No person is immune from bone fractures, regardless of age, gender or any other individual characteristics. A fracture is a complete or partial damage to the integrity of the bones. This can be caused by a fall, a strong sudden blow, a man-made or natural disaster, a car accident.
Types of fractures
Fractures are divided into:
- open;
- closed.
Common features of an open fracture
Open fractures - damage to the bones of the skeleton, 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 a complex injury, as such injuries increase the risk of infection of parts of the bone with microbial flora.
This is what distinguishes open and closed limb fractures. characteristicfor an open fracture is also the exposure of the bone, which greatly complicates the treatment, as well as the crushing and detachment of soft tissues in the area of damage, which increases the risk of an infectious process. Bleeding and shock are considered life-threatening when a fracture is open.
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 limb mobility in a place where there is no joint;
- when palpation of the affected area under the skin, a crunch is heard;
- presence of a wound, both very small and extensive;
- venous bleeding;
- victim's condition is deteriorating rapidly;
- show signs of traumatic or hemorrhagic shock.
Open fracture: classification
Open fractures, depending on the mechanism of development, 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 by capital Russian letters, which means:
- A - fractures with minor soft tissue damage, whose viability is fully preserved or slightly impaired.
- B - injuries are of moderate severity, whilethe viability of soft tissues in the affected area is partially or completely impaired.
- B - a fracture with severe irreversible damage to soft tissues, the removal of which is inevitable to maintain he alth.
Kaplan-Markova's classification complements the diagnosis by indicating the type of wound, where A - stab wounds; B - bruised-lacerated wounds; C - 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 varies between 2-9 centimeters.
- III - wound over 10 centimeters.
IV group includes fractures of a very severe extensive character. There is a disorder of the viability of the limb, accompanied by severe blood loss and shock. Often the limb is amputated. Localization of open fractures is determined by the name of the damaged bone. It can be:
- shoulder;
- elbow;
- femoral;
- tibial and fibular.
Mechanisms of bone destruction and type of damage on x-ray divide fractures into:
- oblique;
- transverse;
- bumper fractures that appear in the event of a car collision;
- helical;
- coarse/finely splintered;
- double (fracture with and without displacement of bone fragments).
Diagnosis
Open fractures are easy to diagnose. The fracture should be palpated to identify any damage. Next, an x-ray should be taken, which allows you to determine the exactthe duration of the injury, the type of fracture, the nature of the displacement, the number of bone fragments. Open fractures of the extremities, fractures of tubular bones and the spine require at least two radiographs taken in two mutually perpendicular planes. In some cases, soft tissue assessment requires an MRI. With an open fracture, there is a risk of damage to the integrity of the nerves and blood vessels. If there are any, or there is a suspicion, then a neurosurgeon and a vascular surgeon should be consulted.
First aid for an open fracture
First aid for this kind of injury is to:
1. Stop the 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 like analgin, pentalgin.
4. Immobilize the limb in the position it was before the injury.
5. Transport the victim to the nearest trauma center. Aid for an open fracture should in no case include attempts to set a protruding bone, eliminate a twisted limb, or realign damaged bones. This will only exacerbate 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 debris, which leads the victim into a state of pain shock.
The first thing to do is 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 cannot be applied from the side where the broken bone is visible.
Open hand fracture 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 may be accompanied by severe swelling of the limb, joint deformity. The risk of this type of damage lies in the possibility of severe blood loss in the event of a rupture of the artery, since it will be difficult to stop the blood. Emergency first aid consists in imposing a fixing splint to ensure immobility. Moreover, it must 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 the blood loss. Fractured toe is an equally common injury resulting from direct trauma such as falling heavy objects, impact, compression, twisting of the foot. First aid for this kind of injury 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. The injured finger should be bandaged to any hard object or to an adjacent finger. A broken toe can be:
- open;
- closed;
- displaced fracture;
- comminuted;
- marginal fracture.
Fracture withdisplacement is obtained as a result of the force acting on the bones of the finger, which led to the occurrence of injury. May be accompanied by infringement of neighboring nerves, blood vessels, muscles. Damage is accompanied by severe pain, swelling not only of the injured finger, but of the entire foot, hemorrhage under the skin, nail, dysfunction of the limb.
Further treatment
After providing first aid, the victim should be hospitalized in the Traumatology Department. Moscow has many specialized centers operating around the clock, where the patient will be provided with all the necessary assistance. Providing qualified assistance, doctors will determine the severity of the injury, evaluate hemodynamic parameters, and conduct an initial diagnosis of the fracture, which includes examination and treatment of the wound, detection of clinical signs of injury, and an x-ray. The patient will be given novocaine blockades and tetanus shots, and broad-spectrum antibiotics will be prescribed to avoid infection.
Next, the patient is transferred to the operating room, where the wound will be cleaned of foreign bodies and contamination, bone fragments lying separately will be removed, severely damaged, non-viable tissues will be excised, the wound will be closed and turned into a closed fracture. Stitching the edges of the wound should be carried out without tension, if this is not possible, then skin grafting 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 conditions for favorable wound healing. Moreover, the excision of "low-quality"tissue is a good biological factor, because he althy living tissue is better at fighting infections and healing.
It is better if the primary surgical care is performed in the first 8 hours after the injury. During this period, microorganisms will not have time to penetrate deep into the wound to the tissues, spread throughout the body through the blood and lymphatic pathways.
PHO 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.
Basic methods of immobilization of fragments
It is necessary to immobilize the damage in any case. To do this, taking into account the indications, select:
- plaster cast;
- skeletal traction;
- primary, delayed internal osteosynthesis with metal structures;
- external osteosynthesis with an external fixator.
The plaster bandage has good hygroscopicity, is suitable as a means of fixation for seriously ill patients, does not require technical skills, allows you to give a gradual load to the injured limb. However, the cast immobilizes adjacent joints and can compress a bandaged limb.
Skeletal traction allows you to observe the limb and make dressings. If there was an open fracture with displacement, then it is traction that allows repositioning of the displaced fragments. But this method of immobilization requires bed rest,rest of the limb is not complete, it requires control and adjustment. Osteosynthesis is performed for oblique, helical, multi-comminuted hard-to-hold fractures, as well as for double and multiple.
How open fractures heal
Healing of a bone in case of a fracture takes place in several stages. The first stage can be called preparatory. Here, lymph and blood coagulation occurs, the resulting blood clots 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 texture, despite the fact that it contains neither lime s alts nor bone tissue. This callus does not allow the bones to move freely in the damaged area. The duration of this process may vary. A large amount of inflamed tissue, the presence of soft tissue between the ends of the bone, infection, reduced ability of bone tissue stem cells to reproduce can slow down the process.
The third phase starts about 2-3 weeks after the fracture. It is characterized by ossification. The connective tissue corn is compacted. However, she is not yet able to transfer static or dynamic loads, so reliable immobilization is still relevant. During this period, the level of calcium in the blood serum rises.
During the fourth phase, the final restructuring of the callus into a full-fledged bone takes place. A few months after the fracture, a newthe bone can support the weight of the body. The callus is often much larger than the broken bone itself. The more extensive the damage to the bone and surrounding tissues, the larger the size of the callus will be. In the future, it decreases due to tissue compaction and resorption of old bone areas. Moderate functional load will accelerate the restructuring of the callus.
Delayed callus formation is characterized by an open fracture. Treatment and healing of an injury may take longer if:
- an insufficient amount of blood clots form at the fracture site, stimulating the formation of primary callus;
- on the basis of infection, acute inflammatory processes, destructive changes that prevent the formation of callus;
- bone fragments are dying off;
- Fibrous cartilage is formed in the connective tissue callus.
The rate of callus formation largely depends on how and when assistance was provided, on the location of the fracture, the age of the patient and other reasons. To accelerate the process of callus formation, you can use Bogomolets antireticular cytotoxic serum, bone meal, eggshell powder, phosphorus with fish oil.
Consequences of fractures
Open fractures have several threats. Timely unqualified assistance - in the first 6-8 hours after the injury - can lead to irreversible consequences. After this time, sepsis, blood poisoning, may begin.
Tetanus can develop if it gets into the wound of the earth. If the victim gets into traumatology, the contaminated areas are excised, but with a significant removal of muscle or tendon sections, in order 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 medical aid provided by traumatology. Moscow, being a large city, provides every opportunity to provide the necessary assistance.
Is it possible to insure yourself against fractures
A fracture is a mechanical injury that 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 you from damage received in the event of a fall from a height, an accident, or strong blows, but not every fall or twisting of the legs will end in a fracture. This means that the main goal of prevention is to strengthen bone tissue and prevent osteoporosis.
The first thing you should pay attention to is food. 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 foods will help to fill the deficiency and ensure good absorption of calcium by the body.
This leads to another fracture prevention measure – maintaining a he althy weight. Osteoporosis can develop not only withthe 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 when to stop.
Sports can help with a he althy weight. Sports activities do not mean new world records or long evenings spent in the gym. But almost everyone can set aside half an hour or an hour three times a week. Naturally, the complexes of classes should be selected individually, taking into account the age, state of human he alth, and opportunities. Gym trainers or a doctor can help with this. Both men and women should be careful with excessive physical activity.
Bone density is also adversely affected by bad habits: drinking and smoking. Moreover, if the use of the former should be reduced to minimal doses, then smoking must be completely abandoned. In smokers, fractures not only heal longer, but there is also a high probability of improper fusion. The effect of alcohol is to disrupt the metabolic processes of the body. Alcohol abuse interferes with the absorption of calcium by the body, which worsens bone density.
Vitamin D is also important for the he alth 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. Of course, no one should abuse sunbathing, especially people with sensitive skin. But the benefit of the modern beauty industry offers a wide choicea range of skin protection products not to be missed.
Fractures are very poorly tolerated by the elderly. And even a banal fall in your own apartment or house can lead to injury. Therefore, in this case, maximum attention should be paid to preventive measures. What does it mean? Any overhanging or loose wires in the floor area should be removed. Carpets and rugs should lie flat, not stray. If there is a bathroom, it is necessary to install handrails and put non-slip mats in it. Home shoes should be comfortable, with a hard sole, and should not fall off the foot while walking.
Open type fractures are very unpleasant injuries with a long recovery period. Proper first aid and medical assistance will contribute to the normal recovery of the limb.
