Injury Location:
A compound tibia fracture involves multiple body parts in the lower leg. The main bone affected is the tibia bone, which is crucial for bearing weight and enabling an individual to stand and walk. Surrounding the tibia bone are muscles including the anterior tibialis, extensor digitorum longus, and extensor hallucis longus. The tibial nerve, which surrounds the tibia, is essential for the lower leg to receive signals from the brain. Additionally, the skin that covers the tibial muscles is involved. Together, the tibia bone and surrounding muscles allow for standing and walking, while the nerves facilitate communication with the brain.
Signs/Symptoms:
A compound tibia fracture presents with sharp pain in the lower leg region, along with swelling, bruising, and bleeding. The tibia bone can visibly break through the muscles and skin, creating an open wound. This injury also results in instability and reduced range of motion.
Treatment:
Immediate First Aid
Call 911 if the person is unconscious, or if there is spurting or pooling blood. Begin by stopping the bleed using any barrier device available (a sterile wrap is advised). Immobilize the wounded region and avoid too much direct movement of that area.
Diagnosis
A doctor will conduct assessments, physicals, and scans to determine the region and severity of the fracture. The initial evaluation assesses the injuries, including the injury history (how and where the individual got it) and the medical history of the patient. The doctor will physically examine the wound to determine its site. X-ray scans help further affirm the degree of severity and the location of the fracture, showing the pieces of bones and the distances between them. A CT scan (computerized tomography), though not always required, may be necessary to further understand the fracture.
Emergency Medications
A tetanus shot is given if the patient has not had one in the past five years, as the open nature of a compound wound makes it more susceptible to infections, and this shot helps prevent infection from Clostridium tetani bacteria. Antibiotics are administered to fight bacteria that can potentially cause infection.
Stabilize the Wound until Surgery
Casts are used to keep the bone from moving and causing more damage to muscles and nerves. The wound is cleaned before surgery to ensure a clean procedure and to further prevent infection. Debridement removes all contaminated material and damaged tissues, while irrigation washes the wound with fluid.
Internal/External Fixation
Open fractures can be treated by either internal or external fixation. Internal fixation involves placing metal implants such as rods, plates, and screws inside the bone on the broken surface, allowing the bone to stay in place and eventually heal. External fixation involves placing metal screws and pins above and below the fracture site to stabilize it. Usually, external fixation is followed by internal fixation, though sometimes external fixation alone may be sufficient for healing.
Complex Wounds
Certain wounds are too severe to be cleaned immediately. These wounds are temporarily covered with dressing to avoid further complications. Permanent closure of these wounds is achieved by using skin from other parts of the body.
Return to Daily Life
Tibia compound fractures usually take more time to heal, and patient medical history can also impact the recovery duration. Specific exercises, instructed by a physical therapist, help restore function in bone and muscle.
Rehabilitation and safer practice:
Recovery Plan for Compound Tibia Fracture
Bedrest and Initial Phase: 1-4 Weeks
Bedrest is required for the first 12 weeks, or more if advised by the physician.
Engage in non-weight bearing activities such as hip exercises and early quadriceps activities.
Intermediate Phase: 4-6 Weeks
Gradually increase weight-bearing activities over time.
Incorporate knee bending and quadriceps activities to enhance muscle function and joint flexibility.
Advanced Phase: 6-12 Weeks
Progress to full weight-bearing exercises.
Focus on improving knee and ankle mobility.
This plan may change based on the severity of the fracture but serves as a basic outline for regaining mobility.
Lifestyle and Diet Adjustments
Increase calcium intake to prevent the development of osteoporosis (mineral deficiency in the bones).
Exercise daily to strengthen bones.
Avoid smoking, as it limits the production of bone cells.
Practice safe driving habits to prevent crashes.
Keep the house clean to prevent falls.
Work Cited
"Tibia (Shin Bone): Location, Anatomy & Common Conditions." Cleveland Clinic, 6 May 2022, https://my.clevelandclinic.org/health/body/23026-tibia. Accessed 18 May 2024.
Cleveland Clinic. "Compound Fracture: What Is It, Types, Symptoms & Treatment." Cleveland Clinic, 29 Sept. 2021, https://my.clevelandclinic.org/health/diseases/21843-compound-fracture. Accessed 18 May 2024.
American Academy of Orthopaedic Surgeons. "Open Fractures." OrthoInfo, May 2023, https://orthoinfo.aaos.org/en/diseases--conditions/open-fractures/. Accessed 18 May 2024.
Ashall, G., and A. L. H. Moss. “Severe Open Fractures Of The Tibia.” British Medical Journal (Clinical Research Edition), vol. 296, no. 6621, 1988, pp. 573–74. JSTOR, http://www.jstor.org/stable/29529864. Accessed 18 May 2024.
Chandra, C. Pradeep, et al. "A study on internal fixation of compound fractures of tibia using interlocking nail without reaming." Journal of Evolution of Medical and Dental Sciences, vol. 5, no. 45, 6 June 2016, pp. 2797+. Gale Academic OneFile, dx.doi.org/10.14260/jemds/2016/653. Accessed 18 May 2024. Assessed and Endorsed by the MedReport Medical Review Board