In modern medicine, various injuries are often diagnosed, which is associated with an active lifestyle of young people and various diseases in old age. Also, accidents and accidents that are not uncommon today lead to injuries of varying severity. One of the serious injuries of bone tissue is an intraarticular fracture. This pathology has its anatomical features, therefore, it requires special attention, diagnosis and effective treatment.
Description and description of the problem
An intraarticular fracture is a violation of the integrity of the bone, in which the fracture line is partially or completely located in the joint cavity. This damage is characterized by the involvement in the pathological process of not only bone tissue, but also a violation of the coherence of the articular surfaces, the development of contractures and impaired tendon mobility in the future.
Pathology can occur in the area of large or small joints. Typically, damage to large joints of the limbs leads to the development of negative consequences and complications in the long term.
The joints are part of the musculoskeletal system, providing mobility of the limbs. They consist of two ends of bones that fit together in shape, connected by a capsule and ligaments that hold them. The ends of the bones are covered with cartilage. Inside the joint is a lubricant that allows cartilage to slip and supply nutrients to it. All these structures together form the so-called hinge.
When an intra-articular bone fracture occurs, the pathological process affects all or almost all of the above structures. The integrity of the bone and joint, cartilage is violated. Blood enters the joint cavity, contributing to the development of hemarthrosis. The capsule becomes inflamed, along with ligaments it can burst at the time of injury or as a result of damage by bone fragments. The latter, in turn, are shifted and do not coincide with each other in shape. In case of impossibility to restore the shape of the articular ends or improperly restore them in humans, in the future there is a restriction of movements, chronic pain syndrome.
Fracture classification
Of greatest importance are fractures in the area of large joints:
- An intraarticular fracture of the tibia is difficult to treat, since the blood supply to the head and neck of the thigh is disrupted. Fusion of bone fragments is difficult, especially in people of old age. Usually they do not grow together, but overgrow with scar tissue.
- A fracture of the elbow joint is usually accompanied by intraarticular injuries, which are often accompanied by fractures. The difficulty of treatment is the severity of reposition and retention of bone fragments.
- An intraarticular fracture of the radial bone occurs with an injury to the shoulder and wrist. This type of fracture is easier to treat, since it is possible to restore the normal position of bone fragments that have been displaced. Therefore, the limb is not limited in movements after treatment.
- Fracture of the knee and ankle joint is also difficult to treat. In this case, it is important to fully restore the functionality of all segments.
Types of pathology
In traumatology, the following types of fractures are distinguished:
- Stable, characterized by a transverse kink line.
- Unstable, which are prone to secondary displacement after the removal of locking mechanisms. Shaky intraarticular fracture is also considered unstable.
- Open fractures are caused by soft tissue damage at the sharp ends of bone fragments. In this case, the wound may have a different size, infection may occur in it, which leads to suppuration and osteomyelitis.
- Closed intraarticular fractures, in which the integrity of the entire bone, as well as joints, is not broken.
Causes of the disease
The cause of this type of fracture are domestic, industrial or sports injuries, traffic accidents, falls from a height, natural disasters. As a result of this damage, can be accompanied by fractures of the pelvic bones, head injury, injuries of the abdomen and chest, organs of the genitourinary system.
In people of advanced age, an intraarticular fracture of the condyle (tibia) due to a careless fall, as well as an injury to the bones of the shoulder due to a fall on the arm, is most often found. Children often damage the wrist joint. This happens due to straightening or bending at the elbow of the hand when falling on the palm. In this case, an intraarticular fracture of the finger is often observed. Athletes usually injure knee joints.
Symptoms and signs of fractures
With such a fracture, as with any others, pain, edema and impaired limb functionality occur. In case of trauma, joint deformation occurs, hemarthrosis develops. Joint hemorrhage can be determined by its increased size and the accumulation of fluid in it. The severity of these symptoms depends on the location of the injury, its type, as well as other factors. One of the signs of joint damage is an effusion with an admixture of blood, which is obtained by puncture. If drops of fat are present in the material obtained, this indicates an intra-articular fracture.
Symptoms of each group of injuries may be different, but all fractures have common signs: pain and swelling in the damaged area.
Diagnostic measures
To make an accurate diagnosis in traumatology, two main diagnostic methods are used:
- Clinical examination in the form of a visual examination of the patient, the study of complaints and an anamnesis of pathology.
- X-ray of the bone in several projections (face and profile). For some joints, a half-profile picture may be assigned.
In most cases, an intraarticular fracture is differentiated with a traumatic dislocation. A more accurate diagnostic technique is tomoentgenography, arthroscopy, and tangential projections.
First aid
If you suspect a fracture, you should immediately contact a medical institution. When transporting the victim to the clinic, it is necessary to immobilize the ankle, knee and hip joints with the help of a long tire, which should cover the area from the armpit to the ankle. For complete immobilization of the victim, it is recommended to use the Diterichs bus. In the absence of a tire, it is recommended to use improvised means. In this case, you can wind the damaged limb to the body.
Pathology treatment
In case of intraarticular fracture, the victim is hospitalized in the trauma unit. The treatment is aimed at the most accurate restoration of the anatomical position of the bone fragments.
If the knee joint is damaged, puncture is first performed. Plaster is usually used for fractures without displacement. In the opposite case, apply skeletal traction or resort to surgery.
Most often, surgical intervention is used to treat such injuries, since it allows the patient to resume motor activity in a short period of time and reduce the risk of contracture. In each case, the doctor chooses a particular treatment technique. During the operation, the surgeon compares the bone fragments as accurately as possible and fastens them with screws or pins, this makes it possible to achieve the normal functioning of the joints.
In some cases, endoprosthetics are required, as a result of which the affected joint is replaced with an artificial prosthesis. This procedure is used for complex fractures when osteosynthesis is not possible, for example, with extensive injuries or the presence of a large number of bone fragments.
Rehabilitation
During the rehabilitation period, the doctor prescribes physiotherapy and exercise therapy, as well as massage. In this case, massage is prescribed individually, as sometimes this procedure can cause the formation of excess bone marrow. This technique allows you to restore blood circulation in the vessels and improve trophic tissue that has been affected. An important point in the recovery period is the complete restoration of joint functions. A doctor selects a set of therapeutic exercises for each patient.
Forecast and Prevention
With stable fractures, the prognosis will be favorable. In severe cases, pathology can lead to disability of the patient. In the treatment of fractures, the main thing is to choose the right technique, which will make it possible to restore the functionality of the joints in the shortest possible time.
Prevention of pathology should be aimed at eliminating provoking factors. Since older people are at risk, they are advised to behave carefully even when doing homework.
An intra-articular fracture is the kind of damage that is quite common today. Such an injury can occur at any age, it refers to emergency conditions that require timely medical intervention and a long rehabilitation period. To prevent the development of complications, it is necessary to contact a medical institution as soon as possible.