www.travm.info Traumatology The largest medical portal dedicated to injuries to the human body

The largest medical portal dedicated to injuries to the human body. Consultation with a doctor.
A hip fracture is a serious and dangerous injury. Its outcome and consequences largely depend on the correctness of first aid and the timely delivery of the victim to a medical facility. One of the first aid measures is immobilization of the injured limb - in the case of a hip fracture, this can be done using a Cramer splint.

The article indicates the rules for immobilizing a broken hip using a Kramer splint. The main symptoms of injury are described and the need for splinting is indicated.

Immobilization is a mandatory manipulation for hip injury

Characteristics of injury

A hip fracture is one of the most complex and dangerous skeletal injuries. The femur is one of the largest bones. Around it there are main blood vessels and important nerves.

A hip fracture can be accompanied by massive bleeding, which can be fatal. Nerve damage can leave a person disabled.

It is not so easy to break the femur - it is strong and thick, surrounded by a massive layer of muscle.

Hip fractures usually occur in unusual situations:

• car accident;
• earthquake;
• train accident;
• falling from a great height;
• attack by a large animal.

It happens that a person has a predisposition to pathological fractures - osteoporosis, hormonal disorders, bone tumors. But even in this case, it is difficult to break the femur.

Symptoms

It is not difficult to recognize a fracture of the femur; the injury has pronounced symptoms. Fractures can be open or closed - in the first case, damage to the muscles and skin occurs, in the second the skin remains intact.

The main symptom of injury is pain. It is so intense that a person can even lose consciousness - this condition is called painful shock. The pain is caused by damage to a huge number of nerve fibers located in the periosteum and muscle layer.

If the fracture is closed, there will be no external bleeding. The deformation of the limb and its pathological lengthening in comparison with the healthy leg are determined. A bruise quickly appears on the skin at the site of the fracture, which increases in size (photo). The person cannot step on the injured leg.

A bruise forms on the surface of the thigh

With an open fracture, a wound is visible on the leg, at the bottom of which fragments of muscle and bone fragments are determined. Large vessels are inevitably damaged and severe bleeding occurs. If the femoral artery or iliac trunk is damaged, the person can die within minutes.

Immobilization

If any part of the femur is damaged, three adjacent joints must be fixed simultaneously during transportation - the hip, knee and ankle. Such fixation in case of a fracture is achieved by applying three splints of different lengths: the first, the longest, is fixed to the body. It runs from the armpit along the torso and leg, protruding slightly beyond the foot. The second runs along the back of the thigh from the buttock to the foot. The third is from the groin to the foot. The splints must be fixed at three points - at the level of the joints.

For an open fracture, the technique for applying immobilization agents is similar. Additionally, you will need to use a tourniquet to stop bleeding; a splint is applied with fixation above and below the fracture area.

Types of tires

Special medical immobilization devices differ not only in design features, but also in materials (metal wire, wooden slats, plastic, cardboard), sizes, and operating principles (a distinction is made between fixing splints and those with a traction function). In the warm season, a gypsum splint is used. Let's take a closer look at some types:

• Ladder - its appearance resembles a rope ladder made of wire. An undoubted advantage is flexibility; due to the physical properties of the material, such a splint can be molded to the shape of the injured limb. At the same time, this design has low strength, and since in case of a hip fracture it is necessary to use a long-length clamp (to fix three joints, including a very mobile one - the knee), such a splint is easy to break.
• Dieterichs splint - consists of wooden planks, has high rigidity and reliable fixation, mainly used for hip fractures. Disadvantage: during long-term transportation, due to its high rigidity, it provokes the formation of bedsores.
• Pneumatic tires - easy to apply, the fixing effect is achieved due to the air pressure inside the tire. They are compact, mobile, and thanks to their design features, they completely replicate the relief of the limb being fixed.
• Boller, Pankov splints are extension splints, the limb is half-bent and slightly abducted, but at the same time it is fixed to the body and healthy leg. Such designs allow you to change the position of the limb, which subsequently makes it possible to carry out therapeutic exercises. Thanks to the design features, the size can be easily adjusted and is used for both adult and pediatric patients.

Read also: How to get rid of panic attacks with osteochondrosis

Overlay methods

The main rule of splinting for a femur fracture is that the injured limb must be fixed on both sides simultaneously.

The internal splint immobilizes two joints - the knee and ankle, while the external splint immobilizes three - the ankle, knee and hip. The main task of such immobilization is to prevent dislocation of the head of the hip joint. A small soft cushion is placed on the groin side to prevent injury and minimize discomfort.

Splinting is performed in the supine position after using painkillers. If the victim has open wounds, appropriate aseptic and antiseptic treatment is performed, and a sterile bandage is applied. The immobilization agent should not be allowed to come into direct contact with the skin - you can apply a gauze bandage or any other available means. The splint is fixed firmly over clothing and shoes, but maintaining the normal intensity of blood circulation. If there is visible deformation, the remedy is applied on the side opposite to it; it is strictly forbidden to correct the damage on your own. Some splints (Diterikhs, for example) must be adjusted to the patient’s height before use, or parts of the splints must be used when helping children.

First aid

Timely first aid significantly increases a person’s chances of recovery. The algorithm for providing assistance depends on the type of fracture. If the injury is open and there is heavy bleeding, the first thing you need to do is stop it. This is done by applying a tourniquet to the limb - for arterial bleeding above the site of injury, for venous bleeding - below.

When the bleeding has stopped, the person is transferred to a place more convenient for assistance. It is necessary to assess his state of consciousness and, if possible, give him an anesthetic.

The next important step in first aid is immobilization of the limb. This is usually done by emergency doctors, but anyone needs to know how to apply a splint for a hip fracture.

The need for immobilization

With any movement of the injured leg, bone fragments are displaced and further injure the muscles, blood vessels and nerves. Also, when moving, the pain increases. To avoid this, it is necessary to immobilize the injured limb, that is, immobilize it.

For immobilization, any available means can be used - boards, thick branches, pieces of cardboard. But it is best to carry out this manipulation using special transport tires.

There are general rules for applying splints for a femur fracture:

• the manipulation is carried out after anesthesia;
• the person must lie on a flat surface;
• open wounds are treated with an antiseptic and a sterile bandage is applied;
• existing bleeding must be stopped;
• if a tourniquet is applied, it should not be covered with a splint;
• no bone realignment is performed;
• A splint for a fracture of the femur is applied from the tips of the fingers to the lower back, covering three joints of the limb.

The most common are Kramer and Dieterichs tires. Below are instructions for their use and a description of the tires.

Cramer tire

One of the types of transport tires is the Kramer tire, also known as the stair tire. The tire is a wire structure made in the form of a rope ladder. It has good flexibility, which allows you to model it according to your body shape.

The Kramer splint is rarely used for hip fractures because it does not have a sufficiently rigid fixation. But if this is the only remedy at hand, it can be used. A staircase splint for a hip fracture is applied as follows.

1. To immobilize the hip, you need to take three stair splints. The first is modeled along the back surface of the body - from the shoulder blade to the foot. The second is modeled along the lateral surface - from the armpit to the foot. The last splint is modeled along the inner surface of the leg - from the groin to the foot. Wire splints must be wrapped in a layer of cotton wool and gauze to avoid friction.
2. Then the person is placed on the first splint, and the remaining ones are applied. They should all bend over the foot and converge there. A layer of cotton wool should be placed under the knee and in the groin area.
3. The splints are firmly bandaged to the body so that they do not move. If a tourniquet is applied to the leg, it should be left accessible.

Simulation of stair tires

The person is then carried on a stretcher into the vehicle.

There are several mistakes made when immobilizing:

• incorrect modeling;
• lack of limb treatment;
• insufficient fixation of the splint;
• lack of an insulating layer.

These errors lead to the tire slipping and the lack of immobilization effect.

Dieterichs tire

The application of a Dieterichs splint for a hip fracture is more desirable, since it has sufficient rigidity. The structure is made of several wooden slats and fastening belts.

The technique for applying a splint for a hip fracture is as follows:

• The side slats are adjustable in length - from the lower back to the foot;
• the footrest is secured with a figure-of-eight bandage;
• connect the side rails and the footrest;
• cotton wool is placed under the knee, in the groin area, under the lower back;
• Additionally, the splint is secured with bandages.

Dieterichs splint application

This design is more rigid and the risk of displacement of bone fragments is minimal. The video in this article clearly presents the rules for applying splints for a hip fracture.

In addition to the classic tires of Kramer and Dieterichs, there are pneumatic tires. They are a double-walled bag. The injured leg is placed in it, then a vacuum is created in the bag using a pump. Thanks to this, the fabric firmly fixes the limb, preventing the bones from moving. The price of such devices is quite high, so not all ambulances are equipped with them.

How to apply a splint for a hip fracture - useful information for everyone. At the time of injury, most often only improvised immobilization is available, but knowledge of this manipulation will allow a person to help the doctor and speed up the transportation of the victim to the hospital.

We treat fractures without plaster

The practice of restoring broken bones using plaster has been used in the world for a long time. But it turns out that plaster has a more convenient alternative - plastic orthoses, and they recently appeared at the Istochnik clinic. Let's find out why doctors and patients often choose plastic!

"Cheap and cheerful"

In 1811, Russian surgeon Karl Giebenthal first used plaster to fix a fracture. A little later, in 1847, another famous Russian doctor, Nikolai Pirogov, created a “stick-on dressing,” using first starch, then colloidin, gutta-percha, and finally gypsum to harden the material. Pirogov’s bandage has “survived” to this day. Gypsum is an inexpensive material, so from an economic point of view it is still profitable to use it for medical purposes.

But for a patient who has to walk in a cast for weeks and months, such a bandage is completely uncomfortable. It is heavy, often puts too much pressure on the fixed area, is afraid of moisture and is quite fragile. Under the cast, diaper rash and bedsores may appear, the skin itches, and swelling occurs. Plus, the bandage sometimes prevents you from taking a high-quality x-ray. A person with a plaster cast wants only one thing: to get rid of it as soon as possible, to scratch himself properly and wash himself calmly.

Plastic help

Now imagine that the doctor offers you material with which you can take a shower, go to the pool, or put on your favorite clothes even after a fracture. If necessary, you can even remove and put the bandage back in place. This is not science fiction: these are thermoplastic orthoses.

“Such orthoses are used for various fractures of the limbs, as well as during rehabilitation after dislocations, bruises, ligament ruptures, carpal tunnel syndrome and some other injuries,” says Ivan Anatolyevich Gromov, sports medicine doctor, head of the center for traumatology, orthopedics and sports medicine at the Istochnik clinic. — The orthosis is 10 times lighter than plaster, which makes the plastic structure convenient for treating patients, especially small children. Some people also like that they can choose different colors of the material.

The orthosis is simple and comfortable

Orthoses for fixing broken limbs are made from polyurethane foam. Depending on the complexity of the fracture, making an orthosis can take from a few minutes to 1.5 hours. Everything happens in the presence of the patient. The plastic is heated to 60-70 degrees Celsius and then applied to the affected area. The procedure is comfortable for the patient: the temperature of the plastic when applied is about 40 degrees Celsius. The doctor models the design so that the orthosis accurately follows the contours of the body and fits well to the surface.

After about 6-8 minutes, the plastic will harden and turn into a durable structure. The bandage is secured with Velcro strips or zippers. But if necessary, the material can be reheated and remodeled.

Lightweight and very durable thermoplastic does not injure the skin; there is no need to place additional pads under it. The brace is not afraid of moisture, so if there are no contraindications, you can go with it to the beach, shower or pool. The design fits tightly to the limb, maintains blood flow and muscle tone. This means that healing will be faster than with a regular plaster cast.

The plastic orthosis is easily removable: a convenient option for physiotherapy or hygiene procedures. The orthosis is then put back on and fastened.

— Modern thermoplastic orthoses have become a complete replacement for plaster. They allow the patient to undergo treatment and rehabilitation of injuries, slightly changing their usual lifestyle. Now the installation of plastic orthoses is available to patients of the Istochnik clinic,” summed up Ivan Gromov.

Questions for the doctor

Good afternoon. My friends and I are going on a hike in the mountains. I understand that various injuries may occur during this. Therefore, I would like to know how to apply a splint for fractures of the hip bones, and other parts of the body.

Mikhail, 25 years old, Tver

Good afternoon, Mikhail. Indeed, anything can happen while hiking in the mountains. For a hip fracture, Kramer or Dieterichs splints are best, but you are unlikely to be able to take them with you. Therefore, in such a situation, you can use available means.

Take long boards or thick branches and apply them to the back of the victim’s body from the shoulder blade to the foot. Also attach branches to the sides, secure everything carefully with bandages. Don't forget that you need to secure your foot. In this situation, the victim must be taken to the doctors.

In case of fractures, the main task is to immobilize the damaged limb or area. Any movement of a broken bone can lead to painful shock, loss of consciousness and damage to surrounding tissue. Moreover, if the victim, after a fall or blow, complains of severe pain that intensifies with any movement or touch, there is no need to guess whether there is a fracture, or a dislocation, or a severe bruise - in any case, you need to immobilize the limb and call an ambulance. To transport the victim, it is necessary to make a splint to prevent the movement of broken bones - but it is best to leave this matter to the doctors. First, they will administer pain medication first. Secondly, they will be able to apply the splint more painlessly and competently. But if the victim has an open fracture (a bleeding injury with a broken bone), it is necessary to disinfect the wound (iodine, brilliant green, alcohol) and apply a pressure bandage and/or tourniquet without waiting for doctors. Because Blood loss can cause more serious problems than a fracture. under no circumstances recommended to attempt to correct the position of a damaged bone or to replace a broken bone on your own. Moreover, you should not set protruding bones into the depths of the wound. Let the professionals do this. To alleviate the condition of the victim, you can apply cold to the sore spot to reduce swelling, and also give him analgin, tempalgin or another painkiller. You can give the patient a drink of water or warm tea and cover him (if it’s cold). If it is not possible to call an ambulance, then you will have to make a splint yourself and transport the person. The tire can be made from any auxiliary material (stick, rods, boards, skis, cardboard, bundles of straw, etc.).

When applying a splint, the following rules must be observed: - the splint is always applied to at least two joints (above and below the fracture site); — the splint is not applied to the naked part of the body (cotton wool, gauze, clothing, etc. must be placed under it); — the applied tire should not dangle; it must be attached firmly and securely.

With a broken arm.

The easiest way to immobilize a hand is to hang it with bandages or a triangular scarf on a sling that is tied around the neck. When the bones of the forearm are fractured, two splints are used, which are applied on both sides - palmar and dorsal.

With a fracture of the shoulder, collarbone, scapula.

For fractures of the shoulder girdle, you need to place a small cushion under the arm, and hang your arm with a bandage or scarf and tie it to your body. The victim is transported in a sitting position. When a finger is broken.

If a finger is broken, it must be tightly bandaged to the adjacent healthy finger.

With a broken leg.

Tie the injured leg to the healthy leg in the area above and below the fracture. Or, if it is not possible to transport the victim in a lying position, apply a splint covering at least two leg joints. A primary splint is placed on the back of the leg to prevent joint flexion. In case of a hip fracture, a splint is applied right up to the waist and bandaged to the waist. When a rib is fractured .

Because The main task in case of a fracture is to immobilize the broken bones, and the ribs usually move when breathing, then it is necessary to apply a pressure bandage to the chest. Thus, the person will breathe using the abdominal muscles and it will not be so painful for him to breathe. If there are not enough bandages, wrap the chest tightly with a sheet, towel, scarf or other large piece of fabric. There is no need to talk to the victim - it hurts him to talk. Don't let the person lie down because... Sharp rib fragments can damage internal organs. In case of rib fractures, the patient must also be transported in a sitting position. With a fracture of the pelvic bones .

Fractures of the pelvic bones are often accompanied by damage to internal organs, bleeding and shock. It is necessary to place the victim in a position in which there is a minimum of pain. Usually, this is lying on your back with a bolster under your feet. In this case, the hips are slightly spread to the sides. The cushion can be made from a pillow, clothing or any material that comes to hand. The patient is transported on a hard board after various anti-shock measures (pain relief, stopping bleeding).