Fractures of bone injury. Displacement of bones at a fracture. Symptoms of different types of fractures

fracture

This is not only unbearable pain, but also slow healing. Recovery can take up to several months.

So, what is a fracture, what are its types, symptoms, causes and treatment?

A fracture is a break in a bone, partially or completely, due to mechanical intervention. various factors, as well as, as a result of diseases that were caused by injuries. Despite the fact that the bone is one of the hard tissues of the body, it cannot always withstand a large load.

Causes of fractures

Types of fractures

Most often, bone fractures are caused repeatedly due to diseases.

Such as:

Osteogenesis (genetic disease)
- osteomyelitis
- bone cancer
- bone brushes
- bone metastases
- hyperparathyroid osteodystrophy.

Fractures are also classified from tissue damage:

Open, which in turn are divided into primary open and secondary open fractures
- closed, which are also divided into complete and incomplete.

Bone fracture defects

A bone fracture is possible in 3 areas: upper third, middle third, lower third.

According to the fragmentation of the bone, a multi-comminuted and large-comminuted fracture can be distinguished. Bones may not always break evenly or be evenly cracked.

Therefore, they are divided into 4 groups in the areas:

transverse fracture
- longitudinal fracture
- helical fracture
- oblique fracture.

Fractures with displacement:

Displaced fracture (in width, length, at an angle)
- fracture without displacement.

Clinical condition:

stable
- unstable.

Symptoms that occur with fractures

Even the victim himself during the injury can hear the crunch of a breaking bone. For example, with a hip fracture, it will be difficult to hear such a sound, but immobilization is already a signal that there may be damage not only to the external, but also to the bone tissues. The pain will increase with movement. In some cases, complete immobilization. At open fracture, this area begins to quickly swell and acquire a reddish tint (bleeding appears). As a result, there is a shock. This is the most danger sign. It can cause a violation of the central nervous system (lethargy, apathy, activity of the patient or "slowdown"). Circulation is disturbed. The face becomes pale and there is increased sweating.

The final and reliable confirmation of the injury will be - X-ray.

Treatment Method

There are three types of them: operational, conservative (fixation or extension) and replacement bone tissue.

Often used for rehabilitation shock wave therapy. In the absence of competent treatment, the consequences may not please. Depending on the type of fracture, the consequences will also be different. If you don't get it on time needed help, you can get suppuration at the fracture site, blood poisoning, anaerobic infection, anemia, improperly fused bones, fragments will remain inside and thus not only cause acute pain in the joints, but also in the bones.

The apparatus-motor function is disturbed and muscle atrophy appears.

Konstantin Mokanov

Fracture - violation of the integrity of the bone throughout, caused by mechanical action (trauma) or the influence of a pathological process in the bone (tumor, inflammation).

An incomplete fracture is a type of damage in which the fracture surface does not pass through the entire diameter of the bone, i.e. when there is a crack or fracture of the bone (like a "green branch" for fractures in children).

Bone fractures account for 6-7% of all closed injuries. Fractures of the bones of the hand and foot are more often observed (more than 60%), fractures of the bones of the forearm and lower leg are equally common and together make up 20%, ribs and sternum - 6%, fractures of the scapula (0.3%), vertebrae (0, 5%), pelvis (0.6%), femur (0.9%).

Fracture classification

I.Origin: a) congenital (intrauterine); b) acquired (traumatic and pathological).

II. Depending on the damage certain organs or tissues (complicated, uncomplicated) or skin (open, closed).

III.By localization: a) diaphyseal; b) epiphyseal; c) metaphysical.

IV.In relation to the fracture line to the longitudinal axis of the bone: a) transverse; b) oblique; c) helical (spiral).

v.According to the position of the bone fragments relative to each other: a) with an offset; b) without displacement.

Cause congenital fractures are changes in the bones of the fetus or abdominal trauma during pregnancy. These fractures are often multiple. pathological fractures due to changes in the bone under the influence of tumors, osteomyelitis, tuberculosis, echinococcosis, bone syphilis. Allocate obstetric fractures that occurred during the passage of the fetus through the birth canal.

The complicated ones are open fractures with damage to the skin or mucous membrane (which creates conditions for the penetration of a microbe through the wound and the development of inflammation in the area of ​​the bone fracture), as well as fractures accompanied by damage large vessels, nerve trunks, internal organs(lungs, pelvic organs, brain or spinal cord, joints - intra-articular fractures). At closed fractures damage skin not happening.

incomplete fractures.Crack (fissura) - incomplete front, in which the connection between parts of the bone is partially broken. There are also fractures subperiosteal, in which the fragments are held by the surviving periosteum and do not move, are observed in childhood.

The action of the traumatic agent on the bone can be different, its nature determines the type of bone fracture. Mechanical impact, depending on the point of application and direction of the acting force, can lead to fractures from a direct impact, bending, compression, twisting, tearing, crushing (Fig. 68). Direct hit inflicts an object moving at high speed on a fixed bone; when the body falls, a sharp load on the bone fixed by its ends leads to its bend; compression bones are observed with a sharp load along the length of the bone, for example, a fall on an outstretched arm or compression of the vertebrae with a sharp strong load along the length of the spine in the event of a fall from a height onto the buttocks; twisting bones occur during rotation of the body, when the limb is fixed (for example, when a skater moves on a turn, when the skate falls into a crack).

The fracture line may be straight (transverse fracture) - with a direct blow, oblique - bending, spiral (helical) - when twisting the bone hammered - when a bone is compressed, when one bone fragment enters another. At tear-off In a fracture, a detached bone fragment departs from the main bone, such fractures occur with a sudden, sharp, strong contraction of the muscles, which create a sharp traction on the tendons attached to the bone, with tension on the ligaments due to a sharp overextension of the joints. When a bone is broken, several fragments (fragments) of bones can form - comminuted fractures.

Rice. 68. Types of bone fractures depending on the mechanism of injury: a - from bending; b - from a direct blow; in - from twisting; g - from fragmentation; e - from compression along the length. The arrow indicates the direction of action of the traumatic agent.

open bone fractures resulting from various conditions, have their own characteristics: workers in industrial enterprises are more likely to observe open fractures of the bones of the forearm, hand and fingers that occur when hands get into rapidly rotating mechanisms; such fractures are accompanied by extensive lacerations, bone crushing, crushing of soft tissues, damage to blood vessels and nerves, tendons, extensive skin detachment and its defects.

Those employed in agriculture observed open fractures of both upper and lower extremities. The wound is deep, large, contaminated with earth or manure.

For open fractures received in a railway accident, during a transport accident, collapses of buildings, comminuted fractures of the limbs with extensive crushing of the skin and muscles, contamination of the wound are characteristic; the tissues are imbibed with blood, mud, and earth.

The more extensive, deeper and more severe the damage to the skin and underlying tissues in open bone fractures, the greater the risk of infection. With agricultural and road injuries, the risk of developing aerobic and anaerobic infections (tetanus, gas gangrene) is high. The severity of the course of open bone fractures largely depends on the location of the fracture. The risk of infection in open fractures of the lower limbs is greater than that of the upper limbs, since the lower limb has a larger array of muscles, the skin is more contaminated, and the possibility of infection and contamination of the wound with soil is higher. Especially dangerous are open fractures with crushing of bones and crushing of soft tissues over a large area, with damage to large main vessels and nerves.

Fragment displacement(dislocation). When bones are fractured, fragments rarely remain in their usual place (as is the case with a subperiosteal fracture - a fracture without displacement of fragments). More often they change their position - a fracture with displacement of fragments. Displacement of fragments can be primary (under the influence of the mechanical force that caused the fracture - impact, flexion) and secondary - under the influence of muscle contraction, which leads to displacement of the bone fragment.

Rice. 69. Types of displacement of bone fragments in fractures: a - lateral displacement (in width); b - offset along the axis (at an angle); c - displacement along the length with elongation; g - displacement along the length with shortening; e - rotational displacement.

Displacement of fragments is possible both in case of a fall during an injury, and in case of improper transfer and transportation of the victim.

There are the following types of displacement of fragments: along the axis or at an angle (dislocation ad an), when the axis of the bone is broken and the fragments are located at an angle to each other; lateral offset, or in width (dislocatio ad latum), in which the fragments diverge to the sides; bias along the length (dislocatio ad longitudinem), when fragments are displaced along the long axis of the bone; bias along the periphery (dislocatio ad periferium), when the peripheral fragment is rotated around the axis of the bone, rotational displacement (Fig. 69).

Displacement of bone fragments leads to deformation of the limb, which has a certain appearance with one or another displacement: thickening, an increase in the circumference - with a transverse displacement, violation of the axis (curvature) - with an axial displacement, shortening or elongation - with a displacement along the length.

Bone fractures throughout human history have been notable problem for the entire medical community. Still at dawn human civilization people faced this phenomenon and tried to deal with the consequences. Not a single person is immune from this misfortune - it always happens unexpectedly and brings a lot of suffering and inconvenience.

Fractures of bones for a long time take a person out of their usual way of life and partially deprive them of their ability to work. Based on this, the acceleration of the recovery of the body and the return of a person to normal condition become an important task for orthopedists around the world.

Essence of a broken bone

In its essence, a bone fracture is a complete or partial destruction of the bone, i.e. loss of integrity of bone tissue when a force is applied that exceeds the tensile strength of the substance. This phenomenon may be the result of a direct application excessive load or be a consequence of a decrease in the strength of the bone structure in the process of certain diseases.

In general, bone is made up of mineral (calcium, phosphorus and trace elements) and organic (collagen) ingredients. mineral component provides the necessary strength, and the organic composition - the elasticity of the structure.

Any fracture is accompanied by damage to blood vessels, nerve processes and surrounding tissues, incl. muscles, joints, ligaments, tendons. The most typical is a fracture with a displacement of the destroyed bone, which is due to the direction of the load and the reflexive reaction of the muscles. Human body provides self-repair of damaged tissues. An active process of fusion of the bone structure begins with the formation of a new tissue, the so-called bone callus. The duration of bone regeneration depends on individual features person (state of health, age, etc.) and type of injury. Fractures in children heal much faster than in adults. The mechanism of the formation of a new bone composition based on cell division periosteum, endosteum, bone marrow and vascular adventitia.

Classification of pathologies

The classification of bone fractures is made according to several main parameters. The main types of pathologies are traumatic and pathological. Traumatic is caused by the impact of extreme load on a normally formed skeletal system. Pathological is characterized by a decrease in the strength of bone tissue as a result of internal processes, which causes fracture of the bone under a small load.

According to the degree of damage, complete and incomplete (partial) fractures are distinguished. In turn, complete destruction is subdivided into a fracture without displacement and with displacement of fragments. Incomplete types include partial fractures and cracks in the bone.

Taking into account the direction and type of destruction, the following types of fractures are classified:

1. Transverse type: the direction of destruction is perpendicular to the bone axis.
2. Longitudinal type: the fracture is directed along the bone body.
3. Oblique variety: the fracture is directed under acute angle to the bone axis.
4. Helical variety: the load had a rotational moment, as a result of which the bone fragments were displaced in a circle from their usual location.
5. Comminuted type: a clear fracture line is not traced - the bone is simply crushed.
6. Wedge-shaped type: a wedge-shaped deformity occurs as a result of indentation of one bone into another (most often, a fracture of the spine).
7. Impacted variant: fragments of a broken bone are displaced along the bone axis.

Types of bone fractures

The following main types are distinguished: closed and open. Closed damages are isolated from the external environment, i.e. do not cause destruction of the skin. Such injuries can be single (only one segment is destroyed support system) and multiple. The open version implies a violation of the integrity of the skin and the presence of direct contact of the site of destruction with air. Among such processes, combined fractures are distinguished, which are accompanied by damage to internal organs.

Taking into account the localization of the process, it is customary to distinguish between such fractures:

1. Epiphyseal fracture: belongs to the intra-articular variety, causes destruction of the ligaments, joint, capsule, as well as displacement of bones and damage to the surface of the joints: most common in children.
2. Metaphyseal type (periarticular): manifests itself in the region of the cortical layer; a typical representative is the impacted type; displacement of debris is not observed.
3. Diaphyseal fracture: The most common type of fracture in a bone, it occurs in the middle part of the bone body.

According to the severity of the manifestation, uncomplicated (typical) and complicated fractures are noted. The main complicating factors include: pain shock, damage to internal organs, profuse hemorrhage, fat embolism, concomitant infection, the presence of osteomyelitis and seasis.

Among the damage various parts of the skeleton most often fractures are manifested in the following elements: fracture of the bones of the limbs - lower and upper (incl. radius, bones of the lower leg, foot), spine, femoral neck, coccyx, collarbone, shoulder region, jaw, nose, pelvis, skull, tibia.

Causes of fractures

The etiology of fractures is divided into two groups - traumatic and pathological factors. Traumatic fracture occurs under the influence of excessive mechanical load of a static or kinetic nature. Most often, the destruction of the bone occurs as a result of extreme kinetic (moving) load applied perpendicular or at an angle to the bone axis. Such a load occurs with a strong blow, a fall, an unsuccessful jump. One of the most common causes of our time is an accident. Longitudinal rupture of the bone is less common and is usually caused by pinching of the limb under the action of axial force. Static loading is shown, for example, at blockages.

The pathological factor reduces the strength of the tissue to such an extent that the bone collapses under small loads - a sharp rise from a chair, squatting, and even when walking. The main diseases leading to such consequences are tissue tumors, osteoporosis, osteomyelitis. It is because of the weakening of the bone structure that the risk of fractures in the elderly increases with ice.

The main signs of fractures

Bone fractures have characteristic symptoms, which allow you to identify the pathology when it occurs, which is very important to exclude complications. The following main relative signs fracture:

1. Pain syndrome: sharp pain when a bone is broken and aching pain in the future, moreover, aggravated by a longitudinal load or its imitation.
2. Swelling: Swelling in the affected area develops gradually.
3. Hematoma: different sizes on the affected area; at the same time, a hematoma with a pulsation indicates continued bleeding.

The absolute sign of a fracture occurs as a result of the direct destruction of the bone and indicates the completion of the process. These signs of a fracture are:

1. A characteristic crunch (crepitus): occurs when the bone tissue is ruptured, later it is heard with a phonendoscope due to the friction of the fragments.
2. Unnatural direction of a limb or other bone.
3. Increased mobility with joint rupture.
4. Fragments of the bone are visible visually.
5. Shortening of the limb when the fragments are displaced, protrusion of a broken bone.

Some signs of a non-displaced or incomplete fracture may not appear, making diagnosis difficult. The symptoms of a fracture are unambiguously determined by radiography - localization, type and degree of destruction are recorded.

Regeneration process

The fusion of bone tissue and the restoration of the entire structure is a natural reflexive process that usually proceeds according to the chondroblastic scenario (due to the activation of chondroblasts). The regeneration process is divided into the following stages:

1. Catabolic phase: duration 8-10 days; all symptoms are manifested in fractures, develops inflammatory response, profuse bleeding, blood supply to tissues is disturbed, intoxication of the body occurs; cellular enzymes are activated in the rupture zone, necrosis develops on the surface of the site, fusion does not yet occur.
2. Differential phase: 15-30 days after fracture; there is a process of the appearance of new cells, which leads to the formation of calluses on a fibrous-cartilaginous basis; synthesis of glycosamiglycans develops; the basic basis of callus begins to form - metrics; collagen production is activated.
3. Primary accumulative phase: 15-40 days; gradually formed vascular system from small capillaries; chondroitin sulfate combines with phosphate and calcium ions to form bone tissue; synthesis of calcium phosphate is activated; with the participation of silicon and magnesium ions, the primary callus.
4. Mineralization phase: up to 4 months; crystalline hydroxyapatite is formed; their complex with collagen appears; crystallization nuclei are formed - primary mineralization; intercrystalline bonds are created that complete the secondary mineralization of callus.

Fracture treatment

When fractures are fixed, treatment must be urgently started with first aid, and then immobilization, anesthesia, conservative and restorative therapy, other methods of treating fractures are applied, and if necessary, surgical treatment is performed.

In order to accurately understand the nature of the injury, an x-ray is required.

First aid. the main task when rendering before the arrival of the doctor - to remove the pain shock, to provide peace to the victim, to exclude damage to soft tissues as much as possible, to ensure the immobility of the damaged area.

With an open fracture, it is necessary to stop the bleeding by applying a bandage. For anesthesia, analgin or promedol is used. Immobilization for fractures is carried out by fixing a homemade splint.

immobilization activities. Main principle treatment of fractures - complete immobilization of the damaged area. Immobilization is provided by layer-by-layer application of bandages impregnated with gypsum or modern synthetic compounds. Gypsum splint has different amount layers depending on the location of the fracture (for example, shoulder - 6, lower leg - up to 10, thigh - 12 layers). Before applying the splint, the damaged area is treated with an antiseptic and lined with cotton wool to prevent bedsores.

Recovery activities. Restoration of the damaged area is a rather lengthy process. Exercise therapy is widely used for fractures, in addition, physiotherapy is used for full functional rehabilitation, massotherapy, CRM-therapy, treatment of bone fractures with folk remedies. In the event that for some reason there is an incorrectly fused fracture, the resulting callus is carefully destroyed and re-immobilized; more often, surgery is used to correct an improperly healed fracture.

Gelatin is an effective remedy. It is used when home treatment by ingestion and as a compress. Of the other folk remedies, mummy is the most popular in different combinations. Also used folk remedies from comfrey root or in the form of mixtures of rose hips and currants, budra and plantain, lemon and spinach, and many other folk recipes.

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

In a child, the bones are more elastic and less durable than in adults. This causes the vulnerability of the skeleton to the action of traumatic factors. high risk The formation of fractures in children is associated with the mobility of the child and poor development of self-preservation skills. In the elderly, the effect age-related changes calcium salts are washed out of the bones, which leads to the phenomenon of osteoporosis and a decrease in the strength of the skeleton. Violation cerebral circulation, leading to poor balance and dizziness, causes unsteady gait and frequent falls.

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

Classification

The classification of fractures was created to simplify the diagnosis, determine the tactics of treatment and the prognosis of the disease. Injuries are distinguished by etiology (cause of origin), form of bone defect, displacement of bone fragments, formation of bone fragments and other factors. What are the fractures, we will consider below and present different classifications of skeletal injuries.

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

Fractures are classified according to the cause of their occurrence:

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

Traumatic bone defects appear with a direct blow, falling from a height, violent actions, awkward movements, gunshot wounds. Such fractures are called straight. Sometimes the place of application of force and the area of ​​formation of injury may be 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, impaired osteogenesis during embryonic development, and chronic debilitating diseases.

According to the report of bone fragments from environment distinguish fractures:

• 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 are characterized by the formation of a wound when exposed to a traumatic factor. Secondary appear after the moment of injury as a result of eruption of the skin by sharp edges of the bones during improper transportation of the patient to the emergency room or unsuccessful reduction of the bone during treatment.

Bone fractures differ in the direction of the line of the bone defect

Closed fractures are:

• incomplete - are formed according to the type of crack without displacement of bone fragments;
• complete - characterized by complete separation of the ends of the bone and displacement in different directions;
• single - injury to one bone;
• multiple - trauma 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 the impact of a minor traumatic force. 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 branch" type - bone fractures without displacement of fragments. Incomplete defects include marginal and perforated fractures, fractures and cracks. Complete separation of bone fragments develops when exposed to a significant striking force or the formation of a defect in areas of bones with well-developed muscle 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 the joint

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

According to the localization of the bone defect, the following types of fractures are distinguished:

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

Epiphary injuries can occur as a fracture-dislocation, 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.

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

Defects with a transverse fracture line are classified as stable injuries with a 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 methods treatment 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. staging accurate diagnosis, according to modern classification improves the prognosis of injury and reduces the risk of severe complications.

Effects

After the occurrence of a fracture, it is necessary to urgently apply for medical care. At severe injuries which are accompanied by the formation of a wound or displacement of damaged bones, bleeding, multiple bone lesions, deterioration general condition victim due to hemorrhagic and pain shock, an ambulance should be called. If it is impossible to call the doctors, the patient is independently transported to the trauma department after first aid and imposition of transport tires.

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

Internal blood loss leads to hematoma formation

Undesirable consequences of a fracture occur when the victim is not properly transported to the hospital, late seeking medical help, inadequate choice of therapy and violation of the treatment regimen. If you suspect an injury, you should consult a doctor, go X-ray diagnostics and start treatment in a timely manner when a bone defect is confirmed.

Fracture healing outcomes:

• full recovery anatomical structure and function of the injured leg or body part;
• full restoration of the anatomical structure with limited functionality;
• improper fusion of bones with impaired function of a limb or part of the body (deformity, shortening of a limb);
• non-union of bone fragments with the formation.

Complications that arise after injury healing depend on the correct reposition (comparison) of fragments and sufficient fixation of the bone, concomitant soft tissue injuries, rehabilitation measures, and the duration of the period of limitation of motor activity. Types of bone fractures affect the healing time of the injury. Longer therapeutic immobilization is needed for open injuries, closed damage with displacement of bones and the formation of bone fragments, as well as in the case of intra-articular disorders and the formation of fractures and 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 the bone tissue (absence or improper healing, deformity or shortening of the leg, the 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 malunion of the bone

Unclosed bone fractures are formed when the fragments are incorrectly compared, as a result of which the formation of callus is disrupted. When hit between the ends of the damaged bone of soft tissues, false joint, which leads to pathological mobility in the area of ​​injury and impaired normal function limbs. Due to the pathology of bone consolidation, shortening or deformity of the limbs develops, which leads to disability.

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

Fracture of bones with damage to the nerve trunks causes a violation motor function and sensitive areas. After the union of the defect, a large callus may form, which compresses blood vessels and nerves. As a result, paralysis and paresis develop, congestion in tissues, leading to disability.

Prolonged immobilization of the limb contributes to muscle atrophy and the formation of immobility of the joints (ankylosis). After removing the plaster, traction or external fixation apparatus, a violation of the outflow of blood and lymph from the damaged area of ​​​​the limb is observed, which causes swelling, blueness of the skin and stiffness of the joints. To prevent the formation of undesirable consequences of a fracture of the limbs, adequate therapy and apply rehabilitation measures to different stages healing of injury.

Formation of a false joint

Infectious complications are typical for open damage bones. As a result of an injury, pathogens enter the wound, which cause suppuration of soft tissues, bones (osteomyelitis) or generalization of infection (sepsis). Rarely, abscesses form in the area of ​​internal or external osteosynthesis (comparison of bones with the help of pins, plates, screws). To prevent infection, aseptic processing wounds, suturing a defect in the skin, prescribe a course of antibiotics.

Improper or prolonged healing of fractures causes scarring that puts pressure on blood vessels and nerves. This leads to chronic pain syndrome after consolidation of bone fragments and return to normal physical activity. Pain intensify after a long walk, carrying heavy loads, changing weather conditions, can cause insomnia and mental exhaustion of the body. Significant decline disability due to constant pain leads to disability.

Fractures of bones differ in various parameters. To make an accurate diagnosis and choose the right treatment method, a classification was created that reflects specific features some kind of injury. The consequences of fractures depend on the severity of the injury, the timely provision of first aid, and the right tactics of treatment and rehabilitation. If the doctor's recommendations are followed, in most clinical cases it is possible to completely restore the anatomical integrity of the damaged bone and functional activity limbs or body parts.

Bone tissue is second in strength only to tooth enamel, which is considered the hardest tissue in the human body. Each of us has more than 200 bones and each of them has its own margin of safety, but with a certain force of impact, any of them can break.

A bone fracture is a complete or partial violation of its integrity, which occurs when a load exceeds the strength of the injured bone. This pathology most often occurs as a result, but in some cases the cause of the fracture is diseases that lead to a violation of the structure of bone tissue.

Causes of fractures

Of course, the main reason for the violation of the anatomy of the bone is an injury received during a fall, impact, at work, in an accident, as a result of natural disasters, etc. Unfortunately, thanks to technical progress, the number of injuries leading to bone fractures has increased significantly.

Types of fractures

In modern traumatology, many various classifications fractures.

Because of

Depending on the cause, fractures are divided into traumatic and pathological.

In some diseases, bone strength is reduced and pathological fractures can occur due to minor injuries, weak blows, and sometimes even just with muscle tension or normal movement. This pathology can occur when oncological diseases bones, in children the cause may be severe congenital disease osteopetrosis (death marble).

One of the risk factors for pathological fractures is age. In older people, bone density decreases, it becomes more fragile, so the risk of fractures increases.

According to the direction and shape of the fracture

This classification is based on the orientation of the fracture line relative to the axis of the bone; fractures can be transverse, longitudinal, oblique and helical.

If there is no clear fracture line, and a lot of small fragments are determined on the radiograph, then it is called comminuted. A comminuted fracture of the vertebrae is called a compression fracture, since it often occurs as a result of a sharp compression of the vertebrae by each other.

Wedge-shaped fractures are also distinguished, when one bone is pressed into another, deforming it in the form of a wedge, and impacted - one bone fragment is driven into another.

By degree of damage

• Complete (with and without displacement of fragments);
• incomplete (bone fracture or crack).

Depending on the damage to the skin

• Closed (no skin damage and open wound);
• open ( soft tissues injured and the wound is open).

Diagnosis of a bone fracture

This diagnosis is often made on the basis of clinical signs but is always confirmed radiologically. X-ray is required even in cases where the fracture is open and bone fragments are visible, of course, in this case the diagnosis is not in doubt, but this study is necessary in order to accurately establish the position of damaged bones and the presence of fragments.

Relative signs of a fracture

• Sharp pain at the site of injury, aggravated by movement, load and any manipulation, in case of damage small bones pain can be the only symptom at the victim.
• Functional failure if we are talking about the limb (limitation of mobility, the victim keeps it in a forced position).
• Swelling at the site of injury appears some time after the injury.
• Hematoma - also does not form immediately, however, with massive bleeding, it quickly increases in volume.

Absolute signs of a fracture

• Change in the shape of the limb;
• in the proposed site of the fracture, pathological mobility of bone fragments and a characteristic crunch are determined;
• visualization of bone fragments in the wound.

First aid for fractures of limbs

These fractures are the most common. The first thing to do is to assess the condition of the victim and call ambulance if it is not possible to transport it to a medical facility on its own. Often, patients with fractures of the bones of the upper limbs get to the emergency room on their own, which cannot be said about the victims with fractures of the bones of the legs.

Usually even in the simplest car first aid kit there is a set of tools that is enough to provide a person with first aid for such injuries. It contains a tourniquet to stop bleeding, bandages and adhesive plasters to fix the limb and splint, a sterile dressing bag and wipes for dressing the wound.

Stop bleeding

If the victim has bleeding, then first of all it is necessary. If the blood beats with a pulsating stream of scarlet color, then the bleeding is arterial, and a tourniquet is required above the injury site. If a dark blood slowly flows out of the wound, the bleeding is caused by damage to the veins. In this case, the victim must apply a pressure bandage, not a tourniquet.

Immobilization

The injured limb must be immobilized. In no case should you try to straighten, set or perform any other manipulations with a limb if there is a suspicion of a bone fracture. Before applying the splint, it is not necessary to remove clothing from the person, it is applied directly to the sleeve or leg. For immobilization, you can use any hard, even objects (for example, a stick, board or ski). Any splint must be applied so that the limb is firmly fixed, for this it is necessary to immobilize the joints above and below the injury site.

If there is a suspicion of damage to the bones of the leg, then the diseased limb can be tightly bandaged to a healthy one, which in this case will act as a splint. In case of damage to the bones of the lower leg or thigh, two tires are applied - on the outer and inner surface legs. The outer one should reach the armpit and exclude movement in the hip, knee and ankle joints. Internal - from the perineum to the ankle joint, also immobilizing knee-joint and ankle.

At a fracture upper limb the victim's arm is bent into elbow joint, the splint is also applied on both sides, the limb is hung on a scarf in a bent state (flexion angle 90 degrees). AT armpit you can put a roller.

All manipulations should be performed with extreme caution so as not to aggravate the condition of the victim. Rough manipulations can cause complications in the future, up to traumatic shock.

Anesthesia

If an anesthetic is at hand, then you need to give it to the victim. Ice can be applied to the injury site, a bottle of cold water or a special cooling package. If transportation to a medical facility is not possible and waiting for special transport is required, the patient must be warmed by covering with a blanket, clothes, etc. If there is no suspicion of an injury to the internal organs, you can give the victim a warm drink.

Treatment of wounds

If the victim has open wound, then it must be treated with a 3% hydrogen peroxide solution or other antiseptic (non-alcoholic) solution. The skin around the wound can be lubricated with alcohol or a solution, which should not fall into the wound itself. into place visible damage skin should be applied with a non-tight sterile bandage.

First aid for spinal injury

Characteristic features spinal injuries are a sharp pain at the site of violation of the integrity of the vertebrae, difficulty or cessation of breathing, numbness, weakness or paralysis of the limbs, involuntary urination and defecation. It is possible to transport and generally move such a victim on your own only in a hopeless situation, when there is no way to wait for qualified help.

You can not try to plant or put him on his feet, turn him over on his side or stomach. It is necessary to lay the victim on a hard, flat surface, the length of which should exceed his height (door, piece of plywood, shield, etc.). It is impossible to lift a person by the shoulders and legs, the transport surface must be carefully slipped under his back.

When the victim is laid on such an impromptu stretcher, it is necessary to firmly fix him on them by any improvised means (bandages, belts, ropes, etc.). It is advisable to put a small dense roller under the neck. If there is a suspicion of damage to the vertebrae cervical region, then with such a roller it is necessary to completely wrap the neck.