Surgery for lower leg fractures

Lower leg fractures with complicated or periarticular fractures of the tibia are treated surgically, i.e. fixed with plates, screws or nails. Simple tibia fractures or fibula fractures can be treated with a plaster cast.

The lower leg consists of two bones; the thicker of the two is called the tibia and the thinner the fibula. A firm bandage is usually sufficient to treat a fibula fracture. A plaster cast or even surgery is rarely needed. Tibia fractures are always treated with a plaster case or with an operation. A plaster case is used for simple, uncomplicated shaft fractures. If the patient has suffered an open fracture, then plates, screws or nails are used to fix it. The same applies for particularly complicated breaks (several fragments, displaced fractures) and periarticular fractures (tibia head fracture). [Osteosynthesis] is the treatment of bone fractures with metal parts.

What preparations are carried out before the procedure?

Firstly, an x-ray is carried out to determine the extent and scope of the injury. In some cases, a CT scan is also used.

All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. The patient must stop taking blood-thinning medication and must have an empty stomach for the procedure.

How is the operation carried out?

Lower leg fracture surgery can be performed under general anaesthetic or with spinal anaesthesia. The bone fracture is exposed with incisions in the skin and muscles. Depending on the type of fracture, it is set and fixed with [intramedullary pins], [metal plates], [metal screws] or with an external support frame [external fixation device]. Injured ligaments, tendons and muscles are also treated and sutured.

Finally, the surgical wound is closed. Depending on the procedure, the operation usually takes one to two hours.

What is the success rate of this procedure?

Lower leg fractures generally heal well after surgical stabilisation and fixation. The healing process is hastened with targeted physiotherapy exercises which are started soon after the operation.

What are the possible complications and risks of this procedure?

Surgery for lower leg fractures usually proceeds without any major complications.  As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots. In rare cases, pseudo osteoarthritis of the knee or the ankle joint occurs.

What happens after the operation?

A tibia fracture takes several weeks to months to heal. The leg must still also be immobilised for some time after the break has been surgically fixed. The knee and the ankle joint are manipulated and the muscles are stretched using targeted exercises while the patient is in a prone position. They can put some weight on the leg from the second day of the operation with the help of crutches, and build this up progressively. The ankle can generally be used as normal approx. six to eight weeks after the operation. The healing process is monitored with regular follow-up checks.

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