematoma, etc., in addition to CT examination, the general X-ray film can also be displayed, especially the lateral position is relatively clear; at this time should pay attention to observe the shape of the tibia leading edge, the normal humeral leading edge is smooth, smooth ,sharp In the case of a fracture, there is an abnormality in the leading edge cortex or wrinkles, unevenness and overlap.

(2) Longitudinal fractures: Longitudinal fractures are rare compared with transverse fractures, which are caused by intense violence. They occur at the same time as pelvic fractures, or there is a side ankle joint separation. In general, the fracture line occurs on the side. At the pupil hole, because the anatomy is weak, the direction and extent of displacement are consistent with the entire pelvic fracture. Therefore, it can also be regarded as part of the pelvic fracture, but it is rare to be seen alone. There are sacral nerve branches, so the neurological symptoms are more common. The local and limb symptoms vary depending on the state of the entire pelvic fracture. In severe cases, the pelvis and the ipsilateral lower limbs are displaced upward, and the bladder may appear. , rectal symptoms and retroperitoneal hematoma.

(3) comminuted fractures: multiple direct violent effects on localized stellate or irregular comminuted fractures, the displacement is not obvious, clinically, if you do not pay attention to the examination, easy to miss diagnosis, and should pay attention to observe X-ray sheet.

(4) Avulsion fracture: It is easy to miss the avulsion fracture at the attachment point of the lower tibia of the tibia due to the sacral ligament.

Examination of the fracture of the tibia

1. X-ray film at the same time to take the right position and lateral X-ray film, suspected and ankle joint involvement, should be taken obliquely, in addition to the observation of the fracture line, it is necessary to type and determine the treatment, because There are more contents in the intestines, and the enema should be cleaned regularly before filming.

2. CT and MRI examination CT examination is more clear than X-ray plain film, especially for determining the fracture line and its displacement direction; while the observation of surrounding soft tissue is clear by MRI examination.

Diagnosis and diagnosis of tibia fracture

1. History of trauma Pay attention to the location and violent direction of the ankle when trauma occurs. Most patients have obvious local symptoms immediately after trauma, often complaining about the special medical history of the hips when they fall.

2. The clinical manifestations should be carefully examined. It is generally not difficult to diagnose. The author has encountered many cases of such wounded people at the Xingtai earthquake site. All of them were diagnosed as tibiofibular fractures by finger palpation and can determine the fracture line and fracture type, such as transverse fracture. , comminuted fractures, etc., were confirmed by X-ray films. Therefore, as long as the injury is carefully performed according to the routine, most of them can be diagnosed in time; at the same time, an anal examination should be performed to determine whether there is rectal injury.

3. X-ray film simultaneously photographs the orthotopic and lateral X-ray films. If the suspected ankle joint is involved, the oblique position should be taken. In addition to observing the fracture line, it is necessary to classify and determine the treatment. There are more contents in the intestines, and the enema should be cleaned regularly before filming.

4. CT and MRI examination CT examination is more clear than X-ray plain film, especially for determining the fracture line and its displacement direction; while the observation of surrounding soft tissue is clear by MRI examination.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.