TYPES OF FRACTURES

TYPES OF FRACTURES- QR

SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention

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What is the TYPES OF FRACTURES and how it is treated?

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Etiology and pathogenesis TYPES OF FRACTURES

Fractures of the scapula.

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.

Fractures of the clavicle.

Occur from a direct blow, often in the fall. Distinguish between transverse and oblique fractures, usually in the outer third of the clavicle.

Fractures of the neck of the shoulder.

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!).

Fractures of the diaphysis of the 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.

Naimisharanya fractures of the shoulder.

Occur when falling on a bent elbow or outstretched hand, often in childhood.

Diaphyseal fractures of the forearm.

Occur more frequently with the direct impact on a solid object.

Fractures of the lower radial epiphysis of the bone.

Are very common in old age. Occur when falling on an outstretched hand.

Fractures of the metacarpal bones and fingers.

Arise more often from a direct hit (sledge hammer, hammer, hit the machine).

Fractures of the femoral neck.

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.

Fractures of the hip.

Arise from the direct application of force - transverse fractures, knee - oblique fractures, torsion - spiral fractures.

Fractures of the patella.

Arise more often from direct impact of the fall on a bent knee.

Fractures of the tibia.

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.

Fractures of the ankle.

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.

Fractures of the calcaneus.

Occur when falling on the outstretched foot, on the heel.

Fractures of other bones of the foot (metatarsus and toes).

Usually occur with the direct hit.

Rib fractures.

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 spine.

Fractures of the transverse processes with a sharp contraction of the muscles of the back - tear-off fractures.

Fractures of the vertebral bodies compression.

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.

Fractures of the pelvis.

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.

Fractures of the skull.

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 and course TYPES OF FRACTURES

Fractures of the scapula.

Symptoms. Swelling in the body of the scapula and shoulder joint, painful and limited movement in the joint lowering down of the head arm.

Fractures of the clavicle.

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.

Fractures of the neck of the shoulder.

Symptoms. Swelling in the shoulder joint. Sharp restriction or lack of movement in the shoulder joint.

Fractures of the diaphysis of the shoulder.

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).

Naimisharanya fractures of the shoulder.

Symptoms. The configuration change to the elbow joint, abnormal mobility above the elbow joint.

Diaphyseal fractures of the forearm.

Symptoms. Deformity of the forearm, abnormal mobility.

Fractures of the lower radial epiphysis of the bone.

Symptoms. Deformation in the region of the wrist joint in the form of a bayonet, the lack of movement in the wrist joint.

Fractures of the metacarpal bones and fingers.

Symptoms. Deformity, pain when local palpation with this axis of the respective finger, restriction of movements.

Fractures of the femoral neck.

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!).

Fractures of the hip.

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.

Fractures of the patella.

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.

Fractures of the tibia.

Symptoms. Deformity, shortening, abnormal mobility, crepitation. For immobilization apply wire bus (one on the rear, two on side).

Fractures of the calcaneus.

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.

Rib fractures.

Symptoms. Pain, difficulty breathing movements.

Fractures of the spine.

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.

Fractures of the vertebral bodies compression.

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.

Fractures of the pelvis.

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).

 

Fractures of the skull.

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.

Treatment.

Fractures of the scapula.

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.

Fractures of the clavicle.

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.

Fractures of the neck of the shoulder.

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.

Fractures of the diaphysis of the shoulder.

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.

Naimisharanya fractures of the shoulder.

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.

Diaphyseal fractures of the forearm.

Transport immobilization: fixing wire bus from the middle third of the shoulder when the bent elbow to the metacarpophalangeal joint. A one-step reduction with fixation longato-circular patch 6 to 8 weeks, after which the plaster is cut (or replaced) to the elbow joint and removed completely for 10 - 12 weeks. Finger movements in the shoulder joint are manufactured from the very first days, in the elbow joint since its liberation from gypsum.
Rehabilitation after 3 to 5 months.

Fractures of the lower radial epiphysis of the bone.

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.

Fractures of the metacarpal bones and fingers.

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.

Fractures of the femoral neck.

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.

Fractures of the hip.

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.

Fractures of the patella.

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.

Fractures of the tibia.

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.

Fractures of the ankle.

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.

Fractures of the calcaneus.

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.

Fractures of other bones of the foot (metatarsus and toes).

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.

Rib fractures.

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.

Fractures of the spine.

Transportation lying on his back or on his stomach on the hard stretcher. Position in bed or on the shield on his back or on his stomach; not allowed to turn on his side. Systematic physical therapy sessions 4 - 6 times a day. If physiotherapy is not used, possible complications in the form of a radiculitis, complaints about long-term back pain.
Rehabilitation after 1 - 2 months without residual effects.
 

Fractures of the vertebral bodies compression.

Transportation on the back or on his stomach on the hard stretcher. Traction on the shield and on the inclined plane of the loop Glisson fractures of the cervical and upper thoracic vertebrae. In fractures of the lower thoracic or lumbar spine - stretching straps through the armpit (the shield, on an inclined plane) within 2 months. This systematic special therapeutic exercises 4 to 6 times a day for 30 - 40 minutes. This is achieved by strengthening the back muscles and creates a powerful muscular, with which the patient may be discharged after 2 to 3 months after injury. Further treatment (exercises, massage) continues on an outpatient basis.
Work capacity is restored after 4 to 6 months. For those heavy physical work is a translation in light work (up to years).
When spinal cord injury (paralysis, disorders of the function of the pelvic organs) draws particular attention to skin care (bedsores); in connection with a violation of the act of urination - applying suprapubic fistula; strict monitoring of intestinal function. Paralysis - passive therapeutic exercises, prevent the development of stiffness in the joints, and the perverse position of the limbs. The terms of the rehabilitation depends on the nature of the complications and the degree of damage to the spinal cord.

Fractures of the pelvis.

Transportation of the sick on the hard stretcher on the back, under bent knees, placed a cushion or rolled-up coat. Fractures without displacement position on the hard bed with bent (on the shaft) diluted feet during the month; fractures with displacement - traction for Misaki thigh for 1 - 1 ½ months. In both cases, medical gymnastics. Raising to his feet in mild cases a month; after 3 to 4 months with severe multiple fractures with displacement.
Fractures of the pelvis can be accompanied by damage to the urethra - the immediate imposition of suprapubic fistula, later (after the elimination of inflammation and risk of bladder Saakov - operation. If the damage of the bladder - urgent surgical intervention.
Work capacity is restored within 1 ½ - 4 - 5 months.
 

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