Knee brace- an orthopedic device designed to immobilize the knee in the treatment of injuries or diseases of the musculoskeletal system. Knee pads are made from different materials, providing a wide range of applications and a degree of protection. Such devices can be used not only for therapeutic, but also for preventive purposes. They are included in the equipment of professional athletes in order to protect the knee joint in the event of traumatic situations.

Purpose of knee brace

The main purpose of the knee brace is to fix the joint in the correct position, reduce the load on the knee and reduce the pain associated with joint pathologies. Such devices not only unload the joint, but also provide a compression, massage and warming effect. Clamps (bandages) on the knee are recommended to be worn in the following cases:

• diseases of the ligamentous apparatus of the knee joint (arthrosis, gonarthrosis);
• knee injuries (stretching or rupture of ligaments, meniscus damage, dislocation, fracture);
• joint instability associated with weakness of the ligamentous apparatus;
• intense pain syndrome caused by degenerative changes in the tissues of the joint;
• rheumatoid arthritis;
• the rehabilitation period after the surgical intervention on the knee joint.

Professional athletes and people leading an active lifestyle are more susceptible to knee injuries. Therefore, they are advised to wear knee pads as a preventive measure, which allows them to evenly distribute the load on the joint and prevent its injury.

In addition, orthopedists advise the use of knee braces for certain groups of patients. For example, women in late pregnancy, people suffering from obesity or representatives of certain professions who experience high loads when lifting weights.

Properties of knee braces

Orthopedic products for the knee joint bring tangible benefits, which are as follows:

• wearing a knee brace can reduce the severity of edema and pain;
• provides a warming effect, improves blood circulation and nutrition of joint tissues;
• allows you to lead a full life, improving the mobility of the knee joints;
• stimulates metabolic processes in the affected area;
• evenly distributes the load, securely fixes the patella, without restricting the freedom of movement of the limb;
• accelerates recovery after surgeries and injuries;
• prevents re-injury to the joint.

Almost all diseases affecting the musculoskeletal system require an integrated approach. The treatment of arthrosis, arthritis and other inflammatory and degenerative joint lesions is long-term, requiring patience and strict adherence to medical recommendations from the patient. The treatment regimen, in addition to medications, physiotherapy and exercise therapy, must include the wearing of orthopedic structures, which allows you to restore joint function and speed up recovery.

Types of knee pads

Orthopedic products designed to fix the knee joint are divided into several types:

Knee pads with a light degree of fixation (trapes, bandages, calipers)

They are made from natural elastic materials, or from fabrics combined with high-quality synthetics.Elastic knee braceare used for minor knee injuries (bruises, sprains), after surgical operations, or are recommended for wearing in professional sports to reduce excessive stress on the joint.

Such knee pads are characterized by good air and moisture permeability. They are made of modern, durable and high-quality materials that provide orthopedic products with a long service life, a high degree of wear resistance and do not cause allergies. Today, a wide range of elastic bandages are produced to provide stability and fixation of the knee joint. Natural materials additionally have healing properties - they warm, improve blood circulation in the diseased joint, preventing further development of the inflammatory process.

The most popular elasticknee bracefrom neoprene. It is easy and reliable fixation, long service life and ease of operation. It can be washed by hand and dried naturally. The most convenient models are detachable bandages, which are interconnected with Velcro. Such elastic bandages can be direct fixation, lateral (located on the sides of the knee) or provided with stiffeners that run along the kneecap in a spiral.

Semi-rigid knee orthoses

Such orthopedic structures consist of a splint, metal hinges and fasteners that allow you to adjust the degree of fit of the brace to the knee. Orthoses are used for lateral and direct fixation of the joint, they provide reliable protection of the knee, without interfering with the free movement of the leg.

Semi-rigid orthoses help to quickly recover from surgery, fractures (after removal of the cast), dislocations of the patella and other knee injuries. Such designs are recommended to be worn for arthritis, bursitis, gonarthrosis, Osgood-Schlatter disease. In addition, semi-rigid orthoses perfectly protect the joint during intense physical exertion.

Semi-rigid knee pads can have a fabric or neoprene base, silicone side plates and inserts, and other additional devices and straps that allow you to securely fix the joint. They can be washed in cold water, after removing the removable elements and fastening the fasteners. Dry the product away from heating devices.

Rigid fixation knee pads (braces)

Rigid orthopedic structures securely fix the knee, simultaneously covering the upper part of the thigh and lower leg. A knee pad made of polymeric fabrics or leather is equipped with silicone rings, side plates or metal hinges, and can have a different shape, size and configuration. The fixation of the structure on the leg is carried out with the help of special belts or lacing. Tutor performs the following functions:

• securely fixes the knee joint during rehabilitation and treatment;
• in case of injuries, replaces the plaster splint or splint;
• due to immobilization of the joint relieves pain;
• prevents further progression of the disease;
• prevents recurrence of articular pathologies.

Rigid structures should be lightweight, made of hypoallergenic, durable materials with a high degree of wear resistance, provide reliable fixation of the joint during round-the-clock use. Such products are designed for long-term wear, so they are made detachable so that the splint can be removed when performing medical or hygiene procedures.

Other types of knee pads

Heated knee pads are a separate group. These products are in high demand, despite the rather high cost. Now they produce bandages equipped with sources of infrared or halogen light, which provide deep heating of the diseased knee, relieve pain and improve joint mobility. Knee pads made of animal hair (dog, sheep, camel) have a good warming effect.

In case of arthrosis of the knee joint, it is recommended to wear magnetic knee pads, which help to restore the working capacity of the diseased knee by improving blood supply and activating metabolic processes. Magnets inside the knee pad relieve overload from the muscles and ligaments and help to properly distribute the load on the knee joint.

Choice sports knee bracedepends on the intensity of the loads, the type of sport, the reliability and ease of use of the structure. With average physical activity, it is recommended to choose elastic bandages, calipers, neoprene knee pads. With regular sports and increased loads on the knee joint, professional bandages are preferred.

For athletes and extreme sportsmen, knee bandages, supplemented with a patellar ring, are best suited. This design does not slip even under the most intense loads, since the silicone parts placed inside the knee pad are responsible for reliable grip. The lateral fixation of the joint in the products is provided by a spring design, and the silicone ring protects the patella from injuries and strong impacts. Additional fixation is achieved through a special compression bandage.

The materials from which light fixing devices are made are characterized by increased strength and elasticity, well remove moisture, preventing skin irritation. It is recommended to wear such knee pads no more than 8 hours a day.

Sports enthusiasts prefer Fosta neoprene braces with silicone inserts under the knee, knee padsVariteks, which are suitable for surfing and swimming, or orthoses with a warming effect from Pharmacels, which securely fix the joint and prevent sprains during active training.

In professional sports, special sports fixators are used to protect the knee from injuries to the meniscus and ligamentous apparatus; when doing strength sports, it is recommended to wear orthoses with side inserts that immobilize the knee joint while maintaining its mobility.

Material for knee brace

Bandages used in the treatment of joint diseases are made from the following materials:

• Elastane or polyester. Modern materials that are durable, elastic, good breathability, ease of use. However, the synthetic base of such knee pads does not provide a warming effect.
• Neoprene - bandages based on it are distinguished by the highest wear resistance, elasticity and long service life. They are easy to care for - just wash by hand in cool water and dry in the open air. Neoprene knee pads have only one drawback - the skin under them does not breathe, since the material does not allow air to pass through. Therefore, it is recommended to wear such bandages only during sports training, that is, 2-3 hours a day.
• Cotton is a natural material that does not cause allergic reactions, perfectly passes air and removes moisture, but does not differ in durability. To ensure elasticity, stretching fibers are included in the composition of the material. This is a lightweight version of the clamps, which are preferable to use in the warm season. Cotton retainers are easy to wash, dry quickly, but are not as durable as products made from modern synthetic materials.
• Wool - orthopedic fixators made from the wool of dogs and sheep have a healing effect, since they provide deep warming of the joint. Such bandages pass air and moisture well, but from frequent washing they quickly lose their original appearance and some of their healing properties.

How to choose a fixative?

The specialist selects an orthopedic fixator for the knee joint individually, taking into account the specific situation and the purpose of the bandage. The product must be selected according to size, degree of density, structural rigidity and type of material. The retainer should not interfere with the required range of motion, be comfortable to wear, but at the same time securely fix the knee.

It is best to seek help from a specialist - an orthopedist or traumatologist, who will select the optimal type of fixator. The size of the brace is determined by measuring the circumference of the joint above the knee, in the center of the patella and in the popliteal area.

The density of the bandage is selected taking into account the type of articular pathology or the degree of load during sports activities. After an injury, it is recommended to wear rigid fixatives that can replace a plaster cast. Such rigid knee pads are designed for long-term wear.

For arthrosis, elastic knee pads or semi-rigid orthoses are usually used to fix the joint in a certain position. It is recommended to wear them for several hours a day. It is very important that the orthopedic design for joint diseases meets all the requirements and ensures an even distribution of the load. Otherwise, an incorrectly selected fixator can aggravate the course of the disease and accelerate the course of irreversible processes leading to disability.

How much do fixators cost?

Knee braces, braces, orthoses and other devices for fixing the knee joint can be purchased in specialized departments of pharmacies or stores selling orthopedic goods. Mediumpricesfor simple fixators and soft bandages range from 800 to 2500 rubles. The cost of structures with silicone tabs varies from 4,000 to 10,000 rubles. The most expensive and complex orthoses cost about 40,000 rubles.

Knee injuries happen quite often at home, at work, and on the street. This is due to the specific structure of the knee joint. It is strengthened by ligaments, tendons, menisci.

The most susceptible to injury are people involved in certain sports: volleyball, basketball, football, boxing, kickboxing, all-around, etc. Damage to the meniscus or torn ligaments require treatment with a plaster cast. A bandage may be used. After their removal, a long rehabilitation is necessary, in which various fixatives help.

Types of clamps

Today, the produced fixators for the knee joint are simple and easy to use, small in size and evenly redistribute physical loads on the damaged area. A knee brace is also called an orthosis, caliper or knee brace. The elastic bandage provides light fixation, is used for minor articulation disorders, sprains, as well as for increased loads, if outdoor activities or sports are expected. This bandage serves as a means of preventing and preventing accidental injury to the knee joint.

The medium stiffness knee brace can be oblong with silicone rings, special side plates or hinges. This type of orthosis is used in the post-traumatic rehabilitation period. Provides reliable protection of the knee joint, without interfering with the active movement of the leg. They help to recover very quickly after surgery.

Among fixators for the knee joint, special attention should be paid to the neoprene orthosis. It is supplemented with a silicone ring, fixes the patella of the leg and the knee joint itself, provides moderate compression. Fosta knee brace is often used by athletes. This caliper is characterized by increased strength, wear resistance, compactness and ease of fixation. It gives a thermal effect and has a massage effect. Ease of use and easy maintenance are the undeniable advantages of this orthosis.

A neoprene bandage with an annular insert and rigid ribs is placed over the knee. It protects against dislocations, bruises and impacts and supports the knee joint. Immobilization of the damaged area with the help of such an orthosis is necessary in the postoperative period.

Doctors recommend a rigid knee brace for severe and complex injuries, when it is necessary to completely immobilize the knee joint. The infrared heating caliper allows you to warm the damaged area thanks to the built-in halogen or infrared lamps. Relieves pain symptoms.

Fixation of the knee joint is the main medical procedure used by the doctor in case of knee injury. Fractures, rupture of the tendon and ligaments are treated by applying plaster for a minimum period, after which the damaged joint is fixed with a bandage to avoid swelling and weakening of the muscles.

Properties and functions of knee orthoses

A knee brace is prescribed by a traumatologist. The caliper prevents displacement of bones, helps to strengthen muscle tissues, fixing the joint and normalizing movement. The orthosis is selected individually based on the anatomical features of a particular patient. The specialist develops a training regimen and determines the period of wearing a bandage.

All knee braces have the following useful features:

• prevention of re-injury;
• reduction of pain and inflammation;
• increase in lymphatic and venous outflows;
• fixation of the patella;
• protection from overload and stress after an injury;
• reduction of swelling of surrounding tissues and tension in the joint;
• fixation of the knee joint during training, exercise, therapeutic exercises;
• the direction of movement of the knee joint along the frontal plane and the facilitation of motor activity in the axial axis;
• stimulation of metabolic processes in the affected area;
• redistribution of pressure between the patella and periarticular soft tissue;
• normalization of blood circulation in the joint.

Fixation is determined by the quality of the materials from which the knee brace is made.

1. Neoprene. They are used in the manufacture of elastic orthoses of easy fixation. With prolonged wear, an allergic reaction to fabric components may develop. There may also be increased sweating under the kneecap.
2. Lycra and elastane have high elasticity, elasticity, are well ventilated, but do not warm the knee. Often complemented by other fabrics.
3. Nylon is combined with other materials to give the product strength and increase its life.
4. Spandex creates a perfect fit around the knee, allowing enough air to pass through.
5. Cotton and wool are natural fabrics, devoid of elasticity, therefore they are used in conjunction with easily stretchable fabrics, short-lived, subject to regular washing.

Fixer Selection Rules

The patient is not recommended to engage in self-selection of a fixing caliper. The attending orthopedic doctor chooses the type of orthosis based on the complexity of the injury. The fixator should tightly fit the leg, firmly hold the damaged knee joint, but not squeeze it. The size is selected by measuring the girth of the knee in the center of the patella. Also, for fidelity, measure the circumference of the leg 15 cm above and below the knee.

It is necessary to put on the retainer for no more than 2-3 hours, it is strictly forbidden to wear it all day. Otherwise, this can lead to numbness of the limb, swelling and further injury to the joint. It is best to use the knee brace only during the period of increased physical exertion, during exercise therapy, and then remove and rest the tired legs. Orthoses with soft and semi-rigid fixation are usually used to restore the functioning of the knee joint; in advanced situations, a rigid fixator with rings and lateral ribs is used.

The use of fixators during the treatment of the knee joint can alleviate painful symptoms and restore the patient's ease of movement.

Causes: falling on the knee or hitting it with a hard object.

Signs: complaints of pain in the joint, difficulty walking. The damaged joint is enlarged in volume, its contours are smoothed, a bruise is sometimes visible under the skin on the anterior surface. Joint movements are difficult and painful. The accumulation of blood in the joint is determined by balloting the patella. If the amount of blood in the joint is insignificant, then by squeezing the joint with the palms of the hands from the sides, the symptom of patella balloting can be made more distinct. Hemarthroses of the knee joint sometimes reach a significant size (100-150 ml). In this case, the limb is half-bent, since only in this position the joint cavity reaches its maximum size. Be sure to produce x-rays of the joint in two projections.

Treatment. Patients with bruises of the knee joint with the presence of hemarthrosis are subject to treatment in a hospital. For mild bruises without accumulation of blood, outpatient treatment can be carried out with fixation of the joint with a tight bandage. If fluid appears in the joint a few days after the injury, the limb should be fixed with a splint cast from the ankle joint to the upper third of the thigh until the fluid disappears.

In the presence of hemarthrosis, which sometimes develops several hours after the injury, first aid consists in immobilizing the limb with a transport splint from the toes to the upper third of the thigh. The victim is taken to the hospital in the supine position on a stretcher. Treatment of hemarthrosis of the knee joint is to puncture the joint and remove the accumulated blood in it. After that, the limb is fixed with a plaster splint. It can be removed after 4-5 days if fluid does not accumulate in the joint again. The patient can walk with crutches. After the termination of immobilization, exercise therapy and thermal procedures, massage are prescribed.

Sometimes, with a sharp twisting of the leg in the knee joint, the same hemarthrosis can develop, as with a bruise, although there was no bruise of the joint as such. In these cases, probably due to uncoordinated tension of the quadriceps femoris and the displacement of its tendon relative to the condyles, ruptures of the synovial membrane of the joint occur. Symptoms of damage to the ligamentous apparatus of the joint in such cases are absent. Treatment of such injuries is the same as for bruises of the joint.

KNEE MENISKI INJURY

Causes: a direct blow with the knee on a hard object or crushing the meniscus between the articular surfaces when jumping from a height. The indirect mechanism of damage is more often observed. With a sharp uncoordinated flexion or extension of the leg in the knee joint with simultaneous rotation of it inward and outward, the meniscus does not keep up with the movement of the articular surfaces and is crushed by them. The meniscus associated with the joint capsule, when the articular surfaces are abruptly moved, breaks away from it, torn along or across, sometimes shifting into the intercondylar space (Fig. 1 1 4). Damage to the medial meniscus is observed 10 times more often than the lateral one.

Signs: pain and dysfunction of the knee joint. The leg in the joint is often bent and it usually cannot be straightened. In the future, hemarthrosis joins, and the clinical picture resembles a bruised joint. Typical circumstances of the injury, acute pain in the joint space, blocking of the joint in the half-bent position of the limb, recurrence of blockades make it possible to establish the correct diagnosis with a significant degree of certainty.

X-ray examination in case of suspected meniscus injury is mandatory to rule out other diseases and injuries of the knee joint. For more accurate X-ray diagnostics, air, liquid contrast agents, or both are injected into the joint. The development of deforming arthrosis, especially pronounced on the side of damage, can serve as an indirect sign of meniscus damage.

The use of arthroscopy in recent years has greatly improved the diagnosis and treatment of meniscal injuries.

Treatment. Puncture of the joint and removal of accumulated blood, followed by immobilization of the limb with a plaster splint bandage from the toes to the gluteal fold. The blockade is removed under local anesthesia with novocaine, which is injected into the joint cavity. The meniscus, pinched between the articular surfaces or displaced in the intercondylar space, is reduced by bending the leg at a right angle at the knee joint, pulling the lower leg along its length while simultaneously rotating it and moving it to the healthy side. Under these conditions, a gap is formed between the articular surfaces, and the meniscus is set into place.

Immobilization of the limb continues until the disappearance of hemarthrosis and subsidence of the phenomena of secondary synovitis, which takes an average of 10-14 days. Then thermal procedures, muscle massage and exercise therapy are prescribed. Usually after 3-4 weeks the patient can start working.

Early surgical treatment for fresh meniscal injuries is rarely performed and only in cases where the diagnosis is not in doubt. More often it is performed with repeated blockades of the joint. The operation is performed under conduction, local or intraosseous anesthesia. The damaged meniscus is removed completely or partially (only the torn part). After the operation, a plaster splint is applied for 7-10 days, followed by exercise therapy, massage and thermal procedures. Ability to work is restored after 6-8 weeks. With the help of arthroscopic technique, the traumatism of the intervention and the terms of disability are significantly reduced.

INJURIES OF THE KNEE JOINT

The most common combinations are: damage to the anterior cruciate ligament and one or two menisci (up to 80.5%); damage to the anterior cruciate ligament, medial meniscus and tibial collateral ligament ("ill-fated triad" - up to 70%); damage to the anterior cruciate ligament and tibial collateral ligament (up to 50%). The frequency of damage to the anterior cruciate ligament - 33-92%; posterior cruciate ligament - 5 - 12%; tibial collateral ligament - 1 9 - 7 7%; peroneal collateral ligament - 2 - 1 3%.

Causes: simultaneous flexion, abduction and external rotation of the lower leg (sharp, uncoordinated); flexion, abduction and internal rotation; hyperextension in the knee joint; direct blow to the joint.

Signs. General manifestations: diffuse pain, limitation of mobility, reflex muscle tension, effusion into the joint cavity, swelling of the periarticular tissues, hemarthrosis.

Diagnosis of injuries of the lateral ligaments. The main techniques are abduction and adduction of the lower leg. The position of the patient is on the back, the legs are slightly apart, the muscles are relaxed. The test is first carried out on a healthy leg (determination of individual anatomical and functional features). The surgeon places one hand on the outer surface of the knee joint. The other covers the foot and ankle area. In the position of full extension in the knee joint, the doctor gently abducts the lower leg, while slightly rotating it outward (Fig. 1 1 5). Then the technique is repeated in the position of leg flexion up to 150-160°. Change in the axis of the damaged limb by more than 10-15° and expansion of the medial articular

gaps (on radiographs) of more than 5 - 8 mm are signs of damage to the tibial collateral ligament. Expansion of the joint space by more than 10 mm indicates concomitant damage to the cruciate ligaments. Double testing (in the position of full extension and flexion to an angle of 150-160°) allows you to navigate in the predominant damage to the anteromedial or posteromedial part of the medial collateral ligament.

Identification of damage to the peroneal collateral ligament is carried out similarly with the opposite direction of the load forces. In the position of full extension, the peroneal collateral ligament and biceps tendon are examined, in the position of flexion up to 160°, the anterolateral part of the articular capsule, the distal part of the ilio-tibial tract. All these formations provide stability to the knee joint, which is disturbed if even one of them is damaged.

Diagnosis of cruciate ligament injuries.

Drawer front test: the position of the patient on the back, the leg is bent at the hip joint up to 45 ° and at the knee - up to 80-90 °. The doctor sits down, presses the patient's forefoot with his thigh, covers the upper third of the shin with his fingers and gently jerks several times in the anteroposterior direction (Fig. 116): first without rotation of the tibia, and then with external rotation of the tibia (behind the foot) up to 15 ° and internal rotation - up to 25-30°. In the middle position of the lower leg, the stabilization of the knee joint is mainly (up to 90%) carried out by the anterior cruciate ligament. A displacement of 5 mm corresponds to I degree, 6-10 mm - II degree, more than 10 mm - III degree (i.e., a complete rupture of the anterior cruciate ligament). During rotation of the lower leg, additional damage to the lateral ligamentous structures of the knee joint is determined.

Lakhman test (1976): the position of the patient on the back, the leg is bent at the knee joint up to 160 °. The doctor covers the lower third of the thigh with his left hand, with the palm of his right hand, brought under the upper third of the lower leg, gently and smoothly pulls the lower leg anteriorly. With a positive test, a bulge appears in the area of ​​retraction of the patellar tendon due to excessive displacement of the lower leg relative to the femoral condyles.

I degree - the displacement of the lower leg is felt only by the patient ("proprioceptive feeling").

II degree - visible displacement of the lower leg anteriorly.

III degree - passive subluxation of the lower leg posteriorly in the position of the patient on the back.

IV degree - the possibility of active subluxation of the lower leg

(the occurrence of subluxation with muscle tension).

Makintosh test (1972)- detection of excessive rotation of the lower leg in case of damage to the anterior cruciate ligament. The position of the patient on the back, the leg at the knee joint is extended. The doctor grabs the foot with one hand and rotates the tibia inwards, with the other hand exercises a load from the lateral side on the upper third of the tibia in the valus direction, while slowly bending the tibia at the knee joint. When the anterior cruciate ligament is damaged, subluxation of the lateral condyle occurs; when the lower leg is bent to 160-140°, this subluxation is suddenly reduced due to the posterior displacement of the ilio-tibial tract. Valgus load on the knee joint accelerates the reduction of dislocation. In this case, the doctor has a feeling of push. The absence of such a sensation indicates a negative test result (the cruciate ligament is not damaged).

The diagnostic capabilities of tests are most effective in chronic injuries of the cruciate ligaments. The Lachman test is the most sensitive, and with fresh injuries of the knee joint, its diagnostic efficiency reaches 90%.

When the posterior cruciate ligament is damaged, the “posterior drawer” symptom is revealed, which is more pronounced in the acute period and may disappear in the long-term periods.

Joint effusion is an important symptom of ligament injury. It is necessary to specify the rate of formation and the severity of the effusion. Hemorrhagic effusion indicates damage to the ligaments, paracapsular part of the meniscus, synovial membrane. The appearance of effusion after 6-12 hours or on the 2nd day is more often associated with the development of post-traumatic synovitis and indicates a predominant damage to the menisci. With the development of hemarthrosis in the first 6 hours and its volume of more than 40 ml, a diagnosis of serious intra-articular damage to the capsular-ligamentous apparatus should be made, even without pronounced symptoms of knee joint instability. Clarifies the diagnosis of arthroscopic examination (up to 96%).

Treatment. With conservative treatment, after puncture of the joint and removal of accumulated blood, the limb is fixed with a deep plaster splint from the fingers to the upper third of the thigh for 3 weeks. After the plaster bandage has dried, UHF therapy is prescribed, then, after immobilization has ceased, massage, exercise therapy and thermal procedures are prescribed. In the future, if the failure of the ligamentous apparatus is revealed, surgical treatment is undertaken.

Surgical treatment in the early stages is indicated for complete damage to the ligaments. Several U-shaped sutures are applied to the torn capsule and ligament. When the ligament is torn from the bone, a transosseous suture is used. In case of defibration, defect, chronic damage, auto- or alloplasty of the ligaments is performed (Fig. 117).

After the operation, the limb is fixed with a circular plaster bandage with a flexion angle in the knee joint of 140 - 160° for 4-6 weeks, followed by thermal procedures, exercise therapy and muscle massage. Ability to work is restored after 3 months,

117. Variants of plasty of the anterior cruciate and collateral ligaments of the knee joint.

INJURY OF THE BUCKET AND PATELLET LINING TENDON

Causes. The extensor apparatus of the knee joint (quadriceps femoris tendon, patella and its ligament) is damaged as a result of a sharp tension of the thigh muscle or from direct trauma when hitting or falling on one or both knees.

Signs: pain on the anterior surface of the thigh and knee joint, instability of the damaged limb, which, as it were, gives way due to loss of function of the quadriceps femoris muscle. Active extension of the leg in the knee joint is impossible. When pressing with the ends of the fingers along the extensor apparatus, one can feel a drop above or below the patella (especially with active tension of the quadriceps femoris muscle). On radiographs of the knee joint, if the tendon of the quadriceps muscle is damaged, the patella remains in its place or is slightly displaced downward, and with complete damage to the ligament of the patella, the latter is significantly displaced upward.

Treatment. Partial injuries of the extensor apparatus are subject to conservative treatment. The limb is fixed with a circular plaster splint from the ankle joint to the gluteal fold with full extension of the leg in the knee joint. After 4 weeks, the bandage is removed, exercise therapy and thermal procedures are prescribed.

With complete damage to the extensor apparatus, surgical treatment is indicated: the imposition of strong U-shaped silk sutures on the damaged tendon, auto- or alloplasty with the wide fascia of the thigh or tendon grafts. After the operation, the limb is fixed with a plaster splint from the ankle joint to the gluteal fold for 2 months. Subsequently, thermal procedures, muscle massage, active and passive exercise therapy are carried out. Ability to work is restored in 3-3 1/2 months after the operation.

FRACTURES OF THE PATELLUM

Causes: hitting the knee or falling on it. Almost all patella fractures are intra-articular. Only fractures of its lower pole can be extra-articular. The degree of divergence of fragments depends on damage to the lateral tendon sprain of the extensor apparatus of the knee joint. With significant ruptures, the proximal fragment is displaced upward by the traction of the quadriceps femoris muscle. If the extensor apparatus was not significantly damaged, then there may be no displacement of the fragments or it may be insignificant (Fig. 1 1 8).

Signs: the contours of the joint are smoothed, in its cavity a free fluid is determined - hemarthrosis. Expressed instability in the knee joint.

With simultaneous damage to the lateral extensor apparatus, active extension of the lower leg is impossible, the patient cannot keep the extended leg on weight. At the same time, she slides along the plane of the bed without breaking away from it (symptom of "stuck heel"). On palpation of the patella, it is usually possible to feel the fracture gap or the ends of the dispersed fragments. It should be remembered that sometimes the impression of failure is created even with an intact patella, when blood accumulates in the prepatellar bag.

An x-ray examination of the knee joint in two projections is necessary even with a clear clinical picture of a patella fracture in order to exclude other injuries. Be sure to make an additional x-ray in axial projection. At the same time, the patient is laid on his stomach, the injured leg in the knee joint is bent at a right or sharp angle. The cassette is placed under the knee, and the central beam is directed obliquely at an angle of 45° to the cassette from the side of the lower pole of the patella. At the same time, longitudinal fractures of the patella are revealed, which are invisible in the pictures in ordinary projections.

Treatment. For fractures without displacement or displacement of fragments by several millimeters (which indicates the preservation of the integrity of the extensor apparatus), treatment should be conservative. It consists in puncturing the joint and removing the accumulated blood, followed by immobilization of the limb with a deep plaster splint from the fingers to the gluteal fold.

The puncture of the joint should be performed in the first hours after the injury, since the blood in the joint with fractures, unlike bruises, quickly coagulates. Cold is prescribed locally, and on the third day - UHF therapy. 5-7 days after the edema subsides, the longet bandage is replaced with a circular plaster

a splint from the ankle joint to the upper third of the thigh, in which the patient can walk with support on the diseased limb. Further treatment is carried out in the clinic. After 3-4 weeks, the splint is removed. Exercise therapy, massage, thermal procedures are prescribed.

In fractures with displacement of fragments, surgical treatment is indicated. It should also be undertaken in cases where the congruence of the articular surfaces of the fragments is disturbed, although the fragments themselves may not be displaced along the length. The operation is performed under local anesthesia or anesthesia. To connect the bone fragments, a double semi-purse-string suture is used (Fig. 119). It is necessary to impose additional sutures on the lateral extensor apparatus. Thick silk threads are used as suture material. In comminuted fractures, especially when crushing one of the fragments, it is permissible to remove the crushed part of the patella with the restoration of the extensor apparatus of the joint. Screws, knitting needles, wire cerclages, external fixation devices are also used to fasten fragments (Fig. 120-121).

After the operation, the limb is fixed with a splint plaster bandage up to the upper third of the thigh. After 10-12 days, the sutures are removed and the longet bandage is replaced with a plaster splint, in which the patient can walk with full load on the sore leg. After 4-5 weeks after the operation, the plaster bandage is removed, exercise therapy, massage and thermal procedures are prescribed. Ability to work is restored after 2-2 3/2 months.

118. Variants of fractures of the patella. a - the norm; 6 - subaponeurotic fracture; c - fracture with partial damage to the extensor structures; d - fracture with complete

119. Sh about in the patella.

120. Internal (fixation of fractures of the patella.

121. External fixation of fractures by rupture of the extensor apparatus. patella.

DISTRUCTIONS OF THE PATELLA

Causes: a fall on the knee joint or a sharp tension of the quadriceps femoris muscle with simultaneous abduction of the lower leg outward. The inner part of the fibrous capsule of the joint is torn, and the patella is displaced to the outer surface of the joint by the force of impact or traction of the extensor apparatus. Dislocation of the patella is facilitated by the valus installation of the lower leg of a congenital nature, as well as underdevelopment of the external condyle of the femur. Sometimes dislocations become habitual, arise from a little violence and are easily reduced by patients without the help of medical workers.

Signs: typical displacement of the patella on the outer surface of the joint, half-bent position of the lower leg, movement in the joint is impossible. The patella is palpated to the side of the lateral condyle of the thigh, the tendon of the quadriceps muscle and the patellar tendon are sharply strained. The diagnosis is confirmed by X-ray examination.

Treatment. The reduction of the dislocation is performed under local anesthesia. The leg is fully extended at the knee joint and

the patella is shifted into place with the fingers. After that, the limb is fixed for 2-3 weeks with a splint plaster bandage in the extension position in the knee joint. Subsequently, exercise therapy, massage and thermal procedures are prescribed. Ability to work after traumatic dislocation is restored after 4-5 weeks.

With frequent habitual dislocations of the patella, surgical treatment is indicated.

122. Scheme of dislocations of the lower leg, a - anterior; 6 - back.

123. Immobilization of the knee joint with a plaster bandage.

The creation of immobility of nearby joints in the conservative treatment of fractures of the bones of the extremities by the method of fixation bandages is an indispensable condition for optimal consolidation and is recommended in all guidelines for traumatology and orthopedics. For example, immobilization of all three large joints of the lower limb in fractures of the femur with a circular plaster cast is the oldest method of treatment.

At the same time, all specialists understand that the longer the joints do not function, the more often contractures form and muscle hypotrophy develops. So, back in 1936, R.R. Vreden wrote that one of the main defects of the “circular bandages” is the long-term immobilization of the muscles and joints of the leg. Turning off all, even minimal active muscle contractions, leads to weak arterialization of the limb and stagnation of venous blood and lymph. The conditions for resorption of exudate and cellular decay products worsen, and thereby the regenerative abilities of damaged muscles, tendons and ligamentous apparatus decrease.

Full immobilization of the joints causes their stiffness and hypotrophy of the muscles of the limb, which have to be fought for a long time, and sometimes unsuccessfully, after the bandage is removed. He believed that, for example, the treatment of hip fractures by immobilization with "circular bandages" often does not provide a satisfactory anatomical recovery and at the same time prevents the functional recovery of the affected limb. A major drawback of immobilization treatment should be considered that the damage to the function of the limb is not so much the result of the fracture itself, but the result of this method of treatment.

Therefore, not to the detriment of the process of consolidation, for a long time they have been trying to determine the moment when it is possible to start a motor function in previously fixed joints. If this is not possible, other methods are used for treatment. One of the optimal solutions to achieve maximum release from immobility of the joints closest to the fracture was and still is the creation of a rigid bandage, both in its design and with the help of the materials used.

At the end of the 19th century, for fractures in the middle third of the bones of the lower leg, Professor Volkovich applied a cardboard-gypsum or plaster splint 6-7 cm wide to the limb in the form of a stirrup, starting from the level of the knee joint, along the outer surface of the lower leg through the sole to the inner surface as well as to knee lines.

on thus located on the anterior-inner surface of the leg along the tibia and on the posterior-outer along the fibula and was fixed with soft bandages. After the final hardening of the bandage, patients were allowed to load the damaged surface. Volkovich attached great importance to the possibility of independent movement in the joints of the lower limb and early functional loading. The same type of dressing was proposed in 1920. in Germany Brunn. in France in 1910. Delba was also offered a bandage similar to Volkovich's bandage. In the 30s of the XX century, Beler's splint-gypsum bandages (3 splints) were widely used. All these dressings were united by the desire to achieve maximum rigidity of fixation of fractures, the possibility of movements in the joints and early function.

In the future, the design of dressings used in the treatment of bone fractures of both the upper and lower extremities was constantly improved with the advent of new technological possibilities.

Interesting solutions in the use of "functional" dressings with partial release of the ankle joint and foot joints in ankle fractures were proposed by S.N. Khoroshkov (2006).

Sarmiento A et all (2000) on a large group of patients (922 patients participated in the study) used specially made orthoses for the shoulder segment without immobilization of the shoulder and elbow joints with diaphyseal fractures of the humerus. Moreover, in 87% the fractures healed. Less than 16% of them had slight varus deformity or angular deformity with an anterior open angle.

A comparative analysis of the outcomes of treatment of fractures of the shaft of the shoulder in a similar brace with the results of treatment after surgical treatment with a lockable pin (n=89) is given by Wallny Tetall (1997) and Campbell J.T. et all (1998). Thus, 44 patients were treated conservatively in a brace, and 45 patients were treated with an operatively lockable pin. 86% of the patients in the conservative group and 47% in the operative group did not experience any restrictions in movement in the joints after the end of treatment. Functional results in the conservative group were significantly better.

Gypsum bandage is still widely used for the manufacture of fixing dressings in traumatology. But today, plaster bandages are being replaced by various types of orthoses, in the manufacture of which modern materials are used: polyurethane bandage; low temperature or high temperature plastics.

Already today, many manufacturers in this area are establishing and expanding the arsenal of mass-produced orthoses made of various elastic materials such as neoprene or other multilayer dense elastic fabric consisting of elastic and cotton fibers, with additional stiffening ribs made of metal or polymer plates, depending on the location and purpose. applications. This makes it possible in some cases to use a finished orthopedic product instead of plaster, which allows you to maintain control over the fit of the fixator around the limb and, if possible, maintain movement in adjacent joints.

In this regard, it is necessary to understand exactly for what purpose, and for what indications, this or that group of products is used.

Of particular interest to practicing traumatologists, in our opinion, is the "polyurethane bandage", which, again, not in all cases, replaces the plaster bandage.

Bandages made of "plastic plaster" have a number of differences from traditional plaster bandages:

However, the possibilities of its use, and, accordingly, the presence of indications and contraindications for the appointment, as a rule, are little known to doctors working in a wide clinical practice.

Synthetic polymer bandages are produced in the USA - "Scotchcast", "Softcast" (firm "ZM"); in Germany - "Cellacast" (firm "Lohmann & Rauscher"), "Rhena®therm", "Rhena®cast" (firm "Hartmann") and in Russia - "Super-cast" (for rigid immobilization) and "Super-cast- elast" (to create an elastic sleeve) (firm "Novomed", Moscow).

The fabric base of the bandage consists of a fiberglass or polyester mesh impregnated with polyurethane resin. It is made in the form of a bandage or longuet. Form of release of bandages: individual packaging for each bandage in a hermetically sealed foil bag.

When the bandage is exposed to water, the polymerization reaction of the resin is activated, as a result, the bandage hardens. Full strength of the material occurs after 30 minutes. The bandage is applied quickly and easily. Thanks to its stretchability, it precisely follows the contours of the body, which ensures an excellent fit and optimal fixation. Bandages are intended for the manufacture of immobilizing dressings in traumatology and orthopedics, as well as other orthopedic removable devices.

In order to compare the elasto-mechanical properties of plaster and polymer bandages, we conducted special studies of the elasticity, elasticity and rigidity of standardized samples in the laboratory of polymers of GNU CITO.

Identical samples of longet and circular rings (imitation of "circular dressings") were prepared from plaster and polymer bandages (Fig. 1).

Fig.1. Appearance of the prepared samples of longet and "circular dressings" from different layers of plaster and polymer bandages

It can be seen from the table that a splint made of 4 layers of a polymer bandage is 3 times stronger than a 12-layer analogue of a plaster bandage. When comparing the weight characteristics of samples with an equal number of layers and sizes, gypsum samples are 2 times heavier than polymer samples.

Technique for the manufacture of "express orthosis".

The method of applying a bandage differs little from the application of conventional plaster bandages. Although differences exist and lie in the need for even more careful and careful attitude to the application of such bandages with strict observance of all the rules for applying a hard (gypsum) bandage, since irregularities on the inner surface of the bandage due to its high rigidity can lead to skin damage.

The following materials and equipment are required for the manufacture of an express orthosis:

1. Synthetic bandage, consisting of specially woven glass fibers impregnated with polyurethane resin. Under the influence of water or a humid environment, a reaction occurs, leading to the hardening of the material.

2. Seamless knitted tubular bandage with a high degree of stretch in the longitudinal and transverse directions. Used as lining material.

3. Lining bandage made of soft synthetic cotton.

4. Metal rivets, velcro tape, hinged devices

5. Vibrating saw for cutting polymer dressings.

Fig.2. Appearance of a splint for the knee joint made of a polymer bandage

In the manufacture of orthoses, we used the following technique for their manufacture:

1. In case of an acute injury of the limb, at the first stage, a plaster longet lining bandage was applied. A cotton lining layer, especially in case of an acute injury, helps to prevent the development of phlekten and additional damage to the skin. After subsidence of soft tissue edema and relief of pain syndrome, the plaster cast was changed to the necessary one made of synthetic material.

2. PREPARATION for the imposition of a synthetic bandage. Skin, clothing and work surfaces must be protected from contact with the super-cast bandage. The patient's extremity is preliminarily put on a cushioning (synthetic or cotton tight stocking) and lining material (a special thin cotton bandage that allows you to protect the skin, especially in the area of ​​\u200b\u200bbone protrusions).

The doctor and his assistant must wear gloves. Open packages of super-cast bandage as needed (when in contact with air moisture, it begins to harden).

3. SOAKING. Only when moistened does the material acquire excellent adhesive properties. The water temperature should not exceed 20-24°C (otherwise, the patient may get burned due to the heat generated during the hardening of the bandage). When immersing the bandage in water, it is necessary to lightly press on it 3-4 times, for a more complete soaking with water. After that, squeeze out excess water, as carefully as when working with a plaster bandage. If the package of the "super-cast" bandage is opened, but not immersed in water, then the polymerization process will begin from interaction with air containing moisture. The time for the complete hardening of the dressing will increase to 10-15 minutes, which gives more time for the reposition of bone fragments and modeling of the dressing.

4. OVERLAY TECHNIQUE. Super-cast bandages are applied in circular rounds without tension and so that each subsequent round of the bandage overlaps the previous half and overlaps the edge of the underlying round. Due to the special weaving, the “super-cast” bandage is easily applied in difficult places, while there are no folds and bends. The simulation lasts 2.5-3 minutes. At this stage, it is possible to mount various devices into the bandage, such as hinges, staples, etc.

To this end, the legs of metal hinges (or staples) are treated with a specially prepared urethane resin with a brush and applied to the already applied layers of the dressing. Three additional layers of bandage are applied over the legs to secure the hinges in a given position.

Fig.3. The appearance of the patient in a circular non-removable "apparatus on the knee joint"

5. READY BANDAGE. The bandage hardens within 5-8 minutes. The polymerization process is accelerated by wetting the dressing surface with water using a sponge. After 20-30 min. the bandage can be given a partial load. Full polymerization occurs within a day, after which it is recommended to give a full load. Processing, formation of holes, removal of the dressing is possible with conventional tools or an oscillating saw.

The advantage of bandages from the bandage "super-cast" is:

- high strength and reliable stabilization, since, based on our research, a four-layer bandage made of polyurethane bandage has 5 times higher operational strength than a 12-layer plaster bandage.

If we enter the numbers we received into the formula, then for similar dressings from the “super-cast” bandage, 4 units will be required, and from plaster bandages - 12 of the same size.

- 4 - 6-layer circular bandage eliminates the use of reinforcing splints and withstands a weight load suitable for long-term use;

- moisture resistance and moisture permeability;

– breathability (excludes maceration of the skin);

- slight radiopacity;

- the possibility of staged use of the imposed circular bandage for further rehabilitation (the bandage can be cut, form "windows", used as the basis for the manufacture of a removable orthosis, splint).

NOTE: If the super-cast bandage comes in contact with the doctor's or patient's skin, wipe the area with alcohol or acetone. Dressings made of "super-cast" synthetic bandage do not get wet.

Further, during operation, regular bathing or showering is not recommended, because. wet cushioning material can cause maceration of the skin, while at the same time the quality and strength of the dressing itself does not suffer. However, if the patient still resorted to water procedures, it is necessary to dry the bandage using a towel and a hair dryer.

In the course of treatment, if necessary, the circular bandage can be easily converted into a removable longet. With the help of a special vibrating saw, cuts are made along the lateral and medial surfaces of the dressing, and the front “cover” is removed.

Fig.4. Converting a circular dressing to a splint

Then the bandage was completely removed and the sharp edges of the cuts were processed. From 1 to 5 Velcro elastic bands were fixed along the edges of the back splint using a hole punch and metal rivets to ensure the fixation of both parts of the product to each other, thus obtaining a circular split splint. Lining material was added to the inner surface, if necessary, and a bandage was tried on.

Fig.5. Removable ankle splint

A synthetic circular hard bandage has the same scope as a plaster bandage, but, it must be noted, contraindications to its application are:

- cases associated with a rapid significant change in the volume of a limb segment with an increase and decrease in edema in the first week after injury;

- the planned repeated manual repositions of the fracture through the bandage, which cause deformation of the inner wall of the applied bandage and cause severe skin damage in the form of bedsores and deep deposits.

The indication for applying this bandage is the need for the patient to achieve high mobility for a long time. This is ensured by its elasto-mechanical properties and a wider possibility of built-in various combinations of hinges at the level of the joint, which, while providing the necessary rigidity of immobilization, will create the possibility of dosed movement for the prevention of contractures.

Analysis of the results of the use of solid polymer "foot splints" for fractures of the metatarsal bones without displacement and fractures of the metatarsal bones showed an important positive economic effect of the proposed treatment. This method treated 15 patients, 12 of them had a fracture of the 5th metatarsal bone with a slight displacement, 2 patients had a fracture of the base of the 3rd-4th metatarsal bones and 1 patient had a fracture of the cuboid bone. The "foot splint" was made from a synthetic polymer bandage as a one-piece construction. With careful modeling, the bandage provides a high degree of rigidity of fixation of the foot with the talocalcaneal joint and provides partial mobility in the ankle joint, which makes it possible to allow dosed walking at the stages of treatment on the 5th day after the injury in sports shoes. This allowed patients to return to normal life within 2 weeks after the injury.

Fig.6. The appearance of the patient and the function of the limb a week after the injury in a "shortened bandage" for a fracture of the IV metatarsal bone

By the end of immobilization, the patients had no pain and stiffness of the ankle joint. When analyzing the results of a survey of patients on the Hauser Walk Index (I.X.H.) test (Hauser Ambulation Index,) which was developed by Hauser S., 1983. Patients treated according to the traditional method (control group with plaster immobilization) had a level of "4", and patients treated with a "foot splint" had a level of "1 or O", which characterizes a higher level of activity of patients.

However, not in all cases with fractures of the bones of the extremities, short bandages provide the necessary immobilization of the segment.

In difficult situations, you can use combined bandages with the inclusion of hinged devices in the design.

For a correct understanding of the terms, we list all possible types of devices for the lower limb based on the localization for which it is intended:

Devices for the lower limb:

1. Apparatus for the ankle joint;

2. Apparatus for the knee joint;

3. Apparatus for the knee joint with a block for the ankle joint;

4. Devices for the knee and ankle joints (or "Apparatus for the whole leg"):

5. Apparatus for the whole leg with unloading under the tuber;

6. Device for the whole leg with unloading under the tuber and with a stirrup;

7. Full leg device with double track;

8. Apparatus for the hip joint;

9. Apparatus for the hip and knee joints;

10. Apparatus for hip, knee and ankle joints;

11. Devices for two hip, knee and ankle joints connected through a lumbosacral corset (“tee”)

Regardless of the localization of the distribution of apparatuses, in the manufacture of them, hinges of different functions are required, which are used for specific pathological conditions in the joints of the same name:

are used to implement the full range of motion in the joint of the same name when walking, but strictly along the specified axes. To approach the physiology of movement in the knee joint, the hinge is made as biaxial.

is used to implement a dosed range of motion in the joint of the same name when walking along strictly specified axes. To approach the physiology of movement in the knee joint, the hinge can be made as a biaxial one.

It is used for functional deviations associated with instability in the joints or for partial unloading of the joint while maintaining the full range of motion.

A discrete change in the hinge of the angle of fixation - 8 degrees creates the possibility of using it to hold the joint in a given position.

It is used in orthoses designed to develop joint contractures.

The hinge is equipped with a special spring and an adjusting screw to create forced flexion-extension movements.

It is used in orthoses designed to create forced walking conditions in myoneurotrophic diseases leading to muscle weakness of the segment, in post-traumatic manifestations such as "equinovarus foot", "hanging foot" to develop or maintain specified movements.

hinges for the knee joint, having a special device that provides a dosed fixed movement in the sagittal plane, are used to correct the varus or valgus installation of the knee joint. Model - "TRASTER".

Structurally, there is a falling lock that provides rigid fixation at the level of the joint at the moment of full extension, moreover, the lock is released manually, that is, there is no possibility of spontaneous opening of the lock at the moment of walking.

It is recommended in the manufacture of orthoses used for walking with eliminated flexion contractures, with paresis and paralysis of the muscles of the limb, for the treatment of intra-articular and peri-articular fractures of the joint or in the postoperative period.

In the manufacture of an orthopedic device for the knee joint, sleeves from three layers of a "super-cast" synthetic bandage were applied to adjacent segments of the limb. Then, according to the method developed by us, hinges of the same name to the joint were attached to the sleeves.

Since we still do not have mass-produced special models of joints for this purpose, in order to improve the kinematics of movement in the orthosis at the level of the knee joint, a knee joint joint was developed for functional deviations associated with instability in the knee joint to partially unload the joint and maintain maximum volume movements.

Fig.7. Appearance of the patient in a non-removable "apparatus for the knee joint"

The results of clinical, physiological, biomechanical examinations of patients with the consequences of diseases, injuries of the musculoskeletal system, equipped with various designs of orthoses, suggest that training weakened and paretic muscles when walking in lockless devices contributes to the restoration of motor function.

In isolated fractures of the tibial condyles without displacement (18 patients), after the phenomenon of hemarthrosis had subsided (at this stage, “splints for the knee joint” were used), we used express devices individually made directly on the patient from polymer bandages with hinges for the knee joint.

I would like to note that the replacement of plaster immobilization in this group of patients with modern orthopedic products made it possible in all cases to begin active development of movements in the joint not after the immobilization was stopped, but in parallel with it, that is, usually a full course of exercise therapy began in the second week after the injury.

Fig.8. The volume of passive movements in the knee joint after the imposition of a non-removable "apparatus for the knee joint"

This allowed patients treated by this technique to return to normal life without an additional period of rehabilitation, which, on average, reduced the total period of disability by 2–4 weeks. By the end of immobilization, the patients had no pain and stiffness of the knee joint.

Fig.9. Function of the lower limb in a non-removable “knee joint apparatus” by the end of 4 weeks after damage to the lateral ligament of the knee joint

When analyzing the results of the questionnaire according to I.Kh.Kh. patients treated according to the traditional method (the control group was treated with plaster immobilization) had a level of "4", and patients treated with orthopedic apparatus had a level of "1 or O", indicating a higher physical activity of this group.

In conclusion, I would like to answer the question posed in the title of the article that modern possibilities (when used) create ample opportunities in many cases to comply with the principles of combining the conditions necessary for consolidation with early development of movements in adjacent joints.

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Joint immobilization

Most often, the cause of pain and damage in the wrist joint is an injury caused by sudden movements or their large amplitude, which is usually obtained when falling on the hand, less often with a sharp jerk or impact.

Another physiological feature of this joint is the passage through it of the endings of the median nerve. Therefore, quite often the pain can be localized in the area of ​​​​the phalanges of the fingers, and not in the damaged area.

One of the mandatory components of the treatment of injuries is the use of various orthopedic bandages for immobilization. However, the wrist brace is not only used in the case of injuries, it is also necessary:

1. With inflammation of the joint and surrounding tissues with arthritis, tendonitis and myositis.
2. To prevent the development of flexion contractures of the hand that disrupt the normal mobility of the joint.
3. With various neuropathies that develop as a result of compression of the median nerve due to overstrain of the ligaments and tendons, such as carpal tunnel syndrome.
4. In the complex treatment of various osteochondropathy arising from circulatory disorders as a result of injuries or other diseases and leading to microfractures.

Types and features of orthoses

Bandage on the wrist joint may differ in the degree of rigidity and the ability to limit mobility. Usually, the whole variety of models is usually divided into several types, depending on the rigidity of the product and design features.

Soft orthoses

Such products are made of breathable elastic fabrics. They are often called sports bandages or calipers. They do not restrict the movement of the hand and fingers, but at the same time protect the joint from excessive stress.

Often used to prevent injury by athletes, especially those involved in weightlifting, tennis or basketball and people who prefer outdoor activities. Sometimes these dressings are prescribed for such conditions:

• at the last stage of the rehabilitation period after surgery;
• joint instability;
• tunnel syndrome;
• a mild form of inflammation of the ligaments of the hand;
• arthrosis or arthritis.

Depending on the properties of the material, such a wrist brace can additionally have a light, massaging and warming effect.

Semi-rigid orthosis

This orthosis is made of a soft elastic material, but with the addition of stiffeners, which are thin plates made of metal or polymer materials. It moderately limits the movement of the hand in the wrist joint. Most often assigned:

• in the early period after surgical interventions;
• for fixing the wrist after removing the cast;
• with bruises, sprains or torn ligaments.

Rigid orthosis

It is a dense plastic frame, which can sometimes be additionally reinforced with metal inserts. It is attached to the hand and fingers with the help of special straps that allow you to adjust the degree of fixation. Completely excludes movement in the joint. Applies to the following conditions:

• in the early period of rehabilitation, after operations associated with complicated fractures and torn ligaments;
• at the last stage of inflammatory and degenerative diseases.

There are models that fix not only the wrist, but the entire hand with fingers, which allows you to do without plaster even with the most complex fractures.

Appointment of orthoses

Semi-rigid or rigid orthoses prevent the development of contractures in the wrist and fingers - pathological processes that limit passive movements in the joint, in which the arm cannot normally bend and unbend.

Most orthoses tend to combine several functions, such as relieving excess tension and helping to restore mobility. Also, fixing dressings are usually divided, depending on their purpose, into:

1. Preventive, which must be used when playing sports, outdoor activities or any other activity associated with constant stress, as well as in the early stages of the development of joint deformity.
2. Therapeutic fixatives are used temporarily for injuries and in the postoperative period.
3. Constants are appointed with a complete loss of form or function of the wrist joint.

The difference between an orthosis and other dressings

Sometimes an orthosis is confused with a splint or splint. Both of these are orthopedic products that serve to protect, relieve stress and, if necessary, ensure complete immobility of the joints.

However, the orthosis differs in that it is a device fastened with hinges, and the splint looks like a sleeve or shoe connected by tires.

As for the splint, it is a long strip of plaster or quick-hardening plastic, which is usually used for fractures as a fixing bandage on the wrist joint.

How to choose?

Today on sale you can find a huge number of the most diverse models of bandages and among such an assortment it can be very difficult to find exactly the one that is needed.

First of all, it all depends on the disease, the age of the patient and his physiological characteristics. In addition to the wrist itself, orthoses can additionally fix the thumb or the entire hand.

In practice, each manufacturer has its own size grid of orthopedic products. All you need to do before buying is to measure the circumference of the arm in the area of ​​​​the joint.

It is also worth considering for which hand a wrist brace is needed, since not all models are universal. Some manufacturers produce products for both the left and right limbs. As for the material from which it will be made, the main requirement here is the absence of allergies.

Application results

With the help of an orthosis, excess tension is removed from a fixed limb, which helps to avoid injuries. And in case of diseases or after operations, the resting joint and ligaments recover faster. If there is a fracture with a displacement, then the fixator will help prevent the development of deformation.

The effectiveness of the use of an orthosis depends on the correctness of its choice. The doctor should select the degree of fixation, mode and duration of use.

There is an opinion that wearing an orthopedic fixator can cause the development of muscle atrophy. However, this is nothing more than a myth. The cause of atrophy often lies in an improperly fitted bandage or in ignoring exercises to restore joint mobility.

A properly selected orthosis does not compress the tissues surrounding the joint and does not interfere with blood circulation in them. In addition, wearing an orthopedic fixator must be combined with physiotherapy and physiotherapy exercises.

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Immobilization of the lower limb

1. Immobilization in case of a fracture of the lower leg is carried out in a straight position of the leg or slight flexion at the knee joint. The foot is fixed in the position of dorsal flexion at a right angle with respect to the lower leg. An exception to this position may be a gastrocnemius injury, where a slight flexion of the foot can be maintained in order to reduce pain. It is advisable to use at least 2 splints applied in 2 planes for immobilization. Wooden tires are located both on the outer and inner surfaces of the leg, and ladder tires - one on the back, the second on the outer surface. In the case of using 3 splints, the latter is placed along the back surface of the leg, preferably a ladder one (Fig. 8).

Immobilization with 3 splints is desirable for severe, especially gunshot fractures of the diaphysis of the leg, severe pathological mobility of fragments and bleeding from the wound. Modeling requires a rear tire. Curves must be created for the foot, heel, Achilles tendon, calf and knee. The length of immobilization: in case of damage to the foot - from the fingers to the upper third of the lower leg; ankle joint and lower leg - up to the upper third of the thigh; knee joint, hip and hip joint - to the level of the shoulder blade and armpit. With mild closed injuries of the knee joint, immobilization is limited to the level of the hip joint. Side wood splints require thicker padding at the ankles and knees.

2. Transport immobilization for injuries of the knee and hip joints and thigh is usually carried out with a Dieterichs splint, in addition, there are other splints (Goncharov, Thomas-Vinogradov, etc.)

Stages of applying the Dieterichs bus (Fig. 9):

1. Before applying, the splint is adjusted in height, while the lower ends of the crutches should protrude beyond the “sole” by 15-20 cm.

2. Fitted crutches at the level of the pegs are tied with bandages.

3. The plantar part of the tire is fixed to the foot with an eight-shaped bandage, carefully strengthening the heel area.

4. The lower ends of the crutches are passed through the metal eye of the plantar part of the tire and applied to the side surfaces of the limb and torso.

5. In the area of ​​​​the protrusions of the greater trochanter and the knee joint, cotton is placed.

6. The tire is attached to the body with scarves or straps threaded through the crutches on the lower leg, thigh, abdomen and chest.

7. The ends of the twist laces are threaded through the hole in the transverse bar of the inner branch and inserted into the sole rings, brought back through the hole in the bar and tied around the twist.

8. The leg is pulled by the foot until the transverse bars of the branches rest against the groin and armpit.

9. After stretching, the splint is fixed along the entire length of the limb with circular tours of the bandage.

To improve fixation under the back surface of the leg and pelvis, a ladder or plywood splint with thick pads is placed in the region of the hamstring and Achilles tendon. Under favorable conditions, the Dieterichs tire can be strengthened with plaster rings.

Transport immobilization for fractures of the spine in the cervical and upper thoracic regions is carried out on the back with a roller under the neck. The most reliable immobilization for severe, especially multiple fractures can be performed using vacuum immobilizing stretchers (Fig. 11,12).

Fig.11. Preparation for immobilization Fig.12. Case lacing

using NIV-2

Transport immobilization in case of damage to the thoracic and lumbar spine and transportation must be carried out on a rigid stretcher. The victim is placed on a stretcher and fixed together with a solid pad to the stretcher. A small roller is placed under the knees, and in the presence of paraplegia, an inflatable rubber or cotton-gauze circle is placed under the sacrum.

If the victim has to be transported on a conventional soft stretcher, then he should be laid on his stomach, which provides some extension of the spine. Some kind of roller (coat, etc.) is placed under the chest. With gunshot wounds of the spine, lordosis should not be created, but it is better to put the victim flat on his stomach.

In case of pelvic fractures, the victim can be transported on a regular stretcher, but it is better on a hard stretcher. The legs should be bent at the knee and hip joints, for which a roller is placed under the knees of the victim. The victim must be fixed to a stretcher.

Currently, at the pre-hospital and early hospital stages, an anti-shock pneumatic suit "Kashtan" is used (Fig. 13).

Pneumatic anti-shock fixing suit "Chestnut" is intended for emergency use in order to prevent and relieve hypovolemic shock at the pre-hospital and resuscitation stages. The action of the suit is based on the principle of controlled circular external pressure. When inflated, controlled pressure in the suit (up to 100 mmHg) redistributes blood from the lower extremities and abdomen to the heart and vital organs of the upper half of the body. Simultaneously with In this way, external pneumatic compression often helps to stop sludge, significantly reduce internal and external bleeding, and also provides stable immobilization of fractures of the lower extremities and pelvis.

Indications for use are:

1. Systolic blood pressure of 100 mm Hg accompanied by symptoms of shock (pallor, cyanosis, cold clammy sweat, tachycardia, tachypnea) or systolic pressure below 80 mm Hg, regardless of the cause, are absolute indications for the use of the suit, in the absence of contraindications.

2. Traumatic shock II - IV degree with multiple fractures and amputations of the lower extremities, pelvic fractures.

3. Internal and external bleeding of the lower half of the body: intra-abdominal bleeding as a result of blunt or penetrating abdominal trauma; postpartum, uterine, gastrointestinal bleeding; bleeding or ruptured aneurysms of the abdominal aorta.

Contraindications:

1. Respiratory failure due to pulmonary edema, tension hemopneumothorax.

2. Massive unstopped bleeding of the upper half of the body.

3. Prolapse of internal organs.

4. Cardiac tamponade, acute heart failure, cardiogenic shock.

5. Pregnancy (because of the threat of miscarriage).

If there are contraindications, only the abdominal section cannot be inflated on the suit, but the leg and pelvic sections can be inflated.

Sticks, boards, skis and any similar items can be used as improvised means for transport immobilization. When immobilized with these objects, it should be borne in mind that they are hard, inflexible and cannot be modeled on the surface on which they are applied. Therefore, improvised means should be applied only from the outer and inner surfaces of the limb, always with soft pads in the area of ​​the ankles and knee joint. Improvised means, like standard ones, should immobilize 2 joints - above and below the fracture.

If there are no means for transport immobilization at hand, then the injured arm can be immobilized with a jacket, bandaged to the chest, and the leg is fixed to the other, healthy leg (Fig.). Foot-to-foot immobilization is a last resort and is not very reliable for hip fractures, especially in the middle and upper third.

STOP BLEEDING (HEMOSTASIS).

In almost any injury, blood vessels are injured. In this case, bleeding is of varying intensity and depends on the type and nature of the damaged vessel.

Anatomically distinguish:

arterial bleeding characterized by intense blood loss. The blood is bright red (scarlet) in color, beats with a pulsating jet under great pressure. In case of damage to large vessels (aorta, femoral artery, etc.), blood loss that is incompatible with life can occur within a few minutes.

Venous bleeding. The blood is dark cherry in color, flows out slowly, evenly, in a continuous stream. This bleeding is less intense than arterial, and therefore less likely to lead to irreversible blood loss. However, it must be borne in mind that if, for example, the veins of the neck and chest are injured, air can enter into their lumen at the time of inspiration. Air bubbles entering the heart with blood flow can cause an air embolism and cause death.

capillary bleeding observed with superficial wounds, shallow skin cuts, abrasions. Blood from the wound flows slowly drop by drop, and with normal clotting, the bleeding stops on its own.

mixed bleeding occurs with simultaneous injury of arteries and veins, most often with deep wounds.

Parenchymal bleeding in case of damage to parenchymal organs (liver, spleen, kidneys), which have a developed network of arterial and venous vessels, the walls of which do not collapse when damaged.

By time of occurrence:

1.primary

2.secondary

- early (from several hours to 5 days)

- late (after 5 or more days)

In relation to the external environment:

1. external (if blood is poured outside the body)

2. internal (if blood accumulates in cavities and tissues)

- open - if the cavity has an anatomical connection with the environment (nasal, pulmonary, uterine, gastric, intestinal)

- closed - if the cavity has no anatomical connection with the environment (hemothorax, hemoperitoneum, hemarthrosis, hematoma)

3.interstitial

- petechiae - small hemorrhages in the skin

- ecchymosis - pinpoint hemorrhages in the skin

- hematomas - accumulations of blood in tissues and organs.

By clinical course:

- acute

- chronic

By intensity:

- profuse

- moderate

- weak

Distinguish temporary and final stop of bleeding.

Temporary stop of bleeding used in the provision of first medical and first aid. It can be achieved by pressing the damaged vessel in the wound or along the length, maximum bending and fixation of the limb in this position, applying a pressure bandage, giving an elevated (elevated) position to the damaged part of the body, applying a hemostatic tourniquet (twisting) and clamping the vessel.

Pressing the vessel throughout is carried out by squeezing the bleeding vessel above the site of bleeding when an artery is injured and below it when a vein is injured. Pressing with a finger (fingers) to the underlying bone formations is carried out in case of damage to large arterial or venous vessels, when it is necessary to immediately stop the bleeding and gain time to prepare for stopping the bleeding in other ways that allow the victim to be transported. Besides, manual pressing of the bleeding vessel demands application of considerable efforts; even a physically strong person can perform this procedure for no more than 15-20 minutes.

For each large arterial vessel, there are typical places where it is digitally pressed (Fig. 10). However, stopping bleeding with finger pressure should be replaced as soon as possible by pressing the bleeding vessel in the wound with tight tamponade, clamping it with a clamp or applying a tourniquet. If finger pressure on a bleeding vessel can be performed in a mutually beneficial manner, then tight tamponade of the wound should only be performed by a physician. A tampon that has tightly filled the wound must be fixed on top with a pressure bandage. It should be remembered that tight tamponade is contraindicated for wounds in the popliteal fossa, as it often leads to gangrene of the limb.

Fig.10 (1-temporal, 2-mandibular, 3-carotid, 4-subclavian, 5-axillary, 6-humeral, 7-ulnar, radial, 8-femoral, 9-popliteal, 10-rear foot)

The fastest way to temporarily stop arterial bleeding is to apply a hemostatic tourniquet. This manipulation is indicated only for massive arterial (not venous!) bleeding from the vessels of the limb. In the absence of an elastic rubber band, you can and should use the material at hand: a rubber tube, a towel, a belt, a rope. A tourniquet is applied above the (central) site of bleeding and as close as possible to the wound (Fig. 11).

The harness is applied as follows:

the place of the alleged application of the tourniquet is wrapped with a towel, a piece of cloth, several layers of a bandage;

the tourniquet is stretched and 2-3 turns are made around the limb along the specified substrate, the ends of the tourniquet are fixed either with a chain and hook, or tied in a knot;

the limb must be tightened until the bleeding stops completely;

the time of applying the tourniquet must be indicated in a note attached to the victim’s clothing, as well as in medical documents accompanying the victim.

With a properly applied tourniquet, bleeding from the wound stops and the peripheral pulse on the limb is not determined by palpation. You should know that the tourniquet can be kept for no more than 2 hours on the lower limb and no more than 1.5 hours on the shoulder. In the cold season, these periods are reduced. A longer stay of the limb under the tourniquet can lead to its necrosis. It is strictly forbidden to apply bandages over the tourniquet. The tourniquet should lie so that it is conspicuous. After applying a tourniquet, the victim must be immediately transported to a medical facility for the final stop of bleeding. If the evacuation is delayed, then after the critical time for the tourniquet to partially restore blood circulation, it must be removed or loosened for 10-15 minutes, and then reapplied slightly above or below the place where it was located. For the period of release of the limb from the tourniquet, arterial bleeding is prevented by finger pressure of the artery throughout. Sometimes the procedure for loosening and applying the tourniquet has to be repeated: in winter every 30 minutes, in summer after 50-60 minutes.

Fig.11 Places of overlap

hemostatic tourniquet to stop bleeding from the arteries. 1-foot; 2-shin and knee joint; 3-hands and forearms; 4-shoulder and elbow joint; 5-neck and head; 6-shoulder joint and shoulder; 7-hips.

To stop arterial bleeding, you can use the so-called twist from improvised means (belt, scarf, towel). When applying a twist, the material used should be loosely tied at the required level and form a loop. A stick is inserted into the loop, and, rotating it, twist until the bleeding stops. After that, the specified stick is fixed. It must be remembered that the application of a twist is a rather painful procedure, and skin infringement is possible. To prevent infringement of the skin during twisting and reduce pain, some kind of dense gasket is placed under the knot. All the rules for applying a twist are similar to the rules for applying a tourniquet.

To temporarily stop bleeding at the scene, it is sometimes possible to successfully apply a sharp (maximum) flexion of the limb, followed by its fixation in this position. This method of stopping bleeding is advisable to use in case of intensive bleeding from wounds located at the base of the limb. The maximum flexion of the limb is performed in the joint above the wound and the limb is fixed with bandages in this position. So, in case of injury to the forearm and lower leg, the limb is fixed in the elbow and knee joints; in case of bleeding from the vessels of the shoulder - the arm should be brought to failure behind the back and fixed; when the thigh is injured - the leg is bent in the hip and knee joints and the thigh are fixed in the position given to the stomach.

Often bleeding can be stopped with a pressure bandage. Several sterile napkins are applied to the wound, over which a thick roll of cotton wool or bandage is tightly bandaged.

To temporarily stop venous bleeding, in some cases it is effective to create an elevated position as a result of placing a pillow, rolling up clothes or other suitable material under the injured limb. This position should be given after applying a pressure bandage to the wound. It is advisable to put an ice pack and a moderate load such as a sandbag on top of the bandage on the wound area.

final stop bleeding carried out in the operating room, tying the vessel in wound or throughout, stitching the bleeding area, applying a temporary or permanent shunt.

ANESTHESIA

Anesthesia for bone fractures and associated injuries has the following goals:

eliminate pain impulses;

minimize the negative effects of psycho-emotional stress;

prevent or normalize neuroendocrine disorders that occur in response to severe mechanical damage.

Methods and means of prehospital anesthesia have a number of specific features and the following requirements must be imposed on them:

high analgesic and hypnotic activity of the drugs used;

fast-onset and soon-to-be-passing action;

sufficient simplicity and reliability of the applied methods;

a large therapeutic latitude and the absence of pronounced side effects.

It is important that the duration of any method of pain management used for pre-hospital injury does not exceed the time required to complete the evacuation from the scene and transport the patient to a medical facility. This is due to the fact that the presence of spontaneous reflex activity remains the basis for making the correct diagnosis.

For anesthesia in an ambulance, in addition to immobilization and rational laying of the patient, analgesics, hypnotics, inhalation and intravenous anesthetics are fundamentally applicable.

Most often, narcotic (opioid) analgesics are used for pain relief in prehospital injuries.

M is traditionally considered the reference opioid. orfin. Its main effect - painkiller - develops against the background of preserved consciousness. The average dose is 1-2 ml of a 1% solution, however, morphine has a number of side effects, such as dose-dependent depression of the respiratory center, nausea, and vomiting. They try to avoid respiratory depression by observing the recommended dosages of the drug, nausea and vomiting are stopped by the introduction of metoclopramide.

Widespread and available in ambulance settings romedol. In terms of analgesic activity, the drug is inferior to morphine by about 10 times, but to a lesser extent it depresses the respiratory center. The average dose is 1-2 ml of a 2% solution. Preference is given to the intravenous route of administration of the drug, since under conditions of shock, absorption from the subcutaneous tissue and muscles is slow.

Quite widely used drugs from the group of opioid agonist-antagonists or partial agonists of opioid receptors. The main distinguishing feature of this group of drugs is that the analgesic effect and respiratory depression increase with increasing dose to a certain level, and then change little (the “plateau” effect). A prominent representative of the agonist-antagonist group is Nalbufin(Nubain). The drug is characterized by a distinct analgesic, sedative effect and a limited depressant effect on breathing. Nalbuphine can be combined, if necessary, with midazolam or etomidate for ultrashort anesthesia in manual simultaneous reposition of bone fragments.

Convenient to use stadol, which is 5 times superior to morphine in analgesic activity (used at a dose of 2-4 mg). Stadol is not included in the official list of drugs subject to strict accounting and is an opioid that can be prescribed for traumatic brain injury.

For minor injuries, use is indicated Tramalol(tramal) at a dose of 50-100 mg. The analgesic effect persists for 2.5-3 hours, the drug does not depress external respiration, does not have a significant effect on central and peripheral hemodynamics.

It must be remembered that any analgesic used at the prehospital stage is able to mask the clinic of intracavitary injuries. Therefore, before deciding on their introduction, it is necessary to reliably exclude an intra-abdominal catastrophe.

In cases of excessive pain of certain types of injuries (burns of the face, hands), narcotic analgesics are added Diazepam (relanium) at a dose of 5-10 mg, midazolam(flormidal, dormicum) at a dose of 0.15 mg/kg or non-narcotic analgesic (analgin, ketorolac).

Inhalation anesthetics are not used so often in prehospital care, but they have one important advantage - their action is easily dosed and controlled, which makes it possible to correct the diagnosis when delivering the victim to the hospital at a minimum level of analgesia.

Previously, the most commonly used in ambulances was 3 nitrous oxide. In a mixture with oxygen (1:2, 1:3), nitrous oxide has a slight negative effect on hemodynamics, but often causes strong excitation, which is extremely undesirable in injuries due to the risk of displacement of bone fragments, secondary damage to large vessels and nerves. In addition, this anesthetic has a small breadth of therapeutic action, which implies a certain experience of the anesthesiologist when working with him.

Fluorotan has properties that are valuable for anesthesia precisely at the prehospital stage: a powerful anesthetic effect, a quick loss of consciousness, and the absence of a masking effect on the clinic of abdominal injuries. However, its use requires a special evaporator, which must be carefully calibrated. In addition, the use of halothane has several more negative aspects: a small breadth of therapeutic action, the need for prior administration of atropine, the risk of serious heart rhythm disturbances (tachycardia, fibrillation).

Methoxyflurane (pentran, inhalan) has a good analgesic effect in injuries. For its inhalation, a special evaporator (Analgizer, AP-1) was designed, which is convenient for prehospital anesthesia. The device is used for autoanalgesia. The method is extremely simple (the principle of "smoking pipe"), safe and associated with a small consumption of anesthetic (15 ml for 2-2.5 hours). The evaporator is fixed to the patient's wrist with a loop of ribbon. With the onset of anesthesia sleep and relaxation of the muscles, the hand, together with the apparatus, goes down and self-analgesia is interrupted until the moment of awakening. With this technique, an overdose of methoxyflurane is excluded. After the cessation of inhalation of anesthetic vapors, pain sensitivity remains reduced for 8-10 minutes. The main disadvantage of autoanalgesia with methoxyflurane for pre-hospital pain relief is its late development - 5-12 minutes after the start of inhalation.

The method of inhalation autoanalgesia can be used when extracting a victim from a rubble or from a damaged vehicle, when performing transport immobilization of fractures and applying bandages to burnt surfaces, less often during transportation.

Of the intravenous anesthetics at the prehospital stage, they use Ketamine, which is used here not as an anesthetic agent, but as an analgesic, therefore, doses of ketamine should not exceed 0.5 mg / kg when administered intravenously and 1.5 mg / kg when administered intramuscularly. The introduction of ketamine at recommended doses for bone fractures, closed injuries, wounds and burns is accompanied by either complete disappearance or a sharp decrease in pain without a noticeable effect on the state of consciousness. Sometimes drowsiness, disorientation develops, which, as a rule, disappear by the time of delivery to the hospital. Ketamine is the drug of choice for hypovolemic conditions, because it does not lower blood pressure, and often even slightly increases it. In small doses (up to 0.5 mg/kg), ketamine does not increase intracranial pressure, therefore, it can also be used for traumatic brain injuries. Relative contraindications to its use are alcohol intoxication and concomitant hypertension. Sometimes, when using ketamine, psychomotor agitation develops, which is stopped by diazepam at a dose of 0.15-0.3 mg / kg.

In recent years, hypnosis has become widespread at the prehospital stage. Etomidat (hypnomidat), which is characterized by rapid action and a slight effect on hemodynamics. It is administered once at a dose of 0.2 - 0.3 mg.

Specifically and reliably suppresses pain reactions local anesthesia in its various versions: superficial, infiltration, regional.

Sometimes used for local anesthesia novocaine blockades fracture sites (40 - 80 ml of a 0.5% solution of novocaine in the area of ​​\u200b\u200beach fracture).

Intercostal nerve block indicated for fractures of the ribs and severe contusions of the chest. It is performed in the position of the patient on the back or on the healthy side. After anesthesia of the skin, the needle is inserted until it comes into contact with the surface of the lower edge of the rib. With a slight advance in depth, the end of the needle enters the zone of the neurovascular bundle, where 10-30 ml of a 0.25% solution of novocaine is injected.

Brachial plexus block indicated for trauma to the upper extremity. It is performed with the patient in the supine position. The left forefinger is pressed outwards from the middle of the clavicle downwards and backwards in order to push the subclavian artery. Anesthesia of the skin is carried out at the upper edge of the clavicle, after which the needle is advanced backwards, down and inwards at an angle of 30 degrees towards the first rib. Enter 30 - 60 ml of a 0.25% solution of novocaine. Then the end of the needle is brought to the lateral edge of the first rib and an additional 20-30 ml of 0.25% novocaine solution is injected.

Pelvic ring block carried out in the position of the patient on the back or on the side with knees pulled up to the stomach. In the area between the coccyx and the anus, the skin is anesthetized, then a long needle is inserted along the midline parallel to the anterior surface of the sacrum. Enter 100 - 200 ml of a 0.25% solution of novocaine.

In case of fractures and associated injuries, DO NOT:

DO NOT administer central (opioid) analgesics for traumatic brain injury (except Stadol) and signs of abdominal damage. It is not recommended to enter diphenhydramine.

DO NOT lift an injured person lying on the ground, on the road, or on the floor until the nature of the injury is established.

DO NOT tilt the head of the victim and turn it if you suspect a fracture of the spine in the cervical region; lift and place an adult patient alone or together with a fracture of the cervical or thoracic spine; only 3-4 people can put such a victim on a hard stretcher and fix it.

It is IMPOSSIBLE to transfer and transport the victim with obvious and possible fractures of large bones without transport immobilization.

It is IMPOSSIBLE to transport the victim with signs of shock without initial compensation of blood loss by jet infusion of 1-1.5 liters of crystalloids; when installing a plastic cannula in a peripheral vein or catheterization of the subclavian vein, infusion therapy (colloidal solutions) can be continued during transportation.

DO NOT transport an unconscious victim without an inserted airway or endotracheal tube.

Introduction…………………………………………………………………………
Injuries of the bones of the extremities……………………………………………………….
Transport immobilization………………………………………………….
Stop bleeding (hemostasis).……………………………………………… Elbow bandage

A bandage on the knee joint is used not only in the presence of an injury, but also to prevent its development. A tight bandage allows you to fix the affected area, thereby accelerating the healing process. Today there are many variations of bandages. Therefore, before buying, it is advisable to consult with a specialist.

There are several basic conditions in which it is simply necessary to wear a bandage. Indications include:

• mild and severe joint damage;
• inflammatory processes, in particular arthritis and synovitis;
• chondromalacia;
• the period of rehabilitation after an injury or surgery;
• prevention of injuries during sports.

Bandage on the knee joint is selected together with a specialist. The period of wearing is determined by the orthopedic surgeon. The device is sized. This parameter is one of the most important. The bandage should not hinder movement, irritate the skin and cause pain.

Some people mistakenly believe that an elastic bandage helps to heal the joint. The bandage is just an auxiliary component, it allows you to remove swelling and inflammation. The only way to get rid of the cause of joint damage is through medical or surgical intervention.

There are 4 main criteria for wearing an elastic bandage. The first option is the prevention of injuries and diseases of the joint. It is advisable to wear a bandage for sports, it allows you to reduce the load on the limbs and prevent serious injuries. It is recommended to use a bandage for people suffering from overweight and weakness of the ligamentous apparatus.

The second criterion for the use of an orthosis is the fixation of a damaged joint. In this case, a compression bandage is used, it helps to cope with many diseases of the musculoskeletal system.

The third criterion is the restriction of joint movement. In this case, special types of dressings are used, which are particularly rigid.

The fourth criterion is the unloading of the damaged joint. A bandage of this type is advisable to use in inflammatory processes.

The bandage is characterized by a lot of advantages, but not everyone can use it. The bandage is not applied in case of:

• acute injury;
• infectious or inflammatory lesions of the skin;
• the presence of signs of thrombophlebitis;
• allergic reactions.

In order to avoid deterioration of the condition, a specialist should be consulted before using an elastic bandage.

To date, there are 3 main types of dressings:

• soft;
• reinforced;
• tough.

Soft bandages are based on natural fabric with the addition of special fibers. Previously, elastic bandaging was widely used, but it was not comfortable, and the bandage constantly slipped. Soft bandages have replaced the old method.

Reinforced bandages include synthetic material. It has high strength and elasticity. Moreover, it completely repeats the shape of the joint and remembers it. The canvas is characterized by many microperforations, thanks to which the skin breathes. The bandage is equipped with straps, some models are designed with stiffeners.

Orthoses and splints are complex structures. They are based on metal plates and plastic. Many bandages come with stiffeners and hinges. Used in the presence of serious injuries and lesions of the knee joints.

The optimal type of dressing can be selected after examining the diseased area. Both fractures and inflammatory processes can affect this process, which requires the use of a specific bandage.

How to choose an orthosis?

Before choosing a bandage, you need to decide on the size. This parameter is the most important, in case of an error, the bandage will be useless. The main function of the bandage is to fix the knee joint without squeezing and aggravating the condition, so the product must be compressive, stabilizing and supporting.

To select the optimal size, it is necessary to measure the circumference of the thigh in the lower third. This option allows you to choose the right bandage. The length of the bandage also depends on the size of the bandage.

To avoid errors, measurements must be taken with a centimeter tape. It should be applied to the skin, but do not pinch them. It is worth noting that rigid bandages for sports do not have sizes. This parameter is regulated by special fasteners and belts.

When choosing a caliper, it is necessary to take into account a certain degree of fixation and the main indications for its use.

Important criteria are the price and the manufacturer, not always an expensive dressing is highly effective. The material of the caliper must be wear-resistant and easy to wash. Before choosing a specific bandage, you should check all the elements and try on the bandage to determine the degree of comfort.

Bandages and orthoses for the knee joint with arthrosis

To learn more…

All kinds of damage to the joints require long-term treatment and recovery. For reliable fixation of the damaged joint and its immobilization, manufacturers of medical equipment produce a huge range of special devices.

• Orthosis.
• Caliper.
• Bandage.
• Magnetic knee pads.
• Tutor.
• Tire.

A knee brace is one such product.

What is a knee brace for?

The human knee joint has a very complex structure, it consists of three bones, three synovial bags, menisci and tendons. Cartilage plates (menisci), ligaments and tendons take part in the connection of the lower and upper parts of the joint.

Thanks to the coordinated work of all elements of this mechanism, the knee can carry out flexion and extension movements. But with various damages, the joint loses its functionality.

The causes of impaired motor activity in the knee joint are due to:

1. Significant physical exertion that occurs during sports training or during work involving lifting and carrying weights.
2. Excessive weight of the patient has a great effect on the knee joints, since it burdens the knees with an additional load.
3. Degenerative-dystrophic diseases are also risk factors for the development of gonarthrosis of the knee joint, bursitis and other similar diseases.

For the treatment of pathologies of the knee joint and for recovery during the rehabilitation period after an injury or surgery, doctors, in addition to medications, prescribe patients to wear orthopedic bandages.

These simple devices provide stability to the weakened knee, relieve pain and reduce the load.

Bandage on the knee - indications

A brace or orthosis is an orthopedic device that tightly fits the knee joint and guarantees its stability. You can wear knee pads both for therapeutic purposes to get rid of an existing disease, and for prevention purposes.

For athletes, knee orthoses are especially necessary, as these people put their legs at risk of injury on a daily basis. An elastic bandage will help to cope with minor joint damage, inflammation or swelling.

The device has an unloading, warming and compression effect.

Immobilization of the knee is necessary in the following situations:

• sprains, dislocations, bruises;
• gonarthrosis, tendinitis, osteoarthritis, arthritis;
• partial or complete rupture of the meniscus by the type of watering can handle;
• inflammation of the tendons;
• swelling of the knee;
• Osgood-Schlatter disease;
• old trauma;
• after joint surgery.

The main quality of the knee brace is rigid fixation. An ordinary elastic bandage cannot guarantee such an effect. Properly selected orthosis inhibits the development of the inflammatory process.

The soft knee brace is equipped with a layer made from dog hair. Such a device provides limbs with a warming effect and improves blood circulation. Therefore, the product has only positive reviews.

Types of knee braces

Fixing bandages for knee joints differ not only in their design, but also in the material that the manufacturer uses in the manufacturing process.

The most primitive products are soft knee pads that replaced elastic bandages. These orthoses are used by athletes and patients with simple knee pathologies.

The brace for the knee joint, additionally equipped with stiffeners, is a retainer made of polymer fiber.

It has straps and Velcro to give the joint complete rest and maximum stability. A brace with stiffeners is indicated for the treatment of arthritis, osteoarthritis, serious injuries and for wearing in the postoperative period.

If pain occurs under the patella, it is recommended to use a retainer with a tendon support function. Such a product does not limit the mobility of the ligaments, as evidenced by numerous patient reviews.

The most complex in design are articulated knee pads and splints. Knee pads are universal devices that can be used to relieve pain from sprains and sprains, to treat destructive changes in the tissues of the joint.

Types of bandages by efficiency

In medical practice, knee bandages are classified by type and strength of fixation.

1. Functional type - provides stability to the joint, limits its mobility. Products can be equipped with regulators, hinges and reinforced with stiffeners.
2. Dynamic (compression) - this type of orthoses is recommended for wearing after operations, injuries and as a preventive measure during sports. A dynamic knee brace is often used in exacerbation of chronic joint pathologies.
3. A stabilizing latch is a product with plastic and metal inserts. Tires are replaced with such bandages. They are indicated after serious operations and injuries on the knee joints. Immobilization is achieved maximum.
4. A stage-functional orthosis is a rigid device that allows you to gradually increase the range of motion during joint rehabilitation. The effect is achieved by reducing fixation.

The choice of fixator for the knee joint with arthrosis

Arthrosis is a pathology that affects more and more people every year. Degenerative change in the structure of the joint causes intense pain and limits the mobility of the limb.

The patient experiences torment even during short walks. The brace on the knee with stiffeners helps to reduce symptoms of the disease, eliminate swelling and restore freedom of movement.

At the initial stage of arthrosis, you can wear soft knee pads and open-type bandages. In order to prevent arthrosis and with unclear localization of pain, closed devices are indicated.

When buying an orthosis, special attention should be paid to the material that the manufacturer used to make the fixator. Polyester and elastane are considered the most comfortable and practical.

Devices with an insert of dog hair provide the joint with additional warmth and a healing effect. Tourmaline has similar properties. The mineral emits infrared radiation and warms the affected joint, penetrating deep into the skin.

Before going to a pharmacy or a specialized store to buy a knee brace, the patient should consult with a doctor who takes his medical history. The doctor will take into account all the features of the disease and give the patient useful recommendations regarding the type of product.

An elastic retainer that protects the knee from various mechanical damage can be purchased independently. The product must correspond to the size of the limb of the patient. When buying, you need to keep in mind that each manufacturer has its own size range. To determine the size, you need to measure the girth of the leg under the knee and above it with a tailor's centimeter.

It is better to buy medical fixing devices in trusted online stores or in specialized salons where it is possible to try on a bandage. If it is a rigid fixator, it should not squeeze the leg too much. Otherwise, the process of blood circulation and nutrition of the tissues of the joint is disrupted, and this will only harm the already sore knee.

You should not expect a therapeutic effect from a freely dangling orthosis. When buying, you must also consider the practicality of the material. The product must be washed or washed, be wear-resistant and breathable. It is recommended to check all fasteners, fastenings and bandage straps. Velcro wears out quickly, so products with similar elements are unlikely to last long.

The most popular manufacturers:

• Mueller Sports Medicine is a leading manufacturer of sports medicine products.
• Rehard Technologies GmbH is a German company that produces various devices for the treatment of joints and spine.
• Medi is a German brand producing high quality sports bandages and other orthopedic products.
• Pharmacel is an American company that manufactures products for sports medicine and physical therapy.

• Relieves pain and swelling in the joints with arthritis and arthrosis
• Restores joints and tissues, effective for osteochondrosis

To learn more…

Synovitis of the knee joint: symptoms and treatment with photos

Synovitis of the knee joint is an inflammation of the inner membrane lining the joint cavity (synovia) with accumulation inside the exudate or transudate (fluid of an inflammatory and non-inflammatory nature). In the normal position, the synovial membrane completely lines the articulation cavity, in addition to cartilaginous bone surfaces, it is rich in nerve endings and blood vessels.

• • Varieties and causes of synovitis
• • Symptoms of an acute form of synovitis of the knee joint
  • Symptoms of chronic synovitis of the knee joint
  • Consequences
  • Diagnostics
• How to cure synovitis?
  • Medical treatment
  • Puncture
  • Surgical intervention
  • Immobilization
  • Prevention

Its inner surface has villi that increase the surface for suction and production of liquid. It is thanks to the moisture and synovia that it produces that the intra-articular cartilage, which do not have their own vessels, is nourished, metabolic processes take place.

Synovitis of the knee joint, what is it?

The synovial membrane both produces fluid and absorbs excess fluid. It also creates many bursae and folds that may or may not connect to the main body of the knee. They play a cushioning and protective role. Also, these bursae do not allow the progression of the pathological process, localizing the focus of inflammation and infection of aseptic origin. That is, during synovitis, the membrane may be completely damaged or only one bursa may become inflamed, for example, with suprapatellar synovitis, only the synovial sac located above the patella on the front surface of the knee joint is affected.

The synovial membrane is the most sensitive indicator of the state of the knee joint, which will be the first to respond to the influence of pathological factors. Often, it is the appearance of synovitis that is the first symptom of a disease or a signal that something is happening to the knee.

Varieties and causes of synovitis

Taking into account the cause that caused the inflammation of the synovia and the accumulation of fluid in the joint cavity, the following types of synovitis are classified:

There are also 2 large types of synovitis:

• Aseptic, if the cause of the disease is not associated with microbes. This group includes allergic and post-traumatic synovitis in rheumatological diseases, metabolic and endocrine diseases, etc.
• Infectious if they are pathogenic microorganisms (viruses, bacteria, fungi, protozoa). As a rule, the cause of this inflammation are streptococci, staphylococci, Mycobacterium tuberculosis, pneumococci, Escherichia coli, Brucella, which penetrate into the cavity of the knee joint directly from the environment during injuries or from other foci of infection in the body with the flow of lymph or blood.

Taking into account the International Classification of the Disease of the Tenth Revision (ICD-10), synovitis of the knee joint was assigned the code M65.

Given the characteristics of the contents in the cavity of the knee joint, synovitis is:

• Serous-fibrinous;
• serous;
• Purulent;
• Hemorrhagic.

Signs of acute and chronic synovitis

Synovitis can be both acute and sometimes gets recurrent and chronic.

Symptoms of an acute form of synovitis of the knee joint

Inflammation appears within a couple of hours or sometimes days. The first sign is the formation of smoothness of the contours of the joint (defiguration), its increase in volume (edema). The reason for this phenomenon is the accumulation of fluid in the articulation cavity, the greater its amount, the more clearly the edema is visible. Most often, the joint does not greatly increase in size (moderately pronounced synovitis). What makes it possible to distinguish it from hemarthrosis in children (accumulation of blood in the cavity of the knee joint), when the articulation can significantly increase in size, and this happens within a couple of minutes or several hours.

Another sign of synovitis is a violation of the functions of the joint, in other words, the limitation of movements in the knee joint. Most often this is observed due to pain or swelling.

Moderate synovitis in the knee can be completely painless. Either pain is perceived as discomfort in the knee joint of a dull nature of medium or low intensity.

The skin during acute synovitis of the left or right knee joint does not change, the color remains normal, no increase in body temperature is observed.

The course of purulent acute synovitis is slightly different:

• fever and other symptoms of general malaise (lack of appetite, weakness, headache, muscle pain);
• the temperature rises over the sore knee;
• severe pain of bursting or pulsating nature;
• the skin over the articulation may have a bluish tint, becomes tense and shiny, turns red;
• pronounced swelling of the joint, movements are quite painful.

As a rule, synovitis affects only one joint, in rare cases inflammation of the right and left knee joint is observed.

Symptoms of chronic synovitis of the knee joint

These forms of inflammation are very rare, and they have the character of minimal synovitis. People at the onset of the disease complain of fatigue when walking, general weakness, periodic aching pain, and slight limitation of movement in the knee.

At the same time, effusion accumulates in the joint cavity and chronic dropsy of the joint or hydrarthrosis is formed. If this condition passes for a very long time, then this can lead to additional pathological changes in the joint, for example, instability develops, ligaments stretch, dislocations and subluxations of the joint.

As a result of the constant presence of inflammatory fluid in the joint cavity, secondary hypertrophic and sclerotic processes occur directly in the synovial membrane. It loses the ability to absorb the secret, which greatly aggravates the course of the disease. As a result, special forms of pathology may appear, for example, villous synovitis, which will require surgical intervention.

Consequences

The consequences of severe or moderate synovitis will depend on the timeliness of diagnosis, the cause of inflammation of the synovial membrane, the patient's compliance with medical recommendations and the adequacy of the prescribed treatment.

Different types of pathology have different consequences. Most often, allergic and serous forms of inflammation are completed successfully and do not have any negative consequences for the articulation function. But purulent forms threaten not only the knee joint, but also human life, since they can be complicated by the development of a state of shock and sepsis.

If the disease has become chronic, then it can cause chronic instability of the joint, its dislocations and subluxations, the appearance of secondary arthrosis.

Therefore, synovitis must be taken very seriously, even in cases where the disease is not accompanied by severe swelling and pain in the knee. This can help to avoid serious consequences in the future.

Diagnostics

Confirming the diagnosis of synovitis is quite simple, it is much more difficult to identify its cause. Diagnostics includes:

Determining an accurate diagnosis may require consultation with doctors such as a rheumatologist, orthopedic traumatologist, infectious disease specialist, allergist-immunologist, endocrinologist, hematologist.

How to cure synovitis?

Methods and principles of treatment will depend entirely on the severity and cause of synovitis. If during minimal inflammation it is possible to manage with adherence to the regimen and drug therapy, then during severe inflammation, with severe effusion, a joint puncture may be necessary, and chronic forms often require surgical methods of treatment.

There are four main ways to treat synovitis:

• drug treatment;
• joint puncture;
• surgical treatment (as needed);
• knee immobilization.

Medical treatment

To remove inflammation and causes of pathology, drugs of the following groups are used:

• inhibitors of proteolytic enzymes;
• medicines to increase microcirculation;
• anti-inflammatory nonsteroidal drugs and analgesics;
• antibiotics;
• glucocorticosteroids.

The choice of the required drugs, their dosage, method of administration and combinations is prescribed only by a doctor, taking into account the causes of synovitis.

Puncture

This manipulation is both diagnostic and therapeutic. It is done as a first aid for a large accumulation of fluid. It makes it possible to quickly remove its excess, eliminate severe pain and reduce pressure in the joint. In addition, the fluid that is taken after the puncture of the joint is sent for research (this allows you to identify the cause of the disease).

Puncture is a painless process, therefore it is performed without anesthesia. The knee joint is pierced with a thin needle, and the fluid is pumped out with a syringe. Also, after pumping out, drugs can be injected into the joint cavity, for example, glucocorticoids, antibiotics, etc.

Surgical intervention

It is indicated in the chronic course of the disease with the appearance of specific complications (the formation of petrificates, the development of villous synovitis, sclerotic processes). A synovectomy is performed (removal of the entire pathologically altered or a certain part of the synovial membrane).

Immobilization

This is a mandatory part of the treatment of any type of inflammation. During the disease, any physical activity for the knee joint is completely contraindicated. Sometimes the knee can be immobilized with a splint, cast, brace, or orthosis.

Immediately after the removal of acute inflammation and the absence of excess fluid in the joint, it is necessary to start therapeutic exercises, since prolonged immobilization threatens the formation of joint stiffness.

Prevention

The main prevention is the timely treatment of traumatic, infectious and inflammatory lesions of the knee, which lead to the accumulation of fluid. It is necessary to take care of the safety of the knee joints when doing hard work, sports, since injury is the most common cause of inflammation.

Symptoms, as methods of treatment and synovitis of the knee joint, are different, which complicates the choice of therapy and the initial diagnosis of the disease. If inflammation is suspected, it is necessary to consult a specialist doctor who will determine the cause of the disease and can help get rid of its symptoms.