Not a single person is immune from bone fractures, regardless of age, gender or some other individual characteristics. A fracture refers to complete or partial damage to the integrity of bones. A fall, a strong sudden blow, a catastrophe of a man-made or natural character, a road accident can lead to this.
Varieties of fractures
Fractures are divided into:
General features of open fracture
Open fractures - damage to the skeleton bones, accompanied by a violation of the integrity of the skin and underlying soft tissue, where the fracture area communicates with the external environment.
An open fracture is considered complex damage, since such injuries increase the risk of infection of parts of the bone with microbial flora.
This is what distinguishes open and
closed fracture of limbs. A characteristic feature of an open fracture is bone nudity, which significantly complicates the treatment, as well as softening and soft tissue detachment in the area of damage, which increases the risk of an infectious process. Hazardous to a person’s life when an open fracture is considered bleeding and shock.
Signs of an open fracture
Signs of open and closed injuries are slightly different, but in the first case, the severity of symptoms is ten times stronger. So:
- unusual mobility of a limb in a place where there is no joint;
- upon palpation of the affected area, a crunch is heard under the skin;
- the presence of a wound, both very small and extensive;
- venous bleeding;
- the condition of the victim quickly worsens
- signs of traumatic or hemorrhagic shock are visible.
Open fracture: classification
Open fractures, depending on the development mechanism, are divided into:
- primary open, resulting from simultaneous damage to the bone and soft tissues;
- secondary open, when the skin and soft tissues are damaged by the ends of bone fragments.
The severity of the fracture and the danger to human life underlie further classification. In the diagnosis, it is indicated in capital Russian letters, which means:
- A - fractures with minor damage to the soft tissues, whose viability is fully preserved or slightly impaired.
- B - injuries are of moderate severity, while the viability of soft tissues in the affected area is partially or completely impaired.
- B - a fracture with severe irreversible damage to the soft tissues, the removal of which is inevitable to maintain health.
The Kaplan-Markova classification complements the diagnosis by indicating the type of wound, where A is a puncture wound; B - bruised-lacerated wounds; B - crushed, crushed.
Roman numerals in the diagnosis indicate the size of the wound:
- I - small size up to 1.5 centimeters.
- II - the size of the wound ranges from 2-9 centimeters.
- III - a wound of more than 10 centimeters.
Group IV includes fractures of a very severe, extensive nature. There is a limb vitality disorder, accompanied by severe blood loss and shock. Often the limb is amputated.
The location of open fractures is determined by the name of the damaged bone. He can be:
- humeral;
- elbow;
- femoral
- tibial and fibular.
The mechanisms of bone destruction and the type of damage in the x-ray image divide the fractures into:
- oblique;
- transverse;
- bumper fractures that occur in the event of a car collision;
- helical;
- coarse / finely split;
- double (fracture with displacement of bone fragments and without it).
Diagnosis
Open fractures are easy to diagnose. To detect all damage, the fracture should be palpated. Next, an x-ray should be done, which allows you to determine the exact duration of the damage, the type of fracture, the nature of the displacement, the number of bone fragments. Open fractures of the extremities, fractures of the tubular bones and the spine require a minimum of two radiographs taken in two mutually perpendicular planes. In some cases, assessing the state of soft tissues requires an MRI. With an open fracture, there is a risk of damage to the integrity of nerves and blood vessels. If there are any, or there are suspicions, then you should consult a neurosurgeon and a vascular surgeon.
First aid in open fracture
First aid for injuries of this kind is to:
1. Stop bleeding, treat the edges of the wound with an antiseptic.
2. Apply a sterile dressing directly to the wound and fracture site.
3. Give an anesthetic such as analgin, pentalgin.
4. Immobilize the limb in the position that was before the damage.
5. Transport the victim to the nearest trauma center.
Assistance with an open fracture should in no case include attempts to reposition the bone that has come out, eliminate the bent limb, or combine damaged bones. This can only aggravate the problem.
An open hip fracture can result from a fall from a height or a car collision. Often this is accompanied by a displacement of the fragments, which leads the victim to a state of pain shock.
The first thing to do is to anesthetize. Then be sure to put a splint on the leg. Any long object is suitable for this: a board, a pipe, a stick. Splinting is performed along the entire body from the foot itself to the armpit. But it is impossible to impose it from that side where the broken bone is visible.
An open fractured arm is the most common type of injury. Most often occurs as a result of a strong blow or fall. In addition to bleeding, an open fracture of the arm can be accompanied by severe swelling of the limb, joint deformation. The risk of this type of damage lies in the possibility of severe blood loss in case of rupture of the artery, since it will be difficult to stop the blood. Emergency first aid consists in the application of a fixation tire to ensure immobility. Moreover, it should immobilize at least two joints in the fracture area. It is superimposed directly on the clothes. A tourniquet or tight bandage above the area of injury will help stop blood loss.
A fracture of a toe is no less common damage resulting from a direct injury such as a heavy object falling, shock, compression, tucking of the leg. First aid for injuries of this kind is simple. It can be provided by any person nearby, or the victim himself. The main thing in this case is to immobilize the foot. Shoes must be removed. A damaged finger should be bandaged to any hard object or to an adjacent finger. A fracture of a toe can be:
- open
- closed;
- displacement fracture;
- comminuted;
- regional fracture.
Fracture with displacement is the result of exposure to the bones of the finger of the force that led to the occurrence of injury. May be accompanied by infringement of neighboring nerves, blood vessels, muscles. The damage is accompanied by severe pain, swelling of not only the damaged finger, but also of the entire foot, hemorrhage under the skin, nail, impaired limb function.
Further treatment
After providing first aid, the victim should be hospitalized in the "Traumatology" department. Moscow has many specialized points working around the clock, where the patient will be provided with all the necessary assistance. Providing qualified assistance, doctors will determine the severity of the damage, assess hemodynamic parameters, conduct an initial diagnosis of the fracture, which includes examination and treatment of the wound, detection of clinical signs of trauma, and an x-ray. The patient will be given novocaine blockade and tetanus injections, broad-spectrum antibiotic drugs will be prescribed to avoid infection.
Then the patient is transferred to the operating room, where the wound will be cleaned of foreign bodies and contamination, separately lying bone fragments will be removed, badly damaged, non-viable tissue will be excised, the wound will be closed and turned into a closed fracture. Stitching of the edges of the wound should be carried out without tension, if this is impossible, then skin plastic is performed.
The stage of primary surgical treatment is very important, as it neutralizes the flora favorable for the development of pathogenic microorganisms and creates the conditions for favorable wound healing. Moreover, the excision of "low-quality" tissues is a good biological factor, because healthy living tissues better fight infections and heal.
It is better if primary surgical care is done in the first 8 hours after the injury. During this period, microorganisms do not have time to penetrate deep into the wounds to the tissues, spread throughout the body through the blood and lymph pathways.
PEP can be: early, carried out in the first 24 hours after damage; delayed up to 48 hours; late. The reasons for the delay can be traumatic shock, severe bleeding, surgery, associated with damage to important organs.
The main methods of immobilizing fragments
Any damage should be immobilized. To do this, taking into account the evidence, select:
- plaster cast;
- skeletal traction;
- primary, delayed internal osteosynthesis with metal structures;
- external osteosynthesis with an external fixation apparatus.
The gypsum dressing has good hygroscopicity, it is suitable as a fixation tool for seriously ill patients, it does not require technical skills, it allows you to give a gradual load to the injured limb. However, gypsum immobilizes adjacent joints and can squeeze a limb in a bandage.
Skeletal traction allows you to observe the limb and make dressings. If there was an open fracture with displacement, then it is the traction that allows the repaired fragments to be repaired. But this method of immobilization requires bed rest, rest of the limbs is not complete, requires control and adjustment.
Osteosynthesis is performed with oblique, helical, multi-fragmented, hard-to-hold fractures, as well as double and multiple fractures.
How open fractures heal
Fracture bone healing takes place in several stages. The first stage can be called preparatory. Here, coagulation of lymph and blood occurs, blood clots that form form envelop the ends of the fragments, and the serum secreted by the clot penetrates the soft tissues.
At the second stage, the primary connective tissue callus begins to form. It has a dense consistency, despite the fact that it does not contain lime salts or bone tissue. This corn does not allow bones to move freely in a damaged place. This process may vary in duration. A large amount of inflamed tissue, the presence of soft tissue between the ends of the bone, infection, and decreased ability of bone stem cells to reproduce can slow down the process.
The third phase begins approximately 2-3 weeks after the fracture. It is characterized by ossification. Connective tissue callus is compacted. However, she is still not able to transfer static or dynamic loads, so reliable immobilization remains relevant. During this period, the level of calcium in the blood serum rises.
During the fourth phase, the final reconstruction of the callus into a full bone occurs. A few months after the fracture, the new bone can support body weight. Bone callus is often much larger than the broken bone itself. The more extensive the damage to the bone and surrounding tissues, the more extensive the size of the corns. In the future, it decreases due to compaction of tissues and resorption of areas of the old bone. Moderate functional load will accelerate the reconstruction of bone marrow.
Slow bone formation is characterized by an open fracture. Treatment and healing of an injury can have a longer process if:
- an insufficient number of blood clots is formed at the fracture site, stimulating the process of formation of primary bone callus;
- due to infection, acute inflammatory processes have occurred, destructive changes that prevent the appearance of bone marrow;
- there is a process of death of bone fragments;
- fibrous cartilage forms in the connective tissue callus.
The rate of bone marrow formation largely depends on how and when assistance was provided, the location of the fracture, the age of the patient, and other causes.
To speed up the process of bone callus formation, you can use Bogomolets antireticular cytotoxic serum, bone meal, egg shell powder, phosphorus with fish oil.
Consequences of fractures
Open fractures have several threats. Qualified assistance not provided in time - in the first 6-8 hours after an injury - can lead to irreversible consequences. After this time, sepsis, blood poisoning may begin.
If you get into the wound of the earth, tetanus may develop. If a victim gets into traumatology, contaminated sites are excised, but with significant removal of muscle or tendon sections, to save a person’s life, there is a high probability that the patient will remain disabled.
From the foregoing, the conclusion suggests itself that favorable healing is possible with adequate first aid and first aid provided by traumatology. Moscow, being a large city, provides all the opportunities to provide the necessary assistance.
Is it possible to insure yourself against fractures
Fracture is a mechanical injury, which no one can insure against. However, statistics show that some injuries could have been avoided if the bones had a denser structure. Of course, this will not save from damage received in the event of a fall from a height, accident, or strong impact, but not every fall or torsion of the legs will end in a fracture. So the main goal of prevention is to strengthen bone tissue and prevent osteoporosis.
The first thing you should pay attention to is nutrition. Protein food, combined with a lot of coffee and similar drinks, reduces the amount of calcium in the body. Spinach, beets, celery, green vegetables, nuts, tea, cocoa and zinc-containing products will help to fill the deficiency and ensure good absorption of calcium by the body.
From this follows the next measure for the prevention of fractures - maintaining a healthy weight. Osteoporosis can develop not only in the presence of excess weight, which increases the load on the bones, but excessive thinness will not be a relief for him. You need to know the measure.
Sports can help with healthy weight. Sports do not mean new world records or evenings spent in the gym. But to allocate half an hour or an hour three times a week is within the power of almost everyone. Naturally, training complexes should be selected individually, taking into account age, human health, and opportunities. Gym trainers or a doctor can help with this. Caution with excessive physical exertion should be both men and women.
Bad habits also adversely affect bone density: drinking alcohol and smoking. Moreover, if the use of the first should be reduced to the minimum doses, then smoking should be completely abandoned. In smokers, fractures not only heal longer, but there is a high likelihood of abnormal fusion. The influence of alcohol is a violation of the metabolic processes of the body. The abuse of alcohol violates the absorption of calcium by the body, which affects the density of bone matter.
Vitamin D is also important for the health of our body, which can be obtained in the required amount by being in the sun every day for at least 15 minutes. This vitamin helps the body absorb calcium. Abuse of sunbathing, of course, is not worth anyone, especially people with sensitive skin. But the benefit of the modern beauty industry offers a choice of a wide range of skin protection products that should not be neglected.
Fractures of the elderly are very poorly tolerated. And even a trivial fall in your own apartment, house can lead to injury. Therefore, in this case, maximum attention should be paid to preventive measures. What does it mean? All overhanging or loose wires in the area of the floor should be removed.Carpets and carpets should lie flat, not stray. If there is a bathroom in it, it is necessary to install handrails and put non-slip mats. Domestic shoes should be comfortable, with a hard sole, and should not fall off your feet while walking.
Open fractures are very unpleasant injuries with a long recovery period. The correct first pre-medical and medical help will contribute to the normal restoration of the limb.