Plates and nails
It is difficult to use the word “ranking” in relation to the frequency of injuries, but the most common, in descending order, are fractures of the radius, ankles and clavicle, bruises of the humerus, fractures of the shin bones and damage to the ligamentous apparatus of the ankle and knee joints, and traumatic brain injuries.
— Ice injury includes a wide range of fractures of the bones of the upper and lower extremities resulting from a slip and fall on street ice, —
The director of the center, Doctor of Medical Sciences, Professor Mikhail Gerasimenko, explains .
— Many of the ice injuries can be treated without surgery using a plaster cast, a bandage made of polymer materials (adhesive soft cast), or orthoses.
Getting a person back into action as early as possible is what traumatologists strive for today.
— If you need to do an operation for this, then we perform one so that after the intervention the person is not wrapped in plaster for one and a half, three, six months, but proceeds to developing the limb,
- notes
the head of the adult traumatology laboratory, Alexander Sitnik
.
Alexander Alexandrovich shows a titanium plate for his left hand. Specialists use such implants for fractures of the radius.
— The surgeon sets the fracture, fixes it with a plate, secures it with screws, —
for clarity, the doctor applies the material to his hand.
— After the operation, you can immediately move your fingers and work the wrist joint. We apply a plaster cast for a week. Let the wound heal quietly, and then you can work with your hand. Of course, not immediately as intensely as a healthy person, but still. We use plates for complex fractures with displacement or other features, such as intra-articular fractures or when two arms are broken at once.
Titanium implant for bone treatment.
Patient Vera, falling, put both her arms in front of her and broke both. So that she could take care of herself, she had one arm operated on with a titanium implant, especially since the fracture was not easy. Five days have passed since the intervention. The woman has one arm in a cast, and the patient already has full control of the other, which was “repaired” with the help of a plate.
— If performed correctly, with good bone quality, and the presence of good material, the operation makes it possible to immediately work with the hand, —
says Alexander Sitnik.
— Medical steel and titanium, from which the plates are made, are well tolerated by the body.
Alexander Alexandrovich shows a device in the form of a tube. This is a metal nail for the surgical treatment of a mid-tibia fracture. Such devices allow you to recover faster from injury.
At the present stage, in the surgical treatment of an intra-articular fracture, direct open reduction is used, and in the case of an extra-articular fracture, minimally invasive reduction is used. The priority is always to be gentle on the soft tissues surrounding the bone, which is the key to rapid healing of the fracture. Any fracture must be adequately fixed to allow movement of the joints of the limb in the immediate postoperative period, as well as ambulation with the help of crutches.
Ice injury is considered a relatively benign injury that doctors can treat quite well. The complexity of the problem lies in its widespread nature, when the clinic is under heavy load.
How do fractures heal? And what to do if they don’t grow together?
We have known since childhood that fractures heal on their own, you just need to fix the damaged part of the body for a while. How does the process of fracture healing proceed?
The reunification of bone fragments consists of three stages:
1. Hematoma formation. Lasts up to 2 weeks.
The bone contains blood vessels that rupture during a fracture. Blood flows out of them, coagulates and forms a hematoma. This is the key factor in starting the healing process.
At this stage, it is important to fix the victim’s bone fragments. In “simple” cases, this is done with the help of an external orthosis - plaster, polymer dressings and fixators.
If the bone fragments cannot be fixed in the correct position without direct access to the fracture site, then osteosynthesis surgery is performed. This is the “assembly” of a bone or joint using fixing structures installed directly on the damaged bone and its fragments.
2. Soft callus. Lasts up to 6 weeks.
The hematoma creates a suitable environment for the maturation of soft callus. It is built from threads of connective tissue and new tiny vessels.
3. Hard callus and successful bone restoration. Lasts up to 12 weeks
Gradually, the soft callus is filled with the main building cells of bone tissue - osteoblasts. The density and hardness of the connective tissue increases, its threads are woven tighter.
When a fracture does not heal
Unfortunately, there are fractures that do not heal without additional medical care. According to statistics, the number of such injuries reaches 10%.
People over 55 years of age who have diabetes and are taking non-steroidal anti-inflammatory drugs are at risk. And, of course, owners of various degenerative and dystrophic diseases of the skeletal system (osteoporosis, arthritis, arthrosis, etc.)
The direct reasons that the bone does not heal may be disturbances in the process of bone tissue regeneration - insufficient formation of edema and hematoma, weak growth of new vessels, connective tissue does not mature.
Depending on these reasons, adequate treatment is selected. However, the first stage is osteosynthesis. With the help of surgical intervention, the correct and denser arrangement of the fragments is established; if necessary, additional bone tissue is taken from healthy bone.
The Life Line clinic specializes in the surgical treatment of complex fractures.
Fragile neck
The proportion of successful falls is lower among older people. In old age, injuries have serious consequences. Especially when it comes to hip fractures. “Fractures of the proximal femur in the elderly, as a rule, require early, within 1-3 days, gentle surgery, which allows you to rely on the injured limb without restrictions,”
explains
the director of the center, Mikhail Gerasimenko. — This can be achieved by osteosynthesis with Gamma-type rods, endoprosthetics of the femoral head, and total endoprosthetics of the hip joint.
Intramedullary osteosynthesis with locking has the advantages of minimally invasive installation of a rod without exposing the fracture site, and the possibility of early loading of the limb with body weight. As a rule, it is used in the treatment of fractures of the diaphysis of the tibia, femur, and in some cases the humerus.
According to Mikhail Aleksandrovich, recently the center has been introducing endoprosthesis replacement of the head of the radial bone for its comminuted fractures in combination with a dislocation of the forearm. Also, although less frequently, endoprosthetics of the humeral head is performed for comminuted fractures of the anatomical neck.
Titanium crown
Although much less common than fractures of the limbs, it also happens that the consequence of a “winter” injury is damage to the spine.
In old age, injuries have serious consequences.
The head of neurosurgical department No. 1, Sergei Makarevich,
introduces a patient who fell from a bicycle, slipped the wheels on the ice, and suffered a fracture of the cervical vertebra. This happened a month ago.
Gennady's head is framed by a titanium crown. The injury turned the 54-year-old man from Nesvizh into a martyr. A halo device, screwed with pins to the bones of the skull, corrects and fixes the damaged spine. The chest is supported by a removable corset. Ankylosing spondylitis, which the man has suffered from for many years, has turned his figure into a question mark. When Gennady fell off the bike, his head stuck into his chest. As if the hook of the question had closed with its stem. This body position made it impossible to breathe or swallow. — There wasn’t enough oxygen, I couldn’t drink, I couldn’t eat,
- the patient says quietly.
Doctor Sergei Makarevich says that Gennady was admitted bedridden:
— To ensure breathing, he was given a tracheostomy tube. For 10 days, nutrition was provided through a vein. Due to ankylosing spondylitis, the spine became monolithic, like bamboo. And then there was a fracture of the cervical vertebra due to a fall. We installed a halo device, and the spine was able to straighten a little. It is, of course, still very curved, but the head lags behind the chest even more than before the injury. The patient eats and breathes on his own.
“It’s hard, of course,”
admits Gennady,
“but it’s much better this way.” Coming soon. I will wear the device at home, and then they will remove it.
What problems are most often treated at the emergency room?
Fractures
If anyone has ever broken an arm or leg, they will probably remember for the rest of their lives what inconvenience a regular cast causes. It is heavy, makes movement very difficult, the skin under the plaster cast does not breathe, and begins to itch and itch. It is very inconvenient to take water procedures with such a cast (the bandage gets wet and loses its shape). After removing the cast for a fracture, the damaged arm or leg has to be returned to its normal state for a long time.
Today, plaster has been replaced by modern polymer dressings. Plastic plaster is 4-5 times lighter than usual. It is more convenient and comfortable to wear, which allows the patient to live a normal, full life.
What modern types of plaster are used for fractures?
Scotchcast is one of the lightest types of plastic cast; you can hardly feel it on your foot. The body breathes in it. Gypsum is available in a variety of colors. Disadvantage - it can only be worn with a special cotton-rag stocking, so it cannot be wet. This type of plaster can only be removed using a special tool.
Softcast is an elastic material used in the postoperative period and for dislocations. When swelling appears, it can stretch and take on new shapes. For fractures, this bandage is worn together with adhesive tape.
HM-cast is a synthetic mesh with large cells. It is very light, but you only need to wear it with a special synthetic stocking. Used as a cast on the arm.
Turbocast is the most common plastic gypsum with high strength. A cotton stocking is not worn under this cast, so you can take water procedures in the turbocast. Another plus is that this material has a working memory, so it can be heated and used repeatedly. A turbocast plaster cast looks aesthetically pleasing and is easy to use (it can be hygienically treated with a soap solution).
Don't put up with that uncomfortable old cast! In our clinic you can replace the old plaster with a modern lightweight turbocast bandage. From time to time we run a promotion that allows you to exchange old plaster for a new one at a discount in case of fractures.
Wounds
A wound is damage to a tissue or organ, accompanied by a violation of the integrity of the mucous membranes or skin. These injuries are a common reason for going to emergency rooms.
Wounds can be cut, punctured, torn, bitten, chopped, or gunshot. In relation to the cavities of the human body - penetrating (open wounds) or non-penetrating (closed).
Depending on the presence of infection, wounds may be infected (purulent wounds) or without signs of pus. Blood can be released into the body cavity (internal bleeding) and out (external bleeding).
The main signs of a wound are pain, bleeding and dehiscence. Serious wounds with extensive damage and large loss of blood can cause traumatic shock in a person and even lead to death.
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Diagnosis and treatment of wounds
In the case of superficial, small wounds, the diagnosis is made based on the clinical picture. For deep wounds affecting a large surface, X-ray examination, laparoscopy, and ultrasound are used. In some cases, consultation with a vascular surgeon or neurosurgeon may be necessary.
The emergency room treats minor superficial injuries. The technology for treating a wound depends on its size, depth, presence of infection, etc.
On the first day after injury (and in the absence of inflammation), primary surgical treatment of the wound is performed, which includes washing the wound, removing foreign bodies and blood clots, excision and suturing of the wound cavity with insertion of drainage. If the damaged part is well supplied with blood, the edges of the wound are not crushed and are well connected to each other, then after about a week the wound heals with the formation of a pink scar.
Old wounds cannot be sutured. Treatment occurs by applying a bandage. If pus occurs, the wound is drained. Wound healing occurs in approximately 2 weeks. If necessary, the doctor can recommend the optimal remedy for wound healing, which can be used at home.
In case of significant tissue damage, plastic surgery with a displaced or free skin flap can be used.
Wound dressing plays a special role in the treatment of all types of injuries. Depending on the indications, the doctor can use various types of dressings (protective bandage, medicinal, hemostatic, occlusive, etc.)
dissection
Dissection is an injury to the skin, which leads to divergence of the lower tissues and layers. The cut can appear anywhere, but the face is especially common.
A strong cut in the eyebrow can leave an imprint on it in the form of a scar or scar!
If deep tissue damage occurs during the dissection, it is necessary to wash the wound, treat it with any antimicrobial agent (for example, streptocide) and go to the nearest emergency room as quickly as possible, where traumatologists will stitch the wound.
A split lip can also cause a lot of trouble. With this incision, the victim experiences pain when articulating, and the wound bleeds.
If you have a cut, try to treat the wound on your lip with an antiseptic, apply ice to the existing swelling, and use special wound-healing ointments. If your lip is severely injured, seek treatment at an emergency room. After the necessary examination and examination by specialists, you will be prescribed adequate treatment, perhaps this will be surgical intervention. There is no need to be afraid of surgery when you have a cut lip; it is quick and effective, and soon there will be no trace left of your wound.
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