Tibial head fracture
introduction
The tibial head fracture is a fracture of the Shin (Tibia) in its upper area, i.e. near the knee. Typically, such a fracture is caused by a accident-related force on the shin itself. The exact pattern of the fracture differs depending on how the accident happened. Depending on the type of fracture, the whole thing is then either with the help of a Plaster of paris or but operational provided.
causes
As already mentioned, the tibial head fracture is usually caused by a Violence. Both direct mechanical forces on the shin and a landing on the shin may be the cause Legs in the event of a fall from a great height.
In addition, as with all broken bones, there are also internal causes, such as one osteoporosis or a Bone tumor conceivable. The bone substance becomes so unstable and porous that a fracture can occur with minimal external stress.
But that is much more common traumatic Root cause. Typical for this are among others Impact injuries on the dashboard as part of a Car accident, but also direct influences. Landing on the straight leg can also cause a tibial head fracture. This does not even require particularly high heights. Even jumping down a few steps or the like can cause a fracture if the landing is unfavorable.
diagnosis
The basis of the diagnosis is the exact examination of the Knee joint . It should be paid particular attention to the extent to which the stability of the Tapes and other structures are preserved or affected. There are also some on the tibial head Muscles and Tendons their function can be affected by a fracture or further strain on the muscles can worsen the symptoms.
Subsequently, if a tibial head fracture is suspected, imaging is carried out in the form of a X-ray image in 2 levels. Since this usually only confirms the presence of a fracture, but the injury can only be roughly estimated, an additional one can then also be performed CT examination be necessary. In the case of suspected severe soft tissue damage, a MRI helpful in assessing any ligament injuries.
With the help of imaging, a further division into different Fracture types respectively. Depending on the type of accident, it may also be necessary to injure Vessels to be excluded in the vicinity of the injury. This can be done, for example, with the help of a simple Ultrasound happen.
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Classification / division
Depending on the type of injury caused by the course of the accident, the tibial head fracture can be divided into different ones Types of fracture subdivide. This subdivision is based on the so-called AO classification. A distinction is made primarily according to whether only through the break a or the same several fragments have arisen. The so-called Impression fractions of the Depression fractures distinguished.
Another important criterion is the question of whether the fracture extends to Joint space extends and to what extent this is also affected. According to these criteria the respective injury can then be one of the degrees ABC be allocated. But there are also other sub-groups.
ICD code
The ICD system is a international coding systemto clearly record diseases. Each disease can be classified with a unique code. The ICD code for a fractured tibial head is S82.1A further subdivision with regard to the location of the fracture or the structures involved is also possible within the ICD code. Then for example S82.11 for a tibial head fracture involving the fibula, i.e. the Fibula.
Symptoms
Typical symptoms of a tibial head fracture are besides the Pain below the Knees, also one swelling in this area. The pain will be taking burdenif this is still possible worse.
The fracture usually creates instability in the Lower leg. Depending on the injury pattern, the lower leg can also be affected by his typical axis, or twisted be. In addition, it can form on the entire lower leg Hematomas because blood vessels can also be affected by the injury.
Are through the break too annoy It may also be that feeling in the lower leg or area foot is disturbed. However, this sensitivity can also recover after the therapy, especially with quick care.
Conservative therapy
The therapy depends very much on the Extent of injury from. With a slight fracture, e.g. if the tibial plateau has only a few cracks, a conservative therapy sufficient. This then usually consists of the leg with a plaster to calm down. Sometimes it may be necessary to close the leg before putting on the cast repositionso that the fracture heals in its natural position.
Usually the plaster of paris has to be 4-6 weeks remain.
It is also possible to use other methods that fix the leg in a certain position. This includes above all Rail systems.
After the immobilization phase, it is particularly important to start the therapy as early as possible through a physical therapy to complete. This can often result in too pronounced muscular dystrophy prevented or muscles are rebuilt.
If the response to therapy is good, the leg can then usually after about 3 months to be fully charged again.
Overall, however, is conservative treatment more tedious than the operation. Since the time in which the leg is immobilized by a splint is also longer than in the surgical procedure, you often have to plan a little more time until complete healing.
OP methods
In most cases it is necessary to have a tibial head fracture operational to provide for a long term smooth articular surface and to enable undisturbed movement. In the case of smaller fractures, however, the operation may be sufficient arthroscopic perform. In doing so, the joint surface is merely raised a little and thus smoothed.
In addition, you can reline your own bone tissue.
In most cases, however, is one open surgery necessary. The leg is pulled back on his normal axis brought. This train is then either with the help of a Fixators or through plates, Screws and Wires Maintained enough to allow the fracture to heal in the correct position. In the process, any bone fragments that may have arisen from the accident are fixed again.
In all operations it is particularly important that not only the leg axis is restored, but also one if possible smooth articular surface arises. This is especially important for a stronger one arthrosis To prevent development on the operated knee. Of course, any existing injuries to the Ribbons or Tendons of the knee. Damage to blood vessels or nerves can also be partially taken care of.
Even after the operation, the leg will then have a rail supplied and so immobilized. Physiotherapy also helps to prevent excessive muscle breakdown and early for the mobility of the Joint to care. For this purpose, the leg is primarily moved passively immediately after the operation. In the further course, active training and strengthening of the muscles are in the foreground.
Surgical aftercare naturally also includes sufficient intake of Painkillers. Especially when you try to be particularly brave after the operation, you can do it quickly chronic pain arise. Therefore, if you are in pain, you should always ask for adequate pain reliever medication.
Metal removal
Whether it is necessary to remove the material brought in during the operation depends not only on the operation procedure but also on how old you are and whether you have any with the implanted material complaints Has. Since all plates and screws have a foreign body it can always represent Irritation and Body reactions come to the material. Many patients find the materials uncomfortable.
In some cases it can also be that the plates etc. then tend to get in the way of further healing at some point, for example because they burden pain. In these cases, of course, metal removal is always useful.
Otherwise one can generally say that it is at younger people it is more advisable to remove the foreign material. After all, you carry it around with you for quite a while and that Risk of later complications increases.
In addition, the foreign material may cause the Building new bone material delayed or prevented and thus stands in the way of further healing.
As an older person, it can be perfectly legitimate to leave plates or screws as they are. Especially when this no complaints can do so OP risk can be saved on removal.
If plates or screws remain after surgery and need to be removed later, this removal is usually the case after about a year necessary. The procedure itself is usually very short. Since the removal of metal results in significantly less tissue damage than the original operation recreation essential here more quickly. In most cases, the load must first be increased here too. A full load is usually possible again after a few days.
personal injury compensation
If a tibial head fracture occurred in an accident, it can be a victim Compensation for pain and suffering from the person who caused the accident to stands. For that he has to the accident but very clearly documented be. Also the actual guilt of the person concerned must be clarified.
In general, the amounts of compensation in Germany are usually rather low range. Big sums as you know them from film and media are not possible here. Especially when a court determines the compensation for pain and suffering, the amounts are usually manageable.
However, by completing a Comparison Somewhat higher sums can be achieved with the polluter or his liability insurer. Especially if the person has a Avoid negotiation would like to.
Various factors play a role in determining the compensation for pain and suffering. Besides the Severity of damage that too Age of the person concerned, of the Course of treatment and of course the ones to be expected Long-term consequences.
Also social and professional impact the injury are taken into account here. There are tables with approximate guide values for the approximate amount of compensation for pain and suffering. You should be careful with the statements made by many lawyers about the amount of compensation for pain and suffering. As a rule, a tibial head fracture caused by another can cost around 5,000-15,000 euros calculate. Higher sums are only to be expected in the event of extreme consequential damage.
forecast
The prognosis depends greatly on the particular injury and the Success of therapy and can therefore not be specified as a blanket. In particular one persistent follow-up treatment and physical therapy has an important influence on the healing process and the later resilience and mobility of the leg.
The risk again bone- or Cartilage damageand the risk of an earlier development of osteoarthritis are increased.
This is especially the case when the articular surface not healed smoothly or there is still an axis misalignment after the therapy. Even if other structures in the knee area are also affected, healing may be delayed or the damage may not heal completely. Overall, however, exist good chance of recovery, especially if the follow-up treatment is carried out consistently.
