Fractures

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types of fractures
Fig. 1. Types of fractures: 1 - indoor; 2 - open.

Fractures - full or partial violation of the intact bones. There are traumatic fractures that occur in an unmodified bones under the action of external forces, and pathological - due to the destruction of the bones of the pathological process (tumor, osteomyelitis, and so on). Fractures are divided into closed (Fig. 1, 1) and open (Fig. 1, 2). In open fractures there is damage to the skin over the area of the fracture and fragments in contact with the external environment, which implies the possibility of their infection. The healing of a closed fracture occurs in aseptic, more favourable conditions. Open fractures, as exposed to microbial contamination, give a greater number of complications and adverse outcomes. A special group of open fractures are firearms, which are sometimes extensive defects of soft tissues and bones.
On production often damaged bones of the wrist, foot, in mining industry - the spine, pelvis.
Some fractures (for example, ankles, radial bone) are more likely to occur in autumn and spring (ice). In cities common cause of fractures are traffic accidents.
the main types of fractures

Fig. 2. The main types of fractures: 1 - cross; 2 - impacted; 3 - spiral; 4 - comminuted; 5 - tear; 6 - subperiosteal without displacement (Fig. 1-3 are left schemes directions traumatic force - arrow).

Fig. 3. Typical displacement of bone fragments. Fig. 4. Bone spur.

From traumatic force depends on the type of fracture (Fig. 2). There are transversal, oblique, spiral, comminuted, T and V-shaped, compression, impressed, vouchers and other localization fractures of the tubular bones divided into diaphyseal, metafizare and epiphyseal. Epiphyseal, as a rule, are intra-articular. Depending on the location of fragments distinguish fractures without bias, offset and impacted. In cases where the line of the fracture is not completely crosses the bone, say, a crack or break. The displacement of bone fragments in most cases occurs under the action of muscle pull. There are offset by the length of discrepancies or by the going down of fragments (Fig. 3, 4-6), width offset in part (Fig. 3, 2), with angular deformation (Fig. 3, 1) and rotary offset by rotation of fragments around the longitudinal axis (Fig. 3, 3).
The displacement of fragments in any one direction is rare, more often combine several types of bias.
Fractures accompanied by more or less damage to the surrounding soft tissues. In some cases this related injuries are severe and require urgent remedial measures, for example, a damaged fragments of large vessels and nerves, urethra and bladder, etc. are of Particular importance damage to the spinal cord (see the Spine) and brain (see Traumatic brain injury). Often offset fragments breaks through the skin, and closed fracture goes into the open. Soft tissue can get between the ends of fragments (the interposition of soft tissues)that prevents proper adhesion.
The big help in the recognition of a fracture renders correctly assembled history. The shock, drop, and so on, with immediate disorder functions and pain cause to suspect a fracture. Signs of fracture: pain, limb deformities, bleeding and swelling of the surrounding soft tissues, shortening and changing the function of damaged limbs, abnormal mobility and bone crepitus (the crunch). Invalid persistent attempts at detection of pathological mobility, as they cause to the patient pain, and fragments can damage nearby soft tissue. In any case, if you suspect a fracture need urgent immobilization using tyres (see Bus, splinting). The definitive diagnosis is made only after x-ray examination. X-rays done in two mutually perpendicular planes, the frontal and lateral. Sometimes there is a need for more or multi-axis pictures. Some fractures without displacement of bone fragments (navicular bone, neck of the femur) radiographically not always revealed immediately after the injury. Need to re-survey after 7-10 days, during which the gap between the fragments expands and becomes visible on x-ray.
The fracture along with local changes accompanied by General reaction of the organism with a moderate leukocytosis, increased body temperature, which bears a temporary character and with a closed fracture disappears in a few days. One of the most formidable of early complications of fracture is fat embolism (see), accompanied by the overall poor condition of the patient. Prevention of fat embolism - timely and correct splinting of fragments. First aid in fractures of different depending on whether open or closed fracture. The victim anesthetic is injected. In open fractures after lubricating skin surrounding the wound, iodine tincture impose sterile dressing, produce splinting and immediately transported to hospital for treatment. If fragments of bones protruding outside, put it may not be necessary because of the risk of entry of microbes in the tissues. With closed fractures impose a bus and immediately send the patient to the hospital.