HealthDiseases and Conditions

Open fractures and their classification. First aid with open fractures

From a bone fracture, no person is insured, regardless of age, sex or any other individual characteristics. Under the fracture is meant complete or partial damage to the integrity of the bones. Lead to this may fall, a strong surprise blow, a catastrophe of anthropogenic or natural nature, a road accident.

Varieties 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 the underlying soft tissue, where the fracture region communicates with the external environment.

An open fracture is considered a complex injury, since such traumas increase the risk of infection of parts of the bone with a microbial flora. This is what distinguishes open and closed fractures of limbs. Characteristic for an open fracture is the nakedness of the bone, which significantly complicates the treatment, as well as wrinkling and detachment of soft tissues in the area of injury, which increases the risk of infection. Hazardous to human life in the open form of a fracture is considered to be bleeding and shock.

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:

  • Uncharacteristic mobility of the limb in a place where there is no joint;
  • When palpation of the affected area under the skin, a crunch is heard;
  • The presence of a wound, both very small and extensive;
  • Venous bleeding;
  • The victim's condition deteriorates rapidly;
  • Signs of traumatic or hemorrhagic shock are visible.

Open fracture: classification

Open fractures, depending on the mechanism of development, are divided into:

  • Primary-open, obtained with simultaneous damage to bone and soft tissue;
  • 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 are the basis for further classification. In the diagnosis, it is denoted by uppercase Russian letters, which means:

  • A - fractures with minor damage to soft tissue, whose viability is fully preserved or slightly broken.
  • B - lesions have an average severity, while the viability of soft tissues in the lesion is partially or completely impaired.
  • B - a fracture with a strong irreversible damage to soft tissue, the removal of which is unavoidable to preserve health.

The Kaplan-Markova classification complements the diagnosis, indicating the type of wound where A is the punctured wounds; B - bruised lacerations; B - smashed, 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 fluctuates within 2-9 centimeters.
  • III - a wound more than 10 centimeters.

Group IV includes fractures of a very severe extensive nature. Disorders of viability of the limb are observed, accompanied by severe blood loss and shock. Often the limb is amputated.
The localization of open fractures is determined by the name of the damaged bone. He can be:

  • Brachial;
  • Ulnar;
  • Femoral;
  • Tibial and peroneal.

The mechanisms of bone destruction and the type of damage on the X-ray image divide the fractures into:

  • Obliques;
  • Transverse;
  • Bumper-fractures appearing in the case of a roadside collision;
  • Helical-shaped;
  • Large / finely fragmented;
  • Double (a fracture with a displacement of bone fragments and without it).

Diagnosis

Open fractures are easy to diagnose. For the detection of all lesions, the fracture should be palpated. Next, we should make a radiography, which allows us to determine the exact duration of damage, the type of fracture, the nature of the displacement, the number of bone fragments. Open fractures of limbs, fractures of tubular bones and spine require a minimum of two X-rays produced in two mutually perpendicular planes. In some cases, evaluation of the soft tissue condition requires an MRI. With an open fracture, there is a risk of damage to the integrity of nerves and vessels. If there are any, or there are suspicions, then you should consult a neurosurgeon and a vascular surgeon.

First aid for an open fracture

The first help in trauma of this kind is to:

1. Stop bleeding, treat the edge of the wound with an antiseptic.
2. Apply a sterile bandage directly to the wound and the site of the fracture.
3. Give an analgesic like analgin, pentalgin.
4. Immobilize the limb in the position that was before the injury.
5. Transport the victim to the nearest trauma center.
Assistance in case of an open fracture should in no case include attempts to restore the outward bone, eliminate a twisted limb, and combine damaged bones. This can only exacerbate the problem.

An open fracture of the hip can result from a fall from a height or a roadside collision. Often this is accompanied by a displacement of debris, which leads the victim to a state of painful shock.

The first thing to do is to anesthetize. Then you should always put the tire on your leg. To do this, any long object: a board, a pipe, a stick. Splinting is performed along the entire body from the foot to the armpit. But you can not impose it on the side where the broken bone is visible.

An open arm fracture is the most common type of injury. Most often occurs as a result of a strong impact or a fall. In addition to bleeding, an open fracture of the hand can be accompanied by a strong limb edema, joint deformity. The risk of this type of damage lies in the possibility of severe blood loss in the event of an artery rupture, since blood will be difficult to stop. Urgent pre-medical care consists in applying a fixing strap to ensure immobility. And it must immobilize at least two joints in the area of the fracture. It is applied directly to the clothes. A tourniquet or a tight bandage above the area of injury will help stop blood loss.

Fracture of the toe is no less common injury resulting from direct injury such as falling of a heavy object, impact, compression, tampering of the leg. The first help with injuries of this kind is simple. It can have any person nearby, or the victim himself. The main thing in this case is to immobilize the foot. At the same time, shoes must be removed. The injured finger should be bandaged to any solid object or to the adjacent finger. Fracture of the toe may be:

  • Open;
  • Closed;
  • Fracture with displacement;
  • Comminuted;
  • Edge fracture.


The fracture with displacement is obtained as a result of the impact on the bone of the finger force, which led to the occurrence of trauma. It can be accompanied by infringement of neighboring nerves, vessels, muscles. The damage is accompanied by severe pain, edema not only of the damaged finger, but of the entire foot, hemorrhage under the skin, fingernail, impaired limb function.

Further treatment

After rendering first aid, the victim should be hospitalized in the department of "Traumatology". Moscow has many specialized points, working around the clock, where the patient will be provided with all the necessary assistance. Providing qualified assistance, doctors will determine the severity of the damage, assess hemodynamic parameters, conduct a primary diagnosis of the fracture, which includes examination and treatment of the wound, detection of clinical trauma signs, and an X-ray. The patient will be made novocaine blockades and injections of tetanus, antibiotics of a wide spectrum of action will be prescribed to avoid infection.

Then the patient is transferred to the operating room, where the wound is cleaned of foreign bodies and the contamination, the separately lying bone fragments are removed, severely damaged, nonviable tissues will be excised, the wound will be closed and turned into a closed fracture. Sewing the edges of the wound should be done without tension, if this is not possible, then the skin plastic 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 healing of the wound. Moreover, excision of "substandard" tissues is a good biological factor, because healthy living tissues better fight infections and heal.

It is better if primary surgical care is performed in the first 8 hours after the injury. During this period, microorganisms do not have time to penetrate deep into the wound to the tissues, spread throughout the body through the blood and lymphatic ways.

A PCO can be: early, conducted in the first 24 hours after the injury; Deferred to 48 hours; Late. The causes of delay may be traumatic shock, severe bleeding, surgical intervention associated with damage to important organs.

Basic methods of immobilization of fragments

To immobilize the damage is necessary in any case. To do this, taking into account the evidence, choose:

  • Gypsum dressing;
  • Skeletal traction;
  • Primary, delayed internal osteosynthesis by metal structures;
  • External osteosynthesis apparatus external fixation.

The gypsum dressing has good hygroscopicity, it is suitable as a fixation tool for seriously ill patients, it does not require technical skills, it allows gradual loading of the damaged limb. However, gypsum immobilizes adjacent joints and can squeeze the limb in the bandage.

Skeletal traction allows you to observe the limb and make bandages. If there was an open fracture with displacement, then it is the traction that allows the repaired displaced fragments. But this method of immobility requires bed rest, rest of the limb is not complete, requires control and adjustment.
Osteosynthesis is performed with oblique, helical, multi-lobed fractures that are difficult to retain, and also for double and multiple fractures.

How the open fractures heal

The healing of the bone in the fracture takes place in several stages. The first stage can be called preparatory. Here there is coagulation of lymph and blood, the formed blood clots envelop the ends of the fragments, and the serum secreted by the clot penetrates into the soft tissues.

At the second stage, a primary connective-tissue callus begins to form. It has a dense consistency, despite the fact that it has neither lime salts nor bone tissue. This corn does not allow the bones to move freely in the damaged area. In terms of duration, this process can be different. A large amount of inflamed tissue, the presence of soft tissue between the ends of the bone, infection, a reduced ability of bone marrow stem cells to multiply can slow down the process.

The third phase begins approximately 2-3 weeks after the fracture. It is characterized by ossification. The connective-tissue corn is compacted. However, it is not yet able to transfer static or dynamic loads, so reliable immobilization remains relevant. During this period, the level of calcium in the serum rises.

During the fourth phase, the bone callus is finally transformed into a full bone. A few months after the fracture, a new bone can withstand 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 corn. In the future, it decreases due to tissue tightening and resorption of old bone. Moderate functional load will accelerate the restructuring of the callus.

The delayed formation of bone callus is characterized by an open fracture. Treatment and healing of trauma can have a longer process if:

  • At the site of the fracture, an insufficient amount of blood clots is formed, stimulating the process of primary bone callus formation;
  • On the basis of infection there were acute inflammatory processes, destructive changes that prevent the appearance of bone callus;
  • The process of dying off of bone fragments proceeds;
  • In the connective tissue wool, fibrous cartilage is formed.

The speed of the formation of the bone callus largely depends on how and when the help was rendered, from the location of the fracture, the age of the patient and other reasons.
To accelerate the process of bone callus formation, it is possible to use anti-reticular cytotoxic serum Bogomolets, bone meal, eggshell powder, fish oil phosphorus.

Consequences of fractures

Open fractures have several threats. In time, not rendered qualified assistance - in the first 6-8 hours after the injury - can lead to irreversible consequences. At the end of this time, sepsis, blood infection, may begin.

If you get into the wound of the ground, tetanus can develop. If the injured person is injured, the contaminated areas will be excised, but if the muscles or tendons are removed significantly, to preserve the life of the person, it is more likely that the patient will remain disabled.

From the above, the conclusion suggests that favorable healing is possible with adequate pre-medical care and the first medical assistance that traumatology has. Moscow, being a large city, provides all opportunities for rendering the necessary assistance.

Can I insure myself against fractures?

Fracture is a mechanical trauma, which can not be insured against anyone. However, statistics show that some injuries could have been avoided if the bones had a more dense structure. Of course, from the damage received in case of a fall from a height, an accident, strong blows it will not save, but not every drop or podtavyvanie legs will end with a fracture. So 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. Replenish the defect and ensure a good absorption of calcium by the body will help spinach, beets, celery, green vegetables, nuts, tea, cocoa and zinc-containing foods.

From this follows and the next measure of fracture prevention is the maintenance of a healthy weight. Osteoporosis can develop not only in the presence of excess weight, which increases the burden on the bones, but excessive leanness will not be a relief for him. It is necessary to know the measure.

Help with healthy weight can sport. Sports does not mean new world records or evenings spent in the gym. But to allocate half an hour or hour three times a week under the power of almost everyone. Naturally, classes of classes should be selected individually, taking into account the age, the state of human health, the possibilities. With this can help trainers in the gym or doctor. Cautious with excessive physical exertion should be both men and women.

The density of bone tissue is adversely affected by bad habits: drinking and smoking. And if the use of the first should be reduced to minimum doses, then smoking should be abandoned completely. In people who smoke people, fractures not only heal longer, but the likelihood of improper coalescence is high. The influence of alcohol is a violation of the metabolic processes of the body. Abuse of alcohol interferes with the absorption of calcium by the body, which worsens the density of bone tissue.

Important for the health of our body and vitamin D, which in the required amount can be obtained by being in the sun every day for at least 15 minutes. This vitamin promotes the absorption of calcium by the body. To abuse sunbathing, of course, is not worth anyone, especially for people with sensitive skin. But the benefit of the modern beauty industry offers a choice of a wide range of skin protection products that should not be neglected.

Fractures are very bad for elderly people. And lead to a trauma can even banal falling in own apartment, the house. Therefore, in this case, maximum attention should be given to preventive measures. What does it mean? Remove all loose or loose wires in the vicinity of the floor. Carpets and carpet paths should lie flat, do not stray. If there is a bathroom in it, you need to install handrails and put non-slip mats. Home shoes should be comfortable, with a hard sole, and should not fall off your feet while walking.

Fractures of open bones are very unpleasant injuries with a long recovery period. Correct first-aid and medical help will help the normal recovery of the limb.

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