Bones on the legs

Fractures of bones are their symptoms. What is a closed fracture, its signs and methods of treatment. Methods of simultaneous reposition

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fracture

You can get an unwanted injury in the form of a fracture anywhere and anyhow.

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 bone damage partially or completely due to the mechanical intervention of 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

- mechanical injuries: blows, car accident, gunshot wound, muscle contractions
- bone disease
- lack of minerals and vitamins in the bones
- physiological conditions: old age, pregnancy.

Types of fractures

- Traumatic fractures
- Pathological (non-traumatic) 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

- Metaphyseal
- diaphyseal
- epiphyseal

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

It is not always possible for a person who does not have the appropriate education to determine whether there is actually a fracture or not. But, one way or another, the first signs can still be seen. First of all, if these are limbs (arms, legs), deformations in the affected area will be visible. There will be swelling, accompanied by acute pain. If the ribs are broken, the corresponding signs (trough) will also be visible.

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. With an 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 dangerous 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

If a closed fracture is obtained, an anesthetic is injected into the wound area and plaster is applied. It will be a little more difficult already with an open fracture. After a fracture, bleeding stops for the victim, with local anesthesia or anesthesia, the bone is leveled, fragments are fastened. In some cases, when displacement is detected, a load is used. The method of application of treatment may be different.

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

Shock wave therapy is often used for rehabilitation. 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 do not get the necessary help in time, 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

Fractures of bones - various damage to their integrity as a result of traumatic impact. During an injury, the impact force exceeds the resistance of the bone tissue and the bone breaks. According to the causes of occurrence, all bone fractures are divided into two main groups: those resulting from a strong mechanical effect on a healthy bone and pathological fractures.

Traumatic bone fractures occur as a result of traffic accidents, falls, strong blows and other mechanical effects on the bones.

With pathological bone fractures, the physical force of the impact can be quite insignificant, the real reason lies in the presence of some pathological process occurring in the bone tissue.

A common cause of pathological bone fractures is the disease osteoporosis (rarefaction of bone tissue), due to which the bone tissue becomes extremely fragile and breaks with little or no external force acting on it, for example, during awkward movements, sudden standing up, etc.

The classification of bone fractures by type is extremely diverse. This circumstance is due to the fact that each specific case of a fracture combines a large number of factors that accompany its occurrence - the causes of the fracture, the location of the injury, the nature of the soft tissue injury, etc. displacement of bone fragments, the nature of the fracture and other parameters.

Nevertheless, with all the variety of types of bone fractures, there is an urgent need to accurately determine the area of bone tissue that is the center of the fracture.

The most common classification of bone fractures is:

simple;

Complex (otherwise referred to as wedge-shaped bone fractures, in which multiple comminuted bone fragments are formed);

extra-articular fractures;

Intra-articular fractures.

There is also the following classification of fractures:

Closed bone fractures, in which there is no damage to the outer skin;

Open fractures of bones, in which there is a violation of the integrity of the skin in the area of injury and there is a risk of infection.

Symptoms of bone fractures

The obligatory signs of a fracture of the bones of the traumatologists include the presence of external bruising and swelling in the area of injury. As a rule, when it comes to a limb, its functional mobility is significantly limited. When you try to move sharply expressed pain. In rare cases (for example, with an impacted fracture of the femoral neck), some victims can continue to move independently, but this fact leads to further injury and displacement of bone fragments. With impacted, subperiosteal, periarticular, intra-articular fractures and bone fractures, some of the above symptoms may be completely absent or not very pronounced.

Diagnosis of bone fractures

Before taking measures to apply plaster (or other options for fixing bone fragments) within the walls of a medical institution, an x-ray examination of the victim with a fracture of the bones is mandatory. X-ray images are always taken in several projections for a detailed study of the site of a bone fracture from several different angles.

X-ray examination is the most accurate tool that allows traumatologists to create a complete picture of a bone fracture - its type, location, direction and nature of fragment displacement.

Then control x-rays are made to the patient after conservative or surgical fixation of the broken bone. In the future, an X-ray examination is prescribed after about 14 days (in each case - differently) to monitor the progress of the fusion of the broken bone and the formation of callus at the fracture site.

Treatment of bone fractures

Measures for the treatment of bone fractures should begin directly at the scene. The most urgent help in the first minutes after injury should be measures to eliminate pain shock, especially when it comes to bone fractures in children.

Next, you need to take action to stop the bleeding (if any). Immediately after the above first aid measures, immobilization (creation of conditions for complete immobility) of the bone fracture site should be ensured using special tools or improvised materials.

In the case of an open fracture of the bones, a sterile gauze and a pressure bandage should be applied from above to the wound surface to prevent the possibility of further bleeding and infection of the wound. In no case should you try to independently set the fragments of bones sticking out of an open wound, thereby you can only cause severe pain to the victim, but also cause significant harm to his state of health.

First aid for a closed fracture of the bones consists primarily in immobilizing the damaged area of the body to prevent the possibility of displacement of fragments and the occurrence of internal bleeding.

Timely and competent first aid provided to the victim significantly reduces the subsequent rehabilitation period for bone fractures and guarantees the full restoration of the motor functions of the damaged area of the body.

In a hospital setting, the main medical treatments for bone fractures include the following:

The imposition of a plaster bandage;

Skeletal traction;

Endoprosthetics;

External hardware compression-distraction osteosynthesis;

Internal osteosynthesis, etc.

In order for the victim not to lose his ability to work in the future and to be able to return to his usual way of life as soon as possible, special attention should be paid to the rehabilitation period after a bone fracture. The list of rehabilitation measures after a bone fracture (and especially after prolonged immobilization) should certainly include therapeutic exercises and physiotherapy.

Video from YouTube on the topic of the article:

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

ICD-10

S42 S52 S72 S82

General information

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

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

Causes of the fracture

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

Classification

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

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

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

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

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

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

Fracture symptoms

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

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

Complications

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

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

Diagnostics

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

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

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

Fracture treatment

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

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

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

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

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

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

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

Necessary signs that help differentiate true bone damage from severe soft tissue contusion. Signs are conditionally divided into absolute, that is, obvious and not subject to doubt, and relative, that is, indicative. The absolute symptoms of a fracture are characteristic and immediately confirm a fracture, indicative ones may indicate a possible bone injury, but may also be signs of other, clinically similar injuries.

What are the symptoms of a fracture?

Fracture symptoms are relative:

Pain is present, which may be aggravated by stress on the fracture site. If the lower leg is broken, tapping on the heel will increase pain in the area of injury;
Edema may form at the fracture site, but it does not always develop quickly and cannot serve as direct evidence of a fracture, on the contrary, it is rather evidence of a bruise or sprain;
A hematoma may not form immediately if the hematoma is pulsating, this indicates an extensive hemorrhage into the subcutaneous tissue;
Limitation of motor activity, movement causes pain;
Damaged bone, the limb may look atypical (fracture of the radius, lower leg, and so on).

Fracture symptoms are absolute:

Explicit uncharacteristic position and appearance of the limb;
Excessive mobility in areas where there are no joints;
On palpation, a characteristic crunch is felt - crepitus, crepitus is heard with a phonendoscope, sometimes with the naked ear;
An open wound and bone fragments with an open fracture.

Reliable symptoms of a fracture are pathological, uncharacteristic bone mobility at the site of injury, open wounds, changes in the ratio of joints, crepitus. The probable symptoms of a fracture are edema, single or multiple hematomas, and pain.

A fracture is diagnosed as standard - examination, palpation, percussion (in case of a fracture of the spine), determination of finger mobility, x-ray. Attention is also drawn to the skin in the peripheral areas of the injury, their color and shade are studied. Bluish-pale skin, sometimes with a marble pattern, indicates damage to the nerve endings and blood vessels of the limb. Also, an alarming signal is a weak pulse or its absence in the characteristic metas, where the pulse was always felt (radial artery, rear of the foot, popliteal zone). It must be determined whether there is a violation of blood flow in the peripheral zones of the upper or lower extremities. The most accurate and reliable method for diagnosing fractures of any localization and types is an x-ray. As a rule, it is carried out in several projections to see the state of nearby joints. An x-ray of an intact paired limb may also be prescribed to determine the asymmetry and ratio of the landmarks of the skeletal system. X-ray provides specific information about the nature and severity of the fracture, the possible displacement or presence of bone fragments.

Fracture symptoms and types

Symptoms of an ankle fracture

Such injuries are conditionally divided into four groups:

Isolated, isolated ankle (ankle) fractures;
Fracture with the turn of the foot inward - adduction;
Fracture with rotation of the foot from the outside - outward - abduction;
Fracture of two ankles with damage to the tibia.

If both ankles are injured, then the fracture is accompanied by a dislocation. The clinical symptoms of a fracture are swelling that grows rather quickly, often a hematoma at the site of injury, and severe pain.

Symptoms of a broken leg

Such traumatic injuries are very common and account for up to 30% of the total number of fractures. The clinical symptoms of a fracture are typical, however, with an injury to the lower leg, hemarthrosis (accumulation of blood in the joint cavity) often occurs. Visually, the lower leg is displaced either outward or inward. The knee does not function, its lateral movements are impaired.

Hand fracture symptoms

The hand is the leader in the number of common injuries, it is most often associated with domestic causes. Such symptoms of a fracture are characteristic as: the presence of swelling, severe pain at the fracture site, pain is especially felt in the area of the elbow joint. Sometimes a hand injury is accompanied by an increase in body temperature, which may indicate a severe hemorrhage at the site of injury (combined fracture of the forearm). Deformation of the hand is noticeable only with a fracture with displacement; crepitus is also uncharacteristic. A crunch appears only in the case of a multiple, fragmentary fracture of the bone.

Symptoms of a spinal fracture of varying severity

The symptoms of a fracture of this kind are very characteristic and, as a rule, are not in doubt. Spinal injuries are considered the most disturbing and dangerous, sometimes not only for health, but also for the life of the victim. With a fracture, there is a strong compression of one of the main hematopoietic organs - the spinal cord. Such an injury is fraught with complete immobility, paralysis. In addition to the typical signs that are characteristic of all fractures, a spinal injury is manifested by severe deformity, protrusion or drowning of the vertebrae. There is acute pain, especially on palpation of the damaged area. Often, a spinal fracture is accompanied by immobility, loss of sensation in the area below the waist. This loss of control of the lower half of the body leads to urinary and fecal incontinence, or retention.

The symptoms of a fracture are almost always obvious, they can only be confused with a severe bruise. In any case, before seeking medical help, it is necessary to provide the victim with immobility, immobilize the injured area. The final diagnosis can be made by the surgeon with the help of examination, palpation and X-ray.