Causes of fractures. Fracture, what is it? Absolute signs of a fracture

Fracture - violation of the integrity of the bone along its length, caused by mechanical stress (trauma) or the influence of a pathological process in the bone (tumor, inflammation).

An incomplete fracture is a type of injury in which the fracture surface does not pass through the entire diameter of the bone, i.e. when there is a crack or break in the bone (like a “green twig” for fractures in children).

Bone fractures account for 6-7% of all closed injuries. Fractures of the bones of the hand and foot are observed more often (more than 60%), fractures of the bones of the forearm and lower leg are equally common and together account for 20%, ribs and sternum - 6%, fractures of the scapula (0.3%), vertebrae (0. 5%), pelvis (0.6%), femur (0.9%).

Classification of fractures

I.By origin: a) congenital (intrauterine); b) acquired (traumatic and pathological).

II. Depending on the damage of certain organs or tissues (complicated, uncomplicated) or skin (open, closed).

III.By localization: a) diaphyseal; b) epiphyseal; c) metaphyseal.

IV.In relation to the fracture line to the longitudinal axis of the bone: a) transverse; b) oblique; c) helical (spiral).

V.According to the position of bone fragments relative to each other: a) with an offset; b) without displacement.

Reason congenital fractures are changes in the bones of the fetus or abdominal trauma during pregnancy. Such fractures are often multiple. Pathological fractures are caused by changes in the bone under the influence of a tumor, osteomyelitis, tuberculosis, echinococcosis, bone syphilis. There are obstetric fractures that occur during the passage of the fetus through the birth canal.

Complicated include open fractures with damage to the skin or mucous membrane (which creates conditions for a microbe to penetrate through the wound and develop inflammation in the area of ​​the bone fracture), as well as fractures accompanied by damage to large vessels, nerve trunks, internal organs (lungs, pelvic organs, brain or spinal cord, joints - intra-articular fractures). At closed fractures no damage to the skin occurs.

Incomplete fractures.fissura - incomplete front, in which the connection between parts of the bone is partially broken. Fractures are also identified subperiosteal, in which fragments are held by the surviving periosteum and do not move, are observed in childhood.

Action of a traumatic agent on the bone can be different, its nature is determined by the type of bone fracture. Mechanical impact, depending on the point of application and direction of the acting force, can lead to fractures from direct impact, bending, compression, twisting, tearing, and crushing (Fig. 68). Direct hit hits a fixed bone with an object moving at high speed; when the body falls, a sharp load on the bone fixed at its ends leads to its bending; compression bones are observed during a sharp load along the length of the bone, for example, a fall on an outstretched arm or compression of the vertebrae during a sudden strong load along the length of the spine in the event of a fall from a height onto the buttocks; twisting bones occur when the body rotates when the limb is fixed (for example, when a skater moves on a turn, when the skate gets into a crack).

The fracture line may be straight (transverse fracture) - with a direct blow, oblique - when bending, spiral (helical) - when twisting a bone, hammered - when the bone is compressed, when one bone fragment enters another. At tear-off In a fracture, a severed bone fragment moves away from the main bone; such fractures occur with a sudden, sharp, strong contraction of the muscles, which create a sharp pull on the tendons attached to the bone, when the ligaments are strained due to a sharp hyperextension of the joints. When a bone is fractured, several bone fragments (splinters) can form - splintered fractures.

Rice. 68. Types of bone fractures depending on the mechanism of injury: a - from bending; b - from a direct blow; c - from twisting; g - from fragmentation; d - from compression along the length. The arrow indicates the direction of action of the traumatic agent.

Open bone fractures that occur under different conditions have their own characteristics: those working in industrial enterprises are more likely to experience open fractures of the bones of the forearm, hand and fingers, which occur when their hands get caught in rapidly rotating mechanisms; such fractures are accompanied by extensive lacerations, bone fragmentation, crushing of soft tissues, damage to blood vessels and nerves, tendons, extensive skin detachment and defects.

Open fractures of both upper and lower extremities are observed in those employed in agriculture. The wound is deep, large, and contaminated with soil or manure.

Open fractures sustained in a train accident, transport accident, or building collapses are characterized by crushed fractures of the limbs with extensive crushing of the skin and muscles, and contamination of the wound; the tissues are imbibed with blood, dirt, and earth.

The more extensive, deeper and more severe the damage to the skin and underlying tissues during open bone fractures, the greater the risk of infection. With agricultural and road injuries, there is a high risk of developing aerobic and anaerobic infections (tetanus, gas gangrene). The severity of open bone fractures largely depends on the location of the fracture. The risk of developing infection in open fractures of the lower extremities is greater than that of the upper extremities, since the lower extremity has a larger array of muscles, the skin is more contaminated, and there is a higher possibility of infection and soil contamination of the wound. Open fractures with crushing of bones and crushing of soft tissues over a large area, with damage to large main vessels and nerves, are especially dangerous.

Displacement of fragments(dislocatio). When bones are fractured, the fragments rarely remain in their usual place (as happens with a subperiosteal fracture - a fracture without displacement of the fragments). More often they change their position - a fracture with displacement of fragments. Displacement of fragments can be primary (under the influence of the mechanical force that caused the fracture - impact, flexion) and secondary - under the influence of muscle contraction, which leads to movement of the bone fragment.

Rice. 69. Types of displacement of bone fragments during fractures: a - lateral displacement (width); b - displacement along the axis (at an angle); c - displacement along the length with elongation; d - displacement along the length with shortening; d - rotational displacement.

Displacement of fragments is possible both in case of a fall during an injury, and in the event of improper transfer and transportation of the victim.

The following types of displacement of fragments are distinguished: along the axis, or at an angle (dislocatio ad аn), when the axis of the bone is disrupted and the fragments are located at an angle to each other; lateral offset, or in width (dislocatio ad latum), in which the fragments diverge to the sides; bias along the length (dislocatio ad longitudinem), when fragments are displaced along the long axis of the bone; bias along the periphery (dislocatio ad periferium), when the peripheral fragment is rotated around the axis of the bone, there is a rotational displacement (Fig. 69).

Displacement of bone fragments leads to deformation of the limb, which has a certain appearance with a particular displacement: thickening, increase in circumference - with transverse displacement, disruption of the axis (curvature) - with axial displacement, shortening or lengthening - with displacement along the length.

A fracture is an abnormal condition that leads to bone deformation due to a damaging factor that exceeds the strength of the bone tissue. Damage most often occurs in childhood and old age. This is due to the anatomy and physiology of the body.

The most common injuries include fractures of tubular bones.

In addition to bones, during damage, nearby tissues and muscles are most often affected. Nerves and blood vessels are much less likely to be injured.

Causes of fracture

When determining the cause of injuries, they can be divided into two large groups.

• The causes of fractures of the first group include force on the bone: a fall, a blow.
• The factor causing the second group fracture is the fragility of the bone itself and its weakening.

With the second type of reason, the risk of fracture increases several times. It can get to the point where limbs are broken during normal walking. The danger in this case is that the fracture is associated with the pathology of the bone itself, and not with force on it.

Very often this is affected by a number of diseases, such as osteoporosis or malignant tumors. In older people, the femoral neck is very often affected by a fracture. In the case of open fractures, most often they occur in the lower leg area and on the arms.

If you fall from a height, a fracture of the spine or chest will most likely occur.

Damage classification

What is a bone fracture? What is it like? A bone fracture has its own classification, which was created to simplify the diagnosis, determine therapeutic measures and prognosis of the pathology.

All injuries have differences in etiology, the shape of the bone defect, the displacement of bone fragments, the appearance of bone fragments and a number of other factors. What types of damage there are are described below.

There are two types of injuries based on the type of occurrence:

• Traumatic. It occurs due to the fact that there was a powerful, short-term impact on the bone.
• Pathological. Various diseases provoke bone destruction. With this type of damage, damage occurs accidentally, without force.

Injury occurs from a direct blow, a fall from a height, violent actions, awkward movements, gunshot wounds and are characterized as direct.

Sometimes the place of impact and the area of ​​damage are located at a distance from each other. They are classified as indirect fractures.

Pathological bone injuries occur against the background of diseases that reduce the strength of bone tissue. Such diseases include bone cysts, tumors, metastases, osteomyelitis, osteoporosis, and disorders of osteogenesis during intrauterine development.

Based on the presence or absence of bone fragments, the following injuries are distinguished:

• Closed – no skin deformation, bones are not visible.
• Open - there is a laceration with bone fragments protruding from it.

Open fracture

In turn, open fractures are divided into primary and secondary. Primary ones are distinguished by the presence of a wound when exposed to a traumatic factor. Secondary ones are formed after receiving and are associated with cutting through the skin with bone fragments during improper transportation of the patient to the hospital.

Closed fracture

• Incomplete - occurs like a crack without displacement of fragments.
• Complete - complete separation of the bone ends occurs and their displacement in different directions.
• Single – damage occurs to one bone.
• Multiple – fracture of several bones.
• Combined – damage to bone tissue due to several negative factors.
• Combined – bone fracture with damage to visceral organs.

Incomplete injuries occur due to a minor impact. Most often, such injuries occur in children whose bones are covered with periosteum and they look like a “grapevine” - cracks without displacement of fragments. Incomplete injuries also include marginal and perforated fractures, fractures and cracks.

A complete fracture develops when there is a significant impact or due to a defect in bones with well-developed muscles, the contraction of which leads to the displacement of broken bones in different directions along the trajectory of muscle traction.

Displaced injuries are classified as severe injuries that require long-term therapy and a rehabilitation period. Open fractures are also included in this group. In addition, they are accompanied by wound infection, which leads to osteomyelitis and sepsis. Also, displacement of bone fragments causes complications associated with damage to muscles, nerves and blood vessels.

And as the end result, open and closed bleeding, impaired sensitivity of the limbs, paralysis, painful and hemorrhagic shocks appear. All this significantly complicates the treatment of the fracture and can lead to death.

Important! Injury without displacement does not lead to negative consequences and has a more favorable outcome.

Types of damage according to the location of the bone injury:

• When a tubular bone is damaged, the fracture is located in the lower, middle or upper third of the bone.
• Impression or impacted - this type is typical for vertebral injury.
• Diaphyseal - localized at the ends of the tubular bones.
• Metaphyseal - located in the articular area.
• Epiphyseal – the fracture is located in the articular cavity.
• Epiphysiolytic – refers to a childhood fracture and is located in the growth zone.

Epiphare bone injuries occur as fracture-dislocations, which complicates treatment and increases the rehabilitation period.

Epiphysiolysis with improper therapy leads to premature cessation of skeletal growth and provokes shortening of the damaged limb.

A fracture can also be distinguished by how many parts the bones are broken into or whether there is displacement - an injury with or without displacement.

Bone injuries are distinguished according to the shape of the fracture, focusing on the direction of the fracture line: transverse, V-shaped, helical, oblique, longitudinal, T-shaped, splintered.

Comminuted is characterized by the formation of one or more fragments that are completely separated from the bone and lodged in the soft tissue. These injuries require surgery and a long period of rehabilitation.

A comminuted fracture with the formation of multiple fragments is called comminuted. It causes a defect in the damaged bone. Such fractures can be small or large-comminuted.

A defect with a transverse fracture line is classified as a stable injury that rarely moves. The remaining types lead to the displacement of fragments due to muscle traction, and are included in the group of unstable injuries.

Proper transportation of the victim to the hospital and effective methods of therapy prevent the development of negative consequences due to displacement of bone fragments.

Thanks to the classification of bone fractures, it is possible to choose the correct treatment regimen, prevent the development of unwanted complications, and predict the duration of recovery and rehabilitation period. Accurate diagnosis, thanks to modern classification, greatly improves the prognosis of injury and reduces the risk of developing severe pathologies.

Signs of a fracture

How to determine a bone fracture? Recognizing damage is not difficult. Only in rare cases, when most of the symptoms of a fracture are absent, will it be possible to detect damage only with the help of instrumental examination.

Experts distinguish two signs of a fracture - absolute and relative signs.

• Absolute ones include deformation of the limbs, crepitus, and abnormal mobility. If the fracture is open, then bone fragments visible in the wound are added to the symptoms.
• Relative symptoms include pain, swelling, hematoma, dysfunction, and hemarthrosis.

The pain becomes stronger when trying to make a movement or with an axial load.

Swelling and hemorrhage occur after a certain time after injury and gradually increase.

Dysfunction manifests itself in limited movements, inability to lean on the affected limb or part of the body. Depending on the location of the injury and the type of damage, some absolute or relative symptoms may be absent.

Along with local signs, large and multiple fractures are characterized by general symptoms caused by traumatic shock and severe bleeding.

At the initial stage of injury, there is increased agitation, the inability to independently assess the severity of the condition, tachycardia, rapid shallow breathing, pale skin and cold sticky sweat.

Blood pressure may be low, or less often high. It depends on a number of factors. After a certain time, the patient becomes lethargic, lethargic, blood pressure drops, the amount of urine decreases, thirst and dry mouth appear. If the injury is severe, loss of consciousness and breathing problems may occur.

Important! Before helping the victim, you need to know what certain fractures look like and understand what needs to be done first. If you are not sure that everything will be done correctly, then it is better to wait for the ambulance team.

First aid

For fractures, first aid is a stage on which the effectiveness of treatment and the victim’s ability to restore motor functions in the future depend. And in a number of cases, the life of the victim depends on how quickly and correctly first aid is provided.

Regardless of the location of the fracture and the severity of the damage, the following rules should be observed:

• The first thing to do is call emergency help. The operator should describe any signs of injury present. Such detail will help to send a specially equipped vehicle to the scene of the incident. If it is impossible to understand what damage has occurred, then this should also be reported to the emergency dispatcher.
• Under no circumstances should you move the patient, sit him down or lay him on his side until you understand whether there is a fracture or not. If the presence of a fracture is confirmed, then the site of injury must be fixed in a motionless position.
• If there is a need, the victim is allowed to be taken to a medical facility by himself, after immobilization with the help of splints, which are applied in compliance with all the rules:
• The splint should be applied to clothing or a previously covered injury. Fixation is not performed on a naked body.
• If the splint needs to be applied to protruding parts of the body, namely ribs, joints, then additional material is placed under it to soften friction and pressure.
• To ensure that the damaged area remains motionless during transportation, immobilization is rigid but appropriate to the injury.

It is important to remember, when providing first aid, that if there is bleeding, then it should be stopped first; if the victim is unconscious, then it is necessary to give him a position that will prevent him from choking on vomit; in case of severe pain, taking analgesics is allowed.

Diagnostics

The clinical picture for these injuries is varied, and some signs are absent in some injuries. Therefore, extensive diagnostics are carried out.

The examination of patients consists of a thorough examination for complications. If there is damage to the legs or arms, then the pulse and sensitivity in the distal parts of the extremities must be checked. In case of injuries to the spine and skull, the diagnosis takes into account reflexes and sensitivity of the skin; in case of damage to the ribs, the lungs are listened to for the presence of abnormal sounds.

Patients in an unconscious state and intoxicated are given special attention. If there is a suspicion that the fracture is complicated, then consultations with specialists - a neurosurgeon, a vascular surgeon and a number of additional studies are prescribed.

An accurate diagnosis is made after radiography. On X-ray photographs, in case of a fracture, a gap in the damaged area is clearly visible, indicating a fracture, as well as displacement of fragments, rupture of the cortical layer, bone deformation and disturbances in the bone structure. In children, in addition to the indicated radiological signs, deformation of the cartilaginous plate of the growth zone may be visible during epiphysiolysis, and in case of greenstick injuries, limited protrusion of the cortical layer.

After the attending physician has learned the diagnostic data, he prescribes treatment according to the examination indications. The victim and his relatives are concerned about the questions they ask the specialist - is it possible to treat existing injuries without complications and how to treat a fracture, what consequences can there be?

Treatment

Treatment of bone fractures should take place in an emergency room or in a special trauma department. It can be conservative or operative. The goal of therapy is to fold the bone fragments as accurately as possible for further normal fusion and restoration of the functions of the damaged section. In addition, in case of painful shock, actions are taken to normalize the functioning of all organs and systems; if there is damage to internal organs, then an operation is performed to restore their integrity.

To treat a fracture, surgical reduction is performed. It can be closed or open.

Conservative treatment is divided into immobilization, functional and traction.

A fixation technique in the form of a plaster cast is used for fractures without displacement or with slight displacement. In some cases, plaster is used for complex fractures at the final stage, after skeletal traction is canceled or at the end of the operation.

Functional and traction methods of treatment are indicated for compression fractures of the spinal column and limbs. Traction of the human skeleton is used if the fracture is unstable - comminuted, oblique, helical.

As additional methods of therapy, physical therapy and physiotherapy are used to restore all functions of damaged limbs and parts of the skeleton.

To relieve pain, improve blood circulation and relieve swelling, UHF, inductothermy and ultrasound are prescribed. Subsequently, electrical muscle stimulation, ultraviolet irradiation, electrophoresis or phonophoresis are used. Laser therapy is used to stimulate bone fusion.

Therapeutic exercise is one of the most important methods of treatment and rehabilitation of fractures. At the beginning of therapy, it is used to prevent hypostatic complications, then it is necessary to stimulate restorative metabolic processes, as well as to prevent contractures or tightening of joints. Experts select the exercise program individually, taking into account the nature of the injury, age and general condition of the patient.

After the cast is removed, therapy is carried out to restore complexly coordinated movements, muscle strength and joint mobility.

When using functional methods of treatment, special physical education is the leading treatment technique. The patient is taught special exercises aimed at strengthening the muscular corset, spinal decompression and special movements to prevent aggravation of the damage.

Also, for all types of fractures, massage is used to improve blood circulation and activate metabolic processes in the area of ​​the fracture. The final stage of treatment may be referral to specialized sanatoriums or boarding houses, where there will be therapeutic mud baths.

Consequences of injury

A bone fracture by itself is rarely fatal. In most cases, this is a consequence of collateral damage or if complications arise in the form of fat embolism, pulmonary embolism, hypostatic pneumonia and infection that develops against the background of an open fracture.

The prognosis for fractures largely depends on the nature of the bone damage and the degree of soft tissue injury.

A bone fracture with disruption of the nerve trunks causes problems with motor function and sensory function. After bone fusion, a callus may form, putting pressure on blood vessels and nerves. The result is paralysis, paresis, congestion in the tissues and, as a result, disability.

As a result of an open fracture, pathogenic microorganisms enter the wound, which provoke suppuration of soft tissues, bones or sepsis. Less commonly, ulcers can form in the area of ​​internal or external osteosynthesis.

The consequences of fractures largely depend on the severity of the injury, promptly provided first-aid, and correctly selected treatment and rehabilitation tactics. If all recommendations are followed, in most clinical cases the patient manages to fully recover.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!

– this is a complete or partial violation of the integrity of the bone resulting from an impact exceeding the strength characteristics of bone tissue. Signs of a fracture include abnormal mobility, crepitus (bone crunch), external deformity, swelling, limited function and severe pain, while one or more symptoms may be absent. The diagnosis is made on the basis of anamnesis, complaints, examination data and X-ray results. Treatment can be conservative or surgical, involving immobilization using plaster casts or skeletal traction, or fixation by installing metal structures.

ICD-10

S42 S52 S72 S82

General information

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

Fractures can be single or multiple, complicated or uncomplicated by damage to various anatomical structures and internal organs. There are certain combinations of injuries that are frequently encountered in clinical traumatology. Thus, 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 skull bones is violated, the formation of an intracerebral hematoma, damage to the meninges and substance of the brain, etc. Treatment of fractures is carried out by orthopedic traumatologists.

Causes of fracture

Violation of bone integrity occurs with intense direct or indirect exposure. The direct cause of a fracture can be a direct blow, a fall, a car accident, an industrial accident, a criminal incident, etc. There are typical mechanisms of fractures of various bones that cause the occurrence of 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, while pathological fractures occur on a bone affected by some pathological process and, as a result, partially lost its strength. To form a traumatic fracture, a significant impact is necessary: ​​a strong blow, a fall from a fairly high height, etc. Pathological fractures develop with minor impacts: a small impact, a fall from a height of one’s own height, muscle strain, or even turning over 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 a 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, but 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 dislocation or subluxation - in this case they speak of fracture-dislocation.
• Metaphyseal(periarticular) - occur in the area between the epiphysis and diaphysis. They are often impacted (the distal fragment is embedded in the proximal one). As a rule, there is no displacement of fragments.
• Diaphyseal– are formed in the middle part of the bone. The most common. They are distinguished by 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 impact, 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. V- and T-shaped injuries occur more often in the metaphyseal and epiphyseal zones. When the integrity of the cancellous bone is violated, the penetration of one fragment into another and compression of the bone tissue are usually observed, in which the bone substance is destroyed and crushed. In 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 form along the bone.

All fractures are accompanied by more or less pronounced destruction of soft tissue, which is caused both by direct traumatic effects and by displacement of bone fragments. Typically, hemorrhages, soft tissue bruises, local muscle ruptures and ruptures of small vessels occur in the area of ​​injury. All of the above in combination with bleeding from bone fragments causes the formation of a hematoma. In some cases, displaced bone fragments damage nerves and great vessels. Compression of nerves, blood vessels and muscles between fragments is also possible.

Symptoms of a fracture

There are absolute and relative signs of a violation of bone integrity. Absolute signs are deformation of the limb, crepitus (bone crunch, which can be detected by the ear or detected under the doctor’s fingers during palpation), pathological mobility, and in open injuries, bone fragments visible in the wound. Relative signs include pain, swelling, hematoma, dysfunction and hemarthrosis (only for intra-articular fractures). The pain intensifies with attempted movements and axial load. Swelling and hematoma usually occur some time after the injury and gradually increase. Dysfunction is expressed in limited mobility, impossibility or difficulty in 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 sticky sweat. Depending on the predominance of certain factors, blood pressure may be reduced, or 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, and in severe cases, loss of consciousness and respiratory disorders are possible.

Complications

Early complications include skin necrosis due to direct damage or pressure from bone fragments from the inside. When blood accumulates in the subfascial space, subfascial hypertension syndrome occurs, caused by compression of the neurovascular bundle and accompanied by impaired 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, and thrombosis of the arteries and veins may develop. Damage or compression of the nerve can lead to paresis or paralysis. Very rarely, closed bone injuries are complicated by suppuration of the hematoma. 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 improper and delayed fusion of fragments, lack of fusion and pseudarthrosis. With intra-articular and periarticular 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 fusion of fragments.

Diagnostics

Since the clinical picture of 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 impact. Most fractures are characterized by a typical mechanism, for example, when falling with emphasis on the palm, a fracture of the radius often occurs in a typical place, when twisting a leg - a fracture of the ankles, when falling on the legs or buttocks from a height - a compression fracture of the vertebrae.

The patient's examination includes a thorough examination for possible complications. If the bones of the extremities are damaged, the pulse and sensitivity in the distal parts must be checked; in case of fractures of the spine and skull, reflexes and skin sensitivity are assessed; if the ribs are damaged, 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 with relevant specialists (neurosurgeon, vascular surgeon) and additional studies (for example, angiography or echoEG) are prescribed.

The final diagnosis is made on the basis of radiography. X-ray signs of a fracture include a line of clearing in the area of ​​damage, displacement of fragments, a break in the cortical layer, bone deformations and changes in bone structure (clearing with displacement of fragments of flat bones, compaction with compression and impacted fractures). In children, in addition to the listed radiological symptoms, with epiphysiolysis, deformation of the cartilaginous plate of the growth zone may be observed, and with greenstick fractures, limited protrusion of the cortical layer.

Fracture treatment

Treatment can be carried out in an emergency room or in a trauma department, and can be conservative or surgical. The goal of treatment is the most accurate comparison of fragments for subsequent adequate fusion and restoration of 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 formations, operations or manipulations are carried out to restore their integrity and normal function.

At the first aid stage, pain relief and temporary immobilization are carried out using special splints or improvised objects (for example, boards). For open fractures, remove contamination around the wound if possible, and cover the wound with a sterile bandage. In case of intense bleeding, apply a tourniquet. Measures are taken to combat shock and blood loss. Upon admission to the hospital, the injury site is blocked and repositioned 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, knitting needles, staples and compression-distraction devices.

Conservative treatment methods are divided into immobilization, functional and traction. Immobilization techniques (plaster casts) are usually used for non-displaced or slightly displaced fractures. In some cases, plaster is also used for complex injuries at the final stage, after removal of skeletal traction or surgical treatment. Functional techniques are indicated mainly for vertebral compression fractures. Skeletal traction is usually 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. The 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 great vessels; interposition of a fragment into the joint cavity during 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, reducing treatment time and facilitating patient care.

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

When using functional methods (for example, for compression fractures of the spine), exercise therapy is the leading treatment technique. The patient is taught special exercises aimed at strengthening the muscle corset, decompressing the spine and developing motor patterns that prevent aggravation of the injury. First, the exercises are performed lying down, then on your knees, and then in a standing position.

In addition, for all types of fractures, massage is used to improve blood circulation and activate metabolic processes in the area of ​​damage. At the final stage, patients are sent to sanatorium-resort treatment, prescribed iodine-bromine, radon, sodium chloride, pine-salt and pine medicinal baths, and also carry out rehabilitation measures in specialized rehabilitation centers.

Violation of bone integrity under load. Fractures can occur both due to injury and as a result of various diseases that occur with disturbances in the characteristics of bone tissue.

The severity of the general condition of the injury depends on the extent of the injury. Numerous fractures tubular bones can cause severe bleeding and shock. Patients with this disease take a long time to recover, usually taking more than one month.

Types and classification of the disease

Congenital- This is a rather rare type of damage that develops with various genetic ailments of the skeleton, causing a decrease in its strength.
Acquired– occur most often and in turn are divided into traumatic and pathological.

Pathological Fractures develop in diseases that affect the natural composition of the bone - neoplasm, osteitis, some hormonal disorders, periostitis, osteoporosis. In this case, injury can occur with the slightest impact or without cause. Pathology can be “acquired” even during sleep. This type of fracture is observed in neurogenic dystrophy, that is, when the innervation of the organ is disrupted. Excessive bone fragility is observed in Engel-Recklinghausen disease and “crystal man” disease, osteitis deformans and other skeletal pathologies.

Traumatic a fracture is associated with an external influence on the bone, this could be an accident, a fight, etc. In case of fractures, along with trauma to the bone itself, the integrity of the surrounding tissues is disrupted. If a wound is formed due to damage, this is open a fracture that is infected in any case, and when the skin is not injured - closed.

Open fractures are:

Primary open– in this case, the external force directly affects the location of the fracture, which is typical for a comminuted fracture.
Secondary-open– if the bone from the inside injures the tissue around it.

According to the severity of the lesion, they are divided into full(with and without offset) and incomplete(fractures and cracks) fractures.

Open fractures are classified depending on the degree of trauma to the skin, neurovascular system, tendons and muscles. At first degree tissues are damaged from the inside, when second– from the outside, and the third degree includes severe injuries up to amputation.

According to the shape and nature of the fracture, fractures are: compression, helical, wedge-shaped, T- and V-shaped etc.

Simple a fracture consists of two fragments; under the influence of a damaging force, more than two parts may break off along the bone, then fragmentary fractures occur. If, as a result of injury, the bone consists of many fragments over a long period, this indicates fragmented type of disease.

Full Fractures are usually combined with displacement of parts of the bone in different directions. The “divergence” of bone fragments is also facilitated by muscle contraction. More common for children incomplete fractures or non-displaced fractures.

According to complications, fractures occur complicated And uncomplicated. The most common bones that are broken are the hip, shoulder and lower leg.

There are also inside-, around- And extra-articular fractures. Fractures inside the joint can occur with displacement of the joint surface - dislocations. Such injuries are called fracture-dislocations. They are most often observed with injuries of the hip and shoulder joints.

Before the age of 16, special types of fractures occur in which displacement occurs in the area of ​​​​unossified growth cartilage. One of the variants of this pathology is osteoepiphysiolysis, in which the fracture also affects the cartilage tissue. In the future, this can lead to shortening or curvature of the limb. Injuries in children, especially the arm and collarbone, usually resolve with severe swelling of the soft tissues.

In older people, fractures most often occur due to increased fragility and brittleness of bones. The disease usually appears after a slight fall. Long tubular bones, such as the radius and other limb bones, are most susceptible to fractures. In old age, a callus of low strength forms at the site of injury.

Frequently occurring types of the disease are named after the author who described it. For example, Monteggia fracture- fracture of the upper third of the ulna in combination with nerve damage and dislocation.

After a fracture, the recovery process consists of 4 main stages:

1. Autolysis - development of edema up to 4 days;
2. Proliferation and differentiation - active regeneration of bone tissue;
3. Restructuring - microcirculation is restored, a compact substance is formed;
4. Full recovery.

4 types can form at the fracture site callus: periosteal, endosteal, intermedial And paraosseous.

Symptoms and signs

Bleeding and the presence of a wound are the main signs of an open fracture; they can be expressed to varying degrees. With complex fractures, traumatic shock often develops.

When bone fragments are displaced, a forced position of the limb, bruising, deformation with deviation from the axis, and swelling are observed. When palpated, there is sharp pain at the site of injury, unnatural mobility and crunching of bone fragments. There is no need to specifically establish crepitus in a patient, since it is possible to injure surrounding tissues, nerves, blood vessels, and displace fragments.

The load and movement of the injured limb causes a sharp increase in pain in the fracture area. Shortening of the limb is also observed; natural bony protrusions change position. When a joint is fractured, there is a weakening of its contour and an increase in size as a result of hemarthrosis. Flexion and extension of the joint causes pain, due to which movements are severely limited. With impacted fractures or without displacement of fragments, some manifestations are absent, so the disease can be mistaken for a severe bruise. Often, with an impacted injury to the femoral neck, a person actively moves, which ultimately leads to displacement of the bone parts.

An X-ray is required, for example, in case of fractures of one of the parallel bones (metatarsal, radial, fibula or tibia), the main symptoms may be absent. If an injury is suspected, the length of the limb is determined: lower - from the greater trochanter to the outer malleolus, forearm - from the ulna to the styloid process.

Complications

In the course of improper treatment and non-compliance with the duration of immobilization, complications may develop:

Increased thrombus formation, thromboembolism;
pneumonia;
bedsores due to compression of the skin with a plaster cast;
paralysis due to nerve damage;
bleeding;
joint stiffness, muscle atrophy;
traumatic shock;
fat embolism due to the appearance of disemulsified fat droplets in the blood.

When an injury occurs, bleeding develops, which is very difficult to stop, since the vessels are located in the mineral part, resulting in a hematoma and swelling.

Causes of fractures

Contributing factors:

Pregnancy, old age;
mechanical damage;
diseases affecting the condition of the skeleton;
vitamin deficiency, mineral deficiency in the body.

Diagnostics

Treatment

Spinal fractures are caused by blows to the back and falls from a height. When providing first aid, the main thing is to provide anesthesia and ensure transportation on a flat, hard surface. The most severe manifestations occur with fractures of the cervical vertebrae. When the base of the skull is fractured, the patient develops “spectacles” around the eyes, liquor “leaks” from the nose, and he is bothered by weakness and nausea. The consequence of injury can be sudden and manifest itself in cardiac and respiratory arrest.

Brief interesting data
- Bone fractures in vertebrate animals and humans do not differ significantly.
- “Bone setters” have existed since ancient times, for example, in a study of 36 Neanderthal skeletons with bone fractures, only 11 had the therapy performed incorrectly. This proves that primitive people knew about fractures and knew how to treat them.
- According to statistics, the maximum number of fractures occurs between the ages of 20 and 40 years. A fracture of the coccyx is typical in most cases for older people, and most often the bones of the hand are broken.

Call an ambulance or, if there are no contraindications, take the victim to the first aid station on a stretcher with a solid base;
Anesthetize (ketorol, indomethacin);
Stop the bleeding;
In case of an open fracture, apply a sterile bandage;
Immobilize the injured area and apply a splint (for example, a pneumatic splint for a pelvic fracture).

First aid can be provided both on site and in an emergency room or hospital. At this point, the scope of further treatment is determined. Complications are combated (bleeding, shock), and the damaged area is immobilized. Surgery may be necessary for complex comminuted fractures. Next, the effectiveness of regeneration and reposition is regularly assessed. If bone restoration does not occur after treatment, repeated reposition is allowed.

Rehabilitation is necessary to restore the normal functioning of the injured part, it includes: exercise therapy, CPM therapy, therapeutic exercises, massage, physiotherapy. This period may drag on for several months. Sick leave for a fracture is issued for the entire period of incapacity.

Prevention

Eat a balanced diet;
to refuse from bad habits;
lift weights correctly;
prevent osteoporosis;
take your time, be careful, avoid falls;
maintain normal body weight;
spend at least 15 minutes in the sun;
play sports;
take vitamins and microelements;
warm up before physical activity.

Traditional methods of treatment

Add millet porridge, rice, corn to your daily diet, replace sugar with honey. It is also recommended to eat berries, dairy products, sesame seeds, meat, herbs, fish, rose hips and apples.
After removing the plaster, add a few drops of thyme, fir, marjoram, lavender or rosemary oil to the water before taking a bath.
Boil the egg, peel the shell, removing the film. Grind into powder and add the juice of one lemon. Store in a dark, cool place. There are 1 tsp. in the morning and in the evening.

bone damage with disruption of its integrity. Traumatic fractures usually result from the sudden application of significant mechanical force to healthy bone, such as in motor vehicle accidents. Pathological (spontaneous) is a fracture of a bone that has been changed by some previous pathological process with a relatively minor injury. Both parts of the separated bone are called fragments, and smaller fragments of the bone damaged in the fracture zone are called fragments. Traumatic fractures, depending on the condition of the integument (skin, mucous membranes), are divided into closed and open. With closed fractures, the integrity of the integument is not compromised, although there may be abrasions. With an open fracture, a wound is formed in its area, through which the damaged bone and surrounding soft tissue can become infected.

A special group consists of gunshot fractures, which are among the most severe injuries. Depending on the type of wounding projectile, these can be bullet and shrapnel fractures; depending on the nature of the wound - through, blind and tangential.

There are transverse longitudinal, oblique, helical, T-shaped, Y-shaped, star-shaped and perforated fractures, as well as fractures with or without displacement of fragments. Fractures of bones with intact periosteum (greenstick type), which are more common in children, are referred to as subperiosteal. An impacted fracture is characterized by the penetration of one fragment into another, while the impacted fragment destroys and pushes apart the fragments of the latter. In spongy bone, so-called compression (as a result of compression) fractures can occur, in which structural destruction of the bone occurs.

Based on location, fractures are classified into diaphyseal, epiphyseal (intra-articular) and metaphyseal (periarticular) fractures. Fractures may be accompanied by mutual displacement of the articular surfaces - dislocations or subluxations (for example, fractures of the ankles with subluxations of the foot). These fractures belong to the group of so-called fracture-dislocations. Fractures with one or more fragments are considered to be comminuted. If the bone over a significant length turns into a mass of small and large fragments, the fracture is designated as crushed. Fractures within one anatomical and functional formation are called isolated, while in two or more anatomical and functional formations in one or more segments of the limb - multiple. Fractures with simultaneous damage to internal organs are usually called combined, for example, a fracture of the pelvis with damage to the bladder, a fracture of the spine with damage to the spinal cord. In children, a special type of fracture occurs - the so-called epiphysiolysis - sliding (separation) of the epiphysis of the bone along the line of unossified growth cartilage.

Clinical picture. The general condition of victims with most fractures is satisfactory or moderate, less often severe. However, with multiple fractures, especially in the presence of open or combined injuries, as a rule, a severe or extremely severe condition, and sometimes traumatic shock, quickly develops.

Swelling and bruising are usually noted at the fracture site. The function of the limb is impaired in most cases. Active and passive movements are painful and limited. However, sometimes, for example, with impacted fractures of the femoral neck, some patients even continue to move, which can lead to displacement of the fragments. Unconditional symptoms of a fracture are deformation of the limb in combination with abnormal mobility in the fracture area, crepitation of fragments and shortening of the limb. With fissures, subperiosteal, impacted, intra-articular and periarticular fractures, some of these symptoms may be absent. With intra-articular fractures, hemarthrosis (bleeding into the joint cavity), rotational or lateral displacements, as well as movements that normally do not occur in this joint are detected.

When examining a patient, it is necessary to check for the presence of a pulse below the level of the fracture. The condition of victims who are unconscious or heavily intoxicated must be especially carefully assessed. Along with a fracture, they may have life-threatening injuries to the chest or abdominal organs, severe injuries to the brain and spinal cord, etc.

Open fractures deserve special attention. As a rule, microbial contamination of tissues (and the likelihood of infection) with small wounds is less than with extensive deep and severe damage to the skin and underlying soft tissues. Often the area of ​​soft tissue damage is much larger than the size of the skin wound. The broken bone may be exposed to a greater or lesser extent, or may not be visible at all. The more extensive, deeper and more significant the damage to the skin and underlying soft tissues, as well as bone in open fractures, the greater the likelihood of developing a severe infection - purulent, anaerobic or putrefactive. With open fractures, much more often than with closed ones, damage to the great vessels occurs, as a result of which a disruption of the blood supply to the limb may occur, leading to the development of gangrene.

In children, fractures more often occur in the area of ​​the elbow joint: supra- and transcondylar, avulsion, fractures of the medial epicondyle, combined with dislocation of the bones of the forearm, fractures of the trochlea and head of the condyle of the humerus, neck of the radius and olecranon, avulsion fractures of the coronoid process. In newborns, fractures can occur during childbirth (see Birth Trauma in Newborns).

Fractures are a common injury in elderly and senile people. It is promoted by involutive processes in the musculoskeletal system (osteoporosis, fragility and fragility of bones, loss of elasticity of cartilage). Fractures of the femoral neck and trochanteric region, surgical neck of the humerus, spine, forearm in a typical location and some others can occur in elderly people and with a relatively minor injury.

Complications. In patients with fractures, especially with multiple and combined injuries, with open fractures, fractures of the pelvis or femur, shock, fat embolism, traumatic toxicosis, and anemia may develop. Fractures in older people are often complicated by pneumonia, and in people suffering from chronic alcoholism - by acute psychosis. With open and gunshot fractures (especially with extensive tissue damage), wound suppuration and osteomyelitis are possible. Late complications include delayed bone fusion and formation of a false joint, malunion of a fracture, contractures, post-traumatic arthrosis, edema, etc.

Diagnosis. For diagnosis, a well-collected anamnesis aimed at clarifying the conditions and mechanism of injury is of great importance. The circumstances and mechanism of the fracture that occurs are often very typical. For example, a compression fracture of the spine is often caused by a fall from a height onto the gluteal region, a fracture of the heel bones by a fall from a height onto the legs, a fracture of the pelvic bones and ribs by compression in the anteroposterior or lateral direction; fracture of the femoral neck and trochanteric fracture (especially in the elderly) - falling on the side and bruising in the area of ​​the greater trochanter; fractures of the bones of the foot and hand - heavy objects falling on them; a fracture of the forearm in a typical place - a fall on an outstretched arm in the position of dorsiflexion of the hand. Some types of fractures occur primarily during certain periods of the year. Thus, fractures of the cervical vertebrae often occur in divers when swimming in reservoirs not equipped for this purpose, and helical fractures of the shin bones occur in skiers in winter.

X-ray examination is of great importance in the diagnosis of fractures, which allows not only to recognize a fracture with displacement of fragments, but also to detect cracks, impacted and other fractures. Thanks to radiography, it is possible to determine the nature of the displacement of fragments, monitor the development of callus, and monitor the results of treatment. In cases where there is a suspicion of damage to bone tissue, x-rays should be taken in at least two mutually perpendicular projections. Radiographs should show not only the damaged areas, but also adjacent healthy areas of bone over a sufficient length. The main radiological sign of a violation of bone integrity is the fracture line. Displacement of fragments is of great diagnostic importance, the presence of which is an undoubted sign of a violation of the integrity of the bone. In addition to conventional radiography, radionuclide and ultrasound research methods, angiography, etc. are used.

Treatment should begin at the scene of the incident. The main objectives of first aid for an open fracture are to combat shock, pain, bleeding, prevent secondary microbial contamination of the wound, immobilize the injured limb using transport splints and improvised means, prepare the victim for evacuation and carefully transport him to a medical facility. At the scene of the incident, a sterile bandage is applied to the wound. In cases of an open fracture, bone fragments protruding into the wound through damaged skin should not be reduced. A pressure cotton-gauze bandage applied to the wound not only protects the wound from contamination, but also, as a rule, helps stop bleeding. The need to apply a hemostatic tourniquet rarely occurs. When immobilizing an injured limb, be sure to immobilize the two joints located above and below the fracture. First medical aid for victims with a closed fracture comes down mainly to temporary immobilization with a transport splint. With diaphyseal fractures of the femur, shoulder, both bones of the leg or forearm, a sharp deformation of the limb is possible as a result of angular displacement of the fragments. The paramedic can begin a set of treatment measures aimed at combating shock, including administering local anesthesia to the fracture area. Anesthesia helps to remove the patient from shock and, by reducing muscle tension, facilitates the reposition of fragments. Most often, for fresh fractures, local (into the fracture zone) injection of 20–40 ml of a 1–2% novocaine solution is used.

Displaced fragments must be accurately compared; this ensures anatomical restoration of the length, axis and shape of the limb, and also creates optimal conditions for healing the fracture and the most complete restoration of limb function. It is necessary that the compared fragments be immobilized until bone union.

The main methods of treating bone fractures are skeletal traction, plaster cast, external transosseous compression-distraction osteosynthesis using various devices, osteosynthesis with immersion (internal) fixators, endoprosthetics, for example, for fractures of the femoral neck in the elderly. The duration of immobilization depends on the location and type of fracture, as well as on the age of the patient. For fractures of the forearm bones in a typical location, a plaster cast is applied to adults for 4-5 weeks, diaphyseal fractures of the forearm bones - for 2-3 months or more, ankle fractures - for 6-12 weeks, and shin bone fractures - for 2-4 months. For impacted fractures of the surgical neck of the humerus, the duration of treatment after applying a plaster splint is 7–12 days. It must be taken into account that after immediate reposition of the fragments and application of a plaster cast, due to muscle contraction and reduction of swelling, re-displacement of bone fragments is possible. Therefore, 7–8 days after its application, it is necessary to take a control radiograph. Prolonged plaster immobilization, as a rule, leads to limitation of movements in immobilized joints. In some cases, urgent surgery is indicated.

In children with diaphyseal and metaphyseal fractures, preference should be given to conservative treatment methods. In elderly weakened patients, it is desirable to use simple, easily tolerated and relatively safe treatment methods; Treatment methods that force the patient to remain in bed for a long time or make it difficult for him to move should be avoided. As a result of a fracture, severe functional disorders can occur, which sharply reduce the ability of victims to work and often lead to disability. One of the reasons for this, in addition to the severity of the injury and excessively long immobilization, is the underestimation of the role of physical therapy and physiotherapy in the overall complex of therapeutic measures aimed at restoring bone structure and preventing secondary dysfunctions (contractures, muscle wasting, etc.).