Fractures

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Treatment with fractures consist of repositions (see), solid fixation of fragments by the whole period of accretion and complementary methods of treatment (physiotherapy, physiotherapy, massage, and so on), aimed at restoring the functional usefulness of the affected limb. In the treatment of open fractures great value has a correct and timely primary surgical treatment of skin and bone wounds (see the Wound, injury). The favorable course of the wound process in the soft tissues is the basic requirement for healing of open fracture. In the treatment of open and gunshot fractures, especially in wartime, is successfully used deaf cast (see Plaster technique).
Reposition and fixation of bone fragments can be produced with the help of conservative and operative treatment methods. Conservative treatment of fractures of bones is performed as an outpatient and inpatient conditions, depending on the nature of the fracture, online - only in the hospital. Both methods are equally widespread in trauma patients and are clear reasons in each case. Many fractures complete treatment can be performed as an outpatient (most of the small bones fractures without displacement of bone fragments, some types of fractures with successful simultaneous reduction, such as a fracture of a radial bone in a typical location, fractures, surgical neck of the humerus and some others). A large group of outpatients are past a certain course of treatment in the hospital and was discharged for aftercare.


Fig. 5. Cast

Reposition of fragments in the conservative treatment can be performed manually or with mechanical draught, once, or for a long time (see Traction). In all cases, simultaneous mapping of fragments should be done with General anesthesia or local anesthesia (introduction to the hematoma between fragments 20-40 ml of 2% solution novokaina). Coming after sedation, muscle relaxation facilitates reposition. Reaching a satisfactory state of fragments, impose a plaster cast (Fig. 5), which applied the scheme of the fracture, the date of the damage, overlay and the alleged removal of plaster bandages.
Duration immobilization plaster cast depends on localization of the fracture, the nature of the displacement of bone fragments, method of treatment, the patient's age and other reasons. After the occurrence of the fusion of bone fragments, radiographically confirmed, plaster bandage is removed and appoint gymnastics, massage. The average maturity of Union fractures and restore the function of damaged limbs when conservative treatment is presented in the table.

* Terms reduced at a young age, elderly is increasing.
Reduction of term immobilization leads to different complications - nonunion of fragments, bending axis of the leg, with an excessively prolonged immobilization contractures occur (see) joints, persistent muscle atrophy.
Fusion (consolidation) of fractures is determined by the clinical and radiological signs. Clinically there is a lack of pathological mobility in the former site of the fracture. Radiographically fusion of fragments is characterized by bone spur, spivaye the ends of fragments (Fig. 4). The process of formation of callus long, and radiographically structure corn for a long time differs from the ends of fragments, which it connects. In some unfavorable cases, the processes of monolaurate are violated by the slowdown in the consolidation or by the formation of false joint (see).

  • Fractures in children