Providing first aid for broken limbs

What is a fracture: causes and types

Bones are susceptible to a variety of injuries, but not all of them are fractures. This concept refers to a violation of the integrity of the bone, which occurs due to external strong mechanical influence. If the force of the impact exceeds the strength of the bone, a fracture will inevitably occur.

In practice, there are several types of fractures:

• congenital - occur during intrauterine development of the fetus, against the background of pathologies of bone skeleton growth, as well as during childbirth (if additional force is used);

• acquired - arise during life, from falls, impacts, etc.;
• traumatic - against the background of injury;
• pathological - occur against the background of various pathologies, including syphilis, tuberculosis, osteomyelitis and other diseases.

The main factors leading to fractures are compression, impacts, lifting weights, twisting and turning, as well as twisting and falling from a height.

There is another classification of fractures:

• open – with skin damage;
• closed - without them.

It is quite obvious that the former are more dangerous; they are associated with damage to soft tissue and may be accompanied by bleeding, mixing of bone fragments, infection and other complications.

Fractures are also divided into 2 types:

1. Epiphyseal - the most severe, they lead to confusion of the joint surface and dislocation. A type of epiphyseal fractures are intra-articular fractures, when they affect only the joint capsule itself.
2. Metaphyseal – fixed by the common connection of two fragments.

Causes

Depending on the cause of occurrence, traumatic and pathological fractures are distinguished. The cause of traumatic bone fractures is a sharp, sudden action of a mechanical shock force on the bone. Pathological fractures appear when a certain pathological process affects bone tissue. This may be the result of a cyst or the development of a malignant tumor. In this case, the structure of the bone tissue is gradually destroyed and even small loads can lead to a fracture. With the second type, the risk of fracture increases several times. It even gets to the point where a person can also break a leg while walking. Here the reason is that this is a pathology of the bone itself, and not an external influence on it.

Signs of a fracture

A fracture can be diagnosed based on a number of signs:

• sharp, severe pain in the corresponding area;
• swelling of the tissue;
• swelling;
• clearly visible deformation of the damaged area;
• limited body movements or inability to do so;
• forced adoption of a certain posture to overcome severe pain;
• shortening of limbs;
• pain when tapping;
• sounds of bone fragments crunching under the surface of the skin.

Symptoms

Bone fractures have characteristic symptoms that make it possible to identify pathology when it occurs, which is very important to exclude complications. The following main relative signs of a fracture can be distinguished: - Pain syndrome: sharp pain when a bone ruptures and aching pain in the future, which intensifies with longitudinal load or its imitation. - Swelling: Swelling in the affected area develops gradually. — Hematoma: of different sizes on the affected area; in this case, a hematoma with pulsation indicates continued bleeding. The absolute sign of a fracture occurs as a result of direct destruction of the bone and indicates the completion of the process. These signs of a fracture are: - A characteristic crunch (crepitus): occurs when bone tissue ruptures, and is subsequently audible with a phonendoscope due to the friction of the fragments. — Unnatural direction of a limb or other bone. — Increased mobility in case of joint rupture. — Bone fragments are visible visually during an open fracture. - Shortening of the limb when fragments are displaced, protrusion of the broken bone. Some signs of a fracture without displacement or an incomplete fracture may not appear, which will complicate the diagnosis. The symptoms of a fracture are clearly determined by radiography - the location, type and degree of destruction are recorded.

How to distinguish a fracture from a dislocation

A fracture is a break in the integrity of the bone, while a dislocation is a rupture of the joint capsule and ligaments. This can lead, for example, to sprains. In this case, movements are completely blocked. At the same time, during a fracture, the damaged bones are quite mobile and therefore require immediate immobilization.

If a dislocation occurs, severe pain is felt in the joint, it swells, and a change in shape and unevenness of the surface are visually noticeable. Moreover, during a dislocation, the length of the limb and its shape never change, but the joints themselves are displaced. If a fracture occurs, the length of the bone, on the contrary, may change.

Treatment

The main objectives of treating a victim with a fracture are saving his life and preserving the limb, restoring the integrity of the bone and the anatomical shape of the joint, the function of the damaged limb and the working capacity of the victim. First aid is aimed at preventing displacement of bone fragments, damage to soft tissues, wound infection, the development of traumatic shock and massive blood loss. Necessary actions: immobilize the damaged area of ​​the skeleton using a splint that captures the joints above and below the site of injury. Stop the bleeding with a tourniquet and apply a sterile bandage to the wound. Give an anesthetic: analgin or promedol. Transport the victim to the emergency room. In case of multiple fractures and spinal injuries, it is not recommended to move the patient until the ambulance arrives. Conservative treatment consists of immobilization and the use of plaster casts after closed reduction of the fracture or without it (if there is no displacement). When applying plaster, the limb must be in the physiologically correct position. Its distal parts (for example, fingers in case of a fractured limb) must be open to be able to determine swelling and prevent disruption of tissue trophism. Sometimes traction is necessary for a fracture—the use of skeletal, cuff, adhesive, or adhesive traction. This method helps to neutralize the action of muscle layers that are attached to bone fragments, prevent their displacement and create conditions for bone tissue regeneration. Skeletal traction gives the greatest effect. A weight attached to a wire that is passed through the bone ensures that the bone fragments are maintained in a position that is optimal for tissue restoration. The disadvantage is the forced immobilization of the patient, leading to a deterioration in his general condition. For cracks in long bones and fractures of small bones, functional methods are used. They involve the absence of immobilization or minimal immobilization of the damaged area and are reduced to providing it with rest. Surgical treatment is necessary for jaw fractures (installation of an external fixation device), restoration of spongy bones (cranial vault), excessive formation of callus, etc. In the postoperative period, the fracture site is immobilized. Recovery time ranges from several weeks to several months. If bone restoration does not occur and a false joint is formed (persistent abnormal mobility at the fracture site), endoprosthetics methods are used (replacement of elements of the musculoskeletal system with implants). After the cast is removed, rehabilitation therapy begins. This is, first of all, a massage. Prescribed 10-45 days after the fracture. It accelerates the process of callus formation, improves blood circulation and tissue nutrition, and prevents muscle atrophy. CRM therapy is a passive development of joints (without the participation of muscles) using a specially tuned mechanical device. Physiotherapy. In the first 10 days, exercises are done for intact joints and limbs. They prevent muscle weakness and joint stiffness. After removing the cast, exercise therapy helps restore the mobility of damaged joints and muscle strength. It is recommended to increase the load gradually, completing rehabilitation with active gymnastics, which helps neutralize the consequences of the fracture.

First aid and diagnostics

First of all, the damaged part must be immobilized, i.e. immobilize, ensuring complete rest. To do this, use medical splints and other devices, for example, improvised means (sticks, cardboard).

If a hip or shoulder bone is broken, a splint is applied, covering 3 joints at once. In other cases, it is enough to cover 2 adjacent joints - before and after the fracture site and bandage it securely. If there are bone fragments, under no circumstances should you pull them out yourself. It is also necessary to disinfect the wound to prevent infection of the skin and blood.

To diagnose, you need to seek emergency help as quickly as possible or visit a doctor - therapist, surgeon, or orthopedist. The specialist conducts an external examination and identifies complaints. The patient also undergoes an x-ray to confirm the diagnosis. The picture can be taken in 1 or 2 projections.

Diagnostics

For most closed fractures, X-ray diagnosis plays a leading role. This study is necessary not only to confirm the diagnosis of the fracture and document it. It is very important for the traumatologist, based on radiographs, to get an idea of ​​the nature of the displacement of the fragments, the direction of the fracture lines and the presence of additional cracks indicating splitting of the fragment. This information is needed to determine treatment tactics and select the type of osteosynthesis. X-ray examination is also important during the treatment process. It determines the completeness of reposition, the correct position of the fixing structure, the absence of secondary displacement (as swelling subsides), the appearance and formation of callus. The surgeon and traumatologist must follow the rules for taking radiographs for fractures.

Diagnosis of a closed tibia fracture

The diagnosis is made based on examination and radiographic data. In some cases, specialists may prescribe additional research methods:

• CT scan (can help to study in detail the condition of the bone structure);
• MRI (helps to study the soft tissue surrounding the fracture site);
• Ultrasound of the joint and arthroscopy (help to study the condition of the joint in case of ankle injuries).

If the doctor suspects damage to nerves and blood vessels, it may be necessary to consult other specialists: a neurosurgeon, vascular surgeon or neurologist.

Non-united fracture

A non-united fracture is one in which, after twice the period required for fusion of a given bone, pain and pathological mobility at the fracture site are clinically detected, and radiographically - a gap between the fragments with the bone-marrow cavities of the fragments still closed (osseous non-union). If there is bone fusion of these cavities with end plates, this indicates a developed false joint (pseudoarthrosis).

So, it is possible to differentiate a non-union fracture from pseudarthrosis clinically by pain at the fracture site, which occurs during movements and loading of the limb, and radiographically by the absence of fusion of the bone marrow cavities.

All consequences of impaired reparative osteogenesis are pathogenetically interrelated and depend on causative factors and the quality of treatment. During the movement of fragments, constant injury occurs to the fresh structures of the callus, including newly formed vessels.

While maintaining the ability of the human body to undergo a reparative process, compensatory changes appear in the area of ​​the fracture in the form of marginal growths, which, to one degree or another, gradually reduce the pathological mobility of the fragments. A hypertrophic or hypervascular callus is formed, in which the processes of bone formation predominate over the processes of bone resorption. Despite the formation of significant fusiform hardening in the area of ​​the fracture, pathological mobility and pain are clinically determined; radiographically, bone fusion between them is not visible. The gap between the fragments is filled with coarse fibrous connective tissue.

Further, the regenerative process with slow fusion can go in two directions, which depends on a number of factors. If the fragments are compressed among themselves, and when they are loaded (physiological muscle contraction, dosed load in a bandage), the acting force coincides with the axis of the damaged segment and goes perpendicular to the fracture line, then the fibrous connective tissue turns into cartilage, and then into bone, i.e. e. secondary bone fusion occurs, although it takes quite a long time to occur.

If the force acts not along the axis of the segment, coincides with or approaches the fracture line, then the bones will not heal, and a hypertrophic false joint will gradually form. Characteristic clinical signs of a pseudarthrosis are pathological mobility and absence of pain at the site of the fracture; radiological signs are the closure of the bone marrow cavities (the presence of locking plates) and the gap between the fragments

The processes of bone tissue resorption predominate over bone formation. The ends of the fragments become thinner and pointed, and the gap between them is wider. Paraosal bone layers disappear. The fragments are connected to each other by connective tissue, which is the least differentiated and does not require a good blood supply. With significant pathological mobility, a gap and typical hypovascular (atrophic) pseudarthrosis are formed between the fragments.

How does a fracture manifest itself?

When a fracture occurs, the bone tissue is completely or partially damaged (crack). In some cases, the injured bone can break the skin, coming to the surface - this is an open fracture.

With a closed fracture, bone fragments can move (then they speak of a displaced fracture) or remain in place (a non-displaced fracture).

A fracture is characterized primarily by pain, sharp and severe at the time of injury, sometimes you can even hear the characteristic crunch of a breaking bone.

In case of a fracture, swelling and bruising are also possible. And yet there are differences between it and a bruise.

Types of fractures

Broken arm

First aid for arm fractures is based on prompt immobilization of the limb, application of a splint and fixation. Severe pain is relieved with painkillers. If pain shock begins to develop, the victim is warmed up and given hot tea. It should be noted that drinking is prohibited if the patient is vomiting or has an abdominal injury. When the symptoms of shock are eliminated, the injured person can be moved.

An open fracture of the arm requires stopping the bleeding using a tourniquet, which is applied above the injury. Antiseptics are used to treat the wound. Having stopped the bleeding and treated the wound, it is necessary to carry out the procedure of fixing the hand.

Attempts to realign bones are strictly prohibited.

Broken leg

First aid for leg fractures involves using a splint to secure the limb. An open injury may bleed, so stop the bleeding using a tourniquet. The wound is treated with antiseptics, and if the victim feels severe pain, anesthetics are used.

Independent attempts to straighten the bone are strictly prohibited.

Spinal fracture

A spinal fracture is a serious injury that threatens the life of the victim. For such a fracture, pain relief must be given very quickly, and the body must be fixed immediately. To move a person, boards, doors, and plywood are used. The head is fixed with a rigid collar made of suitable items.

It is prohibited to sit down, try to stand, pull the limbs, or straighten the spinal column of the victim.

Pelvic fracture

A pelvic fracture can be accompanied by severe complications and internal bleeding, which sometimes result in disability and death. When providing first aid in such cases, you should examine the victim, immobilize him in a supine position (knees should be bent), fix the pelvis, and raise the knees with a roller. In addition, the patient’s condition should be constantly monitored until doctors arrive.

It is forbidden to seat or try to position a patient.

Fractured ribs

When a rib is fractured, internal organs and the cardiovascular system can be damaged, which is very dangerous for the victim. However, a simple fracture of one or two ribs does not require the attention of specialists - the patient recovers on his own. In difficult cases, it is necessary to urgently hospitalize the injured person and provide him with qualified assistance.

This type of fracture requires rest, so it is worth limiting active movements and sports.

Tibia fracture

First aid for lower leg injuries consists of fixing the limb, applying a splint, and administering painkillers to the patient. If there is bleeding, a tourniquet is applied.

Repositioning the bone is strictly prohibited.

Shoulder fracture

A shoulder injury can be complicated by internal hemorrhage, which is extremely dangerous to health. The patient needs immobilization for a fracture using a splint, and he should also be given painkillers. The victim must be moved in a sitting position.

It is forbidden to straighten the shoulder and carry the patient without fixing the limb.

Bruise - what is it?

A bruise is an injury in which there is no disruption of the integrity and structure of the tissue. With a bruise, there is no large open wound or heavy bleeding; only abrasions are possible, which quickly disappear. But bruising is quite likely. It is caused by internal hemorrhage: tissues compressed during a bruise are pressed against the bones, damaging blood vessels and the latter bursting. The result is a blue-purple spot that turns yellow-green over time.

Another sign is swelling that forms at the site of the bruise, which limits movement in the damaged organ.

And of course, the main manifestation of a bruise is pain - varying in intensity, from mild to severe.