Clinical manifestations of an open fracture of the limb are. Absolute and relative signs of fracture. What are the symptoms of a fracture

To provide first aid to the victim, it is necessary to examine the site of the injury. If a wound is visible, then it is an open fracture. If the skin is not damaged, then it remains to be determined whether the victim has a closed fracture.

Some signs of a closed fracture

A closed fracture can be identified by a number of characteristic features:

1. Sharp pain in the area of ​​injury.
2. Shortening of the injured limb.
3. Rapidly increasing swelling of the joint and adjacent tissues.
4. The impossibility of active movements or, conversely, pathological mobility in an unusual amplitude.
5. Change in the shape of the joint, deformation of the lower leg or thigh.
6. Characteristic crunch (crepitus) when moving or probing the fracture site.
7. Possible fever, general malaise.

Providing first aid in case of detection of signs of a closed fracture

1. Give an anesthetic to avoid pain shock. It can be any drug containing analgin, as well as water, tea, coffee, but in no case alcohol.
2. Apply a splint, fix it on the joint above and below the injury site. For fractures of the hip or shoulder, you need to capture three joints. If this is not done, then during the transportation of the victim, the pain shock can intensify and lead to death. Any improvised material is used as a tire. When applying a splint, it is necessary to give the normal physiological position of the injured limb.
3. Apply cold to the damaged area. Continue this procedure until the victim is taken to a medical facility.

Treatment options for symptoms of a closed fracture

If at least one of the listed signs of a closed fracture is present, you should consult a doctor for further examination. Depending on the complexity of the injury, the doctor will choose a treatment method, apply a cast or splint, or perform an operation.

It is categorically unacceptable to self-reduce dislocations, this can lead to very serious consequences: damage to blood vessels, nerves, increased traumatic shock. At the slightest suspicion of signs of a closed fracture of the pelvis or spine, the victim should be left strictly in the original position until the arrival of the ambulance. If necessary, it can be transferred, but only to a flat hard surface (table top, door, shield), while strictly ensuring that the body of the injured person maintains its original position. In case of fractures of the clavicle or humerus, the listed signs of a closed fracture may not be so pronounced, the pain may be less pronounced, the function of arm movement may be partially preserved, and therefore the diagnosis of a fracture is often made only on the tenth to fifteenth day when a bone callus is detected.

That is why it is so important to contact a traumatologist in time to take the necessary measures for any symptoms of a closed bone fracture.

Relatives serve as a guideline that suggests this type of injury. Absolute signs establish the fact of a fracture and make it possible to distinguish it from other injuries that are similar in symptoms.

A bone fracture is a diagnosis that only a doctor can make based on x-rays. However, the relative signs of this injury are noticeable to any person, and they may well become a reason for contacting a medical institution. Relative signs of a fracture are pain, swelling, hematoma, and impaired function of the damaged body part.

In a fracture, as a rule, acute pain occurs, which intensifies when simulating an axial load. So, with a fracture of the lower leg, pain worsens when tapping on. Edema of the damaged area does not develop immediately after the injury. Since edema also occurs and, it is not a significant sign of a fracture.

A hematoma is a special type of bruising, characterized by a limited accumulation of blood in the tissues during rupture of blood vessels. This forms a cavity with liquid or clotted blood. The hematoma develops some time after the fracture.

Violation of the function of the damaged part of the body is expressed in the impossibility of loading the limb or the inability to take a deep breath when the ribs are fractured.

The absolute signs of a bone fracture include the unnatural position of the limb and its pathological mobility - the arm or leg is mobile in the place where there is no joint. Also a unique sign of a fracture is crepitus - a characteristic crunch heard when pressing with a hand on the site of injury. Usually this crunch cannot be heard without a phonendoscope. The presence of bone fragments also refers to the absolute signs of a fracture. With an open fracture, fragments are visible in the wound, and with a closed fracture, broken bone fragments are palpated.

X-ray examination in a medical institution allows you to finally diagnose a bone fracture, as well as to establish its type and position of fragments. The x-ray should show two joints on either side of the broken bone. Shooting is carried out in frontal and lateral projection. If these conditions are met, radiography will be as adequate and complete as possible, and the possibility of erroneous diagnosis will be minimized.

- this is a complete or partial violation of the integrity of the bone, resulting from an impact that exceeds the strength characteristics of the bone tissue. Signs of a fracture are abnormal mobility, crepitus (bone crunching), external deformity, swelling, limited function, and severe pain, with one or more symptoms absent. The diagnosis is exposed on the basis of the anamnesis, complaints, data of survey and results of a X-ray analysis. Treatment can be conservative or operative, involving immobilization using plaster casts or skeletal traction, or fixation by installing metal structures.

ICD-10

S42 S52 S72 S82

General information

Fracture is a violation of the integrity of the bone as a result of a traumatic effect. It is a widespread injury. Most people will experience one or more fractures during their lifetime. About 80% of the total number of injuries are fractures of tubular bones. Along with the bone during an injury, the surrounding tissues also suffer. More often there is a violation of the integrity of nearby muscles, less often there is compression or rupture of nerves and blood vessels.

Fractures can be single or multiple, complicated or not complicated by damage to various anatomical structures and internal organs. There are certain combinations of injuries that are common in clinical traumatology. So, with fractures of the ribs, damage to the pleura and lungs is often observed with the development of hemothorax or pneumothorax, if the integrity of the bones of the skull is violated, intracerebral hematoma may form, damage to the meninges and brain substance, etc. Treatment of fractures is carried out by orthopedic traumatologists.

Causes of the fracture

Violation of the integrity of the bone occurs with intense direct or indirect exposure. The direct cause of a fracture can be a direct blow, a fall, a car accident, an accident at work, a criminal incident, etc. There are typical mechanisms for fractures of various bones that cause certain injuries.

Classification

Depending on the initial structure of the bone, all fractures are divided into two large groups: traumatic and pathological. Traumatic fractures occur on a healthy, unchanged bone, pathological fractures occur on a bone affected by some pathological process and, as a result, have partially lost its strength. For the formation of a traumatic fracture, a significant impact is necessary: ​​a strong blow, a fall from a fairly large height, etc. Pathological fractures develop with minor impacts: a small impact, a fall from a height of one's own height, muscle tension, or even a coup in bed.

Taking into account the presence or absence of communication between the area of ​​damage and the external environment, all fractures are divided into closed (without damage to the skin and mucous membranes) and open (with violation of the integrity of the skin or mucous membranes). Simply put, with open fractures, there is a wound on the skin or mucous membrane, and with closed fractures, there is no wound. Open fractures, in turn, are divided into primary open, in which the wound occurs at the time of traumatic impact, and secondary open, in which the wound is formed some time after the injury as a result of secondary displacement and damage to the skin by one of the fragments.

Depending on the level of damage, the following fractures are distinguished:

• epiphyseal(intra-articular) - accompanied by damage to the articular surfaces, rupture of the capsule and ligaments of the joint. Sometimes they are combined with a dislocation or subluxation - in this case they speak of a fracture-dislocation.
• metaphyseal(periarticular) - occur in the area between the epiphysis and the diaphysis. Often they are driven in (the distal fragment is introduced into the proximal one). Fragment displacement is usually absent.
• diaphyseal- formed in the middle part of the bone. The most common. They differ in the greatest variety - from relatively simple to severe multi-fragmented injuries. Usually accompanied by displacement of fragments. The direction and degree of displacement are determined by the vector of the traumatic effect, the traction of the muscles attached to the fragments, the weight of the peripheral part of the limb, and some other factors.

Taking into account the nature of the fracture, transverse, oblique, longitudinal, helical, comminuted, polyfocal, crushed, compression, impacted and avulsion fractures are distinguished. In the metaphyseal and epiphyseal zone, V- and T-shaped lesions occur more often. When the integrity of the spongy bone is violated, the introduction of one fragment into another and compression of the bone tissue are usually observed, in which the bone substance is destroyed and crushed. With simple fractures, the bone is divided into two fragments: distal (peripheral) and proximal (central). With polyfocal (double, triple, etc.) injuries, two or more large fragments are formed along the bone.

All fractures are accompanied by more or less pronounced destruction of soft tissues, which is due to both direct traumatic effects and displacement of bone fragments. Usually, hemorrhages, soft tissue contusion, local muscle ruptures and ruptures of small vessels occur in the injury zone. All of the above, combined with bleeding from bone fragments, causes the formation of a hematoma. In some cases, displaced bone fragments damage nerves and great vessels. It is also possible to compress the nerves, blood vessels and muscles between the fragments.

Fracture symptoms

Allocate absolute and relative signs of violation of the integrity of the bone. Absolute signs are deformity of the limb, crepitus (bone crunch, which can be distinguished by the ear or determined under the doctor's fingers on palpation), pathological mobility, and with open injuries, bone fragments visible in the wound. Relative signs include pain, edema, hematoma, dysfunction, and hemarthrosis (only for intra-articular fractures). The pain is aggravated when trying to move and axial load. Swelling and hematoma usually occur some time after the injury and gradually increase. Violation of the function is expressed in the restriction of mobility, the impossibility or difficulty of support. Depending on the location and type of damage, some of the absolute or relative signs may be absent.

Along with local symptoms, large and multiple fractures are characterized by general manifestations caused by traumatic shock and blood loss due to bleeding from bone fragments and damaged nearby vessels. At the initial stage, there is excitement, underestimation of the severity of one's own condition, tachycardia, tachypnea, pallor, cold clammy sweat. Depending on the predominance of certain factors, blood pressure can be reduced, less often - slightly increased. Subsequently, the patient becomes lethargic, lethargic, blood pressure decreases, the amount of urine excreted decreases, thirst and dry mouth are observed, in severe cases, loss of consciousness and respiratory disturbances are possible.

Complications

Early complications include skin necrosis due to direct damage or pressure from the inside of the bone fragments. With the accumulation of blood in the subfascial space, a subfascial hypertension syndrome occurs, caused by compression of the neurovascular bundle and accompanied by a violation of the blood supply and innervation of the peripheral parts of the limb. In some cases, as a result of this syndrome or concomitant damage to the main artery, insufficient blood supply to the limb, gangrene of the limb, thrombosis of arteries and veins may develop. Damage or compression of the nerve is fraught with the development of paresis or paralysis. Very rarely, closed bone injuries are complicated by hematoma suppuration. The most common early complications of open fractures are wound suppuration and osteomyelitis. With multiple and combined injuries, fat embolism is possible.

Late complications of fractures are incorrect and delayed union of fragments, lack of union and false joints. With intra-articular and peri-articular injuries, heterotopic para-articular ossifications often form, and post-traumatic arthrosis develops. Post-traumatic contractures can form with all types of fractures, both intra- and extra-articular. Their cause is prolonged immobilization of the limb or incongruence of the articular surfaces due to improper union of fragments.

Diagnostics

Since the clinic for such injuries is very diverse, and some signs are absent in some cases, when making a diagnosis, much attention is paid not only to the clinical picture, but also to clarifying the circumstances of the traumatic effect. Most fractures are characterized by a typical mechanism, so, when falling with emphasis on the palm, a fracture of the beam often occurs in a typical place, when twisting the leg - a fracture of the ankles, when falling on the legs or buttocks from a height - a compression fracture of the vertebrae.

The examination of the patient includes a thorough examination for possible complications. In case of damage to the bones of the limbs, it is imperative to check the pulse and sensitivity in the distal sections, in case of fractures of the spine and skull, reflexes and skin sensitivity are evaluated, in case of damage to the ribs, auscultation of the lungs is performed, etc. Particular attention is paid to patients who are unconscious or in a state of severe alcohol intoxication . If a complicated fracture is suspected, consultations of the relevant specialists (neurosurgeon, vascular surgeon) and additional studies (for example, angiography or EchoEG) are prescribed.

The final diagnosis is established on the basis of radiography. The radiological signs of a fracture include a line of enlightenment in the area of ​​damage, displacement of fragments, a break in the cortical layer, bone deformities and a change in the bone structure (enlightenment when fragments of flat bones are displaced, compaction in compression and impacted fractures). In children, in addition to the listed radiographic symptoms, epiphysiolysis may show deformation of the cartilaginous plate of the growth zone, and with green branch fractures, limited protrusion of the cortical layer.

Fracture treatment

Treatment can be carried out in an emergency room or in a trauma department, be conservative or operative. The goal of treatment is the most accurate comparison of fragments for subsequent adequate union and restoration of the function of the damaged segment. Along with this, in case of shock, measures are taken to normalize the activity of all organs and systems, in case of damage to internal organs or important anatomical structures, operations or manipulations are carried out to restore their integrity and normal function.

At the first aid stage, anesthesia and temporary immobilization are carried out using special splints or improvised items (for example, boards). With open fractures, if possible, the contamination around the wound is removed, the wound is closed with a sterile bandage. In case of heavy bleeding, a tourniquet is applied. Carry out measures to combat shock and blood loss. Upon admission to the hospital, blockade of the injury site is performed, reposition is carried out under local anesthesia or general anesthesia. Reposition can be closed or open, that is, through the surgical incision. Then the fragments are fixed using plaster casts, skeletal traction, as well as external or internal metal structures: plates, pins, screws, knitting needles, staples and compression-distraction devices.

Conservative methods of treatment are divided into immobilization, functional and traction. Immobilization techniques (gypsum bandages) are usually used for fractures without displacement or with little displacement. In some cases, gypsum is also used for complex injuries at the final stage, after removal of skeletal traction or surgical treatment. Functional techniques are indicated mainly for compression fractures of the vertebrae. Skeletal traction is commonly used in the treatment of unstable fractures: comminuted, helical, oblique, etc.

Along with conservative methods, there are a huge number of surgical methods for treating fractures. Absolute indications for surgery are a significant discrepancy between the fragments, excluding the possibility of fusion (for example, a fracture of the patella or olecranon); damage to nerves and main vessels; interposition of a fragment into the joint cavity with intra-articular fractures; the threat of a secondary open fracture with closed injuries. Relative indications include interposition of soft tissues, secondary displacement of bone fragments, the possibility of early activation of the patient, reduction of treatment time and simplification of patient care.

Exercise therapy and physiotherapy are widely used as additional methods of treatment. At the initial stage, to combat pain, improve blood circulation and reduce edema, UHF is prescribed to remove the plaster cast, and measures are taken to restore complexly coordinated movements, muscle strength and joint mobility.

When using functional methods (for example, with compression fractures of the spine), exercise therapy is the leading treatment method. The patient is taught special exercises aimed at strengthening the muscular corset, decompression of the spine and the development of motor stereotypes, which exclude the aggravation of the injury. First, the exercises are performed lying down, then kneeling, and then in a standing position.

In addition, for all types of fractures, massage is used, which improves blood circulation and activates metabolic processes in the area of ​​damage. At the final stage, patients are sent to sanatorium-and-spa treatment, iodine-bromine, radon, sodium chloride, coniferous-salt and coniferous therapeutic baths are prescribed, and rehabilitation measures are also carried out in specialized rehabilitation centers.

An objective examination reveals symptoms characteristic of a fracture. They are divided into two groups: absolute (direct) and relative (indirect).

Absolute symptoms:

Characteristic deformity - a change in the configuration of the limb, its axis;

Pathological mobility - the presence of movements in the area outside the joint;

Crepitus - bone crunch at the fracture site due to friction of bone fragments.

Relative symptoms:

Pain at the fracture site, aggravated by movement;

Local pain on palpation;

Increased pain at the fracture site with a load along the axis of the bone;

Hematoma in the fracture area;

Shortening of the limb when the fragments are displaced along the length;

Forced position of the limb;

Function violation.

With open fractures, bone fragments may protrude into the wound.

First aid.

First of all, it is necessary to provide assistance to victims with open fractures.

According to the indications, a hemostatic tourniquet or pressure bandage should be applied, an anesthetic should be administered, and transport immobilization should be carried out with standard or improvised means.

In closed fractures, anesthesia and transport immobilization are usually performed. With the help of immobilization, the limbs create peace, prevent secondary damage to blood vessels, nerves and soft tissues by bone fragments.

The victims with imposed tourniquets and in a state of shock are primarily subject to removal (exportation) from the lesion.

The provision of first medical aid is preceded by a medical sorting, during which the following groups of the affected are distinguished:

Group I - victims with multiple fractures, accompanied by irreversible shock and blood loss. Such wounded are usually in a state of agony;

group - victims who need help for health reasons (unstopped external bleeding, traumatic shock, traumatic amputation of a limb);

group - victims, whose assistance can be provided in the second turn or postponed until the next stage (bone fractures and dislocations of the joints without signs of massive blood loss and shock);

Group IV - victims with minor fractures.

TRANSPORT IMMOBILIZATION.

Transport immobilization is used to prevent further displacement of bone fragments, reduce pain and prevent traumatic shock, secondary tissue damage, secondary bleeding, infectious complications of wounds, and create opportunities for transporting the victim to a medical facility.

A large number of transport splints have been proposed: ladder splints (Kramer splint), plywood splints, special ones for the thigh (Diterichs splint), plastic ones for immobilization of the lower jaw, as well as recently created pneumatic tires and immobilizing vacuum stretchers. Under favorable conditions for transport immobilization, longet plaster bandages can be used, as well as plaster rings for better fixation of transport tires.

Basic rules for imposing transport tires :

1. Ensuring immobility of at least 2 joints (in case of a fracture of the humerus and femur, 3 joints) located above and below the damaged segment.

2. The limbs give a functionally advantageous position (if it is convenient for transportation).

3. The tire is modeled according to the healthy limb of the victim.

4. The tire is superimposed over clothes, shoes - with closed injuries; when open, the clothes are cut to apply an aseptic dressing.

5. Securely fixed with bandages or other material.

6. The tips of the fingers and toes should be open to control blood circulation.

7. The tourniquet must not be covered by the splint fixing material.

8. Finiteness with a superimposed tire in the cold season is insulated.

9. Transport immobilization of the upper limb can be carried out with a soft material (scarf or bandage).

Immobilization with a scarf is carried out in 2 ways .

The second way (Fig. 2): the scarf is tied at the back at the level of a healthy shoulder blade so that one of the ends of the knot is possibly longer. The scarf is fixed to the body approximately at the level of the xiphoid process. The top of the kerchief (its obtuse angle) should hang down along the front surface of the thigh of the injured side. This peak is lifted up and the diseased hand is placed in it. The long end from the corner on the back is tied to the top of the scarf at the back of the body. If the ends of the kerchief are not enough for tying, then they can be lengthened with a handkerchief or other material. The second method fixes the hand more securely than the first.

Bandage tours are shown in fig. 3; numbers and arrows indicate the path of the bandage. It is necessary to perform approximately 4-5 such loop-like tours, and then fix them with 3-4 circular bandage tours (plaster if possible) through the chest and arm. The sequence of applying bandage tours is easy to remember in their direction "armpit-shoulder-elbow". If the brush was not captured by the bandage, then it is hung on a separate strap.

A fracture occurs when the integrity of a bone is broken due to injury. Many types and signs of fractures are easy to detect on the spot, without the help of a specialist, however, some of them are insidious in that the victim may not immediately understand that he has a fracture, and medical assistance is urgently needed: he continues to lead his former lifestyle, experiencing minor pain and limited movement, believing that there was a severe bruise.

Let's see what signs of a fracture speak about themselves in the very first minute after the injury, and which ones only indicate that the bone is probably damaged.

Clinical signs of fractures

Depending on the type of fracture, its signs can be divided into reliable - those that leave no doubt that the bone was deformed by impact, and relative - those that may raise doubts: there is a fracture or bruise.

Reliable signs of fractures:

1. Unnatural position of the arm or leg (if we are talking about signs of a fracture of the limb).
2. Mobility of the broken part in the place where there is no joint.
3. Hearing a crunch.
4. With an open fracture, bone fragments are visible in the wound.
5. Shortening or lengthening of the injured area.

If at least one of these symptoms is confirmed, then we can say with 100% probability that there is a fracture. However, the presence of these signs does not deprive you of the obligation to do an x-ray examination.

Relative signs of a fracture:

1. Pain at the fracture site when immobilized or during movement. Also, if you make an axial load, then the pain intensifies (for example, if you knock on the heel area during a fracture of the lower leg).
2. Swelling at the fracture site can occur quickly (within 15 minutes of injury) or develop over several hours. Along with this, such a symptom has an insignificant role in determining the fracture, because it accompanies other types of damage.
3. Hematoma. It may be absent, but often still occurs at the site of the fracture, and not always immediately. If it pulsates, then the bleeding continues.
4. Restriction of mobility. As a rule, the damaged part cannot function either at all or partially. If there was a fracture not of a limb, but, for example, of the coccyx, then the person will feel difficulty in walking, i.e. there is not only a limitation in the function of the damaged part, but also those that come into contact with it.

The presence of these signs cannot speak with 100% probability of a fracture, but many of this category accompany any fracture (pain, swelling, restriction in movement).

Signs of a closed fracture

All fractures are classified into open and closed. The latter are much easier to diagnose than the former without x-rays and the help of a specialist.

A closed fracture is not accompanied by damage to soft tissues: in this case, bones and joints suffer, which can change position (the so-called fracture with displacement) or simply lose their integrity: split (the so-called comminuted fracture), while maintaining the same position.

The first signs of a fracture are pain in the area of ​​injury and swelling. The movements are limited, cause pain, and there may also be movement of the bone not in the joint area (depending on the location of the injury). Often a hematoma forms.

It is possible to make sure that there is a closed fracture only with the help of x-rays.

Signs of an open fracture

An open fracture is a more severe injury than a closed one, because. in this case, in addition to damage to the bone, the tissues also lose their integrity. This can occur from external influences (during an accident, or a limb getting into a moving mechanism at work) or due to the fact that a broken bone itself damages tissues.

Based on this, the main signs of an open fracture are a wound, bleeding, the appearance of a broken bone or its fragments, pain and swelling. If the damage was very strong, then the victim may experience traumatic shock.