Fracture - This is a complete or partial disorder of the integrity of the bone resulting from the impact exceeding the strength characteristics of bone tissue. Signs of the fracture are pathological mobility, attitudes (bone crunch), external deformation, swelling, restriction of function and sharp soreness, while one or more symptoms may be absent. The diagnosis is made on the basis of anamnesis, complaints, inspection data and radiography results. Treatment can be conservative or operational, implies immobilization using gypsum dressings or skeletal exposure or fixation by installing metal structures.
The fracture is a violation of the integrity of the bone as a result of a traumatic impact. Is widespread damage. Throughout life, most people have to carry one or more fractures. About 80% of the total number of damage make up fractures of tubular bones. Along with the bone during injury, surrounding tissues suffer. More often there is a violation of the integrity of nearby muscles, less often arises compression or breaking nerves and vessels.
Fractures can be solid or multiple, complicated or not complicated by damage to various anatomical structures and internal organs. There are certain combination of injuries in clinical traumatology. Thus, during fractures, the ribs often observed damage to the pleura and the lungs with the development of hemotorax or pneumothorax, with impaired integrity of the bones of the skull, the formation of intracerebral hematoma, damage to the brain shells and brain substances, etc. Treatment of fractures is carried out by orthopedic trauma.
Causes of fracture
Bone integrity violation occurs with intense direct or indirect effects. The direct cause of the fracture can be a straight blow, fall, car accident, industrial accident, criminal incident, etc. There are typical mechanisms of fractures of various bones, which cause the occurrence of certain injuries.
Depending on the initial bone structure, all fractures are divided into two large groups: traumatic and pathological. Traumatic fractures arise on a healthy unchanged bone, pathological - on the bone, affected by some pathological process and as a result, partially lost its strength. To form a traumatic fracture, a significant impact is necessary: a strong blow, drop from a sufficiently large height, etc. Pathological fractures are developing with minor effects: a slight impact, falling from the height of one's own growth, muscle tension, or even a coup in bed.
Taking into account the presence or absence of a message between the damage area and the external environment, all fractures are divided into closed (without damage to the skin and mucous membranes) and open (with impaired skin integrity or mucous membranes). Simply put, with open fractures on the skin or mucous membrane there is a wound, and there is no wound. Open fractures, in turn, are divided into primary open, in which the wound occurs at the time of traumatic exposure and the secondary open, in which the wound is formed after a while after injury as a result of the secondary offset and skin damage to one of the fragments.
Depending on the level of damage, the following fractures are distinguished:
- Epiatrics (intra-art) - accompanied by damage to the joint surfaces, the gap of the capsule and joint bundles. Sometimes combined with dislocation or sublifting - in this case they talk about the fracture.
- Metaphizar (Oil) - arise in the zone between epiphysis and diaphysia. It is often possible (the distal fragment is introduced into the proximal). Displays fragments, as a rule, is absent.
- Diaphyisar - are formed in the middle part of the bone. The most common. They differ in the greatest manifold - from relatively simple to severe multi-danced damage. Usually accompanied by the displacement of fragments. The direction and degree of displacement are determined by the vector of traumatic effects, the weight of the peripheral part of the limb and some other factors attached to the bumps of muscles.
Given the nature of the breakfast, the transverse, oblique, longitudinal, screw-shaped, condiscular, polyfocal, fragmented, compression, and broken and tearful fractures are distinguished. In the metaphizar and epifizar zone, V- and T-shaped damage occurs. In disruption of the integrity of the spongy bone, the introduction of one fragment in another and compression of bone tissue is usually observed, in which the bone substance is collapsed and crushed. With simple fractures, the bone is divided into two fragments: distal (peripheral) and proximal (central). With polyphocal (double, triple, etc.) Damage during the bone forms two or larger fraud.
For convolver fractures, the formation of several fragments, but located "more closely", in one zone of the bone (the difference between polyphocal and sidelic damage is sufficiently conditionally, therefore, in clinical practice, the overall term "ultold" fractures is usually used). In the case when the bone is destroyed and turns into a lot of fragments at a considerable distance, the fractures are called fragmented.
Taking into account the mechanism of injury, fractures from compression or compression, twisting and flexion, damage caused by shift and tear-off fractures. Damage to compression or compression is formed in the field of metaphysis of tubular bones and bodies of the vertebrae. Fractures from bending can occur under the action of indirect or direct forces; For such damage, the formation of a transverse bone break on one side and a triangular fragment on the other is characterized.
Damage from twisting are formed when an attempt to the forced rotation of the bone around its longitudinal axis (a characteristic example is a "police fracture" of the shoulder when unscrewing the hand); Broil line passes spiral or screw. The cause of tear-off fractures is a strong muscle tension, due to the bone, a small fragment in the field of muscle attachment is broken; Such injuries may occur in the area of the ankles, patella and shoulder supermarkets. Shear damage is observed when exposed to direct force; They are characterized by a transverse plane of a break.
Depending on the degree of damage to the bone, complete and incomplete fractures are distinguished. It is incomplete related to the integrity of the bone of the bone type (the fracture is spreading less than half the diameter of the bone), cracks (the fracture occupies more than half of the diameter), cracking or pressure. With incomplete damage to the bone bones of fragments is not observed. With complete fractures, a displacement is possible (fracture with displacement) in length, at an angle, on the periphery, in width and along the axis (rotational).
There are also multiple and isolated fractures. When the integrity of one anatomy-functional formation is isolated, the integrity of the hip, the fracture of the ankle) is observed, with multiple - damage to several bones or one bone in several places (the simultaneous fracture of the diaphysis and neck of the hip; the fracture of both legs; the ships and forearm fracture). If the bone fragile causes damage to the internal organs, they are talking about a complicated fracture (for example, a spinal fracture with damage to the spinal cord).
All fractures are accompanied by a more or less pronounced soft tissue, which is due to both directly by traumatic impact and the displacement of bone fragments. Usually in the injury zone there are hemorrhages, bruise of soft tissues, local muscle breaks and breaks of small vessels. All listed in combination with bleeding from bone fragments becomes the cause of the formation of hematoma. In some cases, the mixed bone fragments damage nerves and main vessels. It is also possible to compress the nerves, vessels and muscles between fragments.
Symptoms of fracture
Allocate absolute and relative signs of bone integrity. Absolute features are the deformation of the limb, attitudes (bone crunch, which may differ in the ear or determined under the fingers of the doctor during palpation), pathological mobility, and with open damage - bone fragments visible in the wound. The relative features include pain, swelling, hematoma, violation of function and hemarthrosis (only with intra-articular fractures). The pain is enhanced when attempting movements and axial load. Edema and hematoma usually occur after some time after injury and gradually grow. Violation of the function is expressed in limiting mobility, inability or difficulty support. Depending on the localization and type of damage, some of the absolute or relative features may be absent.
Along with local symptoms, for large and multiple fractures, common manifestations caused by traumatic shock and blood loss due to bleeding from bone fragments and damaged nearby vessels. At the initial stage, there is an excitement, underestimation of the severity of its own state, tachycardia, tachipne, pallor, cold sticky sweat. Depending on the predominance of certain factors, blood pressure can be reduced, less often - slightly increased. Subsequently, the patient becomes sluggish, inhibited, the blood pressure decreases, the amount of urine released decreases, the thirst and dryness in the mouth observes, in difficult cases there is a loss of consciousness and respiratory disorders.
Early complications include skin necrosis due to direct damage or pressure of bone fragments from the inside. When the blood cluster in the subfascial space, a subfascial hypertensional syndrome occurs, due to the compression of the vascular-nerve beam and accompanied by a violation of blood supply and innervation of peripheral limbs. In some cases, due to this syndrome or related damage to the main artery, insufficient of the blood supply to the limb, the gangrene of the limbs, thrombosis of the arteries and veins can be developed. Damage or squeezing of the nerve is fraught with the development of the paresium or paralysis. Very rarely closed bone damage are complicated by the booming of hematoma. The most common early complications of open fractures is the suppuration of the wound and osteomyelitis. With multiple and combined injuries, fat embolism is possible.
Late complications of fractures are the wrong and slow felt of fragments, the lack of fusion and false joints. At intra-articular and occasional injuries, heterotopic paraarticular mascodes are often formed, post-trap arthrosis develops. Post-traumatic contractures can be formed with all types of fractures, both intra and embracing. Their cause is the prolonged immobilization of the limb or the non-contrinacy of the articular surfaces due to the incorrect fragment of fragments.
Since the clinic with such injuries is very diverse, and some signs in some cases are absent, when making a diagnosis, much attention is paid not only to the clinical picture, but also to clarify the circumstances of the traumatic impact. For most fractures, a typical mechanism is characterized, so, when falling out of fracture, the beam fracture often occurs in a typical place, when the leg fracture is turned - the fracture of the ankle, when falling on his feet or buttocks from a height is a compression vertebrae fracture.
The patient's survey includes a thorough inspection for possible complications. In case of damage to the bones of the limbs, the pulse and sensitivity in distal departments must be checked, the reflexes and skin sensitivity are evaluated during the fractures of the spine, and the ribs are damaged, auscultation of the lungs is made, etc. Particular attention is paid to patients who are unconscious or in a state of expressed alcohol . In suspected of a complicated fracture, consultations of relevant specialists (neurosurgeon, vascular surgeon) and additional research (for example, angiography or an echo) are prescribed.
The final diagnosis is mounted on the basis of radiography. The rhythmic signs of the fracture include a line of enlightenment in the area of damage, the displacement of fragments, the break of the cortical layer, the deformation of the bone and the change in the bone structure (enlightenment when the fragments of the flat bones are shifted, the seal with compression and fragmented fractures). In children, in addition to the listed radiological symptoms, during epiphisheyolise, the deformation of the cartilage plate of the sprout zone may be observed, and during fractures by the type of green branch - limited surveillance of the cortical layer.
Treatment of fracture
Treatment can be carried out in the injury or under the conditions of traumatological separation, to be conservative or operational. The purpose of treatment is the most accurate comparison of fragments for the subsequent adequate battle and restore the function of the damaged segment. Along with this, the shock takes measures to normalize the activities of all organs and systems, with damage to the internal organs or important anatomical formations - operations or manipulation to restore their integrity and normal function.
At the stage of first aid, pain relief and temporary immobilization using special tires or submitted objects (for example, boards). With open fractures, if possible, remove pollution around the wound, the wound is closed with a sterile bandage. With intensive bleeding impose harness. Perform measures to combat shock and blood loss. When entering the hospital, the blockade of damage is carried out by a reposition under local anesthesia or general anesthesia. The reposit can be closed or open, that is, through an operational incision. Then the fragments are fixed using gypsum bandages, skeletal stretching, as well as external or internal metal structures: plates, pins, screws, spokes, brackets, and compression-distraction devices.
Conservative treatments are divided into immobilization, functional and traction. Immobilization techniques (gypsum dressings) are usually used in fractures without displacement or with a slight displacement. In some cases, gypsums are also used in difficult damage at the final stage, after removing skeletal extracts or surgical treatment. Functional techniques are shown mainly in compression vertebral fractures. Skeletal stretching is usually used in the treatment of unstable fractures: common, screw, brazy, etc.
Along with conservative techniques, there is a huge number of surgical methods of treatment of fractures. Absolute testimony to operation are a significant discrepancy between fragments, excluding the possibility of a fight (for example, a fracture of a permanent or elbow process); damage to nerves and main vessels; Interposition of a fragment into the hollow of the joint with intra-articular fractures; The threat of the emergence of the secondary open fracture with closed damage. Relative readings include the interposition of soft tissues, the secondary displacement of the bone fragments, the possibility of early activation of the patient, reducing the time of treatment and facilitating the patient's care.
LFC and physiotherapy are widely used as additional treatment methods. At the initial stage, UHF, inductothermia and ultrasound are prescribed to combat pain, improve blood circulation and reducing edema. In the future, the electrostimulation of muscles, UV irradiation, electrophoresis or phonophoresis is used. To stimulate the battle, laser therapy, remote and appliquational magnetotherapy, variables and constant currents are used.
Therapeutic physical education is one of the most important components of treatment and rehabilitation during fractures. At the initial stage, exercises use exercises to prevent hypostatic complications, subsequently the main task of the LFC becomes stimulation of reparative metabolic processes, as well as the prevention of contractures. The program of exercise doctors of the LFC or rehabilitologists are individually, taking into account the nature and period of injury, age and the overall condition of the patient. In the early stages, breathing exercises, exercises for isometric muscle tension and active movements in healthy limb segments. Then the patient is trained to walk on crutches (without a load or with a load on the damaged limb), in the subsequent load gradually increase. After removing the gypsum bandage, measures are carried out to restore complex coordinated movements, muscle strength and joint mobility.
When using functional methods (for example, with spinal fractures), the LFC is a leading treatment technique. The patient is trained by special exercises aimed at strengthening the muscular corset, the decompression of the spine and the production of motor stereotypes, excluding the aggravation of injury. At first, the exercises are performed lying, then - standing on the knees, and then - and in the standing position.
In addition, with all types of fractures, a massage is used, which allows to improve blood circulation and activate metabolic processes in the area of damage. At the final stage, patients are sent to sanatorium-resort treatment, umodobromic, radon, chloride-sodium, coniferous and coniferous healing baths are prescribed, and rehabilitating measures in the conditions of specialized rehabilitation centers.
The bone fracture is a partial or complete violation of the structure of bone tissue. The main cause of fractures is the physical activity created on the skeleton of a person, which exceeds the strength of the bones. But fractures also arise in various diseases, due to which bone tissues are thinning and lose strength.
Let us consider in more detail the concept of a fracture and its differences from dislocation across symptoms, we will also describe the main causes of injuries and the rules for the provision of first aid.
Bone fracture - definition and significance of the problem
Fracture is a common natural injury. The mechanism for the emergence of this type of injury in humans is the same as all vertebrates. About 80% of all broken bones fall on the tubular: the femoral, radiant, pelvic. Not only bones are damaged, but also nearby softer fabrics - muscles and vessels. Less often squeezing or a complete break of nerve endings.
Fractures in real life are combined with damage to different organs and organism systems. Such diseases in medicine are called combined injuries. For example, during fractures, the ribs develops pleurisy, and during damage to the bones of the skull - intracerebral hematomas.
What are the fractures: generally accepted medical classifications
Fractures are classified according to several criteria: by location of fragments, location of injury and the form of a broken section.
Depending on the location of fragments of bone fractures are open and closed. In the first case, the injury is accompanied by damage to the soft tissues, up to the point that the bone turns out to be visible. With a closed fracture, this does not happen: soft tissues remain whole, no hemorrhage.
Open fractures are divided into primary and secondary. In the first case, soft tissues are injured due to an external provoking factor, and in the second, due to the fact that the bone is wound off the tissue, forming through the wound.
There are separate types, which are closed fractures:
- Combined . Characterized by multiple damage to internal organs.
- Combined . Appear due to external influence, such as injuries or radiation.
- Multiple . Digured several bones immediately.
- Single . Only one bone is injured.
- Full . The ends of the dice are separated from each other.
- Incomplete - The bone is not divided, but there are cracks and edge fragments on its surface.
The hardest type of injury is a bone fracture. Because of the fracture with displacement, complications arise: as paralysis of the limbs or loss of their sensitivity, loss of disability, and sometimes fatal outcome.
By location, the fracture is classified to the following types:
- Epiphysiolysis - With the defeat of the zone of the growth of bone tissue in children.
- Epphysiary - with injury to the custody of the joint.
- Diaphizar - Damage to tubular bones.
- Increased - associated with damage to the spongy bone elements.
The most difficult is curable considered Epphysiary Type of fractures. It is often combined with dislocation, which does not allow you to immediately determine the type of injury and assign accurate treatment.
Another classification of fractures is given in the form of damage to the bone:
- Transverse - Fault line is perpendicular to the dice itself.
- Longitian - The fracture line is located parallel to damaged skin fabrics.
- Oblique - The fault line is located at an angle to the tubular bone itself
- Vintage - type of fracture, in which bone fragments are shifted relative to the initial position.
- Ostrochet - during injury, no fracture line is formed, but separate fragments appear on the bone area.
- Wedge-shaped - This kind of fracture is characteristic of the spinal injuries, when one bone is pressed into another and forms cracks and wedge-shaped defects on its surface.
- Compression - The type of fracture, in which many small debris are formed on the damaged area of bone tissue.
5 most frequent types of bone fractures
Statistics on fractures stunned. According to data, almost every person in developed or developing countries 1-2 times in life breaks bones and joints. 9 million cases of such injuries are registered annually in Russia, in the US — 7 million. This injury of joints and bones is the most frequent, because of which people have to emerge to contact the traumatologists.
Different types of fractures are found with a different frequency. This is due to different bone tissue thickness at different parts of the body and the fact that each of the departments accounts for uneven load. Consider the most frequent types of fractures and their features:
1 - the fracture of the radial bone on hand
This disease accounts for up to 22% of all fractures. In the picture you can see where the radiation bone is located on the hand.
According to the ICD 10, the hand-bone fracture has code S52. 5. The code S 52 on the ICD 10 was assigned another frequently found injury - the stroke of the shoulder bone.
The main reason for the radiation and shoulder bone of the hands is the fall, as a result of which a person instinctively substitutes the limbs.
2 - Fracture of the hip neck
On the ICD 10, this type of fracture is assigned the S72 code. The cause of injury is dropped from height or degenerative processes in the body.
In the photo, see where the neck of the thigh is located
According to statistics after fracturing of the hip neck after 65 years, patients in 88% of cases remain disabled and die 1-2 years after injury.
3 - Ankle Fracture
According to the CCB 10, the S82.5 code is assigned the disease. This injury is classified to the lateral and distal view (internal and external).
In the photo, see where the ankle is located.
The main reason for the injury is to prompt on the street in the cold season or careless descent on the stairs. It occurs when falling on the leg, bent in the knee joint.
4 - Fracture of the facial skull (nose and lower jaw)
Injuries in the overwhelming case are found in those who often come into fights or professionals. Classification of nasal bones and lower jaws on the ICD 10:
- Fracture of nasal bones - code S02. 2;
- Fracture of the bottom jaw bones - code S02. 61.
Such damage is very dangerous.
5 - Fracture of the infant and lumbar spine
Injury arises as a result of falling on straight legs with high height. After the fracture of the thoracic spine, a greater number of neurological complications arise, especially when it comes to children.
Launcher and thoracic spine see pictures.
MO MKB10 these injuries give the following classification:
- Compression fracture of the lumbar spine - code S 32.0;
- Fracture of the thoracic spine - code S22. 0.
In the group of fractures of the breast, the spine also includes injury to ribs: code on the ICD 10 - S 22. 3. The main reason for the injury of ribs and chest is an accident.
3 signs of fracture: absolute and relative
Almost all types of fractures have general symptoms. There are signs for which you can only suspect the injury (they are called relative). According to other features (absolute), it is possible to reveal the broken bone with a 100% probability.
How to distinguish bruise from fracture ! The right sign that is distinguished by bruised —This is the ability to move damaged joint or limb (although it will hurt). A very important distinctive characteristic of fractures is the annual possibility of normal movement and movement. For example, if an ankle ished, then a person will not be able to move the stop, in that clean and thumb on the leg.
The first group of signs of fractures include:
- Pain and discomfort in the field of injury . The pain is intensified when trying to move. This feature is also characteristic of strong injury.
- Sweeping of soft tissues near the painful joint . These symptoms are also characteristic of dislocation. But there is a rule, how to distinguish a fracture from dislocation .
How to distinguish a fracture from dislocation! When dislocation, there is no pathological mobility of the joint, and the crunch is not heard in the place of damage to the bone, as it happens if the bone is broken.
- Bloodstocks on the affected area . The sign is also characteristic of fractures, and for stretching. Therefore, you must familiarize yourself with another memo, how to distinguish injuries.
How to distinguish stretching from the fracture! When tension, the length of the damaged limbs does not change and does not deform the joints.
According to relative features, it is impossible to say for sure, there is a fracture or not: you need to pay attention to absolute. If a crunch is observed in the leg or hand, the deformation of the joint or its pathological mobility (absolute signs), then we can talk about more serious injury than stretching, bruised and dislocation.
Diagnosis of fractures
A surgeon or traumatologist is engaged in the diagnosis of injury. You can independently distinguish fractures from other injuries (dislocation, bruise), but only the doctor can determine the degree of its severity.
The main method of diagnosis is x-ray in two projections. See what it looks like a fracture in the picture:
If there are signs of an open fracture of the limb, then the doctor will additionally appoint a patient MRI or ultrasound to reveal how the fragments damaged soft tissues and are nervous endings.
First aid for fractures - 3 very important stages
When fractures are very important correctly and promptly assist. Sequential competent actions will prevent the consequences of injury and pain in the victim.
Terms and procedures for first aid:
- Call an ambulance . Edit the joint itself is something that can not be done during fractures. Before leaving the emergencies, the victim provides consistent first aid .
- Give the victim painkillers - Ketanov or Naz. It is better if the anesthetic will be introduced intramuscularly, so they will work faster. If there is no ampoule with a medicine at hand, then preparations are used in tablet form. Anesthesia is something that needs to be done during fractures. Otherwise, a person will feel intensive joint pain when trying to fix the injured limb, even pain shock is possible.
- Secure the joint of the tire . Insert the tire to the fracture so that the bones are not damaged by soft fabrics. When providing first aid, you can use scribe tools: Wooden board , ski sticks. If there are no objects suitable for shining, then the body of the victim itself is used as a tire. For example, the broken leg is fixed to a healthy with a bandage or clothing. The upper broken limb is fixed with a tire to neck or torso.
Subsequent first aid rules will depend on the type of fracture. If it is open, then the help will include disinfection of the wound and stopping bleeding before tire overlay. Bacteria through the wound can quickly get inside and cause gangren limbs. Before fixing the joint in the same position. It is necessary to put on the injured area an antiseptic napkin, moistened by hydrogen peroxide.
With an open fracture from the wound, blood is often soooed, so you need to know how to stop it correctly. Assistants must correctly determine the appearance of the bleeding:
- Venous . Blood is slow and has a dark red shade (brown color). In this case, the harness is superimposed below the fracture.
- Arterial . Blood flows over a pulsating jet and has a scarlet color - the harness is fixed above the wounds quickly, so that the blood flows as little as possible.
Instead of a harness, you can use bandages, dressings or clothing flaps; If you need to cut clothes with a knife. Under the bandage must be put on a note sheet. In it, people who provide first help must specify the time for overlaying the squeezing bandage. If the ambulance is delayed, then every 30 minutes weaken the harness!
If a person broke his chest or lumbar spine, then the tire does not impose. In this case, first aid includes only emergency call, anesthesia and blood stop. If you need to transfer the victim from the scene, for example, with a roadway, then for this use only Hard stretcher . The person is fixed on stretchers, so that it does not fly. With a fracture of the cervical spine use Immobilizing collar .
Methods for the treatment of fractures: what they do in the hospital
The basic principles of hospital treatment are the preservation of the patient's life, elimination of anatomical disorders (muscle clamps), restoring the operation of internal organs and damaged limbs.
The main method of treatment of closed fractures is fixing the joint with the help of plaster, Longet or rigid orthosis. If bone fragments have shifted, then the treatment plan additionally includes the stretching - a long comparison of fragments using a cargo system.
Exactly surgical treatment methods. Fractures are treated with osteosynthesis - connecting bone fragments using pins, screws.
Modern methods of treating fractures imply complete prosthetics. This is when the joint changes in whole or in part. it «Golden Standard Treatment »Farm of the hip neck in elderly patients.
After injury, people experience pain, so they need to know what to take with fractures. Usually in the hospital patients, especially with broken spines, give narcotic painkillers - Codeine . After that, go to nesteroid drugs - Analgin , Ketarol. .
After fractures, the risk of blood formation increases, so additionally needs to drink preparations that prevent blood clotting, they are called anticoagulants differently - Heparin , Eanoxaparin .
If the fracture is open, then you need to prevent a bacterial infection that gets inside the wound. For this use antibiotics ( Ceftriaxon or Cefotaxim ) or antibacterial drugs ( Metronidazole. , Ploksacin ).
From how the treatment successfully passes, it depends, how much time will have to walk in the gypsum when a fracture. On average, the treatment period is from 1 to 2 months.
Physiotherapy in the treatment of fractures is used in order. To remove swelling with soft tissues and alleviate painful syndrome. Procedures contribute to the speedy regeneration of bones, as they improve the blood supply to the injured area.
In the acute period, patients are prescribed such treatment methods such as magnetic therapy (it is done even through a gypsum bandage). Magnetotherapy not only reduces pain, but eliminates squeezing soft tissues.
In addition to magnetotherapy, another effective treatment method is used - cryotherapy. But the procedure is possible only on those areas that are free from the gypsum bandage. The main purpose of the appointment of cryotherapy is the removal of edema with soft tissues due to the narrowing of blood vessels.
After an element of the aggravation stage to the listed physiotherapy treatment methods, ultrasonic therapy with hydrocortisone and electrostimulation are added. These techniques help restore the lost muscular volume after fractures.
An important importance in the treatment is also played by therapeutic and recreation physical culture. After removing the gypsum, it is necessary to gradually develop limbs and joints so that they acquire initial mobility. Learn how to develop a radiation and shoulder bone after a hand fracture from the video and the advice of doctors.
|Appearance and corresponding X-ray image of a fracture|
Fracture bone - Complete or partial disruption of the integrity of the bone with a load exceeding the strength of the traumatic area of the skeleton. Fractures may arise both due to injury and as a result of various diseases accompanied by changes in the strength characteristics of bone tissue.
The severity of the status for fractures is due to the size of damaged bones and their number. Multiple fractures of large tubular bones lead to the development of massive blood loss and traumatic shock. Also patients after such injuries are slowly restored, recovery can take several months. [one]
The significance of the problem
The bone fracture is a rather common type of injury in wildlife.
Bone fractures in humans are not fundamentally different from similar fractures from other vertebrate animals. The following are fractures on the example of the human body, but all the above techniques and signs, with amendment on the characteristics of the skeleton, can be attributed to all the vertebral animals.
The problem of treatment of fractures has always been significant, both for a separate individual and for society. In all human civilizations there is an analogue of the profession of "Kostoprava" - a person who is professionally engaged in the restoration of broken limbs of people and animals. So, when analyzing 36 skeletons of Neanderthals, having fractures, only 11 the results of the treatment of the fracture are considered unsatisfactory. This shows that already at such a level of development, the effectiveness of medical care for fractures exceeded 70%, primitive people knew about fractures and knew how to treat them. [L 1]
Basic principles of treatment of fractures have not changed from the era of antiquity [L 2]  Although modern surgery and allowed to restore the anatomical structure of the bones with complex, trapped, multi-sided fractures, fractures incorrectly fragile, without restoring the normal position of the bone, and many other types of injuries [L 3] .
Types of fractures are classified according to several criteria, this is due to the lack of uniform causes and localization of fractures.
In modern classifications, the types of fractures are distinguished depending on the following features:
- Due to the occurrence
- Traumatic - caused by external influence.
- Pathological - arising with minimal external effects due to the destruction of the bone with some pathological process (for example, tuberculosis, tumor or other).
- By severity of the defeat
- Without offset (for example, under the perception).
- With displacement of fragments  .
- Incomplete - cracks and dorms.
- In the form and direction of fracture
- Transverse - The fracture line is conditionally perpendicular to the axis of the tubular bone.
- Longitian - The line of fracture conditionally parallel to the axis of the tubular bone.
- Oblique - The fracture line passes under an acute angle to the axis of the tubular bone.
- Vintage - There is a rotation of bone fragments, bone fragments "rotted" relative to its normal position.
- Ostrochet - There is no single line of fracture, the bone in the place of damage is fragmented on separate fragments.
- Wedge-shaped - As a rule, it occurs during the spinal fractures, when one bone is pressed into another, forming a wedge-shaped deformation.
- Fombing - Bone fragments shift proximal on the axis of the tubular bone or are located outside the main plane of the spongy bone.
- Compression - bone frails are small, clear, there is no single fracture line.
- Skin integrity
- Closed - Without a message with an external environment.
- Open - communicating with the external environment.
- By complications
Also, the most common types of fractures have generally accepted names - by the name of the author, first described them.
So, for example, a fracture of the semi-shaped refrigeration of the radial bone, is called the collings fracture. Also, the pretty well-known type of injuries of the upper limb includes a molding fracture, occurring at a fracture of the elbow bone in the upper third and dislocation of the radial bone head with damage to the branch of the radiot nerve, and the fracture of the Goleazzi, which is a fracture of the radial bone in the lower third with a breakdown of distal radio-ulnar articulation And dislocate in this joint. [four] [five]
In children's and youthful age, fractures are observed on the non-federated sprout (epiphyseal) line - epiphysiolysis. In the elderly, fractures occur with a significantly smaller traumatic load, and the recovery time increases. This is due to a change in the ratio of the mineral and organic components of the bone.
Bone fractures arise as a result of a load exceeding the limit of their strength. For each bone, on different axes, the maximum load values differ. The fracture type in each case depends on the direction of the applied force vector. For example, if the blow has perpendicular to the tubular bone, then there is a transverse fracture, when the vector application is applied parallel to the axis of the bone, longitudinal and condiscular fractures occur. 
The ratio of various types of fractures changed over time, so, for example, if the bumper fractures of the tibia and the extensive fractures of the cervical vertebrae were quite rare, now they constitute a significant percentage of fractures during car injuries.  
With the development of technology, the kinetic energy increases, which can control humanity. The power of modern technical devices significantly exceeds the strength of the human skeleton. Now it has become quite ordinary impact on the human energy of such a order, which only a hundred years ago would be unique or at all impossible. In this regard, as the level of technical development is heard, new, increasingly complex tasks are put before traumatology and orthopedics.  
There are typical locations of fractures. As a rule, they are in those places where the bone is experiencing the greatest load, or where its strength is lower. The most common fractures include:
- Fracture of radial bone in a typical place. In 70% of cases by the mechanism of injury, it is an extensive fracture.
- Fracture of the surgical cervical shoulder.
- A secline leg fracture in the middle third is the so-called "bumper fracture" - a widespread kind of injury that occurs, as a rule, with road injuries.
- Fracture of medial and lateral ankles.
- Fracture of the hip neck. A difficult, but rather common fracture is currently widespread in the elderly, the most effective way of treatment is the installation of an artificial hip joint.
- Various fractures of the bones of the skull.
In addition to these seats of fractures, many others are possible. In fact, any bone can be broken anywhere throughout its entire. [L 4]
Bone tissue consists of mineral and organic components. The bone composition is quite complicated, the organic part of the bone is 30% of its mass, mineral 60%, account for 10%. The mineral component provides strength and consists mainly of calcium, phosphorus and trace elements. The organic component is a collagen that makes the bone more elastic. Collagen strength for stretching - 150 kg / cm², cutting strength - 680 kg / cm², discontinuous elongation - 20-25%. When heated, collagen fibers are reduced by about a third of its length. [L 5] Tubular bones are most resistant to the load along its axis. Spongeless are less durable, but equally resistant to the load in all directions.
With a fracture of bone tissue, bleeding occurs, which does not stop due to the fact that the vessels are fixed in the mineral part of the bone and can not fall. The volume of bleeding depends on the type of fracture and its localization, so, for example, during fractures of the leg bones, the victim loses 500-700 ml of blood. As a result of this hemorrhage, hematoma is formed, which subsequently surrounds bone fragments. 
In the place of bleeding there is an eatery and filament of fibrin filaments, which subsequently serve as the basis for the formation of the protein matrix of bone tissue. Stopping bleeding from bone tissue is a difficult task and with complex convoccient open fractures are possible only in an equipped operating room. [L 5]
Mechanism of origin
Traumatic fracture - It is damage to the structure of bone tissue under the influence of external force exceeding the standard strength characteristics of the damaged element of the skeleton. This type of fractures is most common at present. [ten] It may occur by a variety of reasons, ranging from falling from height and ending with gunshot wounds. The most severely considered combined and combined fractures - fractures of several bones or their combination with other damage, such as wounds or burns.
Pathological fracture of bone - bone fracture in the zone of its pathological restructuring (lesions of any disease - tumor, osteomyelitis, osteoporosis, etc.).
The most vivid symptom indicating the pathological character is the occurrence of a fracture from an inadequate injury (or without injury). In some cases, with anamnesis, pain or discomfort in the fracture area can be revealed before it appears. More reliable in the diagnosis of the pathological nature of the fracture methods of radiography, computer or magnetic resonance tomography. In some cases, the nature of the pathological process, which caused the fracture, allows you to establish only biopsy. [eleven]
Consequences of injury
After the occurrence of the fracture, there is a violation of the integrity of the bone, bleeding occurs and severe pain. With full fractures of tubular bones there is also a shift of bone fragments. This is due to the fact that in the occurrence of pain impulsation, the muscles are reflexively reduced, and since they are attached to the bones, they pull the ends of bone fragments, aggravating the severity of injury and often leading to additional damage. In the region of the closed fracture, a hematoma is formed, and with an open fracture and strong outdoor bleeding. The more massive muscular layer in the area of broken bone, the harder the reposition of bone fragments and their retention in the correct position for adequate bone recovery. [L 5]
The capture of fragments after the fracture is accompanied by the formation of a new fabric, as a result of which bone corn appears. The timing of fracture healing ranges from several weeks to several months, depending on age (children fractures faster), the general state of the body and local causes - the mutual location of fragments, the type of fracture, etc.
The reduction of bone tissue occurs due to the division of cells of the cambial layer of the periosteum, endosta, unoccalued bone marrow cells and mesenchymal cells (adventitia of vessels). [L 6]
In the process of regeneration, 4 main stages can be distinguished:
- Autolysis - In response to the development of injury, the edema develops, there is an active migration of leukocytes, autolysis of dead tissues. Reaches a maximum of 3-4 days after a fracture, then gradually subsides.
- Proliferation and Differentiation - active reproduction of bone tissue cells and active generation of mineral bone bone. Under adverse conditions, a cartilage fabric is first formed, which is then mineralized and replaced by bone.
- Perestroika bone tissue - the blood supply to the bone is restored, the bone compact substance is formed from bone beams.
- Full recovery - Restoration of the bone marrow channel, the orientation of bone beams in accordance with the power lines of the load, the formation of periosteum, the restoration of the functionality of the damaged area.
At the site of the fracture is formed bone corn. 4 types of bone corn are isolated:
- Periosal - a small thickening along the lines of the fracture is formed.
- Endoostal - Bone corn is located inside the bone, it is possible to a small decrease in the thickness of the bone at the fracture site.
- Intermedial - Bone corn is located between bone frails, the bone profile is not changed.
- Parapsof - surrounds the bone with a rather major protrusion, can distort the shape and structure of the bone.
The type of bone corn formed depends on the regenerative abilities of a person and the localization of the fracture. [L 7]
There are relative and absolute signs of fracture, relatives are approximate, and allow us to only suspect the injury of this type. Absolute signs confirm the fact of fracture, and allow it to distinguish it from other, similar to clinical signs of injuries.
At the site of injury
Diagnosis "Fracture" allows certain criteria. The fracture is a diagnosis that is set clinically and only confirmed X-ray.
Relative signs of fracture
- Pain is enhanced at the scene of the fracture when simulating the axial load. For example, when tapping on the heel, pain in the turn of the tibia will increase dramatically.
- Otk - arises in the area of damage, as a rule, not immediately. Bars relatively little diagnostic information.
- Hematoma - appears in the field of fracture (not immediately). The pulsating hematoma indicates continuing intense bleeding.
- Violation of the function of the damaged limb - implies the impossibility of the load on the damaged part of the body and a significant limitation of mobility.
Changing the form of limb with a fracture of radial bone.
Absolute signs of fracture
- Unnatural position of the limb.
- Pathological mobility (with not complete fractures is not always determined) - the limb is movable in the place where there is no joint.
- Capital (peculiar crunch) is felt at hand at the site of the fracture, sometimes heard the ear. Well audible when pressed by the phoneneoscope into place of damage.
- Bone fragments  - With an open fracture, they can be visible in the wound.
X-ray study allows you to more accurately set the type of fracture and the position of fragile. Radiography is a standard diagnostic method when confirming the fracture. It is the presence of an X-ray picture of a damaged area that serves as an objective confirmation of the fact of fracture. The picture should contain two joints located distal and proximal place of lesion, the bone must be depicted in two projections, straight and side. In compliance with these conditions, X-ray examination will be adequate and full, and the possibility of erroneous diagnostics is minimal. [L 8]
On the radiograph, the fracture of the tibia, exposed to surgical treatment. 4 snapshot in 2 projections. On the first pair of images - the upper third of the lower leg and the knee joint (the joint, located proximal places of the fracture), in the second pair of shots - an ankle joint (the joint, located distal scene of the fracture). The tibial bone is fixed by an anterographer entered in the joystone carnail channel (UTN - Unreamed Tibial Nail), blocked by 5 screws. This design allows you to fix fragments and provides adequate regeneration. After the formation of the bone corn, the metal fixer is removed.
In the case of a fracture, it is very important to provide a timely provision of medical care. On time provided medical care can save the life of the victim and prevent the development of serious complications. Often, the fractures themselves are often dangerous, and their accompanying pathological conditions, such as traumatic shock and bleeding.
A person who has the first prefigure help can:
- Estimate the severity of the condition of the victim and localization of damage.
- If there is bleeding - stop it.
- To determine whether the movement of the victim is possible before the arrival of a qualified medical personnel. It is not recommended to transfer or move the patient during the spinal injuries and multiple fractures.
- In case of injury to immobilize  Damaged plot, impose a bus. A bus can serve as any object that will prevent movement in the damaged limb (exciting joints above and below the fracture).
- In the absence of contraindications to the movement of the victim transported to the medical institution.
- If the access of medical personnel is difficult or impossible and there are contraindications to the movement of the victim, it provides for the possibility of complete immobilization of damaged sections, after which stretch stretch is used to which the victim is reliated.
First medical care
The first medical assistance can be provided both in place and in an injury or hospital. At this point, it is important to estimate the severity of the state of the victim, to prevent or facilitate injury complications, to determine the volume of further treatment.
Tactics of the doctor
If the doctor suspects a fracture at the victim, he holds the following activities:
- Assesses the severity of the victim's condition. In the event of complications, first of all begins to fight with the most dangerous for life. The most frequent complications are shock and blood loss.
- Conducts a differential diagnosis, it is convinced that the existing injury is the fracture, and not dislocation, stretching or injury.
- With clinical confirmation of the diagnosis and the relief of states threatening, conducts the immobilization of a damaged area as effective in existing conditions.
- After the implementation of adequate immobilization decides on the need to hospitalize the victims of the hospital or on the conduct of outpatient treatment.
When carrying out transport (temporary) immobilization of the limbs, a person who needs to comply with the following rules:
- Fix the limb in the position in which it is after injury, but do not try to correct the bone in place.
- Fix at least 2 joints (above and below the fracture). In case of injury, hip and shoulder fix 3 joints.
- When the tire is overlapping and the presence of wounds, first process the wounds and stop the bleeding.
Qualified medical care
Qualified medical care is especially needed in case of complex convoccient fractures, when the retention of bone fragments in the correct position is difficult or impossible without specialized treatment methods. In the treatment of fractures both conservative and operational method, X-ray control is carried out every 5-7 days - the effectiveness of the reposition and regeneration is estimated. [L 5]
Treatment of fractures may include the following activities:
Anesthesia and anesthesia
The pain is a damage signal, but after exceeding a certain threshold, it becomes dangerous. Therefore, with any injury, including fractures, you need to control the intensity of pain.
When fractures, effective anesthesia can only be achieved by combining drugs for general anesthesia and local anesthesia. Each of these methods has its advantages and disadvantages: general anesthesia is simpler in performance, but more toxic and less electively; Local anesthesia for fractures requires an honed execution technique, especially in complex localizations, for example, during spinal fractures. It should also be noted that maintaining local anesthesia is more difficult and time consuming than general anesthesia. [L 9]
The methods of conservative treatment of fractures are known to humanity from antiquity and have practically not changed from ancient times. They can be divided into three groups.
Immobilizational (fixative) - the use of gypsum bandages (or polymer analogs) after a closed reposition or without a reposition if the fracture without displacement.
When forming an immobilizing dressing, the following steps are distinguished:
- Preparation of gypsum bandages or their analogues - Bandage, impregnated with plaster or its polymer analogue, is laid out in close proximity to the venue of immobilization. Water is prepared for their subsequent wetting. Gypsum bandage is wetted pre-polymeric in the process of formation of Longets.
- Formation of plaster Longets - On the smooth clean surface is laid out a layer of a layer of bandage defined, pre-measured length. For different parts of the body, the number of layers of plaster Longets are different. For the forearm, the shoulder - 5-6 layers, for the shin - 8-10 layers, for the hips - 10-12 layers.
- Bandage overlay - After the treatment of an abrasion with a solution of antiseptic to all bone protrusions, falling under the immobilizing bandage, pieces of wool or tissue are stacked to prevent the occurrence of laying out. Then the extremity is installed plastering lionet or its polymer analogue and circular bysnation is carried out. The following rules are followed:
- The limb, if possible, is in a physiologically advantageous position.
- The bandage must necessarily cover two joints - one distal, the other proximal place of the fracture.
- The bandage is not twisted, but clipped.
- The distal sections of the limbs (fingertips) should remain open.
The last item is especially important. After the imposition of the dressing, the edema of soft tissues can develop, and when signs of the ethox on the distal parts of the limb appear, you need to abide the bandage longitudinally to prevent the development of trophic changes. [L 10]
The use of different types of stretching - skeletal, less frequently - cuff, leuccophustic, adhesive. The purpose of traction is to create a stretching, which is intended to neutralize the effect of muscle reservoirs that are attached to bone fragments, prevent displacement of them relative to each other and create conditions for adequate regeneration of bone tissue.
Skeletal exhaust - method of traction in which the cargo that ensures the maintenance of bone fragments in a position optimal for regeneration, is attached to the needle, conducted through the bone. For example, during fractures of the leg, the knitting needle is carried out through the heel bone. With hip fractures - through the tibia jergis.
The cargo, as a rule, consists of a set of round plates of the predetermined mass, put on the rod. The mass of plates is standard and is 500 and 1000 grams. It connects with a metal cable, which is connected to the spring damper. The task of the damper is the exhaustion of oscillations, inevitably arising when the patient moves into bed and shifting the cargo.
Skeletal stretch has both their advantages and disadvantages. The advantages include the relative simplicity of execution and the efficiency of traction, reliability of the cargo fixation. The disadvantage is the long-term forced immobilization of the patient, negatively affecting its general condition.
Other methods of extracting are applied relatively rarely due to low efficiency. This is due to the inability in these methods of fixing the cargo fastening weighing more than 4-5 kilograms. Accordingly, it can only be applied during minor bones that can be adequately reposed and without traction treatment methods.
Principles are the same for all tracting methods: the distal place of the lesion is attached a cargo that provides adequate stretching. The weight of the cargo depends on the bone for which traction is carried out. Types of extensions differ only in the way of fastening the cargo. [L 11]
Functional is the treatment methods without immobilization or with minimal immobilization of a damaged segment. Applied relatively rarely - in the case of fractures of small bones or cracks in tubular bones. They are to ensure relative rest of the affected area.
The methods of surgical treatment arose relatively recently. So, in Russia, the first operation of osteosynthesis was carried out in 1805 by E. O. Mukhin. [L 5]
Often the fractures of spongy bones cannot be adequately restored by conservative treatment methods. For example, the fractures of the bones of the skull of the skull require carrying out metalostosynthesis, and the fractures of the upper or lower jaw for adequate reposition often need external fixation devices.
- Closed reposition and parcel metalosynthesis. Fixing bone fragments through spokes or plates conducted through the skin.
- Multinavasive methosynthesis. Fixation of bone fragments of a plate fixed in the bones of screws and located subcutaneously.
- Open reposition. Manual bone bite reposition with subsequent fixation with pins, brackets or plates (depending on the situation) during the operation.
- The imposition of an apparatus of outside compression-distraction osteosynthesis. Fixation of bone fragments by means of an external fixation device (for example, an orizarov apparatus). [thirteen]
In case of inadequateness of the bone recovery after the treatment, a repeated reposition is allowed. In operating conditions, the neat destruction of incorrectly contrived dice is made, and then one of the surgical methods of treatment is applied. The choice of techniques is carried out by a doctor depending on the localization of the fracture, the state of the patient and many other factors.
As auxiliary treatments, medical gymnastics, massage, physiotherapeutic treatment are carried out. The period of recovery during fractures is largely determined by the complexity and localization of the fracture. They vary from a few weeks to several months. In some cases, the restoration after the fracture does not occur, a false joint is formed. In such situations, various methods of endoprosthetics are used. [L 12]
- ↑ Petrov S. V. Decree. op. - P. 398.
- ↑ Petrov S. V. Decree. op. - P. 398-399.
- ↑ Petrov S. V. Decree. op. - P. 400, 437-441.
- ↑ Petrov S. V. Decree. op. - P. 392-398.
- ↑ 1 2 3 4 5 Polyakov V. A. Lecture 6. On fractures of bones, their treatment and regeneration of bone tissue. IV // Decree. op.
- ↑ Petrov S. V. Decree. op. - P. 423.
- ↑ Petrov S. V. Decree. cit. - P. 422-424.
- ↑ Petrov S. V. Decree. op. - P. 426-427.
- ↑ Polyakov V. A. Lecture 4. Prolonged intraskoy blockades in the treatment of injuries and their complications // Decree. op.
- ↑ Petrov S. V. Decree. cit. - P. 433-434.
- ↑ Petrov S. V. Decree. op. - P. 435-436.
- ↑ Petrov S. V. Decree. op. - p. 441.
- Polyakov V. A. Selected lectures on traumatology. - M.: Medicine, 1980. - 272 p. - ISBN UDC 617-001 (081)
- Petrov S. V. General Surgery: Textbook for universities. - 2nd ed. - 2004. - 768 p. - ISBN 5-318-00564-0
Skull • Skull arch • Base of skull • Nasal bones • Elets • Cheekbone • Upper jaw • Lower jaw
Neckline • Compression • Wedge-shaped • Breast Department • Lumbar Department • Cresan • Coccyx
Ribra • Big • Cleaning chest
Shovel • Clavicle • Shoulder • Forearm (ilk bone · Radiation bone) • Wrist (Paluum Bone) • Pin • Fingers
Ilium • Lobc bone • Merilic Wpadina • Thigh (neck · Accomplishing Exposed Diaphysia Nizhny end) • Phanenitor • Skin (tibia · Medial Ankle · Muloberstov bone · Lateral ankle · Bumper fracture) • Stop (tranny bone · Heel · Represented · Plus Fingers)
Disruptive fracture • FRANCED Fracture • Dear bone • Salter Harris Fracture
A fracture is an injury at which bone damage occurs. At the same time, the strength of the bone turns out to be lower than the force of affecting the factor. There is a classification of fractures that helps doctors to make a diagnosis and assign proper treatment.
Fractures and their symptoms
Symptoms vary depending on the type of fracture. For example, during the injury of the spine, pain syndrome may not appear at the point of impact, but in the lower limbs. The displacement injury always leads to the appearance of deformation and atypical mobility. Most fractures are accompanied by a strong incessant with time pain syndrome, the appearance of swelling, redness, skin sinusiness at the injury, the formation of the hematoma. When injuring the limb, its reference and motor function fail.
An open fracture is easy to recognize an open bleeding wound, often with bone fragments sticking out of it. With closed bone bones, they can drink through the skin without punching it. Rib trauma is always accompanied by difficulty breathing, soreness, cough, sometimes hemoop. The displacement fracture always causes a noticeable deformation of the bone if the limb is damaged, it may seem longer or shorter than normal.
The dependence of injury from age
The structure of the baby's bones is more flexible and not so durable, as in adults, because of which their musculoskeletal system is more vulnerable to injuries. In addition, the increased risk of injury in children is associated with high activity and insufficient self-preservation skills. In the elderly in the process of age-related changes from bone tissue, calcium salts are washed out, which is why the skeleton also becomes more fragile. In addition, blood circulation degraded due to age can lead to a deterioration of equilibrium, dizziness, increasing the risk of falling.
In mature people, the risk of injury is associated with seasonal weather conditions, physical labor, sports activities.
Almost all types of fractures have similar, pretty bright clinical carotine. Signs may vary depending on different factors, but allocate general symptoms of bone damage: severe pain, not passing over time, redness, edema, hematoma formation, skin sinusiness at the injury.
Some of these symptoms are absolute signs of the fracture, some relative. The predominance of certain signs depends on the type of injury.
Classification of bone fractures
To simplify the work of medical workers, there is a classification of bone fractures. Damage differ in different factors, including the shape and placement of bone fragments, as well as the cause of injury.
Causes of injury
Depending on the cause of damage to fractures, there are pathological or traumatic. Among the pathological, the following varieties are distinguished:
- Surgent of bones after surgery.
- The presence of chronic pathologies.
- Bone cysts.
- The presence of tumors.
Traumatic damage is divided into direct and indirect. Direct include any injuries in which the place of exposure to fabric coincides with the place of disruption of the integrity of the bone. Otherwise, the fracture is called indirect.
Message bone fragments
Depending on the location of bone fragments, 2 types of fractures distinguish. If the integrity of soft tissues is broken, the fracture is called open. If there is no such damage - closed.
Open fractures, in turn, are divided into primary and secondary. In the first case, damage to soft tissues is formed at the time of injury. The secondary occurs when the bone fragments injure the skin, punching it and forming the wound.
Closed fractures are divided into the following types:
- Combined. It is characterized by the possible presence of damage to visceral organs.
- Combined. The cause of damage was chemical, radiation and mechanical factors.
- Multiple. In this case, there are damage to several bones at once.
- Unit. Watches only one bone damage.
- Full. There is a complete separation of the ends of the bone, their offset is observed.
- Incomplete. Bone fragments are not divided. Such defects are tested, cracks, holes and boundary fractures.
The most difficult, dangerous and long healing types of injuries are fractures with a displacement. They can provoke heavy complications: loss of sensitivity, paralysis, bleeding, congestive processes. Injuries of large muscles and blood vessels are able to lead to death.
Depending on the location, injury is divided into the following types:
- Epiphysiolysis - bone growth zone injury in children.
- Epiphyseal - damage in the joints of the joints.
- Metaphizar - in the joint area.
- Diaphyzar - injuries of the ends of tubular bones.
- Complete - injuries of spongy bone elements.
- Damage to tubular bones.
Epiatric injury is a combination of fracture and dislocation. This complicates the treatment process, and makes the recovery period longer.
Form of fracture line
Depending on the fracture line, they are divided into the following types:
In transverse fractures, damage is considered stable, since no displacement occurs. In other cases, the bones are drawn behind the muscles, and their fragments begin to disperse, if they are not immediately fixed.
In case of sull damage, several sharp fragments are formed, which are absorbed into soft tissues, damage. Such injuries require long-term treatment and rehabilitation.
Possible complications of fractures
Complications in injury of bones are divided into three groups:
- Bone disorders. Incorrect healing, pathological change in the length of the damaged limb, the formation of a false joint.
- Disorders from soft tissues. Bleeding, muscle tissue atrophy, innervation deterioration and blood flow.
- The spread of infection in the wound or throughout the body.
The fracture may not be fighting if the bone is wrong to lie. If soft tissues fall between bones, a false joint may form, because of which the limb will lose the ability to move normally.
Damage to the nerve trunks during injury can cause the formation of a large bone corner, which will lead to paralysis and paresses, as well as a violation of metabolic processes in the tissues. All these complications, ultimately, can cause disability.
Long-term immobilization of the limb will lead to atrophic processes in the muscles and violation of the mobility of the joints. And also when removing the gypsum can be observed swelling, skin sinusiness. To avoid this prescribe therapeutic procedures, special exercise courses.
Infectious complications occur in open damage to the bone when pathogenic microbes fall into the wound and apply to the body. In order to prevent them, the wound is disinfected and closed with a bandage, wounds are sewn, antibiotics are treated.
With incorrectly or tightened treatment, the formation of scars, which begin to put pressure on the vessels and nerves, which leads to the appearance of chronic pain after the end of treatment. In this case, the patient cannot walk for a long time, to transfer gravity, feels pain when changing weather conditions.
Diagnosis of bone fracture
You can diagnose injury, based on the symptoms, but there is a chance to confuse it with a strong injury or crack because of similar symptoms. After providing first medical care, you need to deliver the victim to the hospital, where a qualified specialist will be able to examine him.
The most accurate way to determine the fracture is to make X-ray in different projections. This will not only determine the place of damage, but also to study it well from all sides. As a rule, it is sufficient to form an accurate diagnosis of this procedure. After her, the doctor can assign treatment and impose gypsum.
Relative signs of fracture
Almost any damage to bone tissue is accompanied by the following relative features:
- Strong pain syndrome, not weakened with time;
- loss of motor function;
- swelling and redness of the skin;
- The appearance of bruises.
Important: These signs are not always manifested and may be symptoms of another injury. Only a doctor can diagnose it.
Absolute signs of fracture
The absolute signs of bone injury are attachment - a characteristic crunch of bone fragments when trying to move the damaged limb or forgive it, deformation, as well as pathological mobility at the injury. These symptoms do not always become dominant, but if it is presented, the fracture can be defined for sure.
First aid for fractures of limbs
The victim need to immediately provide first medical care. Important: The right actions in the first moments after injury will avoid traumatic shock, as well as complications for further treatment.
What you need to do first:
- Estimate damage, their severity and the overall condition of the victim.
- Stop bleeding, disinfection wound.
- Damn the victim anesthetic.
- If necessary, move the victim to a more convenient position in which he will be able to wait for ambulance. Before that it is important to estimate whether transportation is possible: it is impossible to somehow move patients with a spinal fracture.
- Imagine a damaged area, impose a tire from the remedies.
If independent transportation of the victim is impossible, after assisting you need to immediately cause ambulance.
With open damage to the bones, severe venous or arterial bleeding can be opened. It needs to be stopped using a medical harness or use to do so remedy: belt, tie, piece of fabric from clothes.
Before applying the harness, you need to determine the type of bleeding. This can be done in the color of the blood and the speed of its selection:
- Venous bleeding - blood flows slowly, evenly, has a dark color. Harness must be imposed under the injury.
- Arterial bleeding is bright red blood, beats from the wound with jerks. Harness impose from above the injured zone.
Important: Ambulance can not come immediately after calling. In order not to give limbs to die, the harness needs to weaken every 1.5 hours, and then tighten again. Therefore, the time of the imposition of the harness should be recorded and do not forget to inform his ambulance doctors.
To avoid blood infection, the wound with open injury you need to quickly process the antiseptic agent and put a sterile bandage. For this, the usual hydrogen peroxide is suitable. After that, the place of injury needs to immobilize.
Immobilization or fixation of damaged bones is the main type of medical care for fractures. On the injured limbs impose a tire - a solid lining that can be made from remedies, such as a wooden board. In the absence of suitable materials, the lower limbs can be tied together, while healthy will serve as a tire for damaged, and the upper hang on the scarf, a scarf or a bandage, riding it around the neck. This will avoid the displacement of bone fragments and further complications during the transportation of the patient.
With a strong pain, it is necessary to give patient analgesic drugs - analgin, ketorol, ibuprofen. Before spending some manipulations with a damaged area: put the bus or try to palpate it, it is necessary to make it necessary otherwise the victim may lose consciousness from pain.
To which doctor to turn
When the fracture is for help, you need to contact a traumatologist or surgeon, you can also refer to the therapist. The doctor will inspect, determine the type of injury and choose the tactics of treatment. The patient's rehabilitation period can be sent to a needle or reflexotherapist, a rehabilitol doctor, a specialist in therapeutic physical education.
Video on the topic
Different types of bone fractures are characterized by different symptoms and require different treatment tactics. To facilitate the diagnosis, a classification was created, taking into account the localization, shape and location of bone fragments, as well as the causes of injury. Following this classification, the doctor can put an accurate diagnosis and determine the best tactics of treatment.
The fracture is the resulting disorder of bone tissue integrity under mechanical exposure, which in most cases arises as a consequence of injury, but are not rare and cases of its formation as a result of dystrophic (arthrosis, rickets), inflammatory (bone tuberculosis, osteomyelitis) and tumor (bone cancer ) Diseases.
The condition of the victim depends on the size of the broken segment, the number and severity of the damage obtained, the number and degree of mobility of bone fragments, as well as from a number of external factors to which the availability and quality of the means of anesthesia and materials to provide first aid, methods of transporting the victim, weather conditions and t. d.
The success of treatment largely depends on how timely and qualified was rendered first aid. The key value for the effectiveness of treatment has the accuracy of the diagnosis, i.e., how correctly the doctor interprets radiography testimony. Treatment and rehabilitation of the patient take a long time and require strict compliance with the immobilization mode of the damaged part of the body.
Classification of fractures
Given the number of parts of a human skeleton, subject to such injury, as well as taking into account the diversity of their etiology, it should be said that fractures are very different both for the reasons for the occurrence and in their consequences for the body. The existing types of fractures, as well as the doctors at the disposal methods and methods of their treatment, are well described in traumatology. However, all over fractures, humanity still does not know. This is evidenced by the fact that doctors are not always able to achieve complete restoration of the integrity of solid tissues and the necessary degree of rehabilitation of damaged joints.
Any fracture is the result of the load, which is superior to the bone strength limits, and always occurs during the human motor activity. In this case, the values of the maximum load for each individual bone are different. They are directly dependent on the angle (vectors) of the rendered mechanical effects and on the state of bone tissue at the time of physical effects (impact, break, sharp axial movement, etc.).
Under the condition of solid tissues of the body is understood to be their mineral composition, which may be different from the normal due to age-related changes or the impact of any pathogenic factors. So, the skeleton becomes more fragile as the organism agrees. Various bone diseases (dystrophic, tumor, inflammatory) are to the same extent capable of weakening bone strength.
Based on the foregoing, the types of bone fractures are distinguished on the following grounds:
- due to their occurrence;
- on the integrity of the skin;
- to localize the damage obtained;
- in the direction and form of a fracture;
- by the mechanism of origin;
- According to the severity of damage;
- By number of damage.
Due to the occurrence
Due to the occurrence, i.e., based on the nature of damage, bone fractures are divided into:
- Traumatic fractures that represent the consequences of a mechanical impact on one or another part of the musculoskeletal system, that is, the impact, sharp break, axial load (turning), strong compression, etc. The reason here can serve the production, household, sports Injuries or combat wounded.
- Pathological fractures, which are the destruction of solid tissue caused by the pathological restructuring of its structure, i.e., with its deception with osteomyelitis, osteoporosis, tuberculosis and other existing bone diseases that are divided into dystrophic, inflammatory and tumor. All of them in one degree or another weaken the skeleton and thereby contribute to the occurrence of injuries of this type.
Depending on the degree of damage to the soft tissues, including skin cover, bone fractures are divided into closed and open.
Closed fractures, which are a closed bone injury, not accompanied by damage to the field of mild tissue injury and non-reported with the external environment. The diagnosis is made on the basis of a survey of the victim and taking into account external manifestations (acute pain in the damaged segment of the musculoskeletal system, its possible deformation, swelling, hematoma, violation of motor functions, pathological mobility, etc.). Since some of these symptoms may be absent, the final diagnosis is made on the basis of radiography data.
Open fractures, which are damage to the bone, in which the area of injury is communicated with the outer medium through the wound on the skin or, less often, the mucous membrane. The greatest frequency is open fractures of the limbs. In the area of injury, the wound is observed, applied from the inside by one of the bone fragments. Bone fragments can be visible in the wound, although this happens not always.
The diagnosis is made on the basis of a survey of the victim and inspection, i.e., taking into account the external manifestations of injury: acute pain in the damaged segment of the musculoskeletal system, its explicitly pronounced deformation, bleeding from bones and dissected soft tissues, swelling, hematoma, violation of motor functions , pathological mobility, attitudes (crisp sound), etc.
According to the existing statistics, this type of damage is about 10% of all cases of damage to the human musculoskeletal system. Most often, he has a traumatic nature and arises as a result of falling, industrial accidents, automotive accident or combat injury. Often it combines with other injuries - bruises, dislocations, closed fractures.
Open forms are much greater than closed, subject to different complications.
By localization of damage
By localization of damage, i.e., according to anatomical indicators, bone fractures are divided into the following types:
- Epiatric, or intra-articular, injuries are the most severe types of fracture. Most often they affect the large beam, shoulder and radial bones. They are often complicated by damage to the periosteum, breaking and stretching bundles, displacement of bone fragments.
- Metaphizar, or ocolatable, injuries - a violation of the integrity of segments localized in the field of tubular bone having a thin cortical layer. The okolossertive fracture often happens in a framed, that is, with it, the fragments penetrate one in another without a large axial displacement.
- Diaphizar injuries - the integrity of the central part of the tubular bone, localized in its middle part. This type has the greatest frequency among the damage to the big bertova, shoulder and radial bones.
In the direction and form of a fracture
Bone fractures in the direction and form are divided into the following types:
- transverse, which are determined if the fracture line with respect to the axis of the bone is located at an angle close to 90˚;
- oblique, which are stated if the fracture line with respect to the axis of the bone is located at an angle with the value significantly less than 90˚;
- screw-like, which are defined if the fracture line has a spiral shape;
- Associated, which are stated if there are fragments on the lines;
- Wedge-shaped, which are stated if one bone is pressed into another, forming a wedge-shaped deformation;
- Compression, which are stated if the bone is fragmented, the fracture line wears fuzzy outlines.
A separate variety is boundary fractures, in which a small fragment of bone tissue is littered from the bone.
By the mechanism of origin
Depending on the mechanism of origin, the fracture of the bone can be the result of squeezing, compression, bending (breaking) and twisting. A separate category is separable fractures. Damage from squeezing and compression occurs along either across the axis of the bone. In case of cross-squeezing, convolver and compression fractures arise. With long squeezing, oblique and wedge-shaped fractures occur more often. Long tubular bones break most often with transverse squeezing, and flat bones - with longitudinal.
Damage to bending bones occur as a result of a sharp breaking of a segment of the musculoskeletal system exceeding its elasticity. Such injuries arise in most cases when falling, however, there are cases of their appearance during industrial activity and during sports loads.
Damage from twisting occurs with the axial load on the bone, at which one end of the bone was firmly fixed, and the second end is subjected to twisting. Just under such circumstances, screw-like fractures arise. Most often, they are subject to large tubular bones, i.e., femoral, tibial and small bones; Shoulder, elbow and radial bone.
Temporable forms arise as a result of sudden and strong muscle contractions. Those are subjected to those fragments of bones to which bundles and tendons are attached. So there are predominantly damage to the ankles, the heel bone and the knee cup.
According to the severity of damage among fractures, complete and incomplete. Full represent the destruction of the bone with loss of resistance to bending and manifest it with attitudes - a characteristic crunch with axial load. In this case, the bone is damaged to all its thickness.
Under the term "incomplete fracture" in traumatology understand cracks in the bones, which arise as a result of impact or strong compression. They do not entail the loss of resistance to bending and the appearance of attitudes, so their symptoms are often mistakenly interpreted as a manifestation of the injury. A crack (Fissura) is an incomplete disruption of the integrity of the bone, in which the fracture plane does not guess, and on the X-ray, there is a longitudinal cross-lumen, which does not cross the entire bone profile.
Young children also have substitute fractures, i.e., bone injuries that are not accompanied by the destruction of the periosteum.
By number of damage
An important point when considering the question of which fractures are, is the separation of single and multiple fractures and clinical distinction of combined and multiple damage. Single, or isolated, the fracture should be considered a single impaired integrity of one human skeleton segment without a combination with other damage (injury, dislocation or stretching).
Combined, or combined, fracture - a single violation of the integrity of one human skeleton segment in combination with other damage (injury, dislocation or stretching).
Multiple fractures are a violation of the integrity of one part of the musculoskeletal system in several places (for example, the middle part of the femoral bone at different levels) and the integrity of two or more segments simultaneously.
Mechanism of fracture
The mechanism of bone fractures depends on the degree of elasticity of bone tissue, which, in turn, is determined by its mineral composition. And if traumatic fractures may occur regardless of the degree of strength and elasticity of bone tissue, then pathological is almost always due to the impaired mineral composition.
Accordingly, the answer to the question of what a fracture is different in these two different situations. In one case, it represents the result of a mechanical effect, which is superior to the limit of natural strength, and in the other - the result of the imbalance of minerals in the structure of parts of the human musculoskeletal system.
Types and signs of fractures are largely determined by the causes of their occurrence. The causes of fractures are to occur in the occurrence of conditions under which the force rendered to the one or another segment of the human musculoskeletal system during pressure, breaking, impact, turning, etc., exceeds the strength of this segment. Therefore, it is necessary, if possible, not allow critical loads to the skeleton and carefully comply with the established safety regulations in everyday life, during sports, in production, in transport, etc.
The fracture can be diagnosed by the following features:
- In the area of alleged damage, there is a sharp stole pain, irradiating above damage. The pain is sharply enhanced by feeling the place of the fracture and when driving, especially with the axial load on the damaged segment.
- Edema and, possibly, hematoma (sinusia), consistently propagating around the place of damage.
- The oppression of the mobility of the limb, expressed in the absence of the ability to fully bend it and blends it.
- Hematoma (bruise) in the area of damage; Blood in place of mechanical exposure. When the finger fracture is possible, bruises under the nail plate followed by its detachment.
- The pathological mobility of the reversible limb (its unnatural bending is not in the place of the joint).
- Capital, i.e., hurt with axial movement, feeling friction of bone bone.
- Possible (but optional) deformation of the outlines of the limb caused by the displacement of the broken part under the action of tendon tension.
- In difficult cases, with open forms, along with the wound can be seams and fragments can be visible.
The final diagnosis in all cases can only be delivered using radiography.
On the degree of reliability of the diagnosis, in particular from the correctness of the interpretation of x-ray data, the adequacy of elected methods and treatment methods depends in many respects.
To diagnose injuries of this kind, clinical and instrumental examination methods are used. During the clinical examination, the doctor polls the patient about the circumstances of injury, inspects the fracture site, establishes the presence of changes in the natural outlines of the affected organ, examines the degree of its mobility, checks the sensitivity by palpation, determines the level of blood supply to the limb.
Instrumental methods for diagnosing fractures in most cases are x-ray. Sometimes, if necessary, more detailed visualization uses computed tomography, nuclear magnetic tomography, etc.
When first aid, the injured primary task is to immobilize the fracture site. This can be done using a tire, which can be used to use a board suitable in size and weight, which is binding with bandages. In the absence of a bandage, it is possible for this purpose to use any clean tissue, breaking it on the ribbon 10-12 cm wide.
For open fractures, it is important to handle the wound with antiseptic means (iodine, alcohol or green) and impose a bandage bandage on the wound. With abundant bleeding arising from damage to large blood vessels, prior to the arrival of the physicians, it is necessary to impose harness or a gouring bandage.
To overcome pain syndrome, it is permissible to give a patient anesthetic.
In no case can you try to independently compare fragments, especially with open forms.
Treatment appoints and implements a traumatologist after diagnosis. The procedure for its actions is as follows:
- Anesthesia is performed.
- After the study of X-ray data, with a full fracture, a comparison (adjustment) of fragments is made and plaster Langeta is superimposed or an immobilizing bandage.
- With open forms, an operation is carried out on comparison (adjustment) of fragments, the seams on the wound and the immobilizing bandage are superimposed, which, in the subsequent period, after healing the wound, is replaced with a gypsum Langet.
In addition, the patient is prescribed drugs aimed at:
- reduction of pain syndrome;
- acceleration of fastening of fabric;
- Restoration of calcium metabolism;
- strengthening the structure of the bones;
- restoration of periosteum;
- adjustment of the mineral composition of bone tissue.
How bones are growing
The acceleration process includes four stages:
- In the first stage, blood is collected at the junction of fragments, gradually forming a viscous mass, and then fibers, on the basis of which the bone is regenerated.
- In the second stage of the clutch is filled with osteoclasts and osteoblasts.
- In the third stage, bone corn is formed
- At the fourth stage, the ends of the bones are growing.
In a number of possible complications, a traumatic shock, limb gangrene, secondary bleeding, breakdown, suppuration in the area of surgery conducted and various diseases of the inflammatory nature, should be specified.
Fracture is a violation of the integrity of the bone. Depending on its nature, either two fragments are formed or two or more fragments. Of course, in this case, the bone temporarily cannot fulfill its functions - ensuring support and movement.
The body has a mechanism responsible for recovery: bone tissue can fire. But in order for this quickly and right, you need to properly compare and fix fragments.
By the decision of this task and is engaged in a traumatologist.
In Calt, you can get advice with an orthopedic traumatologist.
- Primary consultation - 2,700
- Repeated consultation - 1 800.
In order for the bone to break, it is necessary to have one of the following reasons:
- Strong blow by any object. In the place where he fell, the bone could break.
- A fall. It often happens from height. But sometimes in order to break something, sufficiently fall from the height of its own growth.
- Strong bone squeezing. For example, fragments of various collapsing massive structures.
- Excessive violent movement. For example, the vibrant fracture often occurs when the legs turn, for example, during skating.
For all types of bone fractures, certain common symptoms are characterized:
- Pain. During injury, it is strong, sharp, and after becoming stupid. Strengthening pain during axial load.
- Deformation. If fragments are shifted relative to each other, then the leg or hand takes an unnatural form.
- Swelling. She begins to grow immediately after injury.
- Subcutaneous hemorrhage - hematoma. Sharp bumps damage small blood vessels, and blood is poured under the skin.
- Violation of the function. If you ask the victim to move damaged by foot or hand, it will not work out due to severe pain, stretching muscles and damage to ligaments.
The most dangerous fractures of the bones of the skull, vertebrae, ribs, pelvic bones. They can damage internal organs and nervous system. Danger also represent multiple fractures, they can lead to a shock state.
Signs of fracture
There are relative and absolute signs of a fracture. Among relatives are the following:
- Hematomas due to internal hemorrhage due to vessel injury. In the fracture zone there is a swelling and a large hematoma, the touch of which causes an acute pain.
- Cutting and unbearable pain in the affected area. In rare cases, people lose consciousness from pain.
- The inability to move the limb (complete loss of motor function).
- The swelling of soft tissues indicates a fracture or dislider.
Absolute signs of fracture:
- With open fractures, the fragments are clearly visible, and the curvature of the bone and the unnatural position (the rupture of soft tissues is missing) is detected.
- The appearance of clicks and chunks, as well as excess mobility in the affected area.
- Loss of motor function (person can not move the limb and experiences acute pain). Often symptoms resemble strong injury or dislocation, therefore differential diagnosis is required.
Types of fractures
Traumatic - appear due to damage to the bones, which leads to a change in shape, integrity and structure. Heavy injuries may appear as a result of an accident, falling, shocks in contact modes of martial arts or in professional sports.
Pathological - arise due to violation of bone density. Often occur with such diseases as osteoporosis and osteomyelitis. Elderly and children fall into the risk group, since the lack of calcium is often observed in their organism.
It also takes separation on complete and incomplete fractures. At full there is a bone offset and penetration of fragments into soft tissues, and with incomplete partial destruction of bone tissue due to shocks (cracks are formed).
There are 6 types of fractures that depend on the direction of damage to the bone:
- Vintage - turning bones.
- Associates are injuries that are accompanied by crushing bones and penetration of fragments into soft tissues.
- Transverse - a fracture line is approximately perpendicular to the axis of the tubular bone.
- Wedge-shaped - bones are pressed into each other when hitting.
- Longitudinal - line of fracture is approximately parallel to the axis of the tubular bone.
- Kosy - the picture shows a straight angle between the axis of the bone and the fracture line.
It is easily determined by the traumatologist, since the bone fragments are clearly visible due to the rupture of soft tissues. This is the hardest degree, because infections and pathogenic bacteria will quickly penetrate into the open wound. Upon late appeal to the doctor, the development of gangrenes may begin. If you do not start the treatment, then a fatal outcome is possible.
It is characterized by a violation of the integrity of the bone without breaking the soft tissues and the penetration of infection. It is often observed bone offset, so for accurate diagnostics, experts use radiography. These category also includes cracks that cause acute pain and violate the mobility of the limb. If you do not carry out the treatment of cracks, then the deformation of bone tissue is possible.
If the fracture is supected, it is necessary to ensure the victim full of peace, immobilization, reliable fixation of the region of the intended fracture. For example, a hand can be laid in a golk, to climb with bandages or scraps of clothing to the body, a dense board or a piece of fittings. You can feed the foot to the reinforcement, to the board, to a healthy leg.
If the spinal fracture is suspected, you need to put a person on a dense wooden shield or any dense smooth surface. Depending on the severity of the injury, you need to immediately either take the victim to the trauma, or call "ambulance". In the Multidisciplinary Calt clinic, the treatment of fractures are engagedHighly qualified traumatologists
Bone damage is easily detected during radiography. On X-rays, a crack or a fracture line is clearly visible. If doubts arise, then computer tomography is carried out - a study that helps even more accurately and evaluate the condition of the bones.
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Treatment depends on the type and severity of the fracture:
- With cracks and conventional fractures without displacement impose a gypsum Longeta. The term of its wearing depends on which bone suffered, on average - 2 - 4 weeks.
- When fractures with displacement, a closed reposition can be carried out: the doctor compares fragile under local or general anesthesia and immediately imposes a plaster Longet.
- Sometimes a skeletal stretch can be carried out: through a fragment of the bone, the knife is performed, to which the cargo suspend.
- In case of complex fractures with displacement, an open reposition and osteosynthesis can be carried out: the doctor makes a cut, compares fragments and fastens them with various metal structures.
- Sometimes the imposition of an orinator apparatus or similar devices is shown: spokes are performed through the puncture of the skin and bone pieces, and then the metal apparatus is collected on them, which provides the correct bone configuration.
- Other types of osteosynthesis.
In a multidisciplinary clinic, CELT employs experienced traumatologists and installed modern equipment. Our specialists use the most progressive technologies to provide as full-fledged, efficient and rapid treatment of various bone damage. In our traumatology department, complex surgical interventions are performed.
Services of orthopedics and traumatology in Calt
The administration of ZELT JSC regularly updates the price list posted on the clinic website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7 (495) 788 33 88
Fracture - Complete or partial disruption of the integrity of the bone with damage to the surrounding soft tissues. This is a frequent pathology that makes up approximately 6-7% of all closed injuries. The most common fractures of the bones of the foot - 23.5% and bones of the forearm - 11.5% of cases (according to Krupko I. L.) Open fractures in peacetime are found in less than 10% of cases from all fractures.
Symptoms of fractures
- Absolute symptoms (reliable signs). Characterized only for fractures. Specially checked only by a doctor and after anesthesia! Often, these signs feel the victim himself.
- Pathological mobility - the mobility of the limb, is normal, not characteristic of this zone.
- Bone attitudes - sound and feeling on the type of snow crunch, caused by friction of bone fragments of each other.
- Visible bone fragments (with an open fracture).
- Relative symptoms (probable signs). It is found not only for fractures, but also with other damage (for example, dislocation, ligaments damage):
- violation of the limb function;
- Soft tissue edema;
- Change limb shape.
Due to the occurrence
1. Traumatic - arising from the injury factor. The structure of the bone and its mechanical strength is usually normal. The power of the traumatic factor is high.
2. Pathological - arising spontaneously or under the influence of the extremely small force of the traumatic factor (sneezing, changing the position of the body, raising the stable subject).
The reason is in the change in the structure of bone tissue and reduce the mechanical strength of the bone (osteoporosis, metastases of malignant tumors, bone tuberculosis).
By type of bone fragments
- Without offset.
- With offset:
- by lenght;
- in width;
- by periphery;
- at an angle;
- with the discrepancy of fragments;
- Combined fractures.
In relation to the surrounding skin:
On the fracture line:
Diagnosis and treatment is carried out by a traumatologist, less frequently surgeon. The main diagnostic method is Radiography In two projections - straight and lateral. For some types of fractures, special projections are used (for example, iliac and lockable with a fracture of the godded depression). More informative (and expensive) method is X-ray computed tomography (RTC) allowing you to get a voluminous 3D image of a damaged segment. For additional diagnosis of soft tissue damage use Magnetic resonance imaging (MRI), ultrasound research (ultrasound) less likely - Angiography, electronomyrography.
Treatment of bone fractures
Basic principles of treatment of fractures - preservation of the patient's life, elimination of anatomical disorders that impede the activities of vital organs, restoring the anatomy and the functions of damaged limbs.
For the treatment of closed fractures apply Immobilization - immobilizing the damaged segment with plaster dressings, plastic longs or hard orthoses. When the bone fragments are shifted, skeletal extracts (long-term fraction of fragments using a cargo system). Many fractures require Surgical intervention . Its advantages are high-quality comparison and reliable fixation of fragments, the possibility of early activation of the patient, reducing the time of stay in the hospital and time of temporary disability. It includes osteosynthesis - the compound of bone fragments with plates, pins, screws, and endoprosthetics - complete or partial replacement of the joint ("Golden Standard" during femoral fractures in the elderly).
Medicia treatment Rights on the removal of pain and preventing the development of complications. For anesthesia, narcotic drugs are used (only in the hospital - with severe injuries and the threat of development of traumatic shock), non-steroidal anti-inflammatory (NSAIDs). Among the latter, preferably preparations with prevailing anesthetic activity - analgin, ketorol, ketonal. For the prevention of thrombosis (in the fractures of the bottom limb bones, as well as in lying patients), anticoagulants are prescribed (preventing blood intake) - injection derivatives of heparin (heparin, fractioniparin, enochapparine) and modern tableted tools - Pradaks, Xarelto, as well as antiagregants (improving blood fluidity ) - Aspirin, clopidogrel, Trental. With open fractures, the prevention of infectious complications is required. For this purpose, antibiotics are used (more often cephalosporins - ceftriaxone, cefotaxim) and antibacterial drugs (offloxacin. Befloxacin, metronidazole).
Physical church It is used in the acute period to reduce the traumatic edema and pain syndrome, and in the rehabilitation phase - to improve blood circulation in the zone of fracture and ripening of the bone corn.
In the acute period most effective Magnetotherapy . It can be used even through a gypsum bandage that is not an obstacle for the magnetic field. When removing the edema, a good painkiller effect occurs, the compression of soft tissues decreases, the likelihood of the development of bubbles on the skin is reduced, which are contraindicated to surgical treatment.
Cryotherapy It is a good addition to the magnetic field, but it is possible to use only on the dominated area free from immobilizing bandages. Local temperature decline reduces the sensitivity of pain receptors, narrows blood vessels, reducing the edema.
During the rehabilitation period, the arsenal of physiotherapeutic methods is more diverse. In addition to the methods described above, apply Ultrasonic therapy (phonophoresis) with hydrocortisone ointment for pain relief and softening fabrics after immobilization. Electromability is aimed at restoring the lost volume of muscles.
Laser therapy Expands the blood vessels above the fracture zone, contributing to the ripening of the bone corn. Shock-wave therapy destroys pain and non-viable cells, contributing to the regeneration of tissues, improves the formation of bone corn.
The prevention of bone fractures is the wearing shoes on a non-slip sole, compliance with the rules of the road, regular classes of physical culture to improve the coordination of movements, attentive attitude to their health. Separately, it is necessary to mention the need for densitometry (studies of the mineral density of bone tissue) in people over 50 years old, especially in women.
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