In modern medicine, various injuries are often diagnosed, which are associated with an active lifestyle of young people and various diseases in old age. Also, accidents, traffic accidents, which are not uncommon today, lead to injuries of varying severity. One of the serious injuries of bone tissue is an intra-articular fracture. This pathology has its own anatomical features, therefore, it requires special attention, diagnosis and effective treatment.
Characteristics and description of the problem
Intra-articular fracture - a violation of the integrity of the bone, in which the fracture line is partially or completely located in the articular cavity. This damage is characterized by the involvement of not only bone tissue in the pathological process, but also by a violation of the coherence of the articular surfaces, the development of contractures and a disorder of tendon mobility in the future.
Pathology can occur in the area of large or small joints. Usuallydamage to large joints of the limbs leads to the development of negative consequences and complications in the long term.
Joints are part of the musculoskeletal system that provides mobility to 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 ensures the cartilage glides and supplies 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. Violated the integrity of the bone and joint, cartilage. Blood enters the joint cavity, contributing to the development of hemarthrosis. The capsule becomes inflamed, along with the ligaments, it can rupture at the time of injury or as a result of damage by bone fragments. The latter, in turn, are displaced and do not coincide with each other in shape. If it is impossible to restore the shape of the articular ends or their incorrect restoration, a person will experience limitation of movements in the future, chronic pain syndrome.
Classification of fractures
Fractures in the area of large joints are of the greatest importance:
- Intra-articular fracture of the tibia is difficult to treat, as the blood supply to the head and neck of the femur is disturbed. Fusion of bone fragments is difficult, especially in people of senile age. Usually they do not grow together, but are overgrown with scar tissue.
- Fracture of the elbow joint is usually accompanied by intra-articular injuries, which are often accompanied by fracture-dislocations. The difficulty of treatment lies in the severity of the reposition and retention of bone fragments.
- Intra-articular fracture of the radius occurs when the shoulder and wrist are injured. 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 movement 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
Also in traumatology, the following types of fractures are distinguished:
- Stable, characterized by a transverse fracture line.
- Unstable, which are prone to secondary displacement after the removal of the locking mechanisms. A comminuted intra-articular fracture is also considered unstable.
- Open fractures are caused by damage to soft tissues by the sharp ends of bone fragments. In this case, the wound may have a different size, infection may enter into it, which leads to suppuration and osteomyelitis.
- Closed intra-articular fractures, in which the integrity of the entire bone, as well as the joints, is not broken.
Causes of disease development
The cause of this type of fractures are domestic, industrial or sports injuries, accidents, falls from a height, natural disasters. ATas a result of this damage, it can be accompanied by fractures of the pelvic bones, TBI, injuries of the abdomen and chest, and organs of the genitourinary system.
In the elderly, intra-articular fracture of the condyle (tibia) due to an incautious fall, as well as trauma to the bones of the shoulder due to a fall on the arm, is most common. Children often damage the wrist joint. This happens due to straightening or bending at the elbow of the arm when falling on the palm. In this case, intra-articular fracture of the finger is often observed. Athletes commonly injure their knee joints.
Symptoms and signs of fractures
With such a fracture, as with any other, there is pain, swelling and dysfunction of the limb. With an injury, joint deformity occurs, hemarthrosis develops. Hemorrhage into the joint 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, and other factors. One of the signs of joint damage is an effusion mixed with blood, which is obtained by puncture. If there are drops of fat in the obtained material, this indicates an intra-articular fracture.
The 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, twomain diagnostic method:
- Clinical examination in the form of a visual examination of the patient, the study of complaints and history of pathology.
- Radiography of the bone in several projections (face and profile). For some joints, a half-profile shot may be assigned.
In most cases, an intra-articular fracture is differentiated from traumatic dislocation. A clarifying diagnostic technique is tomorentgenography, arthroscopy, tangential projections.
First Aid
If you suspect a fracture, you should immediately contact a medical facility. When transporting the victim to the clinic, it is necessary to immobilize the ankle, knee and hip joints with a long splint, which should capture the area from the armpit to the ankle. For complete immobilization of the victim, it is recommended to use the Dieterichs splint. In the absence of a tire, it is recommended to use improvised means. In this case, you can tape the injured limb to the body.
Treatment of pathology
In case of an intra-articular fracture, the victim is hospitalized in the trauma department. The treatment is aimed at the most accurate restoration of the anatomical position of the bone fragments.
In case of damage to the knee joint, a puncture is first performed. Gypsum is usually used for non-displaced fractures. Otherwise, skeletal traction is used or surgery is performed.
Surgery is most often used to treat such injuries, as it allowsin a short period of time, resume the patient's motor activity and reduce the risk of developing contractures. In each case, the doctor chooses one or another method of therapy. During the operation, the surgeon matches 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, arthroplasty is 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.
Rehab
During the rehabilitation period, the doctor prescribes physiotherapy and exercise therapy, as well as massage. In this case, massage is prescribed on an individual basis, since sometimes this procedure can cause the formation of excess callus. This technique allows you to restore blood circulation in the vessels and improve the trophism of tissues that have suffered. An important point in the recovery period is the complete resumption of the functions of the joints. The 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 that will make it possible for the maximuma short time to return the functionality of the joints.
Prevention of pathology should be aimed at eliminating provoking factors. Since the elderly are at risk, they are advised to be careful even when doing housework.
Intra-articular fracture is a type of injury that is quite common today. Such an injury can occur at any age, it is an emergency that requires timely medical intervention and a long period of rehabilitation. To prevent the development of complications, it is necessary to contact a medical institution as soon as possible.
