| Sažetak | Potkoljenicu čine dvije kosti, goljenična kost (tibia) i lisna kost (fibula). Prijelomi tibije najčešći su prijelomi dugih kostiju s incidencijom 2 na 1000 u godini dana, češći u mlađih muškaraca. Javljaju se kao rezulat visokoenergetske ozljede, npr. pri automobilskim, skijaškim ili biciklističkim nesrećama, ili kao rezulat ozljede niske energije, pri padovima, kontaktnim sportovima, trčanju i slično. Klinički se najčešće prezentiraju prisutstvom boli, edema, patološke pokretljivosti, a ozljeđenik ne može stati na nogu. Klinička slika može varirati ovisno o anatomskoj lokaciji prijeloma, pa se tako kod prijeloma tibijalnog platoa mogu javiti još i ozljede ligamenata i meniska koljena, dok je kod pilon fraktura moguće oštećenje tibiofibularne sindesmoze. Dijagnoza se potvrđuje radiološkim nalazima, najčešće rendgenskom snimkom u dva smjera, anteroposteriornom i lateralnom, koja se kod prijeloma tibijalnog platoa upotpunjuje i trećom, interkondilarnom snimkom. U slučaju opsežnije ozljede i ozljede koja zahvaća meko tkiva, može se uraditi CT i MR. Početno liječenje prijeloma potkoljenice obuhvaća imobilizaciju, primjenu analgetika, leda i elevaciju uda iznad razine srce. Konzervativno liječenje se temelji na 3 Boehlerova načela: repoziciji, retenciji i rehabilitaciji. Najčešće se, neoperativno liječe prijelomi bez pomaka, manualnom repozicijom i imobilizacijom u sadrenom zavoju kroz 12 tjedana. Prijelomi s pomakom, većom angulacijom, neurovaskularnim ozljedama i otvoreni prijelomi se liječi kirurški, unutarnjom i vanjskom fiksacijom. Prijelomi potkoljenice mogu se komplicirati, najčešće akutnim kompartment sindromom, nerovaskularnim ozljedama i infekcijama. Rehabilitaciju valja započeti što ranije nakon prijeloma. |
| Sažetak (engleski) | The lower leg is composed of two bones, shinbone (tibia) and calf bone (fibula). Tibial fractures are the most common fractures of all long bones in the human body with incidence of 2 per 1000 in a year, more frequently affecting younger men. They occur in both high energy trauma, such as car accidents, downhill skiing, and cycling accidents, and low energy trauma such as falls, contact sports, distance running etc. These fractures are clinically presented as pain in the affected limb, edema, deformity of the lower leg, also the patient cannot stand on their feet. The clinical picture may vary depending on the anatomic location of the fracture, so in conjunction with proximal tibial fractures, ligamentous and meniscal injuries frequently occur, and in the case of pilon fracture, injury of tibiofibular sindesmosis may be present. The diagnosis is confirmed by radiological findings, usually anteriorposterior and lateral x-ray should be obtained, while in case of tibial plateau fractures, the third, intercondylar projection has proved to be useful. In presence of more extensive injury , or injury involving soft tissue, the finding may be complemented by CT scan or MRI. Initial management of tibial fractures includes immobilization, analgesics, elevation of the limb above the heart level, and ice. Conservative treatment is based on three Boehler's principles: reposition, retention and rehabilitation. Fractures without displacement can be treated nonoperatively, with manual reposition and cast immobilization for 12 weeks. Fractures with displacement, major angulation, neurovascular injury or open fractures are treated operatively, by internal or external fixation. Lower leg fractures can be complicated by acute compartment syndrome, neurovascular injury or infections. Rehabilitation should be started as soon as
possible after injury. |
