fracture
Introduction
Fracture introduction A fracture is a complete or partial break in the structure of a bone or bone. More common in children and the elderly, young and middle-aged people also happen. Patients often have fractures in one part, and a few are multiple fractures. After timely treatment, most patients can restore their original functions. A small number of patients may have different degrees of sequelae. After the fracture occurs, they may be sent directly to the hospital. Hospitals or ambulances, patients far away from the hospital, must be handled simply to prevent aggravation of the condition on the way to the hospital, and even cause irreversible consequences. basic knowledge The proportion of sickness: 0.6% Susceptible people: no specific population Mode of infection: non-infectious Complications: swelling, muscle atrophy, hemorrhoids, deep vein thrombosis
Cause
Cause of fracture
Direct violence (55%):
When violence directly affects a part of the bone and causes fracture of the part, it often causes fracture of the injured part, often accompanied by different degrees of soft tissue destruction. For example, the wheel hits the lower leg and the humeral shaft fracture occurs at the impact.
Indirect violence (20%):
Indirect violence occurs through longitudinal conduction, leverage or torsion to fracture in the distance. When the foot falls from a height, the trunk flexes forward rapidly due to gravity, and the vertebral body at the junction of the thoracolumbar spine is subjected to folding force. The role of compression fracture (conduction).
Accumulated strain (8%):
Long-term, repeated, minor direct or indirect injury can cause a specific part of the limb to fracture, such as long-distance marching easy to cause second, third metatarsal and lower third of the humerus fracture.
Prevention
Fracture prevention
Some patients can avoid fractures, which requires everyone to be safe in daily life and work. - Attention can reduce fractures at all times, children are unstable, easy to fall, especially in high places, education And optimistic about children, to avoid falls, teenagers play more, curiosity, parents and teachers should do a good job in education, do not climb the tree, young and middle-aged people should concentrate on work and cycling, pay attention to safety everywhere Old people's hands and feet are inconvenient to move, snow and rain and nights try not to go out. When going out, someone needs to support or hold a cane. When going out at night, there must be lighting tools. It is best not to ride a bicycle on the street, not to crowded public places.
Complication
Fracture complications Complications, swelling, muscle atrophy, hemorrhoids, deep vein thrombosis
Common complications and treatment
1. Swelling occurred locally after swelling and trauma, reached a peak after 72 hours, and then the swelling gradually subsided. After swelling occurs, the affected limb should be raised, preferably above the plane of the heart, and appropriate ice should be given to promote swelling.
2. Plaster compression simple fractures by manual reduction of cast immobilization, as the swelling of the limbs gradually worsens, gypsum compression will occur, resulting in obvious swelling, bruising, numbness, etc. at the end of the limb such as fingers, toes, etc., should go to the medical institution in time. Release the decompression to avoid limb compression and necrosis.
3. The joints are stiff and the limbs are fixed for a long time, the veins and lymphatic drainage are not smooth, the fibrous exudation and fibrin deposition in the joint cavity, fibrin adhesion occurs, and the soft tissue contracture around the joints causes joint movement disorder. This is the most common complication of fractures and joint injuries. Timely disassembly and active functional exercise are effective ways to prevent and treat joint stiffness.
4. Muscle atrophy Once the limb is fixed or lacks exercise, muscle atrophy occurs. The active search of the muscle can reduce the degree of muscle atrophy. The specific method is: if the joint can move, you can do the isometric contraction of the muscle (ie muscle but force) It does not produce motion) and isotonic contraction (muscle force and action). If the joint is fixed, it can be exercised in equal length.
5. Congenital pneumonia occurs mostly in patients who have been bedridden for a long time due to fractures, especially those with frail fractures and old and frail patients, sometimes jeopardizing the lives of patients. Patients should be encouraged to go early. Bed activity.
6. After severe hemorrhoids fracture, the patient is bedridden for a long time, the body bone is compressed, and local blood circulation disorder is easy to form hemorrhoids. Common parts include bone, broken, and heel.
7. Lower extremity deep venous thrombosis is more common in pelvic fractures or lower limb fractures, long-term braking of the lower limbs, slow venous return, combined with blood hypercoagulability caused by injury, prone to thrombosis. Active exercise should be strengthened, and equipment such as elastic stockings and plantar venous pumps can be applied to prevent it from happening.
Symptom
Fracture symptoms Common symptoms Severe pain Internal bleeding Old fractures Proliferative periostitis Tongue fractures Longitudinal fractures Long bones and muscles of the limbs... Shock in the wrist
First, the whole body performance:
(1) Shock: For multiple fractures, pelvic fractures, femoral fractures, spinal fractures and severe open bone, patients often suffer from shock due to extensive soft tissue injury, massive bleeding, severe pain or visceral injury.
(2) Fever: There is a large amount of internal hemorrhage at the fracture site. When the hematoma is absorbed, the body temperature is slightly increased, but generally it does not exceed 38 °C. When the open fracture body temperature rises, the possibility of infection should be considered.
Second, local performance:
Local manifestations of the fracture include the proprietary signs of the fracture and other manifestations.
Exclusive signs of fractures:
(1) Malformation: The displacement of the fracture segment can change the shape of the affected limb, mainly showing shortening.
(2) Abnormal activity: In normal conditions, the part of the limb cannot move, and abnormal activity occurs after the fracture.
(3) Bone rubbing or bone rubbing: After the fracture, when the two fracture ends rub against each other, a bone squeak or bone rubbing feeling may be generated.
As long as one of the above three signs is found, the diagnosis can be made, but the three signs are not seen, and the possibility of fracture, such as insertion fracture and fracture fracture, cannot be ruled out.
Examine
Fracture examination
X-ray inspection
X-ray film examinations should be performed routinely for patients with fractures, which can show incomplete fractures, deep fractures, intra-articular fractures and small avulsion fractures that are difficult to detect clinically, even if they have clinically manifested as obvious fractures. X-ray film examination is also necessary to understand the type and specific conditions of the fracture, which is of guiding significance for treatment.
X-ray films should include positive and lateral slices, must include adjacent joints, and sometimes need to add X-ray films of oblique position, tangential position or corresponding part of the healthy side.
2. CT examination
CT examination can be performed for those with unclear fractures but who cannot be excluded, those with spinal fractures that may compress spinal nerve roots and complex fractures. Three-dimensional CT reconstruction can make fracture classification more intuitive and convenient, and it is very helpful for treatment options. It is currently used clinically.
3. MRI examination
Although the fracture line is not as good as the CT examination, it has unique advantages for the display of spinal nerve root and soft tissue injury, and has been widely used for the examination of spinal fractures.
Diagnosis
Diagnosis of fracture diagnosis
Diagnostic points
1. History: There is a clear history of trauma.
2. Signs:
(1) Malformation: The displacement of the fracture segment can change the shape of the affected limb, mainly showing shortening, angulation or rotation.
(2) Abnormal activity: In normal conditions, the part of the limb cannot move, and abnormal activity occurs after the fracture.
(3) Bone rubbing or bone rubbing: After the fracture, when the two fracture ends rub against each other, bone squeak or bone rubbing may be generated.
3. X-ray examination: visible fracture line.
According to its clinical manifestations and X-ray examination, the disease can be clearly diagnosed without identification, but it is necessary to pay attention to the clinical whether the fracture is a simple fracture or a pathological fracture caused by the patient's own disease. In the case of disease and skeletal abnormalities, a slight force can cause a fracture, which occurs more frequently in this case and requires strict observation and diagnosis.
