Case histories of traumatology. Fractures of bones, bruises, dislocations

Anyone at least once in his life meets with people of the medical profession: doctors, nurses. It does not happen according to our will. When we are born, these people give us first aid, care. In the process of life, during a professional examination, we can visit doctors of different specializations, for example, therapists, endocrinologists, ophthalmologists and so on. But sometimes we have to meet with traumatologists. These doctors help to correct the consequences of various injuries. Doctors of this direction are associated with gypsum on the arm or leg. But they treat not only fractures. Traumatologists face a lot of other pathologies every day, for example, joints, bruises or dislocations, make up medical history of traumatology and prescribe treatment. And every trauma requires special knowledge and specialist approach.

What does traumatology do?

Traumatology is a medical specialty and a section dealing with traumatization of the body and methods of treating pathological conditions that have developed as a result of the impact of the traumatic factor. Accordingly, the doctor, prepared to solve these problems, is called a traumatologist.

Depending on the traumatic factor, there are several types of injuries:

1. Strikes by any material bodies and masses. Depending on the strength of the impact and the nature of the matter, any damage can be observed: from bruises to open injuries and fractures. Now traumatology, fractures and bruises are inseparable concepts. Since they are the basis of the specialty.
2. The effects of any corrosive liquids and gases. Lead to the development of local and / or common lesions. The most striking examples are chlorine and mustard. Locally, these gases cause irritation and damage to mucous membranes and skin. Their systemic action is associated with poisoning.
3. Exposure to high and low temperatures. This leads to burns and frostbites.
4. Impact of rays. These are photons of light, radioactive rays. In the first case, a burn can develop (with local effects) and various forms of hyperthermia, up to a sunstroke. In the second, radiation sickness develops.

But at the present stage the specialty traumatology has become narrower, and now it deals only with mechanical injuries, such as bruises, sprains, fractures. All other kinds of traumatism are destinies of other specialties: kambustiology, surgery, cardiology, toxicology, hematology.

What is a medical history of traumatology?

The history of the disease is a mapping of all the main points of pathogenesis and treatment. And the medical history of traumatology is no exception. But they have a number of specific features.

• Primary examination must necessarily contain a section on the mechanism of injury, time, place and circumstances of its receipt.
• Local status is the basis of a traumatological examination. Therefore, he is paid enough attention. He is present at any examination of the trauma.

In addition, the medical history of traumatology should include a description of all manipulations. If necessary, a protocol of surgical interventions and other surgical procedures is made.

Causes of fractures

Fracture - complete or incomplete violation of bone integrity. Occurs as a result of mechanical trauma. It can be applied from outside as well as from the body itself.

Traumatic fractures are associated with external mechanical influences. They constitute the overwhelming majority. Associated with direct or indirect external impact on the bone. And the force of impact must exceed the limits of bone strength.

Pathological fractures are the result of internal causes. For example, bone destruction by tuberculosis or due to osteoporosis. Then fractures can occur even from normal loads.

Classification of fractures, their types

Classification of fractures is built on several criteria. All of them are of great importance for their treatment. Depending on the damage to the skin, all fractures are divided into open and closed. For the first, damage to the skin with the outward release of a part of the bone fragments is mandatory. In case of a closed fracture, the skin is not damaged.

Often there are complete fractures. The bone fragments are completely separated due to damage to its integrity. These fractures, in turn, are divided into fractures with and without bias. At the first, there is a displacement of fragments relative to each other. In the second case, the fragments are not displaced. For example, a child's injury occurs as a closed fracture without displacement due to the great strength of the periosteum. Traumatologists call it "a fracture in the type of a green twig".

Depending on the form of violation of the integrity of the bone, there are several types of fractures:

1. Transversal. The fracture line runs perpendicular to the axis of the bone.
2. Longitudinal fractures are called if the line of injury is approximately parallel to the bone line.
3. Skew. The line is at an angle not equal to 90 ° to the axis. In most cases, the wrist fracture is oblique.
4. Screw-like fractures are formed when the fragments are rotated relative to the normal axis in one direction or another.
5. Splintered. At the fracture site, more than two fragments are formed, the location of which is chaotic with respect to the bone axis.
6. Wedge-shaped. Part of the bone enters the body of another bone. This is typical for spongy bones, for example, for vertebrae. In the tubular this species is called beaten. Since the fragments of one bone are subjected to destruction. The most striking example is a fracture of the leg bones with a vertical jump down.
7. Compression fractures - damage to two contiguous surfaces of bones without a clear line. Also occurs in spongy bones injuries. This is the spine, the pelvic bones.

Particular variants are the so-called incomplete fractures. Here, the damage results in incomplete destruction of bone integrity: cracks, periosteal injury.

Finally, all fractures are divided into complicated and uncomplicated. The first group includes any significant pathological disorders that occur as a result of trauma.

• Shock. Pain and hemorrhagic.
• Damage to organs. Characteristic for bones located in close proximity to the internal environment of the body. Such as ribs, pelvic bones and the spine.
• Embolism or blockage of blood vessels. And not necessarily it can be nearby arteries and veins. Sometimes embolization can be subjected to vessels that are far from the site of damage. In fractures, fat embolism is most common. Since during the injury, the fragments damage the tissues. Including fat cells. Spilled lipids can easily penetrate through the damaged vessels into the general bloodstream and cause blockage of any part of the body.
• Infection of the wound. It occurs only if the skin is damaged. It is connected with free penetration of microorganisms through the damaged parts of the skin.
• Sepsis. The result of infection of the wound. Infectious agents penetrate the blood and spread throughout the body, forming peripheral purulent foci.
• Osteomyelitis. Purulent inflammation of the bone.

Uncomplicated fractures are not characterized by the above pathological conditions. This, for example, closed fracture without the displacement of fragments.

Troubleshooting

Any treatment of fractures is aimed at restoring the integrity of the bone. To do this, use any possible methods.

Conservative methods. They include all actions that do not imply the use of surgical intervention. This includes gypsum and a hard bandage. For example, a wrist fracture is treated. With some degree of probability, one can include skeletal traction. Since for the fastening of the need to drill holes in the bone, with which the loads will be fastened.

Surgical methods consist in the use of various plates, pins, staples and other equipment to restore the integrity of the bone. All these attachments are directly attached to the bone to restore its integrity. After the fusion of the bone fragments, all the structures are removed. Naturally, the medical history of traumatology must reflect this fact.

Simultaneously with mechanical impact on the site of the fracture, systemic therapy is prescribed. Its goal is to improve the nutrition of bone cells. This will increase the speed of recovery processes. Even childhood trauma often requires systemic therapy. It is, of course, less pronounced than in adults.

Injuries: how to spot a bruise?

Under the injury means traumatic tissue damage without significant changes in their structure. Naturally, this type of injury occurs on soft tissues much more often than on hard tissues.

To reveal a bruise is simple. It is enough to have the fact of influence on a certain area and the subsequent soreness. In this case, there is not necessarily the presence of bruising, redness and local edema. For example, a foot injury often occurs without any external signs.

At the heart of any injury is the damage to small vessels of tissues. As a result, plasma is released from them (or even blood). It compresses tissues, causing permanent mechanical irritation of pain receptors. The more swelling, the more pain is expressed. But this rule applies to soft tissues. In the case of mixed densities, everything can look different. The same foot injury can be dramatically painful in the absence of external symptoms.

Treatment

Therapy of contusions often carries a so-called symptomatic character. For this, various analgesics are used. With their help, the pain is removed, the body is given the opportunity to repair the damage on its own.

More radical therapy is necessary in the case of the severity of external signs and the presence of complications. So, a severe bruise can require not only adequate anesthesia, but also the use of local anesthetics or even surgical intervention.

In any case, a severe bruise should be alerted, since this can be the beginning of a more serious injury, even if there are no signs of it during the first call for medical help.

Dislocation: symptoms and treatment

Dislocation - a type of injury, consisting in the violation of the normal structure of the joint with preservation of the integrity of all its tissues. It occurs as a result of external mechanical influence, and because of pathological processes. These are arthrosis, arthritis.

The first (and the most correct) sign is a decrease in the amplitude of movements in the joint. In second place is the next important feature - a change in the shape of the joint. Traumatologists such a change is called "deformation".

What to do with a dislocation? Of course, correct. But it is better to give this procedure to a specially trained doctor. Otherwise, you can get a more serious injury. Joints, especially in children, are very fragile, so when problems arise, it requires specialists to intervene.

But what to do with a dislocation, if it happened far from the place of possible medical care? It is necessary to immobilize the joint. For which a fixing bandage is applied. But in any case it is important to contact a specialist as soon as possible.

Stretching characteristics

Stretching is an increase in the longitudinal length of the ligaments due to the detachment of one side. Investigating the stretching at the cellular level, it should be noted that there is always a rupture of fine fibers.

External signs of stretching are:

• pain;
• edema;
• deformation.

The question of how to treat stretching does not depend on any medications or special treatments. In the case of such a pathology, rest, care and anesthesia is necessary.

Why are children's injuries dangerous?

In childhood, there is a rapid growth of bones. Therefore, the development of the periosteum is maximal, and the connective tissue has a high elasticity. This, it would seem, contributes to a more favorable course of recovery processes after injuries. Therefore, in the question "How to treat stretching in children?" Many specialists do not see any problems.

But here there are their pitfalls. After all, childhood traumas leave an inevitable mark on the processes of growth. Instead of spending their resources on active growth and the formation of new cells, the body is forced to use precious time to recover.

Finally, the main danger of childhood trauma lies in the reassessment by adults and, above all, by the children themselves of their capabilities. What can cause irreparable injuries for life. Sometimes adults want to grow out of their children flexible and active people, not having enough experience and knowledge to do it. As a result of intensified attempts to realize their dreams, parents instead of physical development provoke child traumatism.