SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : BROKEN BONES (FRACTURAE OSIUM) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. The direct mechanical effect of severe injuries, acting in different directions (the kinks, the immediate impact, flattening, twisting).
The pathogenesis. The force that exceeds the elasticity of the bone, causing disruption of its integrity. The result: a partial violation of the integrity of the bone crack or break; violation of the intact bone, exciting all of its diameter without breaking the periosteum - subperiosteal fracture; the violation of the integrity of the bone through the entire cross-section with a violation of the periosteum - the complete fracture; bone separation on a large number of particles lost mutual link - fragmentation; the change in the relative positions of the particles without separation of the bone into separate parts - resistant; full fractures, depending on the direction of action of the forces are divided into transverse, oblique, spiral, comminuted. Fractures can be without violating the integrity of the skin is closed in violation of the skin is open.
Symptoms of a fracture absolute (mostly related to fractures of the limbs): deformity of the affected limb, which result from trauma; abnormal mobility throughout; shortening determined by comparative measurement of the length of the healthy and diseased limbs; crepitus - the crunch from the friction of the bone fragments. Symptoms relative: constant pain, pain when the local pressure pain over (under boost); impaired function of the extremities, swelling, bruising, late bruises. In open fractures joins the violation of the integrity of the skin.
For. In the next few days after the fracture begins the formation of connective tissue of corn, and later develop specific elements oleoides tissue. On the fracture healing is influenced by: General nutrition, circulation, condition of the endocrine and autonomic nervous system. The time required for healing of fractures depend on the thickness of the broken bone, fracture, standing fragments, localization, age, General state of health and condition of the soft tissues in the region of the fracture. In open fractures healing times are extended.
The recognition is based on the mechanism of damage to the bone, which for many fractures are common on absolute and relative grounds. Difficulties encountered in intra-articular fractures, impacted fractures, fractures of the individual spongy bones (spine, calcaneus). In these cases, special importance has x-ray analysis. Radiographs should be done in all cases of fractures or suspected them and be sure in two projections.
First aid and the use of temporary immobilization. Transport immobilization of great importance in time of peace, becomes decisive in war.
Rational treatment of fractures is based on the following principles.
1. Combat shock, blood loss, prevention of infection in open fractures) and the struggle for the preservation of limb - penicillin, sulfonamides, blood transfusion, etc.
2. Restore anatomical relationships, which is an instantaneous or gradual reduction of the displacement of fragments. For withdrawal reflex contraction and retraction of the muscles that are supported by pain, before the reposition of fragments produced subcutaneous administration of 1% morphine and local anesthesia in the area of fracture (2% solution of novocaine in the number 15,0 - 25,0). When you reposition peripheral fragments is set against the Central.
3. Set of fragments must be held in position reposition. The latter is achieved skeletal, cutaneous extension or imposition of plaster bandages.
4. In order to accelerate fusion, recovery of body function and disability is the functional method of treatment: the use of active movements in the joints, improve blood and lymph circulation, prevent stiffness and muscle atrophy, ankylosis with intra-articular fractures.
5. Organization the proper care of the victims.
In rare cases (large divergence of fragments that are supported by muscles, torn tendons and aponeurosis, fractures of the patella, olecranon) applied surgical treatment.
A failure to reposition occur due to interposition muscles, caught between fragments, delayed reset. The result is improperly healed fractures and false joints.
In the treatment of open fractures are pursued two goals: preventing the spread of infection in the wound, and treatment of the fracture. With this purpose it is necessary to strive through primary surgical treatment all open fractures translate into closed. In terms of the military situation blind stitch (with gunshot wounds) is contraindicated.