What does a fracture mean? Fracture - its types and symptoms, causes and treatment of fractures
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Fracture shin is a fairly common injury, both in adults and children. This fracture can be relatively mild or severe, depending on the number of bone fragments and their relative position, as well as the degree of damage to the surrounding soft tissue. Treatment of a tibia fracture is carried out only by a traumatologist or surgeon on the basis of long-term immobilization (immobilization) of the limb in the knee and ankle joints, necessary for bone fusion. Before immobilization, the bone fragments are compared to their normal position, which is fixed with knitting needles, bolts, plaster, pins and other devices for treating fractures. Treatment of a tibia fracture ends with a period of rehabilitation necessary for the complete restoration of all functions of the leg.Fracture of the leg - definition and general characteristics
The shin is the part of the leg from the knee to the ankle joint. A tibial fracture is a violation of the integrity of any part of the bones that make up a given part of a person’s leg. Since the human shin consists of two bones - the tibia and tibia, a fracture of either one of them or both at once is possible. In principle, most often only a fracture of the tibia is recorded while maintaining the integrity of the fibula. However, there is also a simultaneous fracture of both tibia bones of the leg. A fracture of only the fibula with preservation of the integrity of the tibia is extremely rare.Fractures of the leg may have varying degrees severity, which depends on what part of the bone was broken, how the bone fragments are located, how severely damaged soft fabrics, blood vessels and joints, and whether there are complications. Therefore, it is impossible to call all tibia fractures relatively mild or severe. The severity of each fracture must be assessed individually, based on the listed signs.
Mild fractures are usually isolated fractures of the tibia, obtained in a fall on the street, skating rink or in another place, and not combined with other injuries to bones and soft tissues. Severe fractures of the tibia occur when performing complex movements, falls from a height, car accidents, etc.
Causes
The main cause of tibia fractures is the impact of a large force on a small area of the bone. The bone cannot withstand very strong pressure and breaks. Most often, great pressure occurs when you fall on a leg that is bent or fixed in an awkward position, for example, in a boot. alpine skiing, skating, between any objects, etc. Less commonly, a fracture occurs due to a direct and very strong impact on the leg, for example, the fall of a heavy object, an impact, etc.Photos of shin fractures
This photo shows appearance legs with a closed fracture of the tibia without displacement.
This photograph shows the appearance of a leg with an open tibia fracture.
This photograph shows a view of a leg with a closed displaced fracture.
Classification of tibia fractures and brief characteristics of varieties
Currently, there are several classifications of tibia fractures based on the site of injury, the nature, number and location of bone fragments, as well as the degree of damage to soft tissues and joints.Single and multiple fractures of the tibia. Depending on the number of bone fragments formed, tibia fractures are divided into single and multiple. With a single fracture of the tibia, the integrity of the bone is broken in only one place. And in this place there are two free ends of the broken bone (fragment). With multiple fractures, the integrity of the bone is broken in several places simultaneously, resulting in the formation of more than two bone fragments.
Straight, oblique and spiral fractures. Depending on the nature of the fracture line, they are divided into straight, oblique and spiral. If the bone breaks exactly across, then it is a direct fracture. If it breaks diagonally, then it is an oblique fracture. If the fracture line is uneven, resembling a spiral, then this is, accordingly, a spiral fracture.
Smooth and comminuted fractures. In addition, depending on the shape of the edge of the fragment, fractures are divided into even and comminuted. Straight fractures have the same fracture line, which appears to have been neatly filed. Comminuted fractures are uneven breaks that form teeth on the broken bone various shapes and size.
Fractures of the tibia with and without displacement. Depending on the location of the bone fragments, fractures with displacement and without displacement are distinguished. Fractures without displacement are characterized by the normal position of bone fragments relative to each other. If such fragments are simply combined, they form a bone. Displaced fractures are characterized by a change in the position of bone fragments relative to each other. If such fragments are compared with each other, they do not form normal bone. You first need to return them to their normal position and only then compare them. The displacement can be rotational, angular, etc.
Open and closed fracture of the tibia. Depending on the presence or absence of soft tissue damage, tibia fractures are divided into open and closed. Accordingly, open fractures are those in which, in addition to bone damage, there is an open wound formed by torn muscles and skin. In the lumen of this open wound One end of the broken bone may be sticking out. Closed fractures are those in which the skin remains intact and the muscles are minimally damaged, as a result of which bone fragments remain in the thickness of the tissue.
Extra-articular and intra-articular fractures of the tibia. In addition, depending on the presence of damage to the knee or ankle joints, tibia fractures can be intra-articular or extra-articular. If the fracture involves joint structures, it is called intra-articular and is considered severe. If only the tibia is broken, but the joints remain intact, then the fracture is called extra-articular.
Fractures of one or both bones of the leg, as well as their upper, middle and lower thirds. In addition, there is a classification of tibia fractures based on which part of the bone was damaged. In order to have a good understanding of this classification, you need to know the structure of the tibia and fibula. So, both bones consist of a long main part, which at both ends turns into rounded and wide formations. The main long part of the bone, enclosed between the two thickened ends, is called diaphysis. The terminal thickenings are called epiphyses. It is the epiphyses of the tibia that participate in the formation of the knee and ankle joints. The part of the diaphysis and epiphysis located closer to the knee are called proximal, and those closer to the foot are called distal. The proximal epiphysis has two projections called condyles, which are necessary for the formation of the knee joint and the attachment of ligaments.
Depending on which part of the leg was damaged, its fractures are classified into the following three types:
1.
Proximal tibia fractures
(upper third of the tibia and fibula). These include fractures of the condyles and tuberosities of the tibia or the head and neck of the fibula;
2.
Mid-tibia fractures
(middle third of the tibia). These include fractures of the diaphysis of the tibia and fibula;
3.
Fractures of the distal tibia
(lower third of the tibia). These include ankle fractures.
Fractures of the distal and proximal parts of the legs almost always involve damage to the knee or ankle joint, which makes the injury severe.
Severity
Currently, the severity of a tibia fracture is determined by its belonging to one of three types - A, B or C. Mild fractures are classified as type A, moderate severity- to B and heavy ones - to N. B general view we can say that closed fractures without displacement and with minimal trauma to soft tissues are considered mild. Moderate fractures can be open or closed with injury to soft tissues, but without damage to joints or nerves. Severe fractures are those that damage joints, nerves and blood vessels.Symptoms of a tibia fracture
The symptoms of tibia fractures differ somewhat depending on the location of the injury, but there are also common Clinical signs. So, with any location of the fracture, severe pain, swelling and discoloration appear skin. When you try to move a limb or feel it, you can hear the crunch of bone fragments rubbing against each other. It is impossible to lean on a broken leg. It is also impossible to make any active movement of the lower leg. Externally, shortening or lengthening of the leg, or bone fragments protruding from the wound may be visible. If the broken bone has injured the peroneal nerve, the foot begins to droop and cannot be bent. If bone fragments have injured blood vessels, the skin of the lower leg becomes pale or bluish.
The above symptoms are common to all tibia fractures. Below we will consider specific symptoms characteristic of fractures of various locations.
Proximal tibia fractures characterized by a forced slightly bent position of the leg in knee joint. The shin is displaced outward or inward. With strong displacement of the broken condyles directly under the knee joints, severe swelling and deformation are formed. When palpating the knee joint, shin and the site of injury, following signs fracture:
- Pain at the site of injury that does not spread to other areas of the leg;
- The noise of bone fragments rubbing against each other;
- Patella mobility;
- Mobility in the knee of the aligned leg;
- An attempt to make an active movement of the lower leg is impossible.
To clarify the diagnosis of a fracture, it is necessary to perform an x-ray, computed tomography or magnetic resonance imaging.
Diaphyseal fractures characterized by severe pain, swelling and cyanosis of the skin of the leg. The lower leg is deformed, the foot is deviated outward, and the crunching of bones can be heard in the thickness of the tissue. With fractures of the tibia, a person cannot bear even minimal weight on his leg. And if only the fibula is fractured, supporting the leg is quite possible.
Distal tibia fractures (ankle fractures) characterized by very severe pain and swelling. The foot may be turned inward or outward, and support on the leg is impossible.
Treatment
General principles of treatment of tibial fractures
For treatment different types For tibia fractures, various modifications of the same techniques are used, which lead to recovery and fusion of bones in the shortest possible time. However, the general sequence of actions in the treatment of any fracture of the tibia is exactly the same, and therefore it can be considered the principles of treatment for this injury.So, treatment of any fracture of the leg is carried out by sequential application of the following actions:
1.
Reposition of bone fragments, which consists in giving pieces of bone a normal position necessary for subsequent proper fusion. Reposition can be carried out by the surgeon's hands simultaneously under local anesthesia, using a skeletal traction system, or during surgery. The operation is performed either for open fractures or for unsuccessful reduction by hand or by skeletal traction.
2.
Fixation of bone fragments in a normal position using various devices, such as Kirschner wires, side loops, bolts, plates, Ilizarov, Kostyuk, Kalnberz, Tkachenko, Hoffmann devices, etc.
3.
Immobilization of the limb by applying a plaster splint or installing compression-distraction devices (for example, Ilizarov, Kostyuk, Kalnberz, Tkachenko, Hoffman, etc.) for several weeks or months until a callus forms and the fracture heals.
In each specific case, the methods and materials used for reposition, fixation of bone fragments and immobilization of the limb may be different, and their choice is made by a surgeon or traumatologist based on the specifics and characteristics of the fracture. If some methods are ineffective, they can be replaced by others in the process of treating a fracture. Let's consider the features of treatment of fractures of various parts of the leg and the optimal methods for this.
Treatment of proximal tibia fractures
Immediately after the patient is admitted to the hospital, an anesthetic drug (Novocaine, Lidocaine, etc.) is injected into the area of injury, the joint is punctured and the blood accumulated in it is removed. If the fracture is closed and without displacement, then immediately after pain relief a plaster cast is applied to the leg for 1 month. After a month, the plaster is removed and prescribed rehabilitation measures. You can fully put weight on your leg 2 months after the injury. If the fracture is displaced, then after pain relief the fragments are repositioned and then fixed with simultaneous immobilization by applying a plaster splint for 6 to 7 weeks. If it is impossible to compare the fragments with your hands, then reposition is carried out using the method of skeletal traction for 4 to 8 weeks. After traction, depending on the thickness of the callus, either a tight bandage or a plaster splint is applied to the leg, leaving it until the bones are completely fused. You can fully put weight on your leg 3 months after the fracture.
Currently, the application of a plaster splint is often replaced by the installation of an Ilizarov apparatus with the preliminary introduction of special screws and plates into the tissue, which hold bone fragments in the correct position after reposition. In this case, healing of the fracture occurs without applying plaster.
Treatment of diaphysis fractures
In case of displaced fractures of the tibia or both bones of the leg, reduction must be done under local anesthesia. After this, a plaster cast is applied from the middle of the thigh to the fingertips for 2.5 - 3 months. However, the consequence long-term wearing A plaster splint causes stiffness of the knee and ankle joints, therefore, if possible, doctors prefer to immobilize the limb using rod compression-distraction devices such as Kostyuk, Ilizarov, SKID, Hoffman, etc.Oblique, spiral, splinter and other fractures of the diaphysis of the tibia bones, which tend to secondary displacement of fragments, must be treated using a skeletal traction system. That is, after repositioning the fragments, the person was placed on a skeletal traction system for 3–4 weeks, after which a plaster splint was applied from the middle third of the thigh to the fingertips for another 1.5–2.5 months.
Full recovery from injury occurs after 5–6 months, and you can begin walking without crutches and a cane after 4–4.5 months.
Treatment of ankle fractures
Ankle fractures are severe because they always involve damage to the ankle joint. Therefore, reposition of bone fragments is most often performed during surgery. The fragments are fixed with knitting needles, bolts or plates, after which a B-shaped gypsum bandage from the middle of the shin to the beginning of the toes. The cast is applied for 3 to 7 weeks, depending on the volume of surface formed by the bone fracture.If, after repositioning bone fragments, there is very large swelling on the leg, then the lower leg is placed on a Beler splint on a skeletal traction system until the swelling decreases. Only after the swelling has subsided is a plaster cast applied to the leg.
If a fracture of the head of the tibia occurs, then reduction by hand is impossible, and it is carried out during surgery, after which the person is placed on a double skeletal traction system for 3 to 4 weeks. Then a plaster boot is placed on the leg for 3 – 3.5 months. If skeletal traction is not performed, the bones will heal incorrectly, and the foot will acquire a deformed shape that can only be corrected by repeated surgery.
Complete healing of an ankle fracture occurs 6 to 7 months after the injury, but for the best rehabilitation it is recommended to wear an arch support for a year after removing the cast.
Operations for tibia fracture
Operations for a fractured leg are performed if there are the following indications:
- Fractures in which it is impossible to reposition the fragments using conservative methods;
- Double fractures of the tibia with severe displacement;
- Change in the normal position of soft tissues;
- Danger of skin rupture, compression of nerves or blood vessels with bone fragments;
- Open fracture.
When the bones of the leg are fractured, two types of operations are performed to reposition the fragments and restore the integrity of the soft tissues:
1.
Reposition with fixation of fragments metal structures(plates, knitting needles, screws, etc.) followed by fixation with a plaster splint.
2.
Reposition of fragments with simultaneous fixation by applying a compression-distraction device.
Repositioning of fragments with a metal plate is used to treat nonunion or pseudarthrosis of the tibia. In all other cases, it is preferable to treat fractures by applying compression-distraction devices, for example, Ilizarov, Kalnberz, Tkachenko, Hoffmann, etc.
After a broken leg
After a broken leg, a person should direct all his physical and mental strength to recover from the injury. It is necessary to understand that a fracture is a serious injury that violates not only the integrity of bones, but also soft tissues. And during the period of immobilization of the limb, necessary for the fusion of bone fragments, atrophic changes in the muscles and congestion are added due to impaired blood and lymph circulation in the compressed soft tissues. However, with due persistence, all these violations are reversible, that is, they are completely eliminated.Understanding the possibility of complete recovery after an injury, you need to know and imagine that this process is long, difficult, sometimes excruciating and very painful. After all, you will actually have to re-learn how to perform the simplest movements that were previously done automatically, without even thinking about them. You cannot feel sorry for yourself, indulge in your reluctance to walk and do exercises that may cause pain, because the more time passes after the injury, the more difficult the process of restoring functions will be. Also for successful rehabilitation It is very important to put aside the fear of breaking a leg again, which literally holds down many people who have experienced such an injury. Remember that the only factor making it impossible full recovery functions of the leg after a fracture is insufficient perseverance in achieving the goal. If you don’t give up and work hard on your leg every day, then after a while its functions will be completely restored.
Tibia fracture - rehabilitation
The process of rehabilitation of a tibia fracture is a set of measures aimed at the speedy and durable fusion of bone fragments, as well as the complete restoration of all functions of the limb. Rehabilitation is aimed at achieving the following specific goals: - Elimination of atrophy of the muscles of the lower leg and thigh;
- Normalization of tone and elasticity of the lower leg muscles;
- Normalization of blood circulation in the muscles and tendons of the lower leg;
- Normalization of mobility of the knee and ankle joints;
- Elimination of congestion in the soft tissues of the lower leg;
- Normalization motor activity legs.
To achieve all these goals in the rehabilitation process, the following four main methods are used:
1.
Physiotherapy. A person performs daily physical exercise with dosed and selected loads, which help restore muscle structure, normalize blood circulation, eliminate stagnation and inflammation, and also prevent muscle atrophy and joint contractures;
2.
Massages and rubbing. Performing daily massages and rubbing is necessary to prevent joint stiffness, degeneration of the lower leg muscles and scar formation in soft tissues;
3.
Physiotherapeutic procedures aimed at reducing inflammatory process, improving healing and restoration of tissue structure, intensifying metabolism and blood flow in the vessels of the leg;
4.
Diet, which includes foods rich in calcium, vitamins, iron and other microelements.
The listed techniques in various combinations are used throughout the entire rehabilitation period, which lasts 2–4 months. However, since different stages recovery requires the implementation of various activities aimed at achieving strictly defined goals, then three main periods of rehabilitation can be distinguished:
1.
The first stage of rehabilitation lasts 2–3 weeks from the moment the plaster is removed;
2.
The second stage of rehabilitation lasts for 2 – 3 months and begins immediately after the first;
3.
The third rehabilitation period continues for a month after completion of the second.
At the first stage of rehabilitation You should definitely massage and rub the skin and muscles of the lower leg with your hands and using special creams containing substances that promote tissue restoration, such as cedar oil, Collagen Plus, Chondroxide, etc. In addition, in addition to massages, it is recommended to take baths with sea salt , wax and ozokerite wraps, as well as magnetic therapy sessions. At the first stage of rehabilitation, you should not load the limb with exercises, as this may provoke severe pain. It is recommended to simply gently move your foot in different directions, raise and lower your leg, bending it at the knee joint, and also strain and relax your calf muscles.
At the second stage of rehabilitation it is necessary to restore all functions of the leg. To do this, they continue to do massages and warm baths, after which they begin active exercises. A set of exercises for developing and restoring leg functions after a tibia fracture consists of the following movements:
- swing to the sides, forward and backward from a standing position;
- alternately rising on your toes and lowering on your heels from standing and sitting positions;
- walking as much as possible and sustainably;
- crossing the legs in a “scissors” fashion while lying down;
- rotation of the raised leg with the foot in different directions.
At the third stage of rehabilitation need to attend courses physical therapy and practice various programs aimed at strengthening the leg muscles.
In addition, for successful rehabilitation after a tibia fracture, it is necessary to create a diet in such a way that it includes foods containing a large number of silicon and calcium, such as milk, cottage cheese, fish, soybeans, hazelnuts, bran bread, sesame seeds, beans, persimmons, cauliflower, raspberries, pears, radishes, currants, etc. It is also recommended to take vitamins E, C and D that contribute speedy healing fracture and better absorption of calcium and silicon.
Special mention should be made of physiotherapy in rehabilitation after a tibia fracture. On various stages rehabilitation, it is recommended to resort to various physiotherapeutic techniques to improve especially necessary functions.
In the first ten days after a fracture, the following physiotherapeutic procedures are recommended:
- Interference currents (promote the resorption of hematomas, the convergence of swelling and the relief of pain);
- Ultraviolet irradiation (destroys pathogenic bacteria, preventing wound infection);
- Bromine electrophoresis for severe pain.
- Interference currents (normalize metabolism and accelerate tissue healing and bone fusion);
- UHF therapy (improves blood flow, strengthens the immune system and accelerates the restoration of tissue structure);
- Ultraviolet irradiation;
- Massotherapy.
Exercises for a broken leg
Exercises for a broken leg are aimed at restoring normal functioning of the leg, increasing muscle strength and acquiring a full range of motion. After removing the plaster or various external structures such as the Ilizarov apparatus, it is recommended to perform the following exercises to develop the leg after a tibia fracture:
- Walking on level and uneven surfaces in shoes and barefoot with support on the injured leg. You need to try to walk as much and as often as possible.
- Standing on one leg, make rotational movements with the foot of the injured leg.
- While sitting on a chair or other surface, make rotational movements with the foot of the injured leg.
- Swinging movements with legs in different directions. To perform them, you need to stand on both legs and rest your hands on the back of the chair. From this position, you should slowly and carefully lift the injured leg up and hold it suspended for a few seconds, then lower it to the floor. 10 repetitions must be performed on each leg. In addition to swinging your legs forward, it is recommended to also swing them backwards and to the sides.
- Stand up straight, leaning on both legs and resting your hands on the table, back of a chair, window sill or any other stable object. Slowly rise onto your toes and transfer your body weight back to your heels. Do at least 30 repetitions.
- Lie on your back and start swinging your legs in different directions.
First aid for a broken leg
The general sequence of first aid for a broken leg is as follows:- Give painkillers;
- Remove shoes from the injured foot;
- Stop the bleeding and treat the edges of the wound;
- Secure the leg using a splint or any available materials.
Anesthesia
First of all, in case of a fracture of the tibia, if possible, the pain syndrome should be relieved. To do this, you can give a person a tablet of any painkiller (for example, Analgin, Nimesulide, Pentalgin, Sedalgin, MIG, etc.) or inject a solution intramuscularly local anesthetic(Novocaine, Lidocaine, Ultracaine, etc.). The anesthetic solution should be injected as close as possible to the site of the bone fracture.Then it is necessary to remove the shoes from the person’s feet, since the rapidly increasing traumatic swelling will provoke severe compression of the tissues, which will cause increased pain. You should move your leg carefully, supporting it by the knee and ankle joints with both hands (Figure 1). If it is necessary to change the position of the injured leg, it should always be moved in this way.
Picture 1– Rules for moving the leg when the tibia is fractured.
Treating the wound and stopping bleeding
After this, carefully cut or tear the clothing on the leg and inspect the surface of the skin of the lower leg. If there is an open and bleeding wound, then you should determine whether the bleeding is dangerous. If blood flows out in a stream, the bleeding is dangerous because a large blood vessel has been damaged by bone fragments. In this case, you should stop the bleeding by tamponade the wound with any piece of clean cloth, bandage, cotton wool, gauze, etc. To do this, fabric or cotton wool is carefully pushed into the wound, compacting each layer with a finger or some other instrument. A loose regular bandage is applied over the tamponade. It is not recommended to stop bleeding by applying a tourniquet, since in a complex fracture, tightening the muscles can lead to the displacement of bone fragments, which will rupture the vessel in another place, which will aggravate the situation.If blood is simply oozing from the wound, then there is no need to pack the wound. In this case, you should simply treat the edges of the wound with any antiseptic at hand (potassium permanganate, Chlorhexidine, hydrogen peroxide, iodine, brilliant green, any alcohol-containing liquid, etc.), without pouring it into the wound opening.
Tibia fracture splint
After bandaging the wound and stopping the bleeding, the most important stage of first aid for a fracture of the leg begins, which consists of immobilizing the leg (immobilization), which is necessary to fix the current position of soft tissues and bones in order to avoid their movement, during which they can rupture blood vessels, nerves, and muscles. and ligaments, thereby aggravating and aggravating the injury.It is necessary to apply a splint to the injured leg in such a way that the knee and ankle joints are immobilized (see Figure 2). To do this, you need to take any two (stick, umbrella, etc.) available straight and relatively long objects (at least half a meter) and apply them to the injured leg with the outer and inside so that one end is at the level of the heel, and the other reaches the middle of the thigh. Then these items are tightly bandaged to the leg in several places using any available means - laces, ties, bandages, pieces of fabric, etc. Before tying a long object to your leg, it is advisable to wrap it in a soft cloth.
Fracture- This medical term, which denotes a broken bone. Fractures are a fairly common problem, and statistically the average person will have two fractures in their lifetime. A bone fracture occurs when the physical force acting on a bone is greater than the bone itself. Fractures are most often caused by falls, blows, or other injuries.
Risk of fracture is largely related to a person’s age. Fractures often occur in childhood, although fractures in children are usually not as complex as in adults. With age, bones become more fragile, and fractures usually occur after falls, even those that would not entail any consequences. negative consequences at a younger age.
2. Types of fractures
There are many different types of fractures, but most often Fractures are classified into fractures with displacement and without displacement, open and closed. The division of fractures into displaced and non-displaced fractures is based on the way the bone breaks.
At displaced fracture the bone is broken into two or more pieces that are arranged so that their ends do not form a single line. If a bone is broken into many parts, it is called comminuted fracture. During fracture without displacement the bone breaks or may develop a crack, but the bone still remains straight and retains the ability to move.
Closed fracture is a fracture in which the bone breaks, but there is no open wound or puncture on the surface of the skin. During an open fracture, the bone may pierce the skin. Sometimes when open fracture the bone may break the skin, but then return to its original position and not be visible upon superficial inspection. An additional danger of an open fracture is the risk of infection of the wound and bone.
There are some other types of fractures:
- Incomplete fracture, in which the bone bends but does not break. This type of fracture most often occurs in children.
- Transverse fracture– fracture at right angles to the axis of the bone;
- Oblique fracture– fracture along a curved or inclined line;
- Fracture with multiple fragments and bone fragments;
- Pathological fracture– caused by a disease that weakens the bones. Pathological fractures can be caused by cancer or, more commonly, osteoporosis. The most common fractures that occur due to osteoporosis are the hip, wrist, and spine.
- Compression fracture, which occurs from strong compression.
Fractures are also classified depending on which bone was broken. The most common are leg fracture, hip fracture, arm fracture, spine fracture, femoral neck fracture, finger fracture, ankle fracture, collarbone fracture, rib fracture, and jaw fracture.
3. Signs of a bone fracture
Signs and symptoms of a bone fracture may include:
- Swelling and bruising;
- Deformation of an arm or leg;
- Pain in the damaged area, which intensifies with movement or pressure;
- Loss of function of the damaged area;
- In an open fracture, there is bone protruding from the skin.
The severity of the fracture depends on its location and how much damage to the bone and soft tissue located next to it. Serious fractures without timely treatment dangerous for their complications. This may include damage to blood vessels or nerves, infection of the bone (osteomyelitis) or surrounding tissue.
Recovery time after a fracture depends on the age and health of the patient, as well as the type of fracture. Small fractures in children heal within a few weeks. A serious fracture in an elderly person will require several months of treatment.
It accounts for 12.57% of all fractures of the upper extremities.
According to the mechanism of injury there are: transverse fractures of both bones at the same level under direct force; fracture due to rotational force; fracture in the lower third (Wheel fracture).
Fractures of both forearm bones can be:
1) subperiosteal
2) breaks like a green twig
3) complete fractures
For periosteal fold fractures - immobilization for up to three weeks; with fractures, with fractures localized in the diaphysis, often with angular displacement.
Clinic: pain, swelling of the hematoma, deformation in the forearm. Movement in the joint is painful.
Complete fractures
In the clinic: pain, swelling, deformation, hematoma, dysfunction of the limb. X-rays are taken in 2 projections of the bones of the forearm. Possible epiphysiolysis of the head ulna, metaepiphysiolysis requiring ideal reposition. When the diaphysis of the bones of the forearm is fractured under anesthesia, displacement in length, width, and angular displacement is eliminated. Fixation is carried out with a splint from the fingertips to one third of the shoulder. Circular - circular dressings are not applied. In extreme cases, if there is a fracture in one third of both bones, two splints can be applied. Immobilization for children under 7 years old - 4 weeks, for older ones - 5-6 weeks.
Permissible displacements for forearm fractures:
1. Angular:
a) in the lower third of the forearm in children under 5 - 6 years of age the angle is up to 30°, in older children it is no higher than 15 -20%.
b) along the diaphysis up to 5 - 6 years 12 - 15°, in older people 8-10.
2. In the anteroposterior direction across the diameter. When displaced, the interosseous gap should not exceed 1/2 - 1/3 of the diameter.
3. By lenght, if the fragments are displaced in the anteroposterior direction.
If displacements are greater than permissible, surgical treatment is indicated.
Isolated fracture
Isolated fracture radius(lane Kolesa), is 15% of total number forearm fractures. More often found in the lower third. The mechanism of injury is direct impact.
Clinic: pain, swelling, hematoma, deformation of the third third of the forearm, impaired pronation movement.
Osteoepiphysiolysis
This type of damage occurs in 10.7%. Epiphysiolysis is the separation of bones along the growth cartilage. Often, with epiphysiolysis, bone tissue is torn off; this is osteoepiphysiolysis. The mechanism of injury is a fall on an outstretched arm with emphasis on the hand.
Clinic: pain, swelling, hematoma, deformation at the fracture site. The x-ray shows a displacement of the epiphysis in relation to the metaphysis (to the rear to the radial side).
Isolated fracture of the ulna
Occurs in 2.8% of cases. The mechanism of injury is a direct blow to the area of the ulna.
Clinic: pain, swelling, deformation, hematoma. On the radiograph in 2 projections there is a displacement bone fragments ulna (with displacement of fragments along the width and at an angle).
Montage fracture
A complex fracture in which there is a dislocation of the head of the radius and a fracture in the third third of the ulna. Movements in elbow joint limited. The x-ray shows a dislocation of the head of the radius, a fracture in the second third of the ulna.
Galeazzi's fracture
Reverse Monteggia fracture. Dislocation of the head of the ulna, fracture of the radius. Rarely seen. Radial alignment is combined with alignment of the dislocated ulnar head.
A plaster cast is applied in the middle position of the forearm for a period of 3 weeks.
Fracture of metacarpal bones and phalanges
Occurs in 0.59% according to the Turner Institute, in 11.8% according to emergency rooms. Mechanism of injury - falling of heavy objects, bruising of a bone on a hard object, impact on the back side brushes Most often, fractures are non-displaced.
Clinic: pain, swelling, hematoma at the fracture site, pain at the fracture site when moving the fingers. When fragments are displaced, deformation occurs. The diagnosis is confirmed by an x-ray of the hand in two projections.
9. Questions on the topic of the lesson:
1. Features of fractures upper limb in children.
2. Features of diagnosing upper limb injury
3. Timing of appearance of ossification nuclei.
4. Principles of treatment of fractures in children at different ages
groups.
5. Fusion of fractures in different age groups.
6. Features of exercise therapy and rehabilitation in a child with a fracture.
7. Complications, their features in connection with incomplete ossification
8. Specify the classification of trauma to the upper limb, distal and proximal parts humerus
10. Test tasks on the topic:
1. CLOSED REDUCTION OF SURACONYLICAL FRACTURE OF THE HUMERUS IS STARTED IN CHILDREN
1) from eliminating rotational displacement
2) from eliminating the offset in width
3) eliminating displacement along the length
4) eliminating angular displacement
5) eliminating displacement in width and length
2. AN EARLY X-RAY SYMPTOM IN EPIPHYSEOLYSIS OF THE DISTAL END OF THE HUMERUS IS
1) destruction of the metaphysis of the humerus
2) the presence of a visible bone fragment
3) increase in the angle of inclination of the epiphysis in relation to the longitudinal axis of the diaphysis
4) visible callus
2) Doletsky
4) Epstein
5) Rokitsky
4.. AMONG FRACTURES OF THE PROXIMAL END OF THE HUMERUS THE MOST COMMON OPTION
1) fracture of the I/O shoulder
2) surgical neck fracture
3) subcapital fracture
4) fracture of the condyles
5) fracture of the s/w shoulder
5. FOR AN AVOID FRACTURE OF THE INTERNAL EPICONYLE 12-14 YEAR OLD AGED, FIXATION OF THE FRAGMENTS IS MOST PREFERABLE
1) Ilizarov apparatus
2) plate
3) splint
4) bone suture
5) Kirschner wire
6. MONTAGGI FRACTURE-DISCLOSURE IS
1) dislocation of the forearm bones on one arm and a fracture on the other
2) dislocation of the hand and fracture of the forearm bones in the middle third
3) dislocation of the forearm bones in the elbow joint and a fracture of one of the bones of the lower forearm bones
4) dislocation of the ulna and fracture of the radius
5) dislocation of the head of the radius and fracture of the ulna at the border of the middle and upper third on the arm of the same name
7. NOT CHARACTERISTIC FOR OLENARY PROCESS AVOIDANCE
1) hematoma
2) broken Gunther triangle
3) positive symptom Marx
4) restriction of movements
5) Manteja's symptom
8. FOREARM WITH FRACTURE OF THE EXTERNAL CONDYLE
1) given
2) allocated
3) rotated inward
5) internally rotated and adducted
09. CHARACTERISTIC FOR FRACTURE-DISCLOSATION OF THE HEAD OF THE HUMERAUS
1) shoulder shortening
2) the shoulder is not abducted
3) there are no “springy” movements
4) during passive movements a “bone crunch” is felt
5) all of the above are true
10. TIME FOR SHOULDER IMMOBILIZATION AFTER REDUCTION OF THE DISLOCATION IS
1) 1-2 weeks
2) 4 weeks
3) 6 weeks
4) 8 weeks
5) 10 weeks
Sample answers to test task on this topic:
11. Situational tasks on this topic:
Task No. 1
The child was injured on the road. Complains of pain in the hip headache, difficulty in taking a deep breath.
1. Make a preliminary diagnosis.
2. What assistance should be provided at the scene of the incident?
3. Algorithm for X-ray examination.
4. Prevention of complications after hospital treatment.
5. Types of childhood injuries, main age groups taken into account in childhood traumatism.
Task No. 2
A 4-year-old child was admitted to the pediatric surgery clinic with a diagnosis of epiphysiolysis of the proximal head of the humerus.
1. Indicate the data characteristic of epiphysiolysis of the proximal head of the humerus in a 4-year-old child.
3. Duration of immobilization
4. Types of callus
5. Outpatient rehabilitation.
Task No. 3
A child was admitted to the pediatric surgery clinic with a diagnosis of apophysiolysis of the medial condyle of the left humerus.
1. What data are characteristic of apophysiolysis of the medial condyle of the left humerus?
2. Additional Methods examinations.
3. Duration of immobilization with permissible mixing.
4. The basic principles of managing a trauma patient are
5. Outpatient rehabilitation.
Task No. 4
A 7-year-old child with an incised wound of the right forearm in s/3 went to the emergency room.
1. What should your tactics be?
2. Types of tendon suture.
3. Duration of immobilization.
4. Outpatient rehabilitation.
5. Criteria for discharge to work for a trauma patient.
Problem #5
A 13-year-old boy fell from a tree and hit the third third of his right shoulder.
I contacted a traumatologist with complaints of pain in the third shoulder, there was swelling of the limb, and the child could not lift it.
1. Make a diagnosis.
2. What examination needs to be carried out?
3. Prescribe treatment.
4. Types of childhood injuries, main age groups taken into account in childhood injuries.
5. Duration of immobilization.
Sample answers to problems