Bone fractures are a violation of their integrity. The cause of a fracture may be the influence of an external force (impact or heavy load) or certain diseases that reduce bone strength and make them brittle. The severity of the fracture depends on its location, size and type.

Types of bone fractures

Depending on the cause of occurrence, traumatic and pathological fractures are distinguished. The cause of traumatic bone fractures is sudden, sudden action mechanical impact force on the bone. Pathological fractures appear under the influence of a certain pathological process on bone tissue. This may be the result of a cyst or the development of a malignant tumor. At the same time, the structure bone tissue gradually collapses and even small loads can lead to fracture.

In addition, a distinction is made between open and closed bone fractures. With an open fracture, in addition to destruction of the bone at the site of injury, damage occurs to the skin and all structures under it (muscle fibers, nerves, ligaments, blood vessels). A closed bone fracture is not accompanied by damage to the external integument.

Fractures can be complete or incomplete. Incomplete fractures manifest themselves in the form of a fracture, crack, or holey effect of the bone. A complete fracture occurs when a bone is broken into two pieces. In such cases, there is often a displaced bone fracture, in which bone fragments are displaced.

Symptoms of fractures

With multiple fractures, especially in the presence of open fractures, the victim develops a serious condition, sometimes leading to traumatic shock. In case of traumatic shock, the victim falls blood pressure, the pulse becomes weak, rapid, breathing and heart rate increase.

The fracture area is marked by swelling and often bruising. The function of the injured limb is impaired; all movements are limited and painful. Characteristic feature fracture is deformation, shortening of the limb and abnormal mobility at the fracture site. In the case of an intra-articular fracture, bleeding occurs in the joint area (hemarthrosis). With complete displaced fractures of bones, extensive hemorrhage into adjacent tissues is observed, severe swelling appears, and skin sensitivity decreases.

Treatment of bone fractures

The main goal of treating bone fractures is the healing of bone fragments and restoration normal function limbs. The doctor must compare the bone fragments and ensure their secure fixation. In this case, it is necessary to ensure the possibility of movement in adjacent joints and normal functioning nearby muscles.

Artificial restoration of the position of displaced bone fragments (reposition) can be open or closed. Open reduction consists of a surgical incision in the area of ​​the fracture and subsequent connection of bone fragments using special fixing devices. With closed reduction, displacement of bone fragments is eliminated using various manual manipulations and special devices. In addition, in such cases, a skeletal traction system is often used. Closed reduction is often used to treat closed bone fractures.

Treatment of bone fractures can be conservative or surgical. Conservative therapy consists of closed reduction, subsequent application plaster casts, orthoses (external orthopedic devices). If it is impossible to carry out closed reduction and hold the fragments in the desired position, surgical intervention is performed. Indication for surgery It also happens that a patient in a certain condition is easier to tolerate surgical treatment than conservative treatment.

For open bone fractures with or without displacement, primary surgical debridement is performed. Its purpose is to prevent infection of the fracture site.

Basic methods of rehabilitation

After treatment, the patient undergoes rehabilitation for bone fractures. It is based on physical therapy, massage, physiotherapeutic methods. An individual complex of therapeutic exercises is created for each patient. It is aimed at stimulating metabolic processes in the body, prevention of muscle wasting, contractures (limitation of movements in the joint), normalization of the patient’s psycho-emotional state.

Special massage occupies a special place in rehabilitation for bone fractures. Thanks to massage, the muscles of the injured limb are developed and the overall tone of the human body is improved.

Physiotherapy methods have proven themselves well in the rehabilitation of bone fractures. Most often, patients are prescribed ultrasound, UHF, electrical stimulation of muscles, UV irradiation, phonophoresis or electrophoresis with medicines. After bone fusion, the use of iodine-bromine, radon, sodium chloride, pine-salt baths is effective.

Bone fractures in children

In children, fractures of the arm bones are most common, in particular elbow joint and bones of the forearm.

Children are characterized by fractures in which slight displacement of bone fragments occurs. In this case, the bone breaks on one side, while on the other side the bone fragments are held in place by a thick periosteum.

The fracture line often runs along the growth zone of bone tissue, which is located near the joints. Damage to this growth zone during bone fractures in children sometimes leads to its premature closure. As a result, in the future the child may develop curvature or shortening of the affected limb.

The main signs of a bone fracture in children are swelling, swelling, and severe deformation of the limb. A bruise often develops on the skin at the site of the fracture.

Thanks to accelerated processes formation of callus (fusion of bone fragments), good blood supply In children, bone tissue grows together much faster than in adults. How younger age child, the faster his bone fusion occurs.

A bone fracture is complete violation anatomical integrity of the bone which is caused external influence or violence beyond the limits of her physical strength.

With some types of injuries, a person may experience incomplete destruction of the integrity of bone tissue in the form of a crack, fracture, as well as the formation of a perforated or marginal fracture.

An impacted fracture is a type of complete fracture in which one bone fragment is embedded into another. Most often this type is observed in the area of ​​the metaphyses of bones.

Children are characterized by subperiosteal fractures (of the “green stick” type), as well as a type such as epiphysiolysis, in which the separation of bone fragments occurs at the site of the growth zone.

Classification

For the reason that caused the fracture

1. Traumatic
   • Open;
   • Firearms (refer to open);
   • Non-firearm;
   • Closed
2. Pathological
   • Tumor (benign and malignant);
   • Bone cyst;
   • Osteogenesis imperfecta;
   • Severe chronic diseases;
   • Osteoporosis;
   • Thinning bone as a result of surgery.

In connection with the external environment

1. Closed
   • Single;
   • Multiple;
   • Combined;
   • Combined.
2. Open
   • Non-firearm;
   • Firearms.

Open fractures

Open fractures are accompanied by damage to the skin and soft tissues and are associated with external environment. This type of injury is characterized by the fact that as a result of a fracture, the victim develops a wound surface, bleeding and microbial contamination. Gunshot wounds are usually accompanied by severe damage to soft tissue and bone.

In some patients, the wound does not form immediately after the injury, but after some time. Its appearance is due to the fact that the sharp part of the displaced bone fragment tears muscles, skin and blood vessels. This type of fracture is called secondary open.

Closed fractures

This type of violation of bone integrity is not accompanied by injury to the skin. However, with closed fractures, large vessels can be damaged, and then they are accompanied by blood loss.

Average blood loss in closed fractures:

1. Fracture of the femur - 1.5-2 l;
2. Fracture of the lower leg bones - 600-700 ml;
3. Fracture of the bones of the forearm – 100-220 ml;
4. Fracture of the humerus - 300-400 ml.

Bone fractures in humans can be single or multiple. In case of severe injuries, the victim may experience combined fractures of the musculoskeletal system, which are accompanied by damage internal organs and skull bones.

Combined injuries include bone fractures that occur when the body is exposed to several factors (for example, bone fractures are accompanied by thermal, chemical and radiation damage).

Fracture mechanism

There are two mechanisms for the occurrence of a fracture:

1. Direct (a person experiences a bone fracture at the site of application of force);
2. Indirect (far from the place where the force is applied).

Types of fractures:

1. Transverse;
2. Screw;
3. Helical;
4. Oblique;
5. Longitudinal;
6. Fragmented.

Incomplete bone disorders:

1. Cracks;
2. Brokenness;
3. Edge;
4. Perforated fractures.

Localization of the fracture line

1. Lower third;
2. Middle third;
3. Upper third.

Types of displacement of bone fragments:

1. Width;
2. By length;
3. Along the axis (at an angle);
4. On the periphery.

In relation to joints:

1. Intra-articular (the fracture line runs inside the joint);
2. Extra-articular.

Main symptoms and signs of fractures

1. After an injury, the victim experiences pain at the site of bone damage;
2. Swelling and swelling of the soft tissue occurs at the site of injury;
3. When bones are damaged, a bruise occurs (hematoma);
4. If fractures occur in the arms or legs, this limits their mobility;
5. Fractures of the limbs are accompanied by their deformation;
6. When a bone is fractured, the length of the limb may change;
7. After a fracture of the limbs, pathological mobility appears in the arms or legs;
8. Active movements in the damaged limbs are limited;
9. When palpating the site of bone damage, crepitus of the fragments is determined.

Diagnostics

1. Anamnesis;
2. Complaints;
3. Clinical signs of fracture;
4. Additional examination methods.

If the doctor correctly collected anamnesis from the victim, this allows him to establish not only the mechanism, but also the nature of the bone damage.

In terms of diagnosis, it is very important to determine the force that acted on the bone. For example, in older people, fractures can occur even with minor trauma.

Clinical diagnosis must be confirmed X-ray method diagnostics In order to obtain more complete information about the fracture, the injured bone is removed in at least two projections with the obligatory capture of adjacent joints.

In case of complex and combined injuries, the victim is advised to carry out computed tomography and magnetic resonance imaging.

Stages of medical care:

1. Providing first aid to the victim at the scene of injury, depending on the type of fracture;
2. Transporting the victim to the hospital;
3. Diagnosis of fracture;
4. Resuscitation measures;
5. Treatment of injuries that threaten the life of the victim;
6. Treatment of fractures;
7. Rehabilitation.

What does first aid for fractures include?

1. Anesthesia;
2. Anti-shock measures;
3. Stop bleeding;
4. Replenishment of circulating blood volume;
5. Immobilization of the injured limb;
6. Transporting the victim to the trauma department of the hospital.

Anesthesia

In traumatology, there are two types of pain relief:

1. General;
2. Local.

Indications for general anesthesia for fractures:

1. Long-term operations that are accompanied by significant blood loss;
2. Compression fractures of the vertebrae;
3. Fracture of the hip joint;
4. Fracture shoulder joint;
5. Fracture femur;
6. Fracture of the humerus;
7. Complex intra-articular fractures;
8. Multiple fractures;
9. Combined injuries.

General anesthesia is carried out by the following pharmacological groups:

1. Narcotic analgesics (for example, promedol);
2. Not narcotic analgesics(for example, analgin);
3. Ketorol;
4. Non-steroidal anti-inflammatory drugs (for example, Nise).

If the victim after an injury is in in serious condition, then the use of narcotic analgesics for pain relief is prohibited, as this can lead to depression of the respiratory center.

Species local anesthesia which are used for bone fractures:

1. Case novocaine blockade according to Vishnevsky (introduction of novocaine solution into the hematoma or into the fascial sheaths);
2. Epidural anesthesia;
3. Conduction anesthesia (blockade of large nerve trunks);
4. Intraosseous anesthesia.

During intraosseous anesthesia, along with an anesthetic (usually novocaine), you can administer antibacterial drugs and thus create their high concentrations at the site of bone damage.

What is reposition

Reposition is a manipulation that is aimed at matching bone fragments and eliminating all types of displacements.

There are two types of reposition:

1. Open (isolation and comparison of bone fragments occurs during the operation);
2. Closed (comparison of bone fragments occurs without exposing the fracture site).

It is possible to simultaneously correctly compare bone fragments in case of fractures of the bones of the upper and lower extremities. But there are exceptions: for example, in the case of a hip fracture, it is impossible to compare bone fragments at once, since this is prevented by the tension of the leg muscles.

Methods of one-stage reposition:

1. “Manual” reposition;
2. Using special devices (for example, an orthopedic table);

Gradual reduction is used for old bone fractures and hip fractures.

Methods of gradual reduction:

1. Skeletal traction;
2. Using special compression-distraction devices.

How are bone fragments fixed?

Factors on which methods of immobilizing bone fragments depend:

1. General condition of the patient;
2. Age;
3. Location of the fracture;
4. Nature of the fracture;
5. Presence of complications after a fracture;
6. Extensive damage to the skin and soft tissues;
7. The nature of the wound surface;
8. Degree of wound contamination.

The traumatologist must choose a method of fixation of bone fragments that provides reliable fixation and does not cause complications for the patient. The method should allow the patient get involved in the rehabilitation process as early as possible and promote its early activation.

Methods for fixing bone fragments:

1. Plaster casts;
2. Therapeutic splints;
3. Skeletal traction;
4. Devices for extrafocal transosseous fixation;
5. Immersion osteosynthesis.

If the victim is diagnosed with a transverse fracture without displacement of the bone fragments or they are slightly displaced, then after a successful simultaneous reposition of the bone fragments has been carried out, the patient is indicated for fixation with plaster splints or bandages.

Extrafocal fixation and skeletal traction used for comminuted and comminuted fractures, as well as fractures that are accompanied by significant rupture of soft tissue, burns, frostbite and contamination.

Oblique, screw and helical fractures, damage to the femur and humerus, fractures in the forearm should be fixed during the operation using various metal structures(pins, plates, spokes).

Treatment

The main goal of treating fractures is:

1. Achieving fusion of bone fragments in the correct position;
2. Restoring normal anatomical shape bones.

In order to form a strong callus, the following conditions are required:

1. Reposition should restore the correct anatomical position of bone fragments;
2. There should be no layers of soft tissue between the ends of the bone fragments;
3. It is necessary to create immobility of fragments at the fracture site;
4. Good condition of the surrounding soft tissues;
5. The load on the injured limb should be dosed.

What methods are there to stimulate bone fusion?

Modern medicine has the ability to stimulate the formation of callus. To accelerate bone tissue regeneration in traumatology, the following are used:

1. Mumiyo;
2. Anabolic hormones;
3. Special pharmacological groups of drugs;
4. Physiotherapeutic methods.

Rehabilitation after fractures

1. Therapeutic exercise;
2. Massage;
3. Physiotherapy;
4. Proper nutrition;
5. Wearing an orthosis;
6. Sanatorium-resort treatment.

How to eat with fractures

Regardless of the type of fracture, the patient during treatment and rehabilitation should eat foods enriched with vitamins and minerals.

It is necessary to include foods containing calcium in your diet every day - milk, cheese, cottage cheese, vegetables and fruits.

For elderly people and postmenopausal women, the doctor should prescribe tablet forms of calcium supplements and multivitamins.

During the rehabilitation period, the patient is shown spa treatment using mud therapy, balneotherapy, selective physiotherapy and various massage methods. The choice of sanatorium depends on the type and location of the fracture.

Why are fractures dangerous?

Complications of bone fractures:

1. Bleeding;
2. Painful shock;
3. Violation physiological function limbs;
4. Damage to internal organs and soft tissues;
5. Chronic pain syndrome;
6. Violation motor function body;
7. Atroses and arthritis (with intra-articular fractures);
8. Formation of false joints;
9. Infectious complications(eg osteomyelitis)

Prevention of complications after fractures is the timely treatment of the victim for medical care and compliance with all doctor’s recommendations during treatment and rehabilitation.

Types and signs of fractures. Signs of dislocations in the joints. Rules and methods of providing first aid for bone fractures and dislocations. Rules for applying splints. Application of splints and immobilization of joints during certain types fractures and dislocations using standard and improvised means

Types and signs of fractures

1. Types of fractures. Fractures can be closed, in which the integrity of the skin is not broken, there is no wound, and open, when the fracture is accompanied by injury to soft tissue.

Depending on the degree of damage, a fracture can be complete, in which the bone is completely broken, and incomplete, when there is only a fracture or crack in the bone. Complete fractures are divided into fractures with displacement and without displacement of bone fragments.

Based on the direction of the fracture line relative to the long axis of the bone, transverse (a), oblique (b) and helical (c) fractures are distinguished. If the force that caused the fracture was directed along the bone, then its fragments can be pressed into one another. Such fractures are called impacted.

When damaged by bullets and fragments flying at high speed and with great energy, many bone fragments are formed at the fracture site - a comminuted fracture is obtained (e).

Fractures: a - transverse; b - oblique: c - helical; g - driven in; d - splintered

Signs of bone fractures. With the most common fractures of the bones of the limb, severe swelling, bruising, and sometimes bending of the limb outside the joint and shortening appear in the area of ​​injury. In the case of an open fracture, the ends of the bone may protrude from the wound. The site of injury is sharply painful. In this case, it is possible to determine abnormal mobility of the limb outside the joint, which is sometimes accompanied by a crunching sound from the friction of bone fragments. It is unacceptable to specifically bend a limb to make sure there is a fracture - this can lead to dangerous complications. In some cases, with bone fractures, not all of the indicated signs are revealed, but the most characteristic are severe pain and severe difficulty in moving.

A rib fracture can be suspected when, due to bruise or compression, chest the victim notes severe pain when breathing deeply, as well as when feeling the site of a possible fracture. If the pleura or lung is damaged, bleeding occurs or air enters the chest cavity. This is accompanied by respiratory and circulatory disorders.

In the event of a spinal fracture, severe pain in the back, paresis and paralysis of the muscles below the fracture site. Involuntary loss of urine and feces may occur due to dysfunction of the spinal cord.

When the pelvic bones are fractured, the victim cannot stand up, raise his legs, or turn around. These fractures are often combined with damage to the intestines and bladder.

Bone fractures are dangerous due to damage to the blood vessels and nerves located near them, which is accompanied by bleeding, loss of sensitivity and movement in the damaged area.

Severe pain and bleeding can cause the development of shock, especially if the fracture is not immobilized in a timely manner. Bone fragments can also damage the skin, as a result of which a closed fracture turns into an open one, which is dangerous due to microbial contamination. Movement at the fracture site can lead to serious complications, so it is necessary to immobilize the damaged area as quickly as possible.

2. Signs of joint dislocations

A dislocation is a displacement of the articular ends of bones. This is often accompanied by rupture of the joint capsule. Dislocations are often observed in the shoulder joint, in the joints lower jaw, fingers. With a dislocation, three main signs are observed: complete impossibility of movement in damaged joint, severe pain; forced position of the limb due to muscle contraction (for example, when a shoulder is dislocated, the victim holds his arm bent at the elbow joint and abducted to the side); change in the configuration of the joint compared to the joint on the healthy side.

There is often swelling in the joint area due to hemorrhage. It is not possible to palpate the articular head in its usual place; the articular cavity is determined in its place.

3. Rules and methods of providing first aid for bone fractures and dislocations

General rules providing first aid for bone fractures.

To examine the fracture site and apply a bandage to the wound (in the case of an open fracture), clothing and shoes are not removed, but cut. First of all, stop the bleeding and apply aseptic dressing. Then the affected area is given comfortable position and apply an immobilizing bandage.

An anesthetic is injected under the skin or intramuscularly from a syringe tube.

To immobilize fractures, standard splints contained in the B-2 kit or improvised means are used.

First aid for dislocations consists of fixing the limb in the position most comfortable for the victim, using a splint or bandage. A doctor must correct the dislocation. A dislocation in a particular joint may recur periodically (habitual dislocation).

4. Rules for applying splints. Application of splints and immobilization of joints for certain types of fractures and dislocations using standard and improvised means

General rules for applying splints for fractures of extremity bones.
- the splints must be securely fastened, well fixing the fracture area;
- the splint cannot be applied directly to a naked limb; the latter must first be covered with cotton wool or some kind of fabric;
- creating immobility in the fracture zone, it is necessary to fix two joints above and below the fracture site (for example, in case of a tibia fracture, the ankle and knee joints are fixed) in a position convenient for the patient and for transportation;
For hip fractures, all joints should be fixed lower limb(knee, ankle, hip).

First aid for hip fractures. General rules for applying splints

Hip injuries are usually accompanied by significant blood loss. Even with a closed fracture of the femur, blood loss into the surrounding soft tissue is up to 1.5 liters. Significant blood loss contributes to frequent development shock.

Main signs of hip injuries:
- pain in the hip or joints, which sharply increases with movement;
- movements in the joints are impossible or significantly limited;
- with hip fractures, its shape is changed and abnormal mobility is determined at the fracture site, the femur is shortened;
- movements in the joints are impossible;
- no sensitivity in peripheral parts legs.

The best standard splint for hip injuries is the Dieterichs splint.

Immobilization will be more reliable if the Dieterichs splint is reinforced with plaster rings in the area of ​​the torso, thigh and lower leg in addition to the usual fixation. Each ring is formed by applying 7-8 circular rounds of plaster bandage. There are 5 rings in total: 2 on the torso, 3 on the lower limb.

In the absence of a Dieterichs splint, immobilization is performed using ladder splints.

Immobilization with ladder splints. To immobilize the entire lower limb, four ladder splints, each 120 cm long, are required; if the splints are not sufficient, it is possible to immobilize with three splints.

The tires must be carefully wrapped with a layer of gray wool of the required thickness and bandages. One splint is curved along the contour of the back of the thigh, lower leg and foot to form a recess for the heel and calf muscles.

In the area intended for the popliteal region, arching is performed in such a way that the leg is slightly bent at the knee joint. The lower end is bent in the shape of the letter “G” to fix the foot in a position of flexion at the ankle joint at a right angle, while the lower end of the splint should grip the entire foot and protrude 1-2 cm beyond the fingertips.

The other two tires are tied together along the length, the lower end is bent in an L-shape at a distance of 15-20 cm from the lower edge. An elongated splint is placed along the outer surface of the torso and limbs from the axillary region to the foot. The lower curved end wraps the foot over the rear tire to prevent foot drop.

The fourth splint is placed along the inner lateral surface of the thigh from the perineum to the foot. Its lower end is also bent in the shape of the letter “L” and placed behind the foot over the curved lower end of the elongated outer side splint. The splints are reinforced with gauze bandages.

Likewise, in the absence of other standard splints, as a necessary measure, the lower limb can be immobilized with plywood splints.

At the first opportunity, ladder and plywood tires should be replaced with a Dieterichs tire.

Mistakes when immobilizing the entire lower limb with ladder splints:

1. Insufficient fixation of the external extended splint to the body, which does not allow reliable immobilization of the hip joint. In this case, immobilization will be ineffective.

2. Poor modeling of the rear ladder tire. There is no recess for the calf muscle and heel. There is no bending of the splint in the popliteal region, as a result of which the lower limb is immobilized completely straightened in the knee joint, which in case of hip fractures can lead to compression of large vessels by bone fragments.

3. Plantar drop of the foot as a result of insufficiently strong fixation (there is no modeling of the lower end of the side splints in the form of the letter “G”).

4. Not enough thick layer cotton wool on the tire, especially in the area bony protrusions, which can lead to the formation of bedsores.

5. Compression of the lower limb due to tight bandaging.

Transport immobilization using improvised means for hip injuries: a - from narrow boards; b - using skis and ski poles.

Immobilization using improvised means. Performed in the absence of standard tires. For immobilization, wooden slats, skis, branches and other objects of sufficient length are used to ensure immobilization in three joints of the injured lower limb (hip, knee and ankle). The foot must be placed at a right angle at the ankle joint and pads made of soft material must be used, especially in the area of ​​​​the bony protrusions.

In cases where there are no means to implement transport immobilization, the “leg to leg” fixation method should be used. The damaged limb is tied in two or three places to the healthy leg, or the damaged limb is placed on the healthy one and also tied in several places.

Transport immobilization for injuries of the lower extremities using the “foot to foot” method: a - simple immobilization; b - immobilization with light traction

Immobilization of the injured limb using the “foot-to-foot” method should be replaced by immobilization with standard splints as soon as possible.

Evacuation of victims with hip injuries is carried out on a stretcher in a lying position. For warning and timely detection complications of transport immobilization, it is necessary to monitor the state of blood circulation in the peripheral parts of the limb. If the limb is bare, then monitor the color of the skin. If clothes and shoes are not removed, it is necessary to pay attention to the victim’s complaints. Numbness, coldness, tingling, increased pain, the appearance of throbbing pain, cramps in the calf muscles are signs of poor circulation in the limb. It is necessary to immediately loosen or cut the bandage at the point of compression.

First aid for shin fractures. General rules for applying splints

Main signs of shin injuries:
- pain at the site of injury, which intensifies with movement of the injured leg;
- deformation at the site of injury to the lower leg;
- movements in the ankle joint are impossible or significantly limited;
- extensive bruising in the area of ​​injury.

Immobilization is best achieved by an L-shaped curved modeled rear ladder splint 120 cm long and two side ladder or plywood splints 80 cm long. The upper end of the splints should reach the middle of the thigh. The lower end of the side stair rails is bent L-shaped. The leg is slightly bent at the knee joint. The foot is positioned at a right angle to the shin. The splints are reinforced with gauze bandages.

Immobilization can be performed with two 120 cm long stair splints.

Errors in transport immobilization of lower leg injuries using ladder splints:

1. Insufficient modeling of the scalene splint (there is no recess for the heel and calf muscles, there is no arching of the splint in the popliteal region).

2. Immobilization is performed only with the rear ladder splint without additional lateral splints.

3. Insufficient fixation of the foot (the lower end of the side splints is not bent L-shaped), which leads to plantar sagging.

4. Insufficient immobilization of the knee and ankle joints.

5. Compressing the leg with a tight bandage while strengthening the splint.

6. Fixation of the limb in a position where the tension of the skin over the bone fragments remains (the front surface of the leg, ankle), which leads to damage to the skin over the bone fragments or the formation of bedsores. Skin tension caused by displaced bone fragments in the upper half of the leg is eliminated by immobilization knee joint in a full extension position.

Immobilization of lower leg injuries with three ladder splints: a - preparation of ladder splints; b - application and fixation of splints

Immobilization of shin injuries in the absence of standard splints can be performed using improvised means.

First aid for shoulder fractures. General rules for applying splints

Signs of shoulder fractures and damage to adjacent joints:
- severe pain and swelling in the area of ​​injury;
- pain increases sharply with movement;
- change in the shape of the shoulder and joints;
- movements in the joints are significantly limited or impossible;
- abnormal mobility in the area of ​​the shoulder fracture.

Immobilization with a ladder splint is the most effective and reliable method of transport immobilization for shoulder injuries.

The splint should cover the entire injured limb - from the shoulder blade of the healthy side to the hand on the injured arm and at the same time protrude 2-3 cm beyond the fingertips. Immobilization is performed using a ladder splint 120 cm long.

The upper limb is immobilized in the position of slight anterior and lateral abduction of the shoulder. To do this, a ball of cotton wool is placed in the axillary area on the side of the injury, the elbow joint is bent at a right angle, the forearm is positioned so that the palm of the hand is facing the stomach. A cotton roller is placed into the brush.

Preparing the tire

Measure the length from the outer edge of the victim’s shoulder blade to the shoulder joint and bend the splint at an obtuse angle at this distance;

Measure along the back surface of the victim’s shoulder the distance from top edge shoulder joint to the elbow joint and bend the tire at this distance at a right angle;

The person providing assistance additionally bends the splint along the contours of the back, back of the shoulder and forearm.

It is recommended to bend the part of the splint intended for the forearm into the shape of a groove.

Having tried the curved splint on the victim’s healthy arm, the necessary corrections are made.

If the tire is not long enough and the brush hangs down, its lower end must be extended with a piece of plywood tire or a piece of thick cardboard. If the length of the tire is excessive, its lower end is bent.

Two gauze ribbons 75 cm long are tied to the upper end of the splint wrapped in gray cotton wool and bandages.

The splint prepared for use is applied to the injured arm, the upper and lower ends of the splint are tied with braids and the splint is strengthened with bandages. The arm along with the splint is suspended on a scarf or sling.

To improve fixation of the upper end of the splint, two additional pieces of bandage 1.5 m long should be attached to it, then pass the bandage around the shoulder joint of the healthy limb, make a cross, circle it around the chest and tie it.

Transport immobilization of all upper limb ladder tire:

a - applying a splint to the upper limb and tying its ends;
b - strengthening the splint with bandaging; c - hanging a hand on a scarf

When immobilizing the shoulder with a ladder splint, the following errors are possible:

1. The upper end of the splint reaches only the shoulder blade of the affected side; very soon the splint moves away from the back and rests on the neck or head. With this position of the splint, immobilization of injuries to the shoulder and shoulder joint will be insufficient.
2. The absence of ribbons at the upper end of the tire, which does not allow it to be securely fixed.
3. Poor tire modeling.
4. The immobilized limb is not suspended from a scarf or sling.

In the absence of standard splints, immobilization is carried out using a medical scarf, improvised means or soft bandages.

Immobilization with a medical scarf. Immobilization with a scarf is carried out in the position of slight anterior abduction of the shoulder with the elbow joint bent at a right angle. The base of the scarf is wrapped around the body approximately 5 cm above the elbow and its ends are tied on the back closer to the healthy side. The top of the scarf is placed upward on the shoulder girdle of the injured side. The resulting pocket holds the elbow joint, forearm and hand.

The top of the scarf on the back is tied to the longer end of the base. The damaged limb is completely covered by a scarf and fixed to the body.

Immobilization using improvised means. Several planks and a piece of thick cardboard in the form of a trench can be laid on the inner and outer surfaces of the shoulder, which creates some immobility during a fracture. The hand is then placed on a scarf or supported by a sling.

Immobilization with Deso bandage. In extreme cases, immobilization for shoulder fractures and damage to adjacent joints is carried out by bandaging the limb to the body with a Deso bandage.

Correctly performed immobilization of the upper limb significantly alleviates the condition of the victim and special care during evacuation, as a rule, it is not required. However, the limb should be periodically examined so that if swelling in the area of ​​injury increases, compression does not occur. To monitor the state of blood circulation in the peripheral parts of the limb, it is recommended to leave the terminal phalanges of the fingers unbandaged. If signs of compression appear, the bandage should be loosened or cut and bandaged.

Transportation is carried out in a sitting position, if the condition of the victim allows.

First aid for forearm fractures. General rules for applying splints

Signs of forearm bone fractures:
- pain and swelling in the area of ​​injury;
- pain increases significantly with movement;
- movements of the injured arm are limited or impossible;
- change regular form and volume of forearm joints;
- abnormal mobility in the area of ​​injury.

Immobilization with a ladder splint is the most reliable and efficient look transport immobilization for forearm injuries.

The ladder splint is applied from the upper third of the shoulder to the fingertips, the lower end of the splint stands at 2-3 cm. The arm should be bent at the elbow joint at a right angle, and the hand should be facing the stomach and slightly abducted back side, a cotton-gauze roller is placed in the hand to hold the fingers in a semi-flexed position.

A ladder splint 80 cm long, wrapped in gray cotton wool and bandages, is bent at a right angle at the level of the elbow joint so that the upper end of the splint is at the level of the upper third of the shoulder, the section of the splint for the forearm is bent in the form of a groove. Then they apply it to the healthy hand and correct the defects of the modeling. The prepared splint is applied to the sore arm, bandaged along its entire length and hung on a scarf.

The upper part of the splint intended for the shoulder must be of sufficient length to reliably immobilize the elbow joint. Insufficient fixation of the elbow joint makes immobilization of the forearm ineffective.

In the absence of a ladder splint, immobilization is carried out using a plywood splint, a plank, a scarf, a bundle of brushwood, or the hem of a shirt.

Transport immobilization of the forearm:
a - ladder tire; b - using improvised means (using planks)

First aid for sprained limbs

The most common traumatic dislocations are caused by excessive movement in the joint. This happens, for example, when strong impact in the joint area, fall. As a rule, dislocations are accompanied by a rupture joint capsule and separation of articulating articular surfaces. An attempt to compare them does not bring success and is accompanied by severe pain and springy resistance. Sometimes dislocations are complicated by fractures - fracture-dislocations. Reduction of a traumatic dislocation should be as early as possible.

Help with sprains.

Since any, even minor, movement of a limb brings unbearable pain, first of all, it is necessary to fix the limb in the position in which it finds itself, ensuring its rest during the hospitalization stage. For this purpose, transport tires, special bandages or any available means are used. To immobilize the upper limb, you can use a scarf, the narrow ends of which are tied across the neck.

If the lower limb is dislocated, splints or boards are placed under it and on the sides and the limb is bandaged to them.

If the fingers of the hand are dislocated, the entire hand is immobilized to any flat, hard surface. In the area of ​​the joints, a layer of cotton wool is laid between the splint and the limb.

When the lower jaw is dislocated, a sling-shaped bandage is placed under it (reminiscent of a bandage put on the hand of an attendant), the ends of which are tied crosswise at the back of the head.

After applying a splint or fixing bandage, the victim must be hospitalized to reduce the dislocation.

Fractures are pathological condition, in which bone deformation occurs under the influence of a damaging factor that exceeds the strength of bone tissue. Injuries are more common in childhood and old age, which is associated with the anatomical and physiological characteristics of the body.

A child's bones are more elastic and less durable than those of adults. This causes the skeleton to be vulnerable to traumatic factors. High risk the formation of fractures in children is associated with the child’s mobility and poor development of self-preservation skills. In older people, due to age-related changes Calcium salts are washed out of the bones, which leads to osteoporosis and a decrease in skeletal strength. Violation cerebral circulation, leading to poor balance and dizziness, causing unsteady gait and frequent falls.

In young people, the risk of bone deformation is associated with seasonality (ice), professional activity (intense physical activity), and sports (professional athletes). In modern international classification diseases (abbreviated ICD 10) fractures are assigned class 19 - injuries, poisoning and other consequences when exposed to external factors.

Classification

The classification of fractures was created to simplify diagnosis, determine treatment tactics and prognosis of the disease. Injuries are distinguished by etiology (reason of origin), form of bone defect, displacement of bone fragments, formation of bone fragments and other factors. We will look at what types of fractures there are below and present different classifications skeletal injuries.

From left to right there is a fracture inside the joint, open and closed injury

Fractures are classified based on the reason they occur:

• traumatic – occur when healthy bones with a sufficient degree of strength are exposed to an intense traumatic factor;
• pathological - occur when a traumatic factor of insignificant damaging force is exposed to pathologically altered bones with low strength potential.

Traumatic bone defects appear due to a direct blow, a fall from a height, violent actions, awkward movements, or gunshot wounds. Such fractures are called straight. Sometimes the place where the force is applied and the area where the injury occurs may be located at some distance. These are indirect fractures. Pathological bone defects occur against the background of diseases that lead to weakening of bone tissue and reduce its strength. A high risk of skeletal injuries is caused by bone cysts, tumors or metastases, osteomyelitis, osteoporosis, and impaired osteogenesis during embryonic development, chronic wasting diseases.

According to bone fragments from environment fractures are distinguished:

• open – accompanied by damage to the external integument;
• closed - occur without the formation of a wound.

Open bone defects can be primary or secondary. Primary ones are characterized by the formation of a wound when exposed to a traumatic factor. Secondary ones appear after the moment of injury as a result of the cutting of the skin by the sharp edges of the bones due to improper transportation of the patient to the emergency room or unsuccessful repositioning of the bone during treatment.

Bone fractures differ in the direction of the bone defect line

Closed fractures are:

• incomplete – formed like a crack without displacement of bone fragments;
• complete - characterized by complete separation of the ends of the bone and displacement in different sides;
• single – injury to one bone;
• multiple – injury to several bones;
• combined – the occurrence of a bone defect as a result of the influence of various negative factors (mechanical, radiation, chemical);
• combined – skeletal injuries are combined with damage to visceral organs.

Incomplete fractures occur due to exposure to minor traumatic forces. More often, such defects occur in children whose bones are covered with a thick and elastic periosteum. The child is characterized by injuries of the “green stick” type – bone cracks without displacement of fragments. Incomplete defects include marginal and perforated fractures, fractures and cracks. Complete separation of bone fragments develops when a significant impact force is applied or a defect is formed in areas of bones with well-developed muscles. Muscle contraction leads to displacement of bone fragments in different directions along the trajectory of muscle fiber traction.

A displaced fracture is considered a severe injury that requires long-term treatment And recovery period. Open injuries are also included in this group. In addition, they are accompanied by primary infection of the wound, which can lead to osteomyelitis and sepsis. Displacement of fragments of damaged bones causes the development of complications associated with damage muscle tissue, nerves and blood vessels.

Fracture inside a joint

As a result, open and closed bleeding, impaired innervation of the limbs, paralysis and decreased sensitivity occur. Damage to soft tissue and large blood vessels leads to painful and hemorrhagic shock, which complicates the treatment of the injury and can cause death. A fracture without displacement usually does not lead to undesirable consequences and in most cases has a favorable outcome.

Based on the location of the bone defect, the following types of fractures are distinguished:

• formation in the lower, middle or upper third of the bone (in case of injuries to tubular bones);
• impacted or impression (in case of injuries to spongy bones, for example, vertebrae);
• diaphyseal (located between the ends of the tubular bones);
• metaphyseal (located near the joints);
• epiphyseal (located in the joint cavity);
• epiphysiolysis (in the bone growth zone in childhood).

Epipharic injuries can occur as fracture-dislocations, which complicates the treatment of the disease and lengthens the rehabilitation period. Epiphysiolysis with inadequate therapy contributes to the premature closure of skeletal growth zones and causes shortening of the damaged limb.

Depending on the shape of the bone defect line, the following types of fractures are distinguished:

• oblique,
• transverse,
• longitudinal,
• screw,
• splintered.

A comminuted fracture is accompanied by the formation of one or more bone fragments, which are completely separated from the bone and are located in soft tissues. Such injuries require surgical treatment And long period rehabilitation. A comminuted fracture with the formation of multiple fragments is usually called comminuted. He calls significant defect damaged bone. Comminuted fractures can be small- and large-comminuted.

Defects with a transverse fracture line are classified as stable injuries with rare displacement of bone fragments. Other types of fractures lead to displacement of fragments due to muscle traction after injury and are included in the group of unstable fractures. Proper transportation of the patient to the emergency room and adequate treatment methods prevent the development of complications due to displacement of bone fragments.

Classification of bone fractures helps to choose the right tactics treatment, prevent the development undesirable consequences, predict the duration of therapy and rehabilitation period. Making an accurate diagnosis, according to modern classification, improves the prognosis of injury and reduces the risk of developing severe complications.

Consequences

After a fracture occurs, you must immediately seek medical help. In case of severe injuries, which are accompanied by the formation of a wound or displacement of damaged bones, bleeding, multiple bone lesions, deterioration of the general condition of the victim due to hemorrhagic and painful shock, you should call an ambulance. If it is impossible to call doctors, the patient is transported independently to the trauma department after treatment. first aid and application of transport tires.

With methods for using immobilization splints, rules for providing first aid and methods for treating fractures.

Internal blood loss leads to hematoma formation

Undesirable consequences of a fracture occur when the victim is transported incorrectly to the hospital, late seeking medical help, inadequate choice of therapy and violation of the treatment regimen. If you suspect an injury, you must consult a doctor, undergo X-ray diagnostics and promptly begin treatment if a bone defect is confirmed.

Outcomes of fracture healing:

• full recovery anatomical structure and functions of the injured leg or body part;
• complete restoration of the anatomical structure with limited functionality;
• improper fusion of bones with dysfunction of a limb or part of the body (deformation, shortening of the limb);
• Non-union of bone fragments with the formation of a false joint.

Complications that arise after healing of the injury depend on the correct reposition (comparison) of fragments and sufficient fixation of the bone, concomitant soft tissue damage, rehabilitation measures and the duration of the period of limitation of motor activity. The types of bone fractures affect the healing time of the injury. Longer therapeutic immobilization is necessary for open injuries, closed injuries with bone displacement and the formation of bone fragments, as well as in the case of intra-articular disorders and the formation of fracture-dislocations.

Useful information on how to recognize fracture formation, clinical signs of injury and diagnosis of the disease.

Complications of fractures can be divided into 3 main groups:

1. Static disorders of bone tissue (absence or improper healing, deformation or shortening of the leg, formation of a false joint).
2. Soft tissue disorders (deterioration of blood flow and innervation, muscle atrophy, bleeding).
3. Local infection at the site of injury (wound, bones) or spread of infection throughout the body (sepsis).

Limb deformity due to improper bone fusion

Unhealed bone fractures are formed when the fragments are incorrectly juxtaposed, as a result of which the formation of callus is disrupted. When soft tissue gets between the ends of a damaged bone, a false joint may occur, which leads to pathological mobility at the site of injury and disruption of the normal function of the limb. Due to the pathology of bone consolidation, shortening or deformation of the limbs develops, which leads to disability.

Bleeding from large vessels when their integrity is violated by sharp edges of bones causes the development of bleeding. With a closed injury of the hip, the blood loss is 1-2 liters, the bones of the leg - 600-800 ml, the bones of the shoulder - 300-500 ml and the forearm - 100-250 ml. In case of open injuries in the area of ​​large blood vessels (carotid, inguinal, femoral arteries and aorta) bleeding can cause significant blood loss (more than 2 L) and lead to fatal outcome.

A bone fracture with damage to the nerve trunks causes impairment of motor function and sensory function. After the defect heals, a large callus may form, which puts pressure on blood vessels and nerves. As a result, paralysis and paresis develop, congestion in the tissues leads to disability.

Prolonged immobilization of the limb contributes to muscle atrophy and the formation of joint immobility (ankylosis). After removing the plaster, traction or external fixation device, a disturbance in the outflow of blood and lymph from the damaged area of ​​the limb is observed, which causes swelling, bluishness of the skin and stiffness of the joints. To prevent the formation of undesirable consequences of limb fractures, adequate therapy is carried out and rehabilitation measures on different stages healing of injury.

Pseudarthrosis formation

Infectious complications are typical for open bone injuries. As a result of injury, pathogenic microorganisms enter the wound, which cause suppuration of soft tissues, bones (osteomyelitis) or generalization of infection (sepsis). Less commonly, ulcers form in the area of ​​internal or external osteosynthesis (comparison of bones using knitting needles, plates, screws). To prevent infection, the wound is treated aseptically, the skin defect is sutured, and a course of antibiotics is prescribed.

Improper or prolonged healing of fractures causes scarring that puts pressure on blood vessels and nerves. This leads to chronic pain after consolidation of bone fragments and return to normal physical activity. Painful sensations intensify after long walking, carrying heavy objects, changing weather conditions, and can cause insomnia and mental exhaustion of the body. Significant decrease in working capacity due to constant pain leads to disability.

Bone fractures vary according to various parameters. To make an accurate diagnosis and choice correct technique treatment, a classification was created reflecting specific features one or another injury. The consequences of fractures depend on the severity of the injury, timely provision of first aid, and correctly selected treatment and rehabilitation tactics. If you follow your doctor's recommendations, in most cases clinical cases it is possible to completely restore the anatomical integrity of the damaged bone and the functional activity of a limb or part of the body.

Experts distinguish different types of fractures. The classification of fractures depends on large quantity signs.

Is a complete or partial destruction of the integrity of bone tissue when exposed to excessive physical activity exceeding the strength limits of skeletal tissue in the area of ​​injury. Damage occurs both in the event of exposure to a traumatic factor and during the development of various ailments leading to pathological changes in the strength characteristics of skeletal tissue.

The severity of the condition is determined by the size of the damaged bone, the number of lesions and bones affected. Multiple lesions received by tubular bones provoke the occurrence of heavy blood loss and lead to the development of trauma shock. Patients with such lesions slowly restore their health, and recovery sometimes lasts several months.

Criteria for classification of injuries, characteristics of open and closed types of bone injuries

All types of bone fractures are classified according to several criteria, which is associated with a wide variety of causes leading to the occurrence of lesions and areas of localization of injuries.

In modern medical classifications of bone fractures, experts distinguish different types depending on the following signs:

• causes of injury;
• severity of the lesion;
• shape and direction of the injury line;
• degree of skin damage;
• localization of the wound area;
• the likelihood of complications.

The most common classification is the division various types fractures into two groups: closed and open. The main difference between open types and closed ones is that violation of the integrity of a skeletal element is accompanied by damage skin and availability open wound. In the open type, the area of ​​damage to the skeletal element communicates with the external environment, as a result of which all bone injuries are primarily infected.

Skeletal elements can be primary and secondary open. In the case of a primary open injury to a skeletal element, a trauma-forming force affects the affected area, resulting in injury to soft tissue, skin and bone tissue. When this type of injury occurs, the resulting extensive skin wound is characterized not only by an extensive area of ​​soft tissue damage, but also by splintered bone damage. In the case of a secondary open injury, soft tissue injury occurs from the inside as a result of a puncture of fragments of a skeletal element with sharp ends. This type of injury is accompanied by the appearance of a wound and a small affected area.

Classification of bone lesions

Based on the reason for their occurrence, skeletal bone fractures are divided into two groups by experts:

• traumatic;
• pathological.

The formation of traumatic injuries is caused by excessive external forces in the area of ​​injury.

Appear as a result of minimal impact on the bone. Such exposure leads to the appearance of damage in the presence of ailments in the body that contribute to the destruction of tissue of skeletal elements. Such ailments can be tuberculosis and tumors of various natures.

Depending on the severity of the resulting lesion, there are the following types of damage:

• full;
• incomplete.

Complete fractures can occur with or without displacement. Incomplete bone injuries are cracks or fractures.

Depending on the shape and direction of the line of damage, the classification of fractures includes several types of bone injuries.

Medical specialists stand out the following types bone fractures:

• transverse;
• longitudinal;
• oblique;
• helical;
• splintered;
• wedge-shaped;
• driven in;
• compression

Based on the location of the injury, lesions of the diaphysis, epiphysis and metaphysis are distinguished. During the development of the disease, various complications can develop; therefore, injuries are divided into complicated and uncomplicated. When the growth zone of a skeletal element is injured, a special type of injury occurs - epiphysiolysis.

Characteristics of bone injuries depending on the form and direction of injury

Transverse injuries to skeletal elements are characterized by the presence of a fracture line that is perpendicular to the longitudinal axis of the bone element.

Longitudinal damage has a line of tissue destruction, which is directed parallel to the longitudinal axis of the skeletal element.

Oblique injuries are distinguished by the presence of a damage line, which is located under acute angle to the longitudinal axis of the bone element.

A helical fracture differs from other types of injury in that during the injury process, rotation of the fragments relative to their normal position is observed.

Splintered injuries of bone tissue do not have a single line of injury; the bone at the site of injury has a crushed appearance and consists of individual fragments.

Wedge-shaped fractures are lesions characteristic of fractures spinal column. This type of lesion is characterized by pressing one bone into another. When this process occurs, a wedge-shaped deformation is formed.

Features of impacted lesions are the displacement of the proximals along the longitudinal axis or their location outside the main axis of the bone element.

Compression lesions are characterized by the absence of a single line of injury and the presence of small bone fragments in the affected area.

Diagnosis of bone injuries

Each type of injury has characteristic features, which allow specialists to diagnose it.

During the examination, traumatologists identify characteristic symptoms that allow an accurate diagnosis of the victim. All symptoms are divided into absolute and relative.

TO absolute symptoms medical specialists include the following:

• the appearance of a characteristic deformation consisting in a change in the configuration and axis of the bone element of the skeleton;
• the appearance of pathological mobility (the appearance of limb mobility outside the articular zone or restrictions in mobility);
• the appearance of crepitus (a phenomenon characterized by the occurrence of a bone crunch in the area of ​​damage as a result of friction of bone fragments);
• the occurrence of shortening of the limb in the event of displacement of fragments along the longitudinal axis.

All these symptoms are a direct indication of the presence of trauma to a bone element of the skeleton.

Relative symptoms include:

• pain at the site of injury, which intensifies with movement;
• emergence of local painful sensations during palpation;
• increased pain at the site of injury when a load is applied in the direction of the longitudinal axis of the bone element;
• the appearance of a hematoma in the area of ​​injury; the hematoma can be of significant size;
• motor dysfunction.

Relative symptoms can signal the occurrence of not only fractures, but also dislocations and bruises. However, if there are several relative symptoms that occur in a person, it can simultaneously assume the presence of injury to a skeletal element in the form of a fracture. To confirm the diagnosis, the area of ​​injury is examined using radiography in two planes.

Consequences of injury

After an injury, a violation of the integrity of the bone tissue appears, provoking the development of severe bleeding and the occurrence of severe pain. With complete fractures of the tubular elements of the skeleton, displacement of the fragments relative to the longitudinal axis occurs. The displacement of the fragments is caused by the occurrence of uncontrollable pain pulsation in the muscle tissue that surrounds the area of ​​injury. The muscles that are attached to bone fragments, as a result of a reflex contraction, displace the fragments relative to the normal position of the bone. This displacement leads to additional injury, aggravating the severity of the lesion. In the area of ​​injury, an extensive hematoma forms in the closed type and heavy bleeding in the open type.

Bleeding resulting from injury is very difficult to stop, since the blood vessels of the bone tissue do not have the ability to collapse. The vessels are located in the mineral part of the bone, which prevents them from blocking. The amount of blood loss depends on the type of injury received and location, as well as on the type of bone element that was injured.

In the area of ​​bleeding, tissue swelling occurs and fibrin threads are formed, which later form the basis for the formation of the protein base of the bone tissue of the damaged element. Stopping bleeding is challenging task and in most cases is possible only in a specially equipped operating room.

If injured, the person should be taken to a hospital for treatment.