Tibial head fracture

introduction

The fracture of the tibia is also known medically Tibial head fracture designated. This leads to a fracture within the upper end of the tibia (Tibia), usually as a result of an accident. Since this part of the shin is included in the knee joint, a fracture of the tibial head can, under certain circumstances, significantly impair the functionality of the knee joint. Depending on the type, course and extent of the break, different forms of severity can be distinguished.

causes

A fracture of the tibial head is most common in the context of Traffic accidents or falling on the corresponding knee. Such a break can occur in traffic accidents with the car, for example if the knee of the driver or front passenger hits the dashboard in an impact. A harder impact on the extended leg, for example when jumping from a great height and landing on the extended leg, can lead to a fracture of the tibial head. Elderly people in particular are also at risk because they have a lower bone density and break bones more quickly when falling.

Symptoms

In the case of a fracture of the tibial head, pain occurs in the corresponding knee joint, which is usually marked by a significant one swelling and Overheating of the knee and the upper lower leg to be accompanied. Also a bruise (Hematoma) may exist. The pain occurs immediately after the triggering event (accident, fall, etc.) and often makes it impossible to fully stress the knee. There is a strong one Restriction of movement in front. In the knee joint himself often appears effusion.

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Fracture forms

In the case of the tibial head fracture, there are different types of fracture. On the one hand there are the so-called Plateau breaks. The tibial plateau is the upper surface of the tibia, which forms the lower part of the knee joint. At the plateau breaks it now comes to Fractures within the tibial plateau, without that the bone fragments shift against each other. The shin bone remains in its shape even though there are fracture lines. In contrast to this are the Dislocation fractureswhere the Bone fragments emerge from their original position. Due to the proximity of the knee joint, the pieces of bone can get into the joint space and lead to additional damage to ligaments, nerves and blood vessels there. Dislocation fractures are more often associated with a complicated course than plateau fractures.

Complications

Complications are not uncommon, especially with dislocation fractures. The splintered bone fragments can damage surrounding ligaments of the knee joint (Inside-, Outer band or Cruciate ligaments) as well as the Menisci damage. The damaged joint parts can lead to one over the years after the injury Osteoarthritis of the knee come. To prevent this, a fracture of the tibia usually has to be treated surgically. Another special complication is the so-called Compartment syndrome. The result of the injury is a Swelling of the muscles. The muscles on the lower leg are stored in individual compartments or fascia. If there is swelling within these closed boxes, the muscles do not have enough space to expand. So it comes to one quickly Cut off the blood supply. The tissue is poorly supplied with blood and is at great risk of dying. In the clinic, the pressure in the muscle boxes is measured in order to detect a compartment syndrome at an early stage. In such a case, the muscle fascia is surgically split. The lower leg is left open for a while at the surgical scar so that the lower leg muscles can expand and blood flow to the tissue is ensured.

diagnosis

To diagnose a fracture of the tibia, you must X-rays of the affected leg in several levels. On this one can Fracture gap usually already well recognized. Alternatively, such a fracture can be broken using Computed Tomography (CT) to make visible. A MRI examination is only suitable to be accompanying Ligament or meniscus injuries to show. In some cases, an Knee arthroscopy (Arthroscopy) so that the doctor can see exactly how much and where the knee joint is internally damaged. This has consequences for the therapeutic approach.

In addition to the diagnosis of the tibial head fracture itself, the doctor must also have complications, such as a Compartment syndrome, exclude. He will check whether the entire leg is sensitive. He will also be the Feel foot pulses. If these cannot be felt, this could indicate a compartment syndrome. A Pressure measurement within the muscle boxes is also groundbreaking.

therapy

• Conservative therapy

Basically there is the possibility of treating the tibial head fracture conservatively or surgically. Conservative therapy is actually only possible when the bone fragments of the fracture all stayed in place and are not shifted against each other. It is also used when the patient is very old, for example, with many comorbidities who would no longer be able to cope with anesthesia. In the case of conservative therapy the leg in a cast for about a monthso that the bone fragments do not shift and grow back in place.

Is there a Dislocation fracture before, they must Pieces of bone before plastering initially again be brought into their correct position. This is achieved with the so-called Extension therapy, where pull is exerted on the affected leg, thereby stretching it. The bone pieces can thus be brought back into their correct position. Following the plaster treatment are physiotherapy exercises very important to restore and improve mobility in the injured knee joint. As a rule, the knee is fully resilient after about eight to twelve weeks. However, the overall result of conservative therapy is usually not as good as with surgical treatment of the injury.

• Operative therapy

In the vast majority of cases, a fracture of the tibial head is treated surgically. This can the risk of consequential damage (for example osteoarthritis in the affected knee) be minimized. The Bone fragments will be at the operation fixed in their correct anatomical position using plates or screws. Particular care must be taken to ensure that the tibial plateau is reconstructed in an anatomically correct manner, since it forms an articular surface of the knee joint. If the fit is inaccurate, incorrect loading and further consequential damage to the knee joint can develop. After the operation there is also one intensive physiotherapeutic treatment for about three monthsused to mobilize and stabilize the knee joint. The muscles must be strengthened so that they can optimally stabilize the operated knee joint.

Prognosis / healing process / duration

The prognosis or the healing process of a tibial head fracture depends largely on the type of fracture and how successful the therapeutic treatment has been. Simple fractures with no displacement of the bone fragments usually have one better long-term prognosis as complicated comminuted fractures, which subsequently lead to osteoarthritis or other consequential damage more often. With today's medical care, however, it is possible in most cases to achieve a satisfactory operative result and to optimally maintain the functionality of the knee joint. Depending on the chosen therapy method and depending on the complexity of the fracture, the complete healing of the tibial head fracture takes up to the point where the leg is fully loaded again between three and five months. In order to achieve the fastest possible healing with optimal functionality of the knee joint, a intensive physiotherapeutic follow-up treatment significant.

Rehab

The aim of rehabilitation following a fracture of the tibia is the Restoration of the full functionality of the previously injured tibia / knee joint. The therapy concept is individually tailored to the patient, his type of injury, his level of performance and his long-term desired functional level. In the first phase of the injury, when there is still severe pain, swelling and impaired function, rehabilitation aims to To achieve freedom from pain and preservation of the muscles. Once the first signs of inflammation have subsided, the stabilization phase begins, in which the main focus is on building muscles to stabilize the joint apparatus. Over time, you can go back to endurance training, coordination exercises and muscle building with weight loading by increasing the intensity of the exercises. The injured leg is optimally stabilized again and its functionality restored.