SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : TYPES OF FRACTURES - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Arise more often from direct violence, also when falling onto an outstretched hand. There are transverse, longitudinal fracture of body of scapula, break lower and medial angle of the scapula, fracture of the neck or glenoid.
Occur from a direct blow, often in the fall. Distinguish between transverse and oblique fractures, usually in the outer third of the clavicle.
Occur more frequently in older people when falling on the arm bent at the elbow or outstretched hand (not to be confused with a dislocated shoulder!).
Arise from the immediate shock - transverse fractures; from bending when falling on the elbow - angled fractures; torsion (discus, grenades, sharp turn of the hand) - spiral fractures.
Occur when falling on a bent elbow or outstretched hand, often in childhood.
Occur more frequently with the direct impact on a solid object.
Are very common in old age. Occur when falling on an outstretched hand.
Arise more often from a direct hit (sledge hammer, hammer, hit the machine).
Hip fractures occur in old age (after 50 - 60 years) in connection with the General sclerotic phenomena and particularly fragile bones. Occur when falling on its side and direct impact on a large skewer, with the leg advertiseda inside.
Arise from the direct application of force - transverse fractures, knee - oblique fractures, torsion - spiral fractures.
Arise more often from direct impact of the fall on a bent knee.
Occur during a direct action force - transverse fractures of one or two dice; if the break - oblique fractures, usually of both bones; when twisted - spiral fractures of both bones at different levels.
Occur in the fall when povertyline feet inwards or outwards. This may result in fractures of one of the external malleolus, two ankles or two ankles with a margin of posterior edge of the tibia (troglodytidae fractures). Fractures of the ankle can be without bias and offset.
Occur when falling on the outstretched foot, on the heel.
Usually occur with the direct hit.
Occur more frequently with the direct hit, at least in the compression of the entire chest in the frontal or sagittal direction.
Fractures of the transverse processes with a sharp contraction of the muscles of the back - tear-off fractures.
Mainly I and II of the lumbar and lower thoracic, occur when falling from a height on the feet or on the buttocks. While the torso moves forward, the spine bends into an arc and there is a sharp compression of the lumbar and lower thoracic vertebrae. These fractures can also occur in the fall of gravity on the head or shoulders of the victim.
Arise under the influence of severe injury in case of compression pelvic ring in the anterior-posterior or lateral direction. There are isolated and multiple fractures of the pelvis. The latter is often accompanied by severe shock state.
Occur when a direct blow to the head or fall on his head. There are closed and open fractures. In open fractures, the possibility of infection worsens the prognosis. Has the value of the localization and nature of fracture: crack, impression, fragmentation. The course and outcome of skull fractures depend mainly on the presence and nature of damage to the brain and its membranes. In injuries of the skull, a careful neurological examination, on the basis of which the question of the nature of the treatment (see brain Injuries). In open injuries of the skull (except fractures of the skull base) shows a thorough and radical treatment of wounds.
Symptoms. Swelling in the body of the scapula and shoulder joint, painful and limited movement in the joint lowering down of the head arm.
Symptoms. Deformation, performance under the skin of the proximal end of the clavicle, the overhang of the shoulder, limiting the mobility of the upper limb. Possible rare complications: damage to the skin protruding proximal end of the clavicle, damage to major vessels, nerves of the brachial plexus.
Symptoms. Swelling in the shoulder joint. Sharp restriction or lack of movement in the shoulder joint.
Symptoms. Shortening of the limb, deformity, abnormal mobility. If damaged shoulder in the middle third may damage the radial nerve (the overhang of the brush, the impossibility of full extension of the fingers).
Symptoms. The configuration change to the elbow joint, abnormal mobility above the elbow joint.
Symptoms. Deformity of the forearm, abnormal mobility.
Symptoms. Deformation in the region of the wrist joint in the form of a bayonet, the lack of movement in the wrist joint.
Symptoms. Deformity, pain when local palpation with this axis of the respective finger, restriction of movements.
Symptoms. LLD, sharp adduction and rotation outwards. In extra-articular fractures of the observed deformation in the area of the hip joint due to bruising and swelling. When intra-articular fractures of the deformation is not always detected. There are medial and lateral articular - resveracine and povertyline extra-articular fractures.
Healing of hip fractures, mainly intra-articular, is extremely slow and requires a long bed content. There are often complications of the lungs and heart (circulatory disorder). In violation of the trophic disorders in the elderly are easily formed decubitus (care!).
Symptoms. Shortening of the thigh reaches often 10 cm and more pronounced abnormal mobility of fragments, deformation and rotation of the distal part of the limb outwards.
Symptoms. Considerable smoothness of the contours of the knee joint, the presence of effusion in the knee joint, when you break the aponeurotic tension of the quadriceps muscle clearly defined the divergence of fragments of the patella. In these cases, the victim is unable to raise extended leg.
Symptoms. Deformity, shortening, abnormal mobility, crepitation. For immobilization apply wire bus (one on the rear, two on side).
Symptoms. Swelling in the ankles, sharp pain when pressing on the heel. After 3 to 4 days the appearance of a bruise on the plantar surface of the foot.
Symptoms. Pain, difficulty breathing movements.
Symptoms. Sharp pain when pressed in the region of the transverse processes, some distance 1 ½ - 2 cm away from the protruding spinous processes of the spine.
Symptoms. Pain with pressure on the spinous processes of broken vertebrae, a sharp tightening of the muscles in the area of the fracture, restriction of movements.
Symptoms. Pain on compression of the pelvic ring in the frontal and sagittal direction; a sharp pain when pressed in areas where fractures of the pelvis are the most common: the horizontal part of the pubic bone, ischium, the region of the sacroiliac joint and others; fracture of the pubic bone characterized by the inability to raise the foot up in an extended position, the so-called symptom "stuck on your heels (painful sensations occur when the voltage m. ileo psoas).
The course and outcome of skull fractures depend mainly on the presence and nature of damage to the brain and its membranes. In injuries of the skull, a careful neurological examination, on the basis of which the question of the nature of the treatment (see the Bruises of the brain). In open injuries of the skull (except fractures of the skull base) shows a thorough and radical treatment of wounds.
Transport immobilization scarf or premenovavanie to the body, hands, bent at right angle in the elbow joint. Traction onto the bus 3 to 4 weeks with the simultaneous holding of motion in all joints of the upper limb.
Rehabilitation after 1 ½ - 2 months.
Transport immobilization scarf, premenovavanie to the body, hands, bent at right angle in the elbow joint.
The reposition of bone fragments by abduction of the shoulder, lifting it up and rotation outwards. Fixation in 3 - 4 weeks. At the same time systematic exercise therapy; movement in all joints of the upper limb. Rehabilitation after 4 to 6 weeks.
For transportation arm, bent at right angle in the elbow joint, suspended on a scarf or primitives to the body (the risk of secondary damage to the neurovascular bundle).
The treatment of fractures with displacement is reduced to reposition to change in impacted. To hold the fragments entered the platen in the underarm area, attached scarf on the area of the wrist joint; resolved early motion in all joints of the upper limb.
Rehabilitation after 6 to 8 weeks.
Transport immobilization wire bus from the scapula healthy hand over shoulder, bent at a right angle, elbow joint, wrist joint and to partnerlanguage joints (fingers leave open). Forearm and wrist attached position, a cross between pronation and supination; the fingers in position matching of the first third.
Simultaneously reposition of bone fragments, the fixation of extremities skin traction in abduction bus. Early physiotherapy. Position on the abduction splint for 4 to 5 weeks. Subsequent position on the headscarf 1 - 1 ½ weeks with the continuation of all kinds of motion in the joints of the upper limb. In open fractures of the shoulder is recommended fixing coracobrachialis bandage.
Rehabilitation after 2 to 3 months.
Transport immobilization wire bus from the scapula healthy side to the metacarpophalangeal joint. A one-step reduction with fixation of limb deep ISU - owl Longuet from the shoulder joint to the metacarpal-phalangeal joint on the rear surface of the shoulder and forearm. With a 5 - to 7-day removing forearm from a plaster splint and flexion movements in the elbow joint. From the 14th day of Paris splint is placed is removed. Therapeutic exercises to restore function.
Rehabilitation after 1 ½ - 2 ½ months.
Transport immobilization plywood bus from elbow to fingertips. The brush is placed a cotton cushion for packing it with bent fingers. Simultaneously reposition with subsequent fixation plaster back Longuet from the elbow to the metacarpophalangeal joint. Early movement (the first days) in the fingers, elbow and shoulder joint. Fixation of the forearm plaster Longuet 3 - 5 weeks.
Rehabilitation after 5 to 8 weeks.
Transport immobilization: fixation of the forearm and hand in a bent position of the fingers plywood bus. Simultaneously reposition of fragments with subsequent fixation of the Volar Longuet from the elbow to the tip of the damaged finger, giving the brush position extension at an angle of 10 to 15º fingers position of flexion and mapping the first finger on the third. In case of failure to eliminate the displacement - traction soft tissue of the nail phalanx of the corresponding finger. The period of fixation or traction - 3 weeks.
Rehabilitation after 4 to 6 weeks.
When transport immobilization is necessary to commit the entire limb; an external bus must be imposed from the armpit to the foot. The best tire is the tire Diterikhs.
1. Instantaneous or gradual reduction with subsequent fixation of the limb with the help of skeletal or skin traction.
2. The immobilization of the limb using plaster bandages from the upper section of the chest to the tips of the fingers (hard tolerated, especially in the elderly).
3. When intra-articular (medial) fractures - surgical treatment: the knocking together of fragments using three nails. This method reduces the treatment time and allows early rising. As for traction, and when surgical treatment is necessary early application of therapeutic exercises that reinforce the muscles of the pelvic girdle, torso, and hips; at the same time massage the area of the pelvic girdle, femur and tibia, and later paraffin with limitation of movements of the knee joint. The duration of treatment with intra-articular fractures of the conservative treatment much longer: stay on the traction of up to 3 months; walking on crutches for up to 6 - 7 months; after - walking with a stick. When surgical treatment under favorable for the walk to the load with a 2 - 3 month.
In extra-articular fractures of the skeletal or skin traction is applied for 1 - 1 ½ months. Then walk with crutches; going to stick to 2 - 2 ½ months.
Rehabilitation after 3 months.
Transport immobilization bus Diterikhs. Skeletal traction for Misaki hips or below the tuberosity of the tibia; reposition simultaneously with the transverse fractures or step - by oblique and spiral fractures. If the reduction fails (with transverse fractures) or interpositive muscles recommended surgical intervention intraosseous introduction of the nail. The fracture fracture comes to 2 - 2 ½ months. In the future, walking on crutches without weight bearing. Load permitted for 3 - 3 ½ months.
Work capacity is restored after 4 to 5 months.
The position of the extension, fixing plaster Longuet for 10 days. If you have a large amount of fluid in the joint - puncture and moisture content on the 2 - 4th day. From the 10th day of walking and active exercises; a plaster of Paris splint is placed is removed. Different fragments of surgical treatment - stitching torn aponeurosis on the sides and the anterior surface of the patella. After removal of sutures therapy is the same as when the fracture without differences of fragments.
Work capacity is restored within 2 months.
In transverse fractures without displacement - fixing plaster cast from mid thigh to toes: the knee joint angle in 5 - 7º; the ankle joint is at 90 - 100 ° . For unloading when the walk is added to the metal stirrup. In transverse fractures with displacement, oblique and spiral fractures skeletal traction for the heel bone in 2 - 3 weeks with subsequent fixation (plaster boot with stapes) for 2 to 2 ½ months.
Work capacity is restored after 3 to 4 months.
When transport immobilization are three wire bus. When the external malleolus fractures without displacement - fixing U-shaped bus Volkovich for 3 weeks.
Work capacity is restored after 4 to 5 weeks.
Dvojlozkove fractures with displacement require repair fragments under local anesthesia and fixing plaster boot with stapes for 2 months.
Work capacity is restored after 2 - 3 months.
When troglodytique fractures with displacement and subluxation of the foot posterior to the lumbar fragments; the patient is placed in bed in a position of flexion of the lower limb at the knee, Tazo hip joints with hanging legs for the foot; strengthening plaster of Paris splint is placed to 3 weeks; thereafter plaster boot up to 3 months (since broken).
Work capacity is restored after 4 months.
Transportation of lying, fixation of the foot and lower leg wire bus. The elevated position of the foot for 6 to 8 days. Reposition of bone fragments during their displacement, fixation plaster boot with the stapes is not less than 3 months.
Work capacity is restored after 3 ½ - 6 months. Often when the pain is necessary to resort to the imposition of the boot for another 1 - 2 months.
Transport immobilization wire bus. When the displacement of bone fragments - reposition with subsequent fixation plaster boot. In some cases when it is difficult repairwear fractures of the foot require operative intervention. With extensive bruising of the rear foot, with a sharp voltage fabrics to avoid skin necrosis is recommended on the rear foot laxative incisions through the skin, subcutaneous tissue and fascia of the foot.
Anesthesia intercostal nerves 2% solution of novocaine at the seat of fracture; when multiple fractures are one - or two-sided vagosympathetic blockade. The locking band of adhesive tape or a soft bandage. Poluciaetsea position. When the pain first days of subcutaneous administration of morphine or pantopoda. Cough - Sоl. Dionini 1% to 15 drops 3 times a day or Codeini 0,015 1 powder 3 times a day. Breathing exercises 3 - 4 times a day.
Fractures without associated injuries and complications - rehabilitation 1 to 1 ½ months.