Healing time for bone fractures. Mechanisms of callus formation. Healing of fractures

Healing occurs through the formation of callus, that is, newly formed bone tissue connecting the ends of both fragments. This new bone tissue, having completed its development cycle, then undergoes a process of reverse development until all, so to speak, surpluses completely disappear.

It is interesting to note that in the vast majority of cases amount of bone tissue, forming a callus, is much larger than is required to fasten bone fragments. It appears that until the healing of the fracture has been practically tested for strength, callus remains excessive.
This amazing natural phenomenon remains still unexplained from the point of view of the patterns that regulate and control the processes of bone tissue regeneration.

In general, it should be noted that number of studies There are very few studies devoted to the study of the healing processes of a broken bone in humans. At the same time, the number of experimental studies is enormous. Therefore, the assumed patterns in the evolution of callus development are based mainly on the study of animals in which either a bone defect is created artificially, mainly surgically (this occurs most often), or the bone is subjected to a simple osteotomy.

But, not to mention the fact that not a single animal cannot be fully equated to a person, the conditions under which a fracture occurs in a person have nothing in common with the so-called experimental fracture. This must be remembered when using experimental data for clinical purposes. An example is the judgment of some experimenters about the role of a hematoma in the formation of a bone callus: during the surgical creation of an experimental fracture, hemostasis is performed, the wound is repeatedly dried with gauze, and the hemorrhage that remains between the fracture planes, around them and far from them has nothing in common with a hematoma in the resulting the person has no trauma.

That's why, talking about the healing of a fracture in a person, it seems necessary to compare morphological data with clinical manifestations of the evolution of fracture healing. This is all the more important because the radiologically expressed callus does not always indicate fusion: often on the radiograph one can see clear, newly appeared bone growths on the side of both fragments, and clinically not only is there no fusion, but at the fracture site almost the same mobility of fragments, as at the beginning of treatment.

And vice versa, especially in the area epimetaphyses, radiographically there are no signs of callus formation yet, and clinically it can be stated that the fragments are sufficiently immobile and stable even for the purpose of functional therapy. By the way, the same phenomena are observed, although much less frequently, with diaphyseal fractures.

These undoubted facts pose clinician very heavy and difficult question- is it really important and necessary to accurately compare the fragments during reposition? Is it really important and necessary to ensure complete immobility at the fracture site?

After all daily clinical observations show that very often unrelated fragments heal perfectly, while ideally reduced and firmly held fragments in some cases for some reason show a tendency to slow fusion, and sometimes do not heal at all, forming a false joint.

Just as good known that neither taking calcium supplements nor vitamin-rich foods have a noticeable effect on the course of fracture healing, just as the state of the central and peripheral nervous system on this process: everyone knows that bone fractures in patients who have had childhood cerebral palsy, grow together in the same time frame and just as well as in completely healthy people; The wars that have passed in our century have undoubtedly shown that if damaged peripheral nerves fractures heal no worse than without them.

All this testifies that the leading role in determining the healing of fractures remains with the clinic, which should have both laboratory and radiological capabilities, so that decisions can be made based on a combination of all the data necessary for each specific case.

Essentially speaking, the process callus formation occurs as a result of tissue irritation caused by injury. Therefore, we are talking about traumatic inflammation in the area of the fracture, which is characterized by hyperemia, which means the emigration of mobile cells (leukocytes) and the subsequent formation of immobile cells, that is, tissue cells.

It is important to note that all this complex process initially develops in the area of the hematoma from which it forms blood clot. V. O. Markov writes in his monograph about this: “That part of the extravasators is organized that is located directly in the plane of the fracture and close to it.” And further: “The proliferative reaction of inflamed tissues, part of which is the organization of blood extravasators, represents the beginning of the regenerative process of bone damage.”

Bone tissue, like any other tissue derived from connective tissue, is formed from middle embryonic layer. However, it is important to note that even the first rudiments of newly emerging germ tissue are obvious signs specificity. From this we can conclude that the formation of callus is an inevitable result of phylogenetic functional predetermination, or, as they now say, programming. Consequently, it is unlikely that any measures will be able, other things being equal, to speed up the passage of natural way bone formation during fracture healing.

This very important factual circumstance must form the basis of our judgments about the possibility of using methods stimulating bone tissue regeneration in order to accelerate it: you need to think not about accelerating regeneration (which is hardly possible!), but about combating delayed consolidation and the formation of false joints, that is, about creating the most favorable conditions for the development of callus in the usual time frame.

All researchers agree that in callus formation Both periosteum and endosteum are involved. However, we must clearly imagine that the occurrence of a fracture with its numerous tiny bone fragments penetrating into the surrounding soft fabrics and into the bone marrow canal, with bleeding, which does not stop immediately after breaking the integrity of the bone and other pathological phenomena, radically changes the quality of cellular elements of both the periosteum and endosteum: activation of poorly differentiated cambial cells of both occurs.

And if these cells in the periosteum are located only in close proximity from the cortical bone, then the concept of endosteum should be significantly expanded, because cambium cells are located both inside the compact bone, surrounding the vessels of the Haversian canals, and in the supporting substance bone marrow, and in the course of the newly formed blood vessels germinating blood clot. Therefore, there is apparently no sufficient basis to talk about the predominant role of the periosteum in the formation of callus. It is more correct to imagine this entire complex process as a complex of biological, strictly directed reactions on the part of all tissues of the damaged area, against the background of certain biochemical and enzymatic changes that ensure the gradual and cyclical formation of callus, that is, the process of fracture healing.

It is in this aspect that it is necessary to touch upon the issue of the influence of the function of the damaged limb on the structure of the resulting callus.
Taking into account the above, it is necessary to recognize the functional load on the fracture site as unnecessary and even harmful before the organization of the provisional callus, that is, before the onset of ossification.

The point is that the presence basic organic substances and the histological structures that make up the osteoid tissue are not sufficient to call it a formed callus. It is necessary for osteoid tissue to accept mineral salts, mainly calcium phosphate and carbonate salts, and so that they end up bonded with each other. This stage of development will mark the formation of a true regenerate, that is, such bone tissue that is able to respond to the functional load with an adequate response.

Everything said above is directly reflected in clinical course . The first period, the period of acute inflammation, is clinically accompanied by an increase in local, sometimes general temperature and swelling in the area of the fracture and near it. Around the end of the first week, and with epimetaphyseal fractures a little later, this swelling decreases significantly and sometimes completely disappears. As the swelling decreases, the intensity of the pain, both independent and during palpation, decreases. By the end of the second week, if the fracture area is accessible for examination, a significant decrease in the mobility of the fragments can usually be noted.

By the end of the third week of pain when palpating the fracture site almost pass, and the mobility of the fragments decreases so much that only their springiness can be detected. Then the strength of the adhesions increases and by about the fourth or fifth week the mobility of the fragments disappears completely. By this time, radiographically, a clearly visible “haze” of callus, unevenly impregnated with salts, is detected. The gap between the fragments is still preserved, and the ends of the fragments are clearly contoured, but appear osteoporotic. Over time, the callus becomes denser and decreases in size. By this time, the patient can already move the limb freely without experiencing pain.

For epimetaphyseal fractures, radiographic detectable callus turns out to be significantly less than for diaphyseal fractures. Clinical picture differs from the one just described in that movements in the nearby joint at first are more limited.

It should be kept in mind that clinically and radiographically detectable fracture healing is not synonymous with recovery and restoration of working capacity. The latter is delayed until full functional adaptation to everyday and professional needs. Below is a comparative table of the average periods of consolidation (according to Bruns) and the average periods of restoration of working capacity.

Influence of age factor

On average, with a simple fracture, the union of fragments with granulation tissue occurs within several weeks, with a primary callus - 2-3 months, consolidation of the fracture - 4-5 months. The timing of callus formation is determined by a number of factors. The ability to grow tissue in childhood is more pronounced than in adults. A hip fracture in a newborn can heal reliably within 1 month, at 15 years of age - in 2 months, at 50 years of age, such fusion will require at least 3-4 months. Poor nutrition, cachexia, senile osteoporosis and concomitant diseases delay fracture healing.

Influence of anatomical type of fracture

With oblique and spiral fractures, in which the medullary canal is wide open, healing occurs faster than with transverse fractures.

Delayed callus formation

Fracture healing occurs faster with wedged fractures than with a gap between the fragments. After a certain period of time, even with a noticeable distance between the fragments, a callus may form, but still consolidation of the fracture is more difficult, since there is no contact between the fragments and it is more difficult to achieve their complete immobility. Healing becomes even more difficult if the gap is formed as a result of constant excessive traction. However, the fracture heals even if there is a gap between the fragments, provided there is sufficiently long and complete immobilization.

Individual characteristics

For fractures of the same type, at the same age and physical condition In patients, the time frame for healing of fractures can vary significantly. It is a mistake to consider fusion abnormal just because it does not correspond to the average established time frame. A fracture cannot be classified as “non-united” just because after a few weeks or so. months its fusion will be incomplete. And in such cases it may follow normal healing fracture, but over a slightly longer period.

Healing time for rib fractures

The period of pronounced clinical healing of rib fractures is 3 weeks. They are quite conditional, since bone repair depends on a number of conditions. The process of bone structure restructuring lasts about a year. The fracture line disappears between 4 and 8 months.

According to S.Ya. Freidlin, based on a study of 128,936 people, average duration disability for rib fractures is 23.9 days (21.6 days for men, 32.4 days for women)

“...The first signs of a callus appear on the image only when it is calcified. The time for the appearance of callus varies widely and depends on a number of conditions: age, location of the fracture in various bones and various parts of the same bone, on the type and degree of displacement of fragments, on the degree of detachment of the periosteum, on the extent of involvement of surrounding muscles in the process, on the method of treatment / on complications of the regenerative process, for example, infection or some general disease, etc. The regenerative activity of the periosteum is strongest in long tubular bones at the sites of attachment of muscles and tendons, i.e. corresponding to tubercles, processes, roughness. Here the periosteum is especially thick, rich in blood vessels and nerves, and functionally active. For the same reason, the healing of fractures at the border of the middle and distal thirds of the leg and forearm is most unfavorable...

In adults, the first foci of calcification appear on radiographs on average no earlier than 3-4 weeks (on the 16-22nd day) after the fracture. At the same time or a few days earlier, the ends of the fragments become somewhat dull and the contours of the cortical layer of the fragments become somewhat uneven and blurred in the area of the callus. In the future side surfaces, the ends and corners of the bones in the area of the fracture are smoothed out even more; the shadow of the callus becomes more intense and takes on a granular character. Then, when it is completely calcified, the callus takes on the character of a homogeneous shadow. This complete calcification, the so-called bone consolidation, occurs at the 3-4-6-8th month of the fracture, i.e. fluctuates within very wide limits.

During the first year, the callus continues to be modeled; in structure it does not yet have a layered structure; clear longitudinal striations appear only after 1/2-2 years.

The fracture line disappears late, between the 4th and 8th month. Subsequently, according to the development of the osteosclerosis belt in the bone substance, it becomes denser on the radiograph. This darker fracture line, the so-called bone suture, may be visible until the callus has completed its reverse development, i.e. will not resolve completely...”

“With a fresh fracture, on carefully performed radiographs, it is often possible to distinguish protruding denticles at the edges of the image of bone fragments. On the 10-20th day in adults and on the 6-10th day in children, due to osteoclastic resorption of the bone ends, these denticles smooth out and cease to be distinguishable on photographs. In this case, a zone of resorption is formed, as a result of which the fracture line, which until now could not be clearly visible, and sometimes even completely indistinguishable, begins to be clearly defined. At 3-4 weeks, signs of spotty or uniform osteoporosis appear in the damaged bone.

Spotted osteoporosis is radiographically characterized by light areas of round, oval or polygonal shape with unclear contours located against the background of an unchanged or slightly lighter bone pattern. The cortical layer in this type of osteoporosis is usually unchanged, and only sometimes its internal layers appear somewhat loose. With uniform or diffuse osteoporosis, the bone in the image takes on a transparent, homogeneous, glass-like appearance. Its cortical layer is thinner, but against the transparent background of the bone its shadow appears more emphasized.

Typically, spotty osteoporosis is observed for a relatively short period of time, then giving way to uniform osteoporosis. However, in some cases, patchy osteoporosis can exist for quite a long time. By the time osteoporosis appears, approximately on the 16-20th day, the first signs of callus begin to appear on radiographs. These signs are expressed in the presence of low-intensity, cloud-like shadows in the photographs. Over time, the shadows become denser, merge with each other, and after 3-8 months one intense, homogeneous shadow of the callus is visible on the x-ray. Usually, during this period of time, the fracture line also disappears, at the site of which a bone suture begins to appear in the form of a narrow shadow, disappearing along with the callus. With the further development of the callus, its shadow loses its homogeneous character and after 1.5-2 years the callus reveals bone structure with corresponding arrangement of trabeculae and medullary space. This is where the formation of the callus ends and its reverse development begins...”

Qualitative histological signs of the age of rib fractures

Average duration of disability for bone fractures of different locations in men and women (in days)

Any bone fracture becomes an extremely unpleasant event. However, a fracture of the leg bones adds to other troubles a tangible difficulty - limited movement. With such a fracture, it is difficult for a person to walk.

Remember, timely delivery of full-fledged medical care will allow the healing process to proceed as quickly as possible.

Self-medication for broken leg bones is unacceptable. Upon receipt severe injury you should contact a traumatologist and undergo outpatient treatment. If the case is extremely difficult, treatment takes place in a hospital. Only a traumatologist will be able to correctly determine the characteristics of the injury, the location of bone fragments, check how correctly the bone is healing, measure required time and so on.

The doctor strives to normalize the position of the leg bone fragments, return to starting position, before the injury. The traumatologist then strives to keep the fragments in a stationary position while the bone heals.

It is possible to straighten and fix the fragments using plaster casts, specialized devices, and in extremely severe cases, using the method of surgery when used various kinds metal structures.

In the case of treating an open fracture, the Ilizarov compression-distraction apparatus is usually used, concomitant treatment antibiotics. IN mandatory the wound is washed, the affected area is treated, preventing the occurrence of purulent and infectious inflammation.

The patient is given directions for massage, exercise therapy, and other procedures aimed at preventing the consequences of the injury. The patient's diet is enriched with calcium, vitamins C, B and D.

If the victim had to undergo treatment in a hospital setting, if positive dynamics are detected, the person is sent home. Positive dynamics in this case means the correct fusion of the leg bone, when the injured tissue gradually heals.

At home, the patient will have to recover completely and restore the functions of the limb. A person has the right to continue a course of massage and exercise therapy.

After suffering leg injuries, a person will need a lot of time, patience and strength to rehabilitate and fully recover. Treatment must be approached with patience, taking as much time as necessary. If the doctor was able to correctly determine the characteristics of the fracture, prescribe the optimal treatment and rehabilitation program, and monitor strict adherence to his instructions on the part of the patient, the listed provisions will help quickly bring the injured limb back to normal without complications.

How long do you wear a cast?

Many people are interested in this question. Plaster, especially on the leg, causes inconvenience when moving the patient in space. The time of wearing a cast largely depends on the complexity of the injury, type, and complications that have developed. The terms described in the medical literature are very arbitrary; the doctor determines the time individually.

On average, the following periods are distinguished:

If your ankle is broken, the cast is worn for 4 to 7 weeks. If the fracture is aggravated by displacement, the period of wearing the plaster will increase to 4 months.
requires fixation for a period of 100 days, in case of displacement - up to four months. Moreover, patients with such a fracture will have to lie in traction for a month, after which a plaster cast will be applied.
Lightweight requires fixation for up to two months.
The phalanx heals faster - in a maximum of 20 days, without complications.
Small fracture tibia requires a plaster cast up to the knee; the bandage will be removed after 30 days.

The leg bone fuses into different period, damaged tissues will take a long time to recover. Resumption of normal tendon function largely depends on the specific nature of the fracture. The age of a person, the speed and characteristics of the processes taking place in his body are important. Of course, bones young man They will grow together much faster and the tissues will recover much faster than in an elderly person. Strong body will cope with the consequences of injury faster than a weakened person.

When the period of wearing plaster is extended

Often people with a bone fracture have to three times take x-rays to check the fusion. Thanks to the procedure, doctors accurately determine the time of plaster removal. If there is a suspicion of incomplete bone healing, removal of the bandage will have to be postponed. It is forbidden to remove the bandage yourself; serious complications. You must wait patiently for the end of treatment and complete healing of the broken bones.

The process of fusion of leg bones can be complicated by various diseases: osteoporosis, diabetes mellitus, others chronic diseases and so on. Chronic patients wear a cast much longer; sometimes treatment is twice as long as standard.

The quality and speed of bone fusion is directly affected by the method of applying plaster. The presence of kinks and folds is not allowed; the distribution of the bandage must be uniform. Such conditions significantly affect the speed of fusion.

Parts of the leg that experience additional stress are reinforced with additional layers of plaster bandage. The most commonly affected areas are the joints and soles. In the absence of toe fractures, the damaged part of the foot is cast, leaving them open. The doctor continues to monitor the condition of the fixed part of the limb. The toes are less well supplied with blood; their movement allows the foot to function normally.

The way the bandages are applied also affects the wearing time. If the plaster is applied directly to the skin, first lubricated with special oil (usually Vaseline), it is expected to be worn for a short time. If a layer of cotton wool is made before applying a plaster cast, it becomes clear that the cast is designed for long-term wear.

Precautionary rules when wearing plaster

Wearing a cast takes a considerable period of time; a person has to adapt to new living conditions. Complete fixation of the leg leads to immobilization of the limbs, leading to difficulties, especially when moving. Remember, immobility is a necessity, without which it is impossible to achieve normal recovery. You have to live with certain restrictions in mind.

First, the plaster must not get wet. Difficulties in washing are expected. Recently, special waterproof covers have begun to be produced that allow you to calmly wash in the shower or take a bath.

Learning to use a cane or crutches causes particular difficulties. Initially, it is extremely difficult to walk on devices, however, if you are not lazy and train, the body will get used to the unusual situation. You need to walk as much as possible to eliminate possible congestion in the muscles.

Certificate of incapacity for work and insurance

A fracture requires a long stay in treatment. The corresponding certificate of incapacity for work is issued by the attending physician, a certificate is provided at the place of work. The bulletin is issued by doctors of public and private clinics.

The issuance of a certificate confirming the presence of injury leaves the possibility of obtaining insurance, which is paid upon the occurrence of an insured event (if there is an appropriate contract). Insurance is issued upon presentation of the following documents:

Application requesting insurance;
Help from medical institution, confirming the fact of the occurrence of an insured event;
Passport;
Insurance contract.

The insurance company has the right to ask for other documents. When the documents have been studied and the facts have been analyzed, insurance company determines the amount and timing of insurance payments.

How does the healing process of fractures occur in an x-ray image? As you know, the reparative process is carried out using the so-called callus. This callus comes from the endosteum, the bone substance itself, and the periosteum (endosteal, intermediary and periosteal callus). The main, sharply predominant role in healing, as taught especially by radiological observations, falls to the share of the periosteal callus.

The development of callus goes through three stages - connective tissue, osteoid and bone. The blood pouring out from the ruptured vessels forms a large hematoma in the area of the fracture between the fragments and splinters. Blood coagulates very quickly, and a huge number of young connective tissue elements rush into the fibrinous-blood clot from the bone marrow and especially the periosteum in the first hours after the injury, and the number of fibroblasts increases. In 7-10 days everything sprouts in this first stage with proliferating connective tissue. Then, under normal healing conditions, in the second stage, metaplastic transformation of this more primitive connective tissue into osteoid occurs, which also requires the same week or one and a half weeks. Previously, an osteoid callus without a sufficient basis, mainly because of its “cartilaginous density” when palpated, was unconditionally mistaken for cartilaginous. Actually cartilage tissue is formed only when the ends of the fragments rub against each other, i.e. when there is no complete immobilization. Then, in the third stage, osteoid tissue is impregnated with apatites and turns into bone. The callus is initially large and has a loose structure, but later, at a much slower pace, a phase of reverse development of this callus begins, its restructuring, reduction and structural reconstruction with a very gradual slow restoration of more or less normal bone architectonics.

Connective tissue and osteoid calluses, of course, are not identified at all radiologically. The first signs of a callus appear on the image only when it is calcified. The time for the appearance of callus varies widely and depends on a number of conditions: on age, on the location of the fracture in different bones and in different parts of the same bone, on the type of degree of displacement of fragments, on the degree of detachment of the periosteum, on the extent of involvement in the process muscles surrounding the bone, on the method of treatment, on complications of the regenerative process, for example, infection or some general disease, etc. It should be assumed that an important role is played by nervous influences. Based on convincing experimental data, R. M. Minina considers the relationship between the phenomena of bone tissue regeneration and the nervous system to be firmly established, and she considers dystrophic lesions of the nervous system as the predominant factor in this regard. Open fractures heal much slower than closed ones. It is practically important that since signs of calcification of the callus have already appeared on radiographs, conservative reposition of the fragments is overdue.

In subperiosteal childhood fractures, the callus is very small in size; it surrounds the fracture site in the form of a regular fusiform sleeve. The first deposits of lime appear on nice photo baby bone by the end of the first week. They have the appearance of single, delicate, spotted, structureless shadows surrounding the bone and located parallel to the cortex. Between the outer layer of the cortex and the shadow of the calcified periosteal callus, there is initially a free strip corresponding to the cambial layer of the periosteum with osteoblasts.

In adults, the first tender cloud-like foci of calcification appear on a radiograph on average no earlier than 3-4 weeks (on the 16-22nd day) after the fracture. At the same time or a few days earlier, the ends of the fragments become somewhat blunted and the contours of the cortical layer of the fragments become somewhat uneven and blurred in the area of the callus, losing their sharp limitations. Subsequently, the lateral surfaces, ends and corners of the bones in the area of the fracture are smoothed out even more, the shadow of the callus becomes more intense and takes on a focal granular character. Then the individual areas merge and, with complete calcification, the callus takes on the character of a circular homogeneous mass. Gradually, the shadow thickens and so-called bone consolidation occurs at the 3-4-8th month of the fracture. Thus, bone consolidation varies within very wide limits. During the first year, the callus continues to be modeled; its structure does not yet have a layered structure; clear longitudinal striations appear only after 1 1/2 -2 years. The fracture line disappears late, between the 4th and 8th month; In the future, according to the development of the osteosclerosis belt in the bone substance, it becomes denser on the radiograph. This darker fracture line, the so-called bone suture, can be visible even when the callus has already completed its reverse development, i.e., has completely resolved.

This shows that the integrity of the bone under normal conditions is restored much more slowly than is commonly believed in the clinic. X-ray symptoms the course of the fracture healing process is greatly delayed compared to clinical symptoms. This should be emphasized to caution the clinician against being overly conservative; By using radiographic guidance alone, the clinician runs the risk of becoming too restrained in providing functional load to the bone. Already a connective tissue callus with barely noticeable clouds of calcification can, from a functional and clinical point of view, be quite complete, and not allowing the limb to function in such a case means delaying the pace of further normal evolution and involution of the entire recovery process.

Bone callus in comparatively in rare cases acquires a narrow diagnostic value. The callus provides the radiologist with the opportunity to retroactively recognize a violation of bone integrity, which in acute period remained clinically or radiographically visible after injury. This happens mainly with subperiosteal fractures in childhood, but also with cracks and fractures of small tubular bones(phalanxes, metacarpals and metatarsal bones) in adults. It is important that even the fracture line, initially questionable or completely invisible, sometimes clearly appears on photographs only a few weeks or months after the injury. With such a late diagnosis of a fracture based on the appearance of a callus alone, it is necessary to beware of mixing it with traumatic periostitis - the callus at the fracture site surrounds the entire bone in the form of a muff, while the periosteal growth rises above the bone only in one direction. All complex phenomena of restructuring, which are discussed in detail in a separate chapter (book 2, p. 103), also require distinctive recognition.

Rice. 27. Reactive osteosclerotic sheath around a metal pin in the medullary canal femur, which developed after a year and a half of his stay.

Some features represent the healing processes in new methods of treating intramedullary fractures. osteosynthesis, i.e. intraosseous fixation of fragments with a metal pin made of stainless steel. The idea of “snagging” fragments using a metal knitting needle was first expressed in 1912 by I.K. Spizharny. These methods are used not only for fresh closed, uninfected fractures of large tubular bones (hip, shoulder, leg bones and especially the forearm), but also for open infected fractures, delayed consolidation, false joints, reconstructive osteotomies, etc. Thanks to the metal rod, the best comparison of fragments is achieved and, more importantly, their reliable retention. The entire healing process is qualitatively improved and somewhat accelerated. The pin acts as an aseptic foreign body as a stimulator of restorative phenomena.

The X-ray picture of reparative processes when using metal pins was studied by N. N. Devyatov and, under our leadership, N. S. Denisov. Initial signs endosteal callus emanating from the bone marrow canals of fragments appears primarily at the ends of bone fragments, moreover, on the distal fragment earlier than on the proximal one. Periosteal callus appears on radiographs 6-7 days after endosteal callus. This periosteal callus develops first on the lateral surfaces of the fragments, and subsequently forms a circular coupling. With comminuted fractures, the callus here also acquires fancy shapes, is often excessive, with a cloud-like structure. Callus calcification in diaphyseal fractures of the femur, shoulder and forearm bones most often appears during the 2nd month, and by the end of the 3rd month bone consolidation occurs. The bone suture lasts a long time, it disappears after 6-8 months and later, and the complete reverse development of the callus ends, as without a pin, only after 1 1/2 -2 years. If at the ends of bone fragments, instead of the formation of an endosteal callus, a closure appears bone plate, then this is a sure early symptom of the onset of pseudarthrosis formation.

Around the metal rod inside the medullary canal, a dense cylindrical bone case, or sheath, naturally develops (Fig. 27), which only very slowly, over many months, undergoes reverse development after removal of the metal rod. Sometimes, over the head of a nail protruding outside the bone (for example, above and inside the area of the greater trochanter of the femur), reactive calcification and even ossification of soft tissue, most likely displaced bone marrow, occurs in the form of a mushroom.

Hands play one of important roles in a person's life. They allow them to do any work and lead a fulfilling lifestyle. A fracture of the arm bone significantly reduces the quality of life. Therefore, if the victim breaks his arm, then it is necessary to achieve full recovery its functionality.

A broken arm is one of the most common injuries in the practice of traumatologists. In most cases, a broken arm is characterized as a household or work injury, it often occurs when playing sports. To better understand the mechanism of the fracture and subsequent therapeutic tactics, you should know the simplest elements of the anatomy of the upper limbs.

Anatomy

Human hands are made up of large quantity bone elements, which include the girdle of the upper limb and the free part. The largest of them are the clavicle, scapula, humerus, radius and ulna. Particular attention should be paid to the hand, which consists of the wrist, metacarpus and phalanges of the fingers. The long bones are tubular, as are the metacarpals and phalanges of the fingers; only the bones have a spongy structure. The tubular bones are most often injured.

Causes of injury

The main reason that leads to a broken arm is a fall on an outstretched upper limb in an abducted position. It is also possible to damage the integrity of the arm bone with a strong blow along a limb or, with increased physical impact on a limb weakened after a number of diseases or as a result of natural aging of the body.

Arm fractures occupy a leading position among all types of fractures. The most common factors for these injuries include:

Household damage.
Fall from a great height.
Incorrect landing on hand.
Impact with a heavy blunt object.
Sports training.
A blow during a struggle or fight.

Classification

Arm fracture refers to a collective concept that includes all types of arm fractures. These injuries are characterized by such parameters as the number of broken bones, the nature of the injury - a displaced fracture of the arm, location to nearby joints, injury to muscles and blood vessels, an open fracture of the arm and the immediate location of the fracture.

Based on the number of broken bones, fractures are divided into:

Single or multiple.
There is a shift or not.
Open or closed arm fracture.
Hammered.
Splintered.
With a dislocation of the joint located nearby.

In relation to the arm fracture to nearby joints:

Injury affecting a joint.
Diaphyseal or non-joint fracture.

Damage to the hand is almost always accompanied by a violation of the integrity of the soft tissues and can be open - the skin is damaged and closed - without damaging the skin.

The ratio of displaced debris also has great value, the choice of treatment for a broken arm depends on this:

Fracture with displacement of bones within the line of injury.
Non-displaced arm injury.
Damage to the bone of the arm with displacement and disruption of the axis of the affected bone.

According to the location of the fracture:

Injury humerus.
fracture of the forearm bones.
Damage to the bones of the wrist.
Injury metacarpal bones and phalanges of the hand.

Break line shape:

Transverse fracture - the line is located in a perpendicular plane to the axis of the bone.
Longitudinal fracture - the fracture line is located longitudinally relative to the axis of the broken bone.
Oblique, shapes acute angle between the axis of the bone and the fracture line.
Helical fracture - bone fragments rotate along the axis, but remain in one line.

The classification of arm fractures listed above helps the doctor understand what happened and how to treat the fracture. Therapy for damage can vary significantly and can be either conservative or surgical with open reposition of bone fragments.

How to determine a broken arm? Damage can be recognized by the symptoms that occur when an arm is broken.

Symptoms

Knowing the symptoms of a broken arm, even a person who does not have special education, will be able to distinguish a fracture from an ordinary dislocation or severe bruise.

Absolute signs of a fracture indicating that the arm is broken:

The position of the hand is unnatural; it is unusually curved.
When joints and limb segments are damaged, they become mobile.
The presence of a crunching sound characteristic of fractures when palpating the area of the damaged area of the arm.
Visualization of bone fragments.
Presence of an open wound.

Relative symptoms of a fracture that raise suspicion of its presence and allow recognition:

Pain syndrome localized in the damaged area or radiating to nearby areas.
The nature of the pain becomes a shooting type at the slightest attempt by the victim to move the injured limb.
Severe swelling with bruising.
A feeling of coldness in the upper limb, this symptom is one of the most danger signs and indicates a ruptured artery or a developed blood clot.
Hematoma.
Limb deformity - one arm may visually appear shorter than the other limb.
Limited mobility of joints located in the damaged area.
When the integrity of the nerve fibers is disrupted, arm paralysis occurs.
It is possible that the temperature when an arm is broken will rise to 37.5.

What to do if your arm is broken? Which first aid need to be provided to the victim?

First aid

First aid for a broken arm is of great importance to ensure that the bones heal properly and the consequences of the injury are insignificant. It should be provided only by a person who is familiar with the algorithm of actions and is able to find out what kind of injury the victim received and its types. This is due to the fact that, for example, first aid for an open fracture is of a slightly different nature than if the injury is closed.

Let's take a closer look at all the actions:

Immobilization - immobilization of the hand can be achieved by applying splints from improvised materials. These can be planks, strong rods, even sticks. The selected structure should be bandaged to the damaged segment of the arm, thereby ensuring its immobility, which will significantly reduce pain and displacement of the fragments. If your fingers are injured, you can use a comb or nail file to splint them, or tape the broken finger to an adjacent finger. You cannot use force to align the damaged arm segment or try to set the bone yourself. Just hang it up injured limb on a headscarf.
Anesthesia – with strong pain syndrome Any analgesic in the first aid kit will do.
A fracture of the arm, and especially a fracture of the hand and fingers, is often accompanied by swelling of the fingers. To stop the increase in swelling and prevent death of the finger, in the first minutes it is advisable to get rid of rings and other jewelry on the hand. But you cannot forcefully try to remove the ring. In a couple of hours it will not cause harm, and a specialist in the hospital will remove it more competently and painlessly.
An open fracture is accompanied by bleeding. Therefore, you need to remember that it is necessary to apply a tourniquet only when bleeding from large arteries. In other cases, a tight bandage will be sufficient.

If a person is not familiar with the rules for providing assistance, then he may have difficulty ensuring fixation of the shoulder and elbow joints. Therefore, in order not to cause harm or cause unnecessary suffering, you can limit yourself to hanging your hand on a scarf.

Any victim of injury asks questions. How long does it take for a broken arm to heal, can it be treated at home, what medications may be needed and how to treat it in general? And also - how long to walk in a cast, what is the healing period, and is it possible to speed up bone healing? The specialist will answer these and many other questions only after the fracture has been diagnosed.

Diagnosis and treatment

In order to correctly prescribe treatment, it is necessary to conduct a series of examinations. For these injuries, the main diagnostic method is radiography. In difficult cases, if the fracture is accompanied by damage to the nervous tissue, if the fragments are displaced, and to identify double bone damage, use computed tomography or magnetic resonance therapy.

Important! Treatment of a broken arm should only be carried out by a specialist. How long it takes for the fracture to heal and what the hand looks like after the injury will depend only on the correctness of his actions. Self-medication is unacceptable.

Having received the diagnostic results, the attending physician determines which method of therapy should be used to effectively heal the bones in this injury. After all, the speed of healing depends on the chosen treatment method.

Most closed fractures of the upper extremity are treated conservatively using long-term immobilization methods with a plaster cast. Implemented similar treatment in the absence of displacement of the fragments, otherwise surgical intervention cannot be avoided.

After determining the type of fracture, the doctor performs a manual reposition of the bones and compares them. After this, the victim is given plaster cast and a control x-ray is prescribed. The length of time you wear a plaster cast depends on the severity of the fracture. For minor injuries, when one bone is affected, the patient wears a plaster cast for about 6-8 weeks. The fracture must heal within this period.

If there is a joint fracture of the ulna and radius, a plaster cast is applied for 8 to 12 weeks. The bones grow together during this time, if there is no complication.

In rare cases closed fractures are being treated surgically, especially if bone fragments have been displaced. Surgery is also prescribed when treatment conservative method impossible to carry out.

This operation is based on restoring the anatomical integrity of the bone by matching the fragments and securing them with metal plates and screws. Loading of the operated area is allowed earlier, since the bone is fixed and there is no risk of displacement.

Once the bones have fused, the plates and screws can be removed, but this may not be necessary because they are designed to last a lifetime.

Open injuries can only be treated surgical intervention. The specialist compares bone fragments; if necessary, then for fixation they use extraosseous or intraosseous osteosynthesis with plates and pins. When using additional funds a plaster cast is not applied, since the bones are fixed with titanium plates or pins. But more often they use external fixation devices or the Ilizarov apparatus. This technique allows you to care for the wound, increase or decrease the degree of compression of fragments as they heal.

How to speed up the rehabilitation of an upper limb fracture? During subsequent treatment of arm fractures at home, to speed up the recovery process, it is recommended to use a number of additional procedures and carry out a comprehensive drug therapy antibiotics, wound healing agents and microcirculation enhancers. The patient must be prescribed special vitamin complexes aimed at strengthening the immune system.

The victim constantly needs increased quantity protein products, collagen, which contribute to the formation of callus. You also need to take microelements - calcium and magnesium. These substances help form new bone cells and strengthen the musculoskeletal system.

Important! After the formation of the callus is completed, the patient must visit a medical institution for a control x-ray. Only after the doctor confirms that the fracture has healed correctly can the patient consider himself healthy.

Treatment time and prognosis

General terms of therapy, rehabilitation, for different zones damage fluctuates. If a fracture surgical cervix shoulder, then the function of the arm is restored after 3 months, injury to the body of the humerus - 4 months, damage to the bones of the forearm - 3 months, the radius from 1 to 2 months, broken bones of the hand - up to 3 months, scaphoid - up to 6 months, fractures of the fingers – about one month.

If there is restriction of joint movements and open fractures The duration of therapy is much longer and reaches six months or more. And if there is an infection in the bone or damage to the nerve endings, treatment is delayed for years.