So that after a fracture the injured arm or leg does not swell, it is necessary to move your fingers from the first days after applying the plaster. Do I need gypsum after osteosynthesis

Gypsum technique is with the help of gypsum. A plaster cast is widely used for treatment in orthopedics and. This bandage is well modeled, provides secure fixation, adheres tightly and evenly to the body, quickly hardens, is easy to remove and can be applied in any conditions.

Medical plaster, used in gypsum technology - semi-aqueous sulfate salt, obtained by calcining natural gypsum stone at a temperature of 130 °. Medical gypsum - finely ground powder of white or slightly yellowish color, without impurities, dry, soft to the touch, must quickly harden and be durable in the product. These qualities are determined by inspection, palpation and with the help of special sample. Warm water is added to the gypsum in a ratio of 2:1 until a plastic mass is formed, which should harden within 5-6 minutes. Too rapid hardening (in 1-2 minutes) of gypsum is undesirable, since gypsum made from such gypsum can harden during bandaging. The frozen mass should break with difficulty, not knead between the fingers and not release moisture. Plaster of poor grinding with impurities is sieved through a fine sieve. Delayed hardening of gypsum is eliminated by adding hot water or alum at the rate of 20 g per bucket of water. It is necessary to know the setting speed of the gypsum with which you have to work, and adjust the temperature of the water accordingly.

Plaster dressings are applied in a special room - a plaster cast room, where there is a cabinet for storing plaster and plaster bandages, a table for preparing plaster splints, basins for soaking plaster bandages, tools for removing and cutting plaster bandages, a couch or a special orthopedic table.

Gypsum bandages are factory-made or they are made on site by rubbing gypsum powder into ordinary gauze bandages without an edge (Fig. 1). To make a plaster cast, plaster bandages or plaster splints are lowered deep into the pelvis with warm water(Fig. 2). Wetting of the bandage is determined by the cessation of the release of air bubbles. The bandage is removed, grabbing it from both ends so that the plaster does not flow out. Bringing hands together, squeeze out excess water.

Rice. 1. Plastering and folding bandages.

Rice. 2. Soaking and removing the plaster bandage.

Plaster dressings are applied without lining directly to the skin, covering the bony protrusions with special cotton pads (Fig. 3); sometimes thin layers of cotton wool are used in orthopedic practice.

To apply a plaster bandage, plaster splints are often used, prepared from 6-8 layers of soaked plaster bandage. The length of the splint is 60 cm - 1 m. The splint is fixed with a plaster or ordinary gauze bandage. They bandage without excessive tension and constrictions, rolling out the head of the plastered bandage in circular motions in an upward or downward direction, covering the previous round with the next round of the bandage by at least half of its width, while straightening the folds and smoothing out the bandage tours. All the time it is necessary to carefully model a wet bandage along the contours of the body. After applying a plaster cast, it is necessary to carefully monitor the state of blood circulation in the limb, paying attention Special attention on the fingertips: pain, impaired sensitivity, coldness, swelling, discoloration with pallor or cyanosis indicate vascular compression and the need to change the bandage.

Rice. 3. Areas of the body to be protected when applying a plaster cast.

Plaster bed is used for diseases of the spine. 5-6 large splints are made in two layers each, from the crown of the head to the middle of the thighs and a width slightly greater than 1/2 of the chest circumference. The patient is laid on. Bone protrusions are protected with cotton wool, and the head, back, and hips are covered with two layers of gauze. A plaster splint is placed over the gauze and it is modeled well (Fig. 4). Then successive layers are applied in turn. After curing, the plaster bed is removed and cut so that the patient enters it to the middle of the crown, and the ears remain open; from the side, the edges should reach the iliac crests and axillary cavities, but in such a way that movements in were not limited. An oval notch is made in the area for ease of use of the vessel (Fig. 5). After cutting, the edges of the gypsum bed are covered with gauze and rubbed with gypsum gruel. The dried plaster bed is pasted over with a soft material from the inside.

Rice. 4. Making a plaster bed.

Rice. 5. Plaster bed.

A plaster corset is applied for diseases and. The type of corset is determined by the localization of the lesion (Fig. 6). The corset is placed on a special orthopedic table or in a frame, which makes it possible to unload and eliminate the deformity (Fig. 7). The scallops of the ilium, spinous processes of the vertebrae, shoulder blades, and collarbones are preliminarily protected with padded jackets. For a corset, wide plaster bandages or specially cut splints are used; they are alternately applied in 4 layers behind and in front, carefully modeling. The bandage is strengthened with rounds of plaster bandage in 1-2 layers. There are about 20 bandages 25 cm wide on the corset. A correctly applied corset has 3 support points at the bottom - the iliac crests and the pubis, at the top in front it rests against the sternum. A window is usually cut in the abdomen to facilitate breathing. When applying a corset-collar of the patient must be open. The corset-collar is cut so that at the top it ends a little above the back of the head, below the ears and at the level of the chin, at the bottom - at the level of the XI-XII thoracic vertebrae.

Rice. 6. Types of plaster corset depending on the level of the lesion (indicated by the arrow).

Rice. 7. Imposition of a plaster corset.

Rice. 8. Coxite dressings.

in the shoulder area and armpits the corset is cut out so that the movements in the shoulder joints are not limited.

The hip, or so-called coxite, bandage (Fig. 8) is used for disease or damage to the femur. For a coxite dressing, you need wide plaster bandages, plaster longuets 60 cm or 1 m long and cotton pads for laying in the sacrum and scallops ilium. The first 2-3 long splints are laid around the abdomen and pelvis and fixed with circular rounds of a plaster bandage. Then two meter splints are applied along the back and outer surfaces lower limb to the lower third and fix them with a plaster bandage. Two short splints strengthen the front and inner surfaces hip joint, one of them goes obliquely, forming the perineal part of the dressing. Short splints are applied in front from the lower third of the thigh to and behind from the middle third of the lower leg to the fingertips. All splints are strengthened with rounds of plaster bandages. The bandage can also be made from a smaller number of splints, but using more bandages. Particular strength is required in the inguinal fold, where dressings often break.

Thoraco-brachial bandage (Fig. 9) is applied for fractures in the area shoulder joint and humerus. Start with the imposition of a plaster corset, then lay a long splint along inner surface arms from the wrist to the axillary cavity with the transition to the corset. The second splint is applied along the posterior-outer surface from the hand through and shoulder to the corset. The splints are fixed with a plaster bandage and the bandage is reinforced with additional splints at the shoulder joint. Cast between the corset and the elbow joint wooden stick- spacer.

Rice. 9. Thoraco-brachial bandage.
Rice. 10. Circular gypsum bandage with damage to the elbow joint.
Rice. 11. Circular plaster cast for a fracture of the bones of the forearm.

Circular plaster bandages are widely used for fractures of limb bones (Fig. 10, 11, 12). A circular plaster bandage applied directly to the wound is called a blind plaster bandage. Along with the immobilization of fragments, such a bandage protects the wound from secondary infection, prevents drying and cooling, eliminates the need for dressings, providing optimal conditions not only for the fusion of bone fragments, but also for the healing of soft tissue wounds. Blind plaster cast is widely used for the treatment gunshot wounds, facilitates the transportation of the wounded and care for them.

Rice. 12. Piricular plaster bandages for fractures of the leg bones.

To observe the wound or the site of injury in a circular plaster bandage, a window is sometimes made - a window bandage (Fig. 13). It is cut out with a knife in a bandage that has not yet hardened in the intended area. To facilitate cutting out the window, a cotton pad is placed from the inside, and the plaster cast is made thinner in this place. The edges of the window are rubbed with gypsum gruel.

A bridge bandage (Fig. 14) is a kind of fenestrated, when, to strengthen the bandage, metal or cardboard-gypsum arcs are thrown through the window, plastered into the bandage.

Rice. 13. Window dressing.
Rice. 14. Bridge dressing.
Rice. 15. Gypsum splint for the knee joint.
Rice. 16. Removable plaster splint. >

A circular bandage that captures only one of the joints of the limb is called a splint, and does not capture the joints at all - a sleeve. The latter is superimposed mainly as component complex bandages.

In case of damage and disease of the joints, more often the elbow joint, a splint is applied (Fig. 15), which creates complete rest for the joint. It should capture the overlying part of the limb to the upper third and the underlying one to the lower third. The basis of the splint is a gypsum splint, on top of which they are bandaged with gypsum bandages.

Removable gypsum splint (Fig. 16 and 17) is made from a wide gypsum splint, which should cover 2/3 of the circumference of the limb. The longuet is well modeled on the limbs and fixed with a gauze bandage. If necessary, by unwinding the bandage, you can easily remove the bandage. Removable gypsum splint is widely used in pediatric practice.

Rice. 17. Removable plaster splint (fixation with a bandage).

For the gradual elimination of some forms of deformities and contractures, a stage bandage is used. There are several types of such a bandage. For example, in the treatment congenital clubfoot in young children, they are taken out of the vicious position as much as possible and a plaster cast is applied to it in this form. After some time, the bandage is removed, the vicious position is again eliminated and a plaster cast is applied. So gradually, gradually changing the plaster casts, the foot is brought to a natural position. Another type of stage bandage used to eliminate contractures in the joints and angular deformities of the bones is a circular plaster bandage with a cutout over the corrected area. The direction of the cut should be opposite to the angle of deformation. Gradually reducing the size of the cutout with the help of levers cast in a bandage, the deformation is eliminated.

After the end of the treatment, the plaster bandage is removed. For this purpose, there is a special set of tools (Fig. 18). When cutting a plaster bandage with special scissors, the inner branch must always be parallel to the bandage (Fig. 19). In areas with pronounced curvature, it is better to use a saw. After dissection, the edges of the bandage are moved apart and the plastered part of the body is released. The remains of gypsum are removed with warm water and soap.

Rice. 18. A set of tools for removing and cutting the plaster cast.

Rice. 19. Dissection of a plaster cast.

Before making plaster casts when using plaster for fracture, the first step is to check the quality of the gypsum. To do this, powdered gypsum is mixed equally with warm water. The mass should harden in five to seven minutes, in which case the quality of the gypsum should be considered satisfactory. There should be no foreign inclusions in the gypsum powder.

Plaster bandages

In the manufacture of splints and plaster bandages, wide, narrow and medium bandages are used, the length of which can reach up to 3 meters. Plaster bandages are prepared on the table. First, the bandage is untwisted forty centimeters, then it is evenly poured over it. plaster for fracture and rub it with your hand into the bandage. The area treated with gypsum is gently rolled up without tension. Then the next forty-centimeter fragment of the bandage is rolled out and the procedure is repeated with gypsum powder rubbing. For gypsum splints, bandages of different widths and thicknesses are used, depending on the place of application and the need.

Why put on a cast for a fracture

Bedless dressings applied directly to the skin are used.

For soaking splints and bandages is used warm water, approximately 40 0 ​​С. More hot water accelerates the hardening of the plaster cast, and cold slows it down, these properties are used to various occasions plastering.

Why put on gypsum and how much they wear it. Longuets are placed along the extensor surface on the upper limbs, and along the flexion surface on the lower ones. Longuets of small sizes are modeled from a plaster bandage directly on the patient, when, for example,. The longet is fastened with a soft bandage, if it is necessary to apply a full bandage, circular passages of a plaster bandage are used.

Then a plaster bandage is applied without tension.

Plaster technique is the provision of immobility using gypsum, framed in plaster bandages. Such a bandage is optimally modeled, guarantees fixation, evenly adheres to the body, hardens for a short time and can be easily removed, and can be applied in any situation.

What is gypsum

In diseases of the spine, a plaster bed is placed. They make up to six large two-layer splints, from the crown of the head to the middle of the thighs, and the width should be slightly larger than half the circumference of the chest.

For diseases and injuries of the spine also impose a plaster corset. This happens on a special orthopedic table or in a frame. In this case, and the deformation is eliminated. A window is cut in the abdomen for free breathing.

Hip (coxite) bandage used is used for diseases or injuries of the hip joint, femur. Here, wide plaster bandages are used, and cotton pads for laying in the area of ​​the sacrum and iliac crests.

Thoraco-brachial bandage used for fractures in the area of ​​the shoulder joint and humerus. A plaster corset is applied, I adapt a long splint from the hand to the axillary cavity on the inner surface of the arm with the transition to the corset. The second splint is installed on the rear-outer surface. The splints are fixed with a plaster bandage and additional splints in the area of ​​the shoulder joint. A wooden spacer is installed between the corset and the elbow.

Circular plaster bandages have found application in fractures of the extremities.

After the end of the treatment, the plaster bandage is removed.

The time spent by the patient in the cast is determined by the doctor using various methods, including x-rays. It is unlikely that you will be able to wear a cast for less than a month.

Such an injury can be classified according to different features. Based on the number of bone fractures, they distinguish:

• Double.
• Triple.
• Multiple.

Based on the relationship to nearby joints:

• The fracture line enters the joint.
• The fracture line is located along the entire length of the bone.

In adults and children, beam fractures have general classification:

1. Intra-articular. An injury in which the wrist joint is directly damaged.
2. Extra-articular. The joint remains intact;
3. Closed bone fractures. The breakage is hidden under the skin. There is no visible rupture, the integrity of the muscles and ligaments is not broken. Closed fracture radius the safest type of wrist fracture for the victim.
4. Open. Highly dangerous view injury. The danger is that the skin and soft tissues torn, contamination can enter the wound at any time, and as a result, cause serious infection.
5. Shrapnel fracture. The radius is damaged in more than two places. Often it happens with strong squeezing of the limb from both sides. Ultimately, the bone breaks into many small fragments, which in turn seriously damage nearby tissues.
6. Fracture with and without displacement (crack).

exercise therapy at different stages

​operational, with the installation of rods, screws, spokes or plates. Only after this is shown the imposition of gypsum. The terms of rehabilitation increase, compared with the restoration of a limb after a closed injury.​

Feeling of pain, which can be localized both at the site of injury, and move to neighboring areas. In particular, when the ulnar bone is broken, the pain can radiate both to the shoulder and to the forearm. Its character is intense even when the limb is at complete rest, if you try to give the arm a load or move it, then the person will experience backache, and the ache itself will intensify.

Negative points:

Such fractures are clinically mild, so the final diagnosis is made after examining the x-ray. In addition, it is necessary to consider whether the fracture of the beam is combined with a fracture ulna or dislocation.

Wheel Fracture

Ivan Konev

signs

Based on the type of damage and its location, the signs of a displaced hand fracture are different. However, primarily the following symptoms:

• Swelling of the hand.
• Abnormal position of the upper limb.
• Increasing sharp or dull pain.
• Pain is felt during palpation.
• The upper limb sags easily.
• The arm or joint changes shape.

It is also worth noting that the injured hand becomes cold. This is due to the fact that the blood supply is disturbed. When damaged large arteries a lot of blood is lost. In this case, the victim may lose consciousness and end up in intensive care.

It is important to know that while skating or cycling, when falling, you must take the correct position. In no case do not stretch your arm forward to lean on it, as it is not able to support the weight of the body.

Symptoms

When damaged, a crunch is clearly audible - this is a 100% fracture. A clear signal that the injury will be displaced is an outwardly visible deformation of the shape of the hand, accompanied by swelling or bruising.

The hand hurts a lot, with the slightest attempt to change its position, the pain sensations increase significantly.

Diagnostics

Beam methods diagnostics are the "gold standard" in the diagnosis of fractures. Most often, radiography of the limb in two projections is used in routine practice.

X-ray will show not only the presence of a fracture, but also its nature, the presence of fragments, the type of displacement, etc. These data play a key role in choosing medical tactics.

Sometimes, to diagnose complex injuries, traumatologists use the method of computed tomography.

It is quite difficult to diagnose an injury to the upper limb when bone fragments begin to move. And all because some symptoms, for example, with a fracture of the hand, can be similar to a normal bruise.

Therefore, when providing first aid to the victim, it is not recommended to relieve pain with ointments and tightly bandage the injured limb so as not to distort the clinical picture.

To make an accurate diagnosis and choose the method by which the victim will be treated, doctors conduct certain studies:

• An x-ray that allows you to easily and quickly assess the condition of injured bones, obtain data on the extent and nature of damage, and also determine when the injury occurred.
• Ultrasound procedure of bones and joints will help to find out how dense the bone structure is, what condition the joints are in, whether there is osteoporosis.
• Computer or magnetic resonance imaging has to be used if it is required to analyze not only bones and joints, but also to find out what condition the soft tissues are in the area of ​​damage.

The process of treating a broken leg

Self-treatment for broken leg bones is unacceptable. In case of a serious injury, it is necessary to consult 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 features of the injury, the location of bone fragments, control how correctly the bone grows together, measure required time And so on.

The doctor seeks to normalize the position of the fragments of the leg bones, return to their original position, before the injury. The traumatologist then seeks to keep the fragments in a stationary position while the bone heals.

It is possible to set and fix the fragments with the help of plaster casts, specialized devices, in extremely severe cases - by the method of carrying out surgical operation when used different kind metal structures.

I think it's too early to pull up - but the muscles of the arm must be loaded. After gypsum, they became porridge for you.

The tactics of treatment directly depends on the nature of the damage and in each case is selected individually.

In the event of a bone fracture at a typical site, treatment consists of closed reduction (“reassembly”) of the bone fragments and the application of a plaster cast to prevent displacement. Typically, a cast covers the hand, forearm, and lower third of the upper arm.

How long to wear a cast for a fracture of the radius of the arm? Immobilization lasts, on average, 4-5 weeks. Before removing the plaster cast, without fail control radiography. This is necessary to assess the union of inert fragments.

Sometimes it is not possible to heal an injury with a cast alone. Then resort to the following methods:

• Percutaneous fixation of bone fragments with pins. The advantage of the method is its speed and low trauma. However, with this treatment, it is impossible to start early development of the wrist joint;
• Open reposition of bone fragments using metal structures. In this case, the surgeon makes an incision in the soft tissues, compares the bone fragments and fixes them with a metal plate and screws.

Unfortunately, surgical methods have a number of negative points. First of all, it is the risk of infection of the wound.

Therefore, after the operation, it is necessary to drink a course of antibiotics. a wide range actions. The second disadvantage of surgical treatment of fractures is the long period of rehabilitation.

Treatment of a fracture is selected individually, depending on the nature of the injury that the person received. Open fractures require surgery, while closed fractures require reduction.

If the fracture is closed and is not accompanied by displacement of fragments, the main treatment is the application of plaster and compliance with conditions conducive to normal bone fusion.

Fixation during this period is required, it is used local anesthesia, which helps to reduce pain even when there is a simple bruise of the hand. Calcium intake is required.

To further restore motor function hands, it is imperative to eliminate the symptoms of swelling and engage in the development of the limb.

In the case of an open fracture, surgical treatment is mandatory, which is used when, thanks to an x-ray, the traumatologist decides that it will not be possible to set the bones in place with a simple plaster.

To avoid severe consequences in the form of improper accretion, chronic traumatization of the nerve, which becomes a consequence constant pain, not removed by conventional painkillers, first aid - surgery.

The doctor performs the operation during the first weeks after the injury, while the callus has not yet formed. If the bones are correctly aligned, the injury heals in as little as three weeks. The imposition of gypsum somewhat prolongs the healing of tissues.

In order to finally consolidate the results of treatment, the victim is recommended to develop a hand: conducting exercise therapy and visiting a physiotherapy room.

The conservative method of treatment is quite effective. It consists in the fact that the doctor, with the help of his hands, restores bone fragments and fixes them in the position that they occupied before the injury.

In a fixed state, the bones will be until the moment of formation callus. This technique is not dangerous, but sometimes it is better to resort to surgical intervention.

More severe cases require surgical treatment. As a rule, surgery may be needed in the following situations:

• At open fracture.
• pathological fracture.
• Late visit to the doctor.
• If a displaced fracture occurs.
• If a nerve is compressed during a fracture.

The task of specialists is to compare bone fragments, fix them using iron plates or knitting needles. The choice of means of fixation differs from the type of damage.

Most often, surgery is resorted to when an open fracture is obtained, since infection of the wound occurs very easily and there is a risk of its spread throughout the body, including to other parts of the body.

In order for the injury site to heal faster, doctors resort to conservative and surgical treatment. The patient must unquestioningly fulfill everything that the doctor says, then treatment and rehabilitation will be faster.

conservative methods

At conservative treatment an immobilizing bandage is applied to the injured area. It can be made of gypsum or polymer.

However, immediately plaster is applied only to injuries that are not accompanied by displacement. Such a bandage is applied only after the swelling has been removed from the area of ​​injury.

This may take about a week. How much to wear a cast for a fracture of the radius depends on the type of fracture, the patient's condition and the ability of his bones to heal.

Along with this, the doctor prescribes an anti-inflammatory nonsteroidal drugs, painkillers, if necessary, then antibiotics.

Doctors resort to surgery if there is an unstable fracture that can be displaced if the displacement has already occurred or there are many bone fragments. During the operation, the doctor compares the broken bones, that is, makes a reposition.

Reposition

Comparison of fragments can be closed and open. With a closed reposition, the doctor connects the fragments through the skin, therefore this method can be attributed to conservative treatment.

Open reposition involves making an incision at the site of injury, comparing the bones and fastening them with special structures. This procedure is called osteosynthesis.

Osteosynthesis

If the procedure is performed in a timely and skillful manner, then rehabilitation will take much less time than with conservative treatment. For osteosynthesis, a special needle, plate, distraction apparatus can be used if the fracture occurred inside the joint, or has many small fragments.

After a cast is applied or an operation is performed, pain may be present for some time, and doctors use injections and analgesic tablets to eliminate it.

If the fingers begin to turn pale, the hand becomes cold, swelling increases and intensifies pain, you should tell your doctor about it.

With a displaced hand injury, doctors often choose one of two time-tested ways of treatment: reduction of the bone by the hands of a specialist or open reduction followed by fixation of the fragments with knitting needles.

Do right choice they are helped by x-rays of the hand. It is important not only to properly fuse the bone, it is also extremely necessary to maintain the former sensitivity and maneuverability of the fingers.

The healing time for a displaced radius fracture largely depends on the treatment chosen.

By manual method offset is corrected after local anesthesia. After that, not a circular plaster cast is applied to the back of the forearm and hand, but plaster plates (langets).

They will fix the arm for the first 3-5 days until edema subsides. Otherwise, the blood circulation of the injured arm may be significantly impaired.

When the swelling subsides, a second shot is taken, after which the tire is strengthened with bandages or replaced with a circular plaster bandage.

An open reduction is a small operation in which an incision is made over the injury site. Having received open access to the broken bone, the displacement is eliminated. The restored structure is fixed by means of knitting needles, plates or other special structures and plaster is applied.

The interest in how much to wear a cast for a fracture of the radius is understandable. All patients really want to quickly return to the usual course of life.

The answer to this will depend on a number of factors:

• the severity of the injury;
• the age of the patient (in a child, the bone heals faster, in older people longer);
• type of treatment (connection of fragments during surgical intervention significantly reduces the risk of malunion of the bone).

Given the above factors, the period of wearing a cast for a fracture of the radius can vary from three weeks to one and a half months. Average term accretion - 5 weeks.

Prevention of complications when using plaster casts

1. Compression of the upper limb;
2. bedsores;
3. Scuffs and bubbles;
4. Allergic reaction on plaster.

Compression of the upper limb

The main cause of arm compression with a plaster cast is an increase in the volume of the upper limb due to soft tissue edema.

Edema, as a rule, accompanies all damage and is a consequence of local inflammatory reactions. The probability of compression of the upper limb in the victim increases if the immobilization of the broken bone was carried out with a circular plaster cast in acute period.

In order to control the state of blood circulation in the injured hand when applying a cast, the fingers should be open, mobile, pink and warm to the touch.

If the plaster compresses the blood vessels and nerves, then the patient develops pain in the area of ​​the bone fracture or throughout the upper limb, the fingers become swollen and cyanotic, their sensitivity and mobility are disturbed.

If these signs of hand compression appear in the victim, the doctor should immediately remove the plaster cast. In the event that the patient's upper limb is fixed with a circular plaster cast, it must be carefully cut with scissors and forceps to spread the edges in different directions.

When immobilizing an injured arm with a splint bandage, the doctor should cut the soft bandages with special forceps or spread the edges of the splint with his hands. After such manipulations, signs of circulatory disorders and innervation in the hand quickly disappear.

If the bandage is not cut in time, this can lead to irreversible consequences:

1. Volkmann contracture;
2. Loss of hand function;
3. The necrosis of the upper limb and its subsequent amputation.

bedsores

1. Careful adherence to the methods of applying plaster;
2. Constant control by medical personnel;
3. Attentive attitude doctor to the complaints of the patient;
4. Compliance with the rules for the care of a plaster cast.

Caring for patients with a plaster cast:

1. After applying a plaster cast, it should not be broken, so the patient is carefully transferred to a hard surface;
2. upper limb give an elevated position. If the patient is in bed, a small pillow should be placed under the arm (so that the bandage does not break and tissue edema does not develop);
3. The doctor must provide the patient with conditions for the gradual drying of the bandage;
4. If the patient shows the first signs of compression blood vessels and nerves, as well as bedsores, the bandage must be cut in the midline on the dorsum of the forearm.

First aid

There are three fundamental steps that must be carried out when providing first aid. These include:

• Early immobilization (immobilization) of the injured limb;
• Adequate anesthesia;
• Local exposure to cold;

Immobilization of the injured limb is the first step in first aid. Proper limb fixation performs several tasks at once:

• Minimizes additional bone displacement;
• Reduces the risk of damage to soft tissues by fragments;
• Reduces pain.

Before immobilization, it is important to free the hand from rings, watches, bracelets, etc. Otherwise, they can cause compression of blood vessels and nerves.

To give fixed limb physiological position, it must be bent into elbow joint at an angle of 90 degrees and lead to the body, turning the brush up.

To minimize pain, you can use drugs from NSAID groups(non-steroidal anti-inflammatory drugs). These include diclofenac, ibuprofen, ketonal, dexalgin, celebrex, etc.

These drugs can be taken in tablet form or as intravenous and intramuscular injections.

Local application cold also reduces pain. In addition, under the influence of low temperature, vasoconstriction occurs and tissue swelling decreases.

Use cold for pain relief should be careful not to provoke frostbite. To do this, heating pads or ice packs are wrapped in a towel before use.

The broken limb must be calm state, it cannot perform any movements and somehow load. In order to eliminate pain, the victim should be given an anesthetic drug.

In the presence of open wound, it is processed antiseptic solution and covered with a sterile napkin or bandage.

The victim's hand is raised and fixed. To do this, you can use any stick or a long ruler that should be tied to the forearm.

If it is impossible to apply a bandage, for fear of harm, you should simply keep your hand in a raised position and not move it. It is advisable to apply a cold compress to the injury site, which will reduce pain and prevent the development of large edema and hematoma.

The very first thing to do in a fracture situation is to completely immobilize the arm. This is done in order to prevent further displacement of bone fragments and avoid damage to nearby tissues, nerves and tendons.

To do this is within the power of every person, even if he does not have medical education. The main thing is not to be afraid.

If the injury is closed, the limb should be well fixed by splinting. Any flat and hard object can act as a fixation splint.

If an open fracture occurs and is accompanied by profuse blood loss, then first it should be eliminated with a tourniquet, tightly folded fabric, belt or rope.

Only after that we fix the arm with a tire. It should be applied from the middle of the shoulder to the base of the fingers.

Many people wonder how to hold a hand with a displaced fracture of the radius? A correct and safe position is above the waist, in a position bent at a right angle at the elbow, on its own or by tying a wide scarf.

To reduce pain you can briefly apply something cooling. Having received such an injury, you should not hesitate to contact the emergency room.

It is best to apply for qualified help within one to two hours after the incident. With an open fracture, most likely, you will have to go to the hospital for a while.

closed injury can be treated at home. At the same time, the basic rule remains not low - to impeccably follow all the instructions of the attending physician.

Consequences of a fracture

isolated - one bone is injured;

There are many sets of exercises, but before giving preference to one or the other, the advice of the attending physician or rehabilitator is needed. The proposed complex can also be used, but only after consultation.​

They can be divided into two groups: immediate complications of trauma and its long-term consequences.

Immediate complications of injury include:

• Damage to the nerve bundle (for example, rupture). It entails a violation of sensitivity (thermal, tactile, motor, etc.);
• Damage to the finger tendons, as a result of which the function of flexion or extension of the hand may be impaired;
• Damage to blood vessels with the formation of a hematoma;
• Partial or complete break muscles;
• Infectious complications(for example, the attachment of infection to the wound surface).

Long-term complications are not seen very often. These include osteomyelitis (purulent fusion of the bone), deformity of the limb due to improper fusion of bone fragments, and the formation of contractures.

Moisov Adonis Alexandrovich

Orthopedic surgeon, doctor the highest category

Moscow, Balaklavsky prospect, 5, Chertanovskaya metro station

Moscow, st. Koktebelskaya 2, bldg. 1, metro station "Dmitry Donskoy Boulevard"

Moscow, st. Berzarina 17 bldg. 2, metro station "October field"

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Education and professional activity

Education:

In 2009 he graduated from the Yaroslavl State medical academy majoring in medicine.

From 2009 to 2011, he completed clinical residency in traumatology and orthopedics at the clinical hospital ambulance them. N.V. Solovyov in Yaroslavl.

Professional activity:

From 2011 to 2012, he worked as a traumatologist-orthopedist at the emergency hospital No. 2 in Rostov-on-Don.

Currently works in a clinic in Moscow.

Internships:

May 27 - 28, 2011 - Moscow city- III International Conference "Surgery of the Foot and Ankle" .

2012 - training course in foot surgery, Paris (France). Correction of deformities of the forefoot, minimally invasive surgery for plantar fasciitis(heel spur).

February 13-14, 2014 Moscow - II Congress of traumatologists and orthopedists. “Traumatology and orthopedics of the capital. Present and Future".

June 26-27, 2014 - took part in V All-Russian Congress of the Society of Hand Surgeons, Kazan .

November 2014 - Advanced training "Application of arthroscopy in traumatology and orthopedics"

May 14-15, 2015 Moscow city - Scientific and practical conference With international participation. "Modern Traumatology, Orthopedics and Disaster Surgeons".

2015 Moscow - Annual international conference.

May 23-24, 2016 Moscow - All-Russian Congress with international participation. .

Also at this congress he was a speaker on the topic Minimally invasive treatment of plantar fasciitis (heel spurs) .

June 2-3, 2016 G. Nizhny Novgorod - VI All-Russian Congress of the Society of Hand Surgeons .

June 2016 Assigned . Moscow city.

Scientific and practical interests: foot surgery and hand surgery.

Pain when wearing a cast

In most cases, closed fractures are fixed with plaster. There are two types of fixation:

• Fixation with a plaster splint is when a damaged limb or some of its department on one side is fixed (splinted) with plaster. Used for fresh injury (up to 6 days)

• Fixation with a circular plaster cast is when an injured limb or some of its department is circularly fixed with a plaster bandage.

A fresh injury is fixed only with a plaster splint and a bandage. Due to the fact that the swelling of the damaged area will increase within three days from the moment of injury and last up to 6 days. Edema can contribute to the compression of soft tissues under a plaster splint bandage and cause a violation of trophism in the tissues. As a result, areas of skin necrosis, epidermal blisters may appear. In the worst case, when even large (main) vessels are compressed - necrosis of the limb area. But this happens extremely rarely, because. the pain that a person experiences without blood supply to the limb cannot be tolerated, and if the patient is conscious, then in any case he himself will remove the cast.

Only after the edema has decreased, it is possible to change the longet bandage to a circular plaster or polymer one, for a more stable fixation (if it is needed at all).

Signs of severe soft tissue compression:

• Intense pain, unbearable (even painkillers do not help)
• Cyanosis of the distal (lower) part of the injured limb (for example, fingers turned blue after applying a cast to the hand or forearm)
• Numbness and temperature decrease in the distal part of the injured limb (for example, fingers become numb and cold after applying a cast to the hand or forearm)

If you have these signs, then you should cut the bandage of the plaster longet bandage as soon as possible (this will reduce tissue compression) and consult a doctor. If this is non-working time, then to the trauma center where the plaster was applied, or call an ambulance medical care. If you feel this during the day, then contact the surgeon at the clinic at the place of residence! And the third option in private medical Center. In a medical institution, the degree of compression of the limb will be assessed and, if necessary, your splint will be changed or “opened”.

If the pain, swelling is minor, then there is no cause for concern. This may be. Without it, not a single injury goes away. Therefore, give the injured limb an elevated position to reduce swelling and be patient.

After 6 days, the plaster can be replaced with a polymer bandage or a rigid fixation orthosis. They are much more comfortable and easier.

Do not self-medicate!

Make a diagnosis and prescribe proper treatment only a doctor can. If you have any questions, you can call orask a question on .

Everyone knows perfectly well that with such a problem as a fracture, you must immediately contact a traumatologist for qualified help. The thing is that an inexperienced person may not be able to distinguish this injury from another, with similar symptoms. In addition, it is necessary to undergo a qualified examination, including an x-ray.

By the way, limbs are often plastered at home and some unscrupulous pupils or students, so as not to write in the classroom. However, such actions can hardly be called justified, because in educational institution You will definitely need a doctor's note.

Be that as it may, there are situations when, for one reason or another, immediately consult a doctor for help. In such cases, if a person has a fracture, there is only one way out - the victim is put in plaster at home. Naturally, a person should see a doctor at the first opportunity.

When applying plaster casts, of course, there is certain rules which must be observed. Otherwise, you run the risk of only exacerbating the situation. The process itself can be divided into 3 main steps. These are, in particular:

• plaster preparation;
• overlay;
• fixation.

Let's look at them in more detail. The first thing we need here is gypsum powder. You will also need warm water and bandages of different widths, overall length up to 3 meters. There are certain requirements for the choice of gypsum powder. In particular, it must necessarily be white or slightly yellowish in color.

One moment is also important. The powder must certainly be finely ground. Before applying plaster, it is recommended to do a small test. Just mix some gypsum and water in approximately the same proportions, and wait 5-7 minutes. If the mass is frozen, then everything is fine, and the powder is good.

Not all people apply plaster as quickly as professional doctors do. In order to slow down the hardening process, you can add a little 3% glycerin solution to the water.

Now unwind the bandage and cut into fragments about 40 centimeters long. Next, we rub gypsum powder into them with our hands and place them in water preheated to 40 degrees. You need to wait a bit until the gypsum gets wet well - air bubbles will signal this. If they no longer come out, then you can extract it. The bandage should be taken out by holding both edges. Be sure to keep the plaster from leaking out.

Now you can proceed directly to the imposition on the injured limb. Previously, cotton wool should be placed in places of possible compression. A plaster cast is applied in such a way that one of its edges must be closed by the next. All folds here need to be straightened as soon as possible. It is especially worth emphasizing that in case of fractures, not only the injured area is plastered, but also the adjacent ones, moreover, on both sides.

In no case do not tear off the excess parts of the bandage - they only need to be cut off with scissors. Everything must be done quickly and at the same time carefully. Bandage should be without tension. It is best to practice a little before this, making at least a few attempts. Remember to keep your fingers open.

Here we have moved to last stage. It remains only to wait until the applied plaster bandage hardens and fixes. As a rule, this takes 15-30 minutes. During this period, it is strictly forbidden to make any movements with the injured limb. Be sure to pay attention to the condition of the injured limb. If the bandages are not properly applied, the fingers may become bluish. This means that everything needs to be redone. Also ask the victim if they feel numbness, pain, or too much discomfort.