is a combination of symptoms and clinical manifestations that allow suspecting and diagnosing a bone fracture. Knowledge of these signs allows the doctor, paramedic and common man, who happened to be next to the victim in time to start providing correct emergency care.

A fracture is any break in the integrity of a bone. This is one of the most common types of injury. People of any age can be prone to fractures.

What are the signs of a fracture?

The most accurate way to determine the presence of a fracture is an x-ray. It is carried out in any trauma center or hospital. However, injuries can happen anywhere, and it is not always possible to bring the victim for this type of diagnosis in the next few minutes. Therefore, for the diagnosis of a bone fracture, there are certain signs.

Signs of a fracture can be absolute and relative. Absolute signs 100% confirm the fact of a fracture, and make it possible to distinguish it from a number of other types of injuries. Relative signs make it possible to suspect the diagnosis of a bone fracture, but do not give an exact guarantee.

Absolute signs of a bone fracture

1. pathological mobility. The limb becomes mobile in the place where it is normally motionless, that is, where there are no joints. However, with incomplete fractures due to partial preservation of the integrity of the bone, this symptom may be absent.
2. limb position. The limb takes an unnatural position, and this can be seen with the naked eye.
3. Crepitus or bone crunch. It is heard when trying to move an injured limb or when pressing with a phonendoscope.
4. Bone fragments in the wound. When examining the wound, bone fragments protruding from it are visually visible. However, this is typical only for an open fracture, which is accompanied by a violation of the integrity of the skin and contact of the bone with external environment. With a closed fracture this symptom is not detected, and a fracture can be suspected by the first three symptoms.

Relative signs of bone fracture

1. Pain. It occurs when the load on the injured limb. Especially with axial load. For example, with a fracture of the tibia, pain occur when pressure is applied to the heel bone.
2. Edema. Occurs at the site of a fracture as a result of tissue damage. This is not a very reliable diagnostic criterion, since edema occurs with any injury.
3. Hematoma. Appears as a result internal bleeding. Occurs when various injuries, including bruises, sprains, dislocations.
4. Impaired mobility of the injured limb. Often occurs as a reaction to pain. A person cannot lean on the injured limb, or make a movement with it.

Signs of a bone fracture, absolute and relative, together with the data of anamnesis and external examination, help to suspect this species injury. In this case, it is necessary to fix the limb and call an ambulance as soon as possible.

Bone fracture is complete violation of the anatomical integrity of the bone, which is caused by external influence or violence that exceeds the limits of its physical strength.

In some types of injuries, a person may experience an incomplete violation of the integrity bone tissue in the form of a crack, fracture, as well as the formation of a perforated or marginal fracture.

An impacted fracture is a type of complete fracture in which one bone fragment is embedded into another. Most often, this type is observed in the area of ​​\u200b\u200bthe metaphyses of bones.

Children are characterized by subperiosteal fractures (of the “green branch” type), as well as such a type as epiphysiolysis, in which bone fragments are separated at the site of the growth zone.

Classification

For the reason that caused the fracture

1. traumatic
   • open;
   • Firearms (relate to open ones);
   • Non-firearms;
   • Closed
2. Pathological
   • Tumor (benign and malignant);
   • Bone cyst;
   • imperfect osteogenesis;
   • Severe chronic diseases;
   • Osteoporosis;
   • Thinned bone as a result surgical intervention.

In connection with the external environment

1. Closed
   • Single;
   • Multiple;
   • Combined;
   • Combined.
2. open
   • Non-firearms;
   • Gunshot.

Open fractures

Open fractures are accompanied by damage to the skin and soft tissues and communicate with the external environment. This type of injury is characterized by the fact that the wound surface, bleeding and microbial contamination are formed in the victim as a result of a fracture. Gunshot wounds, as a rule, are accompanied by severe damage to soft tissues and bones.

In some patients, the wound does not form immediately after the injury, but after a while. Its appearance is due to the fact that the sharp part of the displaced bone fragment breaks the muscles, skin and blood vessels. This type of fracture is called secondary open..

Closed fractures

This type of violation of the integrity of the bone is not accompanied by injury skin. However, closed fractures can damage large vessels, and then they are accompanied by blood loss.

The average amount of blood loss in closed fractures:

1. Fracture of the femur - 1.5-2 l;
2. Fracture of the bones of the lower leg - 600-700 ml;
3. Fracture of the bones of the forearm - 100-220 ml;
4. fracture humerus- 300-400 ml.

Bone fractures in humans can be single or multiple.. At severe injuries the victim may experience combined fractures of the musculoskeletal system, which are accompanied by damage internal organs and skull bones.

Combined injuries include bone fractures that occur when the body is exposed to several factors (for example, bone fractures are accompanied by thermal, chemical and radiation damage).

Fracture mechanism

There are two mechanisms for the occurrence of a fracture:

1. Direct (a person has a bone fracture at the site of application of force);
2. Indirect (away from the point of application of force).

Types of fractures:

1. transverse;
2. Screw;
3. Helical;
4. oblique;
5. Longitudinal;
6. Shattered.

Incomplete bone disorders:

1. cracks;
2. Breaks;
3. edge;
4. Perforated fractures.

Fracture line localization

1. Lower third;
2. middle third;
3. Upper third.

Types of displacement of bone fragments:

1. By width;
2. By lenght;
3. On the axis (at an angle);
4. Along the periphery.

For joints:

1. Intra-articular (the fracture line runs inside the joint);
2. Extra-articular.

The main symptoms and signs of fractures

1. The victim after an injury has pain at the site of damage to the bone;
2. At the site of injury, swelling and swelling of the soft tissues occurs;
3. When the bones are damaged, bruising (hematoma) occurs;
4. If fractures occur in the arms or legs, then this limits their mobility;
5. Fractures of the limbs are accompanied by their deformation;
6. When a bone is broken, the length of the limb can change;
7. After a fracture of the limbs, pathological mobility appears in the arms or legs;
8. Active movements in injured limbs are limited;
9. On palpation of the site of bone damage, crepitus of fragments is determined.

Diagnostics

1. Anamnesis;
2. Complaints;
3. Clinical signs of a fracture;
4. Additional methods of examination.

If the doctor correctly collected an anamnesis from the victim, this allows you to establish not only the mechanism, but also the nature of bone damage.

It is very important in terms of diagnosis to determine the force that acted on the bone. For example, in older people, fractures can occur even with minor trauma.

Clinical diagnosis must be confirmed X-ray method diagnostics. In order to obtain more complete information about the fracture, the injured bone is removed in at least two projections with the obligatory capture of adjacent joints.

In case of complex and associated injuries, the victim is shown computed tomography and magnetic resonance imaging.

Stages of medical care:

1. Providing first aid to the victim at the site of injury, depending on the type of fracture;
2. Transportation of the victim to the hospital;
3. Fracture diagnosis;
4. resuscitation measures;
5. Treatment of injuries that threaten the life of the victim;
6. Treatment of fractures;
7. Rehabilitation.

What does first aid for fractures include?

1. Anesthesia;
2. Anti-shock measures;
3. Stop bleeding;
4. Replenishment of the volume of circulating blood;
5. Immobilization of the injured limb;
6. Transportation of the victim to the trauma department of the hospital.

Anesthesia

In traumatology, there are two types of anesthesia:

1. General;
2. Local.

Indications for general anesthesia for fractures:

1. Long-term operations that are accompanied by significant blood loss;
2. Compression fractures of the vertebrae;
3. Fracture of the hip joint;
4. Shoulder fracture;
5. fracture femur;
6. Humerus fracture;
7. Complex intra-articular fractures;
8. Multiple fractures;
9. Associated injuries.

General anesthesia is carried out by the following pharmacological groups:

1. Narcotic analgesics (for example, promedol);
2. Non-narcotic analgesics (for example, analgin);
3. Ketorol;
4. Non-steroidal anti-inflammatory drugs (for example, nise).

If the injured person is in serious condition, then the use of narcotic analgesics for the purpose of pain relief is prohibited, as this can lead to depression of the respiratory center.

Types of local anesthesia that are used for bone fractures:

1. case novocaine blockade according to Vishnevsky (introduction of a solution of novocaine into a hematoma or into fascial cases);
2. epidural anesthesia;
3. Conduction anesthesia (blockade of large nerve trunks);
4. Intraosseous anesthesia.

With intraosseous anesthesia, along with an anesthetic (usually novocaine), you can enter antibacterial drugs and thus create their high concentrations at the site of bone damage.

What is a reposition

Reposition is a manipulation that is aimed at comparing bone fragments and eliminating all types of displacements.

There are two types of repositioning:

1. Open (isolation and comparison of bone fragments occurs during the operation);
2. Closed (comparison of bone fragments occurs without exposing the fracture site).

At the same time, it is possible to correctly compare bone fragments with fractures of the bones of the upper and lower extremities. But there are exceptions: for example, in case of a hip fracture, compare simultaneously bone fragments it is impossible, as this is prevented by the tension of the muscles of the leg.

Methods of simultaneous reposition:

1. "Manual" reposition;
2. With the help of special devices (for example, an orthopedic table);

Gradual reposition is used for chronic bone fractures and hip fractures.

Ways of gradual reduction:

1. Skeletal traction;
2. With the help of special compression-distraction devices.

How are bone fragments fixed?

Factors on which the methods of immobilization of bone fragments depend:

1. General condition of the patient;
2. Age;
3. Fracture localization;
4. The nature of the fracture;
5. The presence of complications after a fracture;
6. Extensive damage to the skin and soft tissues;
7. The nature of the wound surface;
8. Degree of contamination of the wound.

The traumatologist should choose a method of fixation of bone fragments that provides reliable fixation and does not cause complications in the patient. The method should allow the patient get involved in the rehabilitation process as soon as possible and promote its early activation.

Methods for fixing bone fragments:

1. Plaster bandages;
2. Medical splints;
3. Skeletal traction;
4. Devices for extrafocal transosseous fixation;
5. Submersible osteosynthesis.

If the victim is diagnosed with a transverse fracture without displacement of the bone fragments or they are slightly displaced, then after a successful one-stage reposition of the bone fragments, the patient is shown fixation with plaster splints or bandages.

extrafocal fixation and skeletal traction used for comminuted and comminuted fractures, as well as fractures that are accompanied by significant rupture of soft tissues, burns, frostbite and contamination.

Oblique, screw and helical fractures, injuries of the femur and humerus, fractures in the forearm must be fixed during the operation with various metal structures (pins, plates, spokes).

Treatment

The main goal of fracture treatment is:

1. Achieving union of bone fragments in the correct position;
2. Restoration of normal anatomically shaped bones.

In order to form a strong bone callus, the following conditions are necessary:

1. Reposition should restore the correct anatomical position of bone fragments;
2. Between the ends of the bone fragments there should be no layers of soft tissues;
3. It is necessary to create immobility of the fragments at the fracture site;
4. Good condition of the surrounding soft tissues;
5. The load on the injured limb should be dosed.

What are the ways to stimulate bone fusion?

Modern medicine has the ability to stimulate the formation of callus. To accelerate the regeneration of bone tissue in traumatology, the following are used:

1. Mummy;
2. Anabolic hormones;
3. Special pharmacological groups drugs;
4. Physiotherapeutic methods.

Rehabilitation after fractures

1. Physiotherapy;
2. Massage;
3. Physiotherapy;
4. Proper nutrition;
5. Wearing an orthosis;
6. Spa treatment.

How to eat with fractures

Regardless of the type of fracture, the patient during the period of treatment and rehabilitation should eat foods enriched with vitamins and minerals.

It is necessary to include daily foods containing calcium in your diet - milk, cheese, cottage cheese, vegetables and fruits.

For older people, women in the post-menopausal period, the doctor should prescribe tablet forms of calcium preparations and multivitamins.

During the rehabilitation period, the patient is shown Spa treatment with the use of mud therapy, balneotherapy, selective physiotherapy and various methods massage. The choice of a sanatorium depends on the type and location of the fracture.

Why are fractures dangerous?

Complications of bone fractures:

1. Bleeding;
2. Pain shock;
3. Violation physiological function limbs;
4. Damage to internal organs and soft tissues;
5. Chronic pain syndrome;
6. Violation motor function organism;
7. Athrosis and arthritis (with intra-articular fractures);
8. The formation of false joints;
9. Infectious complications(for example, osteomyelitis)

Prevention of complications after fractures is the timely appeal of the victim for medical help and the implementation of all doctor's recommendations during treatment and rehabilitation.

A fracture refers to a break in the integrity of a bone as a result of an injury. Many of these injuries are easily and quickly detected by the victims. And there are some types of fractures that cannot be immediately noticed. Even for some time, a person with such damage can lead a normal life. He is worried about a little discomfort and pain, but the symptoms are quite bearable, so he thinks he has a bruise.

When the first signs of a fracture appear, you should immediately seek help from a qualified specialist. And even better, if the patient will have at least some information on this issue.

There is also a second group characteristic symptoms fracture:

• Pain accompany the patient in any position - at rest or during movement. If this is a fracture, then with axial load, the feeling of pain will increase. For example, with a fracture in the shin area, pain is felt more painfully if you tap on the heel.
• Swelling in the area of ​​injury can form immediately or after some time. But this is not such an important symptom, as it can be a sign of any other damage after an injury.
• One of important symptoms is a hematoma. It may not appear immediately, but if it pulsates, then the bleeding is still ongoing.
• In most cases, the functionality of the damaged area is severely limited. It happens partially or completely. Difficulties arise not only in the fracture area, but also with other areas that are in contact with the damaged area. For example, if a person broke his coccyx, the pain will be not only in his area. It will be difficult and painful for the patient to move around.

Many of the symptoms listed above are not an accurate probability of having a fracture. They accompany most injuries after trauma.

Closed fracture

With a closed fracture, they do not suffer soft tissues, their integrity is not violated. Only the bones are damaged, while they can change their position. Such bone fractures in medical language are called displaced. Sometimes a bone or joint retains its position but loses its integrity. Such damage is called comminuted.

The first signs of a closed fracture are pain and swelling at the site of injury. The patient is in pain and has difficulty moving. Depending on where the bone is damaged, it may move. Hematoma is often formed. X-ray examination is necessary to make sure that a closed bone fracture is present.

Each person should know what symptoms accompany him:

• The most basic symptom is pain. But it must be remembered that such a symptom may also indicate a rupture of ligaments, muscle damage.
• The shape of the joint itself, the lower leg or thigh, the injured part of the body changes. Such a sign in medicine is called deformation.
• Wrong movement. With such damage, the bone moves in an unusual direction. The same goes for amplitude.
• If you try to feel the damaged area, you can hear a characteristic sound, a crunch. It also occurs during movement.
• The body temperature rises, the patient feels a general malaise. it natural reaction body for injury.

Open fracture

If we talk about an open fracture, then this injury is classified as more severe. The fact is that with such damage, not only the integrity of the bones at the site of exposure to the traumatic factor is violated, but soft tissues also suffer. Most often, an open fracture is received by people who have been exposed to external factors, for example: road accidents, placing limbs in moving mechanisms, etc., as well as when soft tissues are torn by a broken bone.

The main signs of an open fracture are:

• Heavy bleeding.
• Open wound.
• Intense pain.
• Edema.
• You can see a broken bone or its fragments visually.

In the event of significant damage, a person may experience traumatic shock.

Consider the signs of a fracture on the example of a fracture of the toes.

Finger injury

The bone breaks if it cannot withstand the load. Most often, a person breaks a toe. To determine the injury does not need to be a specialist, but in some situations, a doctor's consultation and additional examinations may be necessary.

• Severe acute pain.
• The injured finger swells.
• A hematoma or hemorrhage is formed under the nail, as well as under the skin.
• The functionality of the limb is impaired.
• If at the moment of rest you can not feel severe pain, then in the process of movement it is noticeably felt.

All of these signs can be aggravated if the fracture occurs on the main phalanx of the toe. This is because it is connected to metatarsal bones. Moreover, the hematoma in this case will be larger, and the swelling as well.

My biggest concern is the fracture of my big toe. There is not only pain, but also a hematoma, as well as swelling. Fractures of the bones of the remaining fingers may not be immediately noticeable. This is because they do not have as much load as thumb. The victim may not immediately seek help from a doctor, but only after a while, when the pain causes severe discomfort.

There are signs that indicate that the finger is broken and in the near future the person needs to go to the hospital:

1. 1. First, the finger moves unusually.
   2. Secondly, the same applies to the position of the limb itself.
   3. In addition, you can hear a characteristic crunch. Especially if you press on the injured area.

External examination does not always give positive result. The leg swells, takes bluish tinge, and of course, when you move your finger, sharp pain. To confirm or exclude bone fractures, it is necessary to do X-ray. It is even better if it is an examination in 2 projections at once.

Complications

After any injury, complications can develop in a person, and a fracture is no exception. One of the main signs that you should see a doctor is tissue necrosis. It occurs for two reasons: the pressure of bone fragments from the inside, or external damage. Circulation may also be affected if fluid builds up inside the fracture.

If you do not take any measures, then there is a high probability of developing gangrene or thrombosis. Another complication is paresis or paralysis, which appears when the nerve is compressed. Doctors rarely diagnose complications of closed fractures in the form of suppuration.

Such phenomena appear in the early stages of healing. Late complications incorrect fusion of bones or its absence, the appearance of false joints. Post-traumatic arthrosis, contracture (restriction of movement) of the joints may develop.

If the patient noticed that he was developing complications, or felt unwell, you should consult a doctor as soon as possible.

Video: Elena Malysheva. Midfoot fracture

Sources

1. Traumatology and orthopedics. Textbook for students medical institutes edited by Yumashev G.S. Publishing house "Medicina" Moscow. ISBN 5-225-00825-9.
2. Kaplan A.V. Closed injuries of bones and joints. Publishing house "Medicine". Moscow.

" . My name is Albert Sagradyan , I am an orthopedic traumatologist, and part-time co-founder of this site. From today I will lead the section "THE MEDICINE", and I'll start, perhaps, with my professional activity. Today we're talking about bone fractures!

Traumatology - Introduction

Traumatology- This is the oldest branch of medicine, which has become the basis of surgery. The stories are known archaeological finds when back in Ancient Rome signs of consolidation of bone fragments were found on the bones of the fallen soldiers. For the first time about traumatology described in the writings of the ancient Greek physician Hippocrates. It was at the time of Hippocrates that the types of treatment for fractures were already described.

Wars of the 20th century played a big role in the formation of traumatology, the one we see now. They not only claimed the lives of people, but also made them physically broken. It was then that traumatology stood out from the general discipline, as a separate branch.

Categories of injuries in traumatology

Let's look at the main types damage, which are included in traumatology:

• fractures - complete or partial destruction of bone tissue.
• dislocations - change in the shape of the joint with or without damage to the joint capsule.
• breaks and sprains - partial or complete rupture of ligaments and muscles with the formation of a hematoma.

Today we will talk about fractures.

What are bone fractures?

bone fracture is a violation of the integrity of the bone tissue caused by mechanical action. Such a breach could be complete, and partial.

And a similar violation is caused under such a load, which is clearly exceeds strength that part of the bone tissue, which, in fact, accounts for the same mechanical effect.

By the way, if we compare bone fractures in primates Homo sapiens(human) and fractures of the bones of all other vertebrates, then there are no fundamental differences in these fractures!

Types of bone fractures:

We will classify the main types of bone fractures according to several criteria:

• According to the etiology
• According to the severity of bone damage
• By type of form and direction
• The integrity of the skin

Let's look at each in more detail!

Types of fractures etiology of occurrence

According to this criterion, all fractures can be divided into traumatic and pathological.

• traumatic - these are fractures that arose due to the influence of external factors
• Pathological - these are fractures that occur due to the influence of pathological factors (for example, tuberculosis, oncology, etc.), and the impact of external factors, at the same time, is minimal!

Types of fractures severity of bone loss

By given feature allocate full and incomplete fractures.

• Incomplete fractures, as a rule, are cracks or fractures.
• Full fractures, in turn, are divided into:
  • fractures without displacement(subperiosteal) - most often found in children in whom the bone tissue is not yet fully formed.
  • displaced fractures- in this case, the bone fragments move away from each other and change the axis of the bone

Types of fractures type of shape and direction

Here are the following types of fractures:

• transverse ,
• oblique ,
• longitudinal ,
• helical ,
• ringed ,
• wedge-shaped

All these fractures are illustrated in the picture below:

In addition to the types shown in the figure, there are:

• Compression fractures - this is when the bone fragments are so small that there is no clear fracture line
• Impacted fractures - these are fractures in which one of the fragments of the bone is embedded in another

By integrity of the skin

According to this criterion, open and closed fractures.

• open- these are those fractures in which damage to the skin and communication with the external environment occurs. Open fractures, in turn, can be gunshot and non-firearms.
• Closed- fractures in which there is no damage to the bones.

In addition to the classification given above, fractures are distinguished:

• Combined- this is when a fracture is combined with trauma to internal organs, or the skull
• Combined- damage to bone tissue in one anatomical region

Diagnosis and treatment of bone fractures

Bone regeneration occurs through the formation bone marol. The terms of formation range from several weeks to several months, depending on the regenerative characteristics of the body.

Fracture diagnosis

When diagnosing fractures, absolute and indirect fracture signs.

• Indirect- this is pain, swelling, hematoma, dysfunction when it comes to a limb.
• Absolute- unnatural shape and position of the limb, crepitation of fragments.

Treatment of bone fractures

Treatment can be divided into:

• Treatment for prehospital stage
• Treatment in the hospital.

under treatment for prehospital stage should be understood first aid. It is very important to remember here that improper first aid can lead to bleeding and traumatic shock!

The first thing to do is:

1. Assess the severity of the victim's condition and localization of injuries.
2. When bleeding - stop it by applying a tourniquet.
3. Decide if the victim can move. In case of spinal injuries, it is forbidden to transfer the patient.
4. Immobilize the damaged area, apply a splint. As a tire, you can use any object that excludes movement at the fracture site.
5. If there are contraindications to changing the position of the victim, provide, if possible, complete or partial immobilization of the damaged areas

Immobilization (fixation) treatment technique - the most common treatment technique without surgery. This technique is based on fixing the injured limb with plaster bandages or its analogues.

Surgical treatment:

Percutaneous metal osteosynthesis . Fixation of bone fragments through the skin with pins

Minimally invasive metal osteosynthesis . Type of fixation in which the plate is fixed to the bone with screws

Open reduction . Manual repositioning of fragments for their further fixation with metal plates, screws and knitting needles.

With the help of the device external fixation CHKDS - for example, the Ilizarov apparatus.

Video of operations for the treatment of bone fractures

*IMPORTANT! The following videos contain recordings of real operations, so The faint of heart, please do not watch!

1. Osteosynthesis of the distal segment of the humerus

Original :

2. Osteosynthesis of the femur using fixators with thermomechanical memory

Original:https://www.youtube.com/watch?v=56di2COy5F8

3. Osteosynthesis of the distal segment of the humerus

Original: www.youtube.com/watch?v=bohOTzWhBWU

General anesthesia. Modern ideas about the mechanisms of general anesthesia. Classification of anesthesia. Preparation of patients for anesthesia, premedication and its implementation.

Inhalation anesthesia. Equipment and types of inhalation anesthesia. Modern inhalation anesthetics, muscle relaxants. stages of anesthesia.

intravenous anesthesia. Basic drugs. Neuroleptanalgesia.

Modern combined intubation anesthesia. The sequence of its implementation and its advantages. Complications of anesthesia and the immediate post-anesthetic period, their prevention and treatment.

Method of examination of a surgical patient. General clinical examination (examination, thermometry, palpation, percussion, auscultation), laboratory research methods.

Preoperative period. The concept of indications and contraindications for surgery. Preparation for emergency, urgent and planned operations.

Surgical operations. Types of operations. Stages of surgical operations. Legal basis for the operation.

postoperative period. The reaction of the patient's body to surgical trauma.

The general reaction of the body to surgical trauma.

Postoperative complications. Prevention and treatment of postoperative complications.

Bleeding and blood loss. Mechanisms of bleeding. Local and general symptoms of bleeding. Diagnostics. Assessment of the severity of blood loss. The body's response to blood loss.

Temporary and permanent methods of stopping bleeding.

History of the doctrine of blood transfusion. Immunological bases of blood transfusion.

Group systems of erythrocytes. Group system av0 and group system Rhesus. Methods for determining blood groups according to the systems av0 and rhesus.

The meaning and methods for determining individual compatibility (av0) and Rh compatibility. biological compatibility. Responsibilities of a Blood Transfusion Physician.

Classification of adverse effects of blood transfusions

Water-electrolyte disorders in surgical patients and principles of infusion therapy. Indications, dangers and complications. Solutions for infusion therapy. Treatment of complications of infusion therapy.

Trauma, injury. Classification. General principles of diagnostics. stages of assistance.

Closed soft tissue injuries. Bruises, sprains, tears. Clinic, diagnosis, treatment.

Traumatic toxicosis. Pathogenesis, clinical picture. Modern methods of treatment.

Critical disorders of vital activity in surgical patients. Fainting. Collapse. Shock.

Terminal states: pre-agony, agony, clinical death. Signs of biological death. resuscitation activities. Efficiency criteria.

Skull injuries. Concussion, bruise, compression. First aid, transportation. Principles of treatment.

Chest injury. Classification. Pneumothorax, its types. Principles of first aid. Hemothorax. Clinic. Diagnostics. First aid. Transportation of victims with chest trauma.

Abdominal trauma. Damage to the abdominal cavity and retroperitoneal space. clinical picture. Modern methods of diagnostics and treatment. Features of combined trauma.

Dislocations. Clinical picture, classification, diagnosis. First aid, treatment of dislocations.

Fractures. Classification, clinical picture. Fracture diagnosis. First aid for fractures.

Conservative treatment of fractures.

Wounds. Classification of wounds. clinical picture. General and local reaction of the body. Diagnosis of wounds.

Wound classification

Types of wound healing. The course of the wound process. Morphological and biochemical changes in the wound. Principles of treatment of "fresh" wounds. Types of seams (primary, primary - delayed, secondary).

Infectious complications of wounds. Purulent wounds. Clinical picture of purulent wounds. Microflora. General and local reaction of the body. Principles of general and local treatment of purulent wounds.

Endoscopy. The history of development. Areas of use. Videoendoscopic methods of diagnosis and treatment. Indications, contraindications, possible complications.

Thermal, chemical and radiation burns. Pathogenesis. Classification and clinical picture. Forecast. Burn disease. First aid for burns. Principles of local and general treatment.

Electrical injury. Pathogenesis, clinic, general and local treatment.

Frostbite. Etiology. Pathogenesis. clinical picture. Principles of general and local treatment.

Acute purulent diseases of the skin and subcutaneous tissue: furuncle, furunculosis, carbuncle, lymphangitis, lymphadenitis, hydroadenitis.

Acute purulent diseases of the skin and subcutaneous tissue: erysopeloid, erysipelas, phlegmon, abscesses. Etiology, pathogenesis, clinic, general and local treatment.

Acute purulent diseases of cellular spaces. Phlegmon of the neck. Axillary and subpectoral phlegmon. Subfascial and intermuscular phlegmon of the extremities.

Purulent mediastinitis. Purulent paranephritis. Acute paraproctitis, fistulas of the rectum.

Acute purulent diseases of the glandular organs. Mastitis, purulent parotitis.

Purulent diseases of the hand. Panaritiums. Phlegmon brush.

Purulent diseases of serous cavities (pleurisy, peritonitis). Etiology, pathogenesis, clinic, treatment.

surgical sepsis. Classification. Etiology and pathogenesis. The idea of ​​the entrance gate, the role of macro- and microorganisms in the development of sepsis. Clinical picture, diagnosis, treatment.

Acute purulent diseases of bones and joints. Acute hematogenous osteomyelitis. Acute purulent arthritis. Etiology, pathogenesis. clinical picture. Medical tactics.

Chronic hematogenous osteomyelitis. Traumatic osteomyelitis. Etiology, pathogenesis. clinical picture. Medical tactics.

Chronic surgical infection. Tuberculosis of bones and joints. Tuberculous spondylitis, coxitis, drives. Principles of general and local treatment. Syphilis of bones and joints. Actinomycosis.

anaerobic infection. Gas phlegmon, gas gangrene. Etiology, clinic, diagnosis, treatment. Prevention.

Tetanus. Etiology, pathogenesis, treatment. Prevention.

Tumors. Definition. Epidemiology. Etiology of tumors. Classification.

1. Differences between benign and malignant tumors

Local differences between malignant and benign tumors

Fundamentals of surgery for disorders of regional circulation. Arterial blood flow disorders (acute and chronic). Clinic, diagnosis, treatment.

Necrosis. Dry and wet gangrene. Ulcers, fistulas, bedsores. Causes of occurrence. Classification. Prevention. Methods of local and general treatment.

Malformations of the skull, musculoskeletal system, digestive and genitourinary systems. Congenital heart defects. Clinical picture, diagnosis, treatment.

Parasitic surgical diseases. Etiology, clinical picture, diagnosis, treatment.

General issues of plastic surgery. Skin, bone, vascular plastics. Filatov stem. Free transplantation of tissues and organs. Tissue incompatibility and methods of its overcoming.

What Causes Takayasu's Disease:

Symptoms of Takayasu's Disease:

Diagnosis of Takayasu's Disease:

Treatment for Takayasu's Disease:

Fractures. Classification, clinical picture. Fracture diagnosis. First aid for fractures.

A fracture is a break in the integrity of a bone.

Classification.

1. By origin - congenital, acquired.

Congenital fractures are extremely rare (occur in the prenatal period). Fractures that occur during childbirth are acquired.

All acquired fractures are divided into two groups by origin - traumatic and pathological (reasons: osteoporosis, malignant tumor metastases, tuberculosis, syringomyelia, osteomyelitis, syphilitic gumma, etc.).

2. According to the presence of damage to the skin - open (damaged skin and mucous membranes) and closed.

A separate group - gunshot fractures.

3. According to the place of application of force:

Direct - a fracture occurs at the place of application of force;

Indirect - a fracture occurs at a certain distance from the place of application of force.

4. Depending on the type of impact, fractures are divided into those caused by: flexion, twisting (rotation), compression (compression), impact (including gunshot), avulsion fractures.

5. According to the nature of bone damage, fractures can be complete and incomplete.

Incomplete fractures include fissures, a subperiosteal fracture in children of the "green branch" type, perforated, marginal, fractures of the base of the skull, fractures of the inner plate of the cranial vault.

6. In the direction of the fracture line, they are distinguished - transverse, oblique, longitudinal, comminuted, helical, compression, tear-off.

7. Depending on the presence of displacement of bone fragments, fractures can be without displacement and with displacement. There are displacements: in width, in length, at an angle, rotational.

8. Depending on the section of the damaged bone, fractures can be diaphyseal, metaphyseal and epiphyseal.

Metaphyseal fractures are often accompanied by adhesion of the peripheral and central fragments (compounded or impacted fractures). If the line of a bone fracture penetrates the joint, it is called intra-articular. In adolescents, sometimes there is a detachment of the epiphysis - epiphysiolysis.

9. By the number of fractures can be single and multiple.

10. According to the complexity of damage to the musculoskeletal system, simple and complex fractures are distinguished.

11. Depending on the development of complications, uncomplicated and complicated fractures are distinguished.

12. In the presence of a combination of fractures with injuries of a different nature, they speak of a combined injury or polytrauma.

Complications of fractures:

Traumatic shock;

Damage to internal organs;

vascular damage;

Fat embolism;

Interposition of soft tissues;

Wound infection, osteomyelitis, sepsis.

Types of displacement of fragments:

Length offset;

Lateral shift;

offset at an angle;

Rotational displacement.

Distinguish primary displacement - occurs at the time of injury;

Secondary - observed with incomplete comparison of fragments:

Mistakes in the tactics of fixing bone fragments;

Premature removal of skeletal traction;

Unreasonable premature changes of plaster casts;

The imposition of loose plaster bandages;

Premature loading on the injured limb;

Pathological changes in fractures can be divided into three stages:

damage caused by trauma;

the formation of callus;

Restructuring of the bone structure.

Bone regeneration.

There are two types of regeneration:

Physiological (constant restructuring and renewal of bone tissue);

Reparative (aimed at restoring its anatomical integrity).

Phases of reparative regeneration.

1st phase - catabolism of tissue structures, proliferation of cellular elements.

2nd phase - formation and differentiation of tissue structures.

3rd - the formation of angiogenic bone structure(remodeling of bone tissue).

4th phase - complete restoration of the anatomical and physiological structure of the bone.

Types of callus.

There are 4 types of callus:

Periosteal (external);

Endostal (internal);

Intermediate;

Paraossal.

Types of union of fractures.

Union begins with the formation of periosteal and endosteal calluses, temporarily fixing fragments. Further fusion can be carried out in two ways.

Primary fusion. Conditions - the fragments are accurately compared and securely fixed, there is no need for the formation of a powerful bone callus.

Secondary fusion. First, the regenerate represented by the expressed callus replaced by cartilage and then by bone.

Fracture diagnosis.

Absolute symptoms of a fracture.

characteristic deformation.

pathological mobility.

Bone crepitus. (with the exception of impacted fractures, where these symptoms may not be present).

Relative symptoms of a fracture.

Pain syndrome, aggravated by movement, load along the axis;

Hematoma;

Shortening of the limb, its forced position (maybe with dislocation);

Function violation.

X-ray examination.

Fracture treatment. Conservative and operative methods of treatment. Compression-distraction method for the treatment of bone fractures. Principles of treatment of fractures with delayed consolidation of bone fragments. False joints.

Treatment methods:

Conservative treatment.

Skeletal traction.

Surgical treatment (osteosynthesis).

The main components of the treatment:

Reposition of bone fragments;

Immobilization;

Acceleration of the processes of formation of bone callus.

Reposition(reduction) of fragments - their installation in an anatomically correct position. Mixing discrepancy in width up to 1/3 of the diameter of the bone is allowed.

Reposition rules:

Anesthesia;

Comparison of the peripheral fragment in relation to the central one;

X-ray control after reposition.

Types of reposition:

Open, closed;

One-step, gradual;

Manual, hardware.

Immobilization.

With conservative treatment, the imposition of a plaster bandage;

With skeletal traction, the effect of constant traction for the peripheral fragment.

In surgical treatment - with the help of various metal structures

Acceleration of callus formation

The following factors contribute to this:

Restoration of pathophysiological and metabolic changes in the body after injury;

Correction of general disorders in the body due to concomitant pathology;

Restoration of regional blood circulation in case of damage to the main vessels;

Improving microcirculation in the fracture zone (general methods: good nutrition, transfusion of blood products, administration of vitamins, hormones, local methods; physiotherapy, massage, exercise therapy).

First aid

Stop bleeding;

Prevention of shock (pain relief, transfusion therapy, etc.);

Transport immobilization;

The imposition of an aseptic bandage.

transport immobilization.

Purpose: prevention of further displacement of bone fragments; decrease pain syndrome, creating an opportunity for the transportation of the victim.

Principles: ensuring the immobility of the entire limb, speed and ease of implementation, implementation in the most advantageous functional position; superimposed before lifting the patient on clothes or a soft pad.

Methods of transport immobilization.

Autoimmobilization - bandaging the injured lower limb of the victim to a healthy or upper limb to the torso.

Immobilization with improvised means.

Immobilization with standard transport tires:

Cramer-type wire bus;

Tire Elansky;

Tire Dieterikhs;

Pneumatic and plastic tires.

Special modes of transportation.

If the spine is damaged, transportation is carried out on a rigid stretcher or shield in the supine position. If the stretcher is soft - in the prone position.

In case of a fracture of the pelvic bones - the victim is laid on his back on a shield, a roller from a blanket or clothes is placed under his knees, his knees are somewhat spread apart (frog pose), as well as a roller under the lumbar lordosis.