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Bone fractures

Fractures of the bones are complete and incomplete. There are also closed (simple) fractures, in which the overlying tissue is not damaged, and open (complex), when there is damage to the skin or mucous membrane, through which the fracture site communicates with the environment. The classification also includes comminuted fractures, each of which produces more than two bone fragments; fractures with displacement, when the ends of the bones at the fracture site are not matched. If a fracture occurs in a bone that has already been damaged in the course of a disease, then it is a pathological fracture. Marching foot (fracture of recruits, “marching” fracture) develops slowly and usually occurs after repeated and increased physical activity (sports training, military transitions, marches, etc.).

Bone is a unique tissue in its ability to repair. It can be fully restored by reactivating those processes that normally occur only during embryogenesis. Unfortunately, successive events during fracture healing can be easily delayed or even blocked. Shifts with displacement and comminuted fractures often lead to deformities. Fragments of fractured bone, devoid of vitality, need to be resorbed before recovery. This slows healing, increases callus volume and requires an excessively long recovery period. Inadequate immobilization (immobilization of bone fragments in the fracture zone) is accompanied by abnormal mobility, and the corns do not form. Corn can be built from connective tissue and cartilage, which causes permanent instability and fusion adhesion or even nonunion. If during nonunion, significant movements of bone fragments along the fracture line are possible, then the central part of the corn undergoes cystic degeneration. In this case, the surface facing the fracture gap may be covered with a lining of cells similar to the cells of the synovial membrane. This forms the false joint (pseudoarthrosis). In the zone of nonunion or pseudoarthrosis, the normal regenerative process can begin again if soft tissue is removed from the fracture gap, and bone fragments are matched. Of course, a very serious obstacle to the recovery process is an infection in the area of ​​the fracture. Often the infection occurs in areas of comminuted and open fractures. The complex process of bone repair can also be impaired with calcium and phosphorus deficiency, vitamin deficiency, systemic infections, diabetes mellitus, and vascular insufficiency. Full, almost complete, reparation occurs mainly in children and young people who have fractures most often uncomplicated. Older people, who often have fractures on the basis of other diseases (osteoporosis, osteomalacia), have a harder recovery and may need mechanical methods of immobilization to facilitate healing.

The rupture of blood vessels that occurs during a fracture leads to the development of a hematoma that fills and surrounds the fracture zone.
In the hematoma, a network of fibrin is formed, which not only fills the fracture zone, fixes bone fragments, but also creates the basis for the arrival of cells of the inflammatory response, further growth of fibroblasts and capillary buds. At the same time, degranulated platelets and migrating cells of the inflammatory response release the platelet growth factor, the transforming growth factor p and fibroblast growth factor. These factors activate cells in the periosteum, the cavity of the bone marrow and the surrounding soft tissues - the precursors of bone elements. By the end of the 1st week, the hematoma is organized, and the surrounding tissue is prepared for future production of the matrix. A spindle-shaped connective tissue callus (procallus) is formed, which provides a connection between bone fragments, but does not create the structural strength necessary to sustain body weight, to retain body parts or limbs.

The activated periosteal osteoblasts form elements of the coarse fibrous bone and the beam, which are oriented perpendicular to the axis of the cortical layer. Osteosynthesis also occurs in the bone marrow cavity. The activated mesenchymal cells of the soft tissues surrounding the fracture zone are differentiated into chondroblasts, which form the fibrous and hyaline cartilage surrounding the fracture site (Fig. 24.2). With an uncomplicated fracture, reparative tissue reaches its maximum development by the end of the 2nd — 3rd week. This helps stabilize the fracture site, but not enough to repair the damaged bone. As the coarse-fibered bone located in the periosteum zone and the bone marrow cavity approaches the newly formed cartilage along the fracture line, the cartilage undergoes enchondral ossification (see Figure 24.2), similar to that found in normal growth zones. Fragments of the affected bone are joined by growing callus. Further, the corn is mineralized to the extent that its strength will allow it to withstand the mechanical loads inherent in this bone.

In the early stages of callus formation, excess connective tissue, cartilage and bone are produced. In particular, if the bone fragments are not aligned, the volume of the corns becomes larger on the concave side of the fracture line. As soon as the callus matures and begins to withstand mechanical

Fig. 24.2.

Long tubular fracture zone

. Replacement of granulation tissue with cartilage, and then bone (black color) tissue.

loads, those parts of it that remain without physical pressure are reabsorbed. The volume of corn is reduced to a "rational" value, up to the restoration of the contours of a broken bone. The bone marrow cavity is also being restored. After the completion of the recovery process, the fracture zone is not always determined.

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Bone fractures

  1. Fractures of the bones of the forearm
    Fractures of proximal epiphysis Fractures of the proximal epiphyses (coronoid and ulnar processes of the ulna, head and neck of the radial bone) are often intra-articular. Clinical picture. Pain and local pain in the area of ​​injury. Deformation and swelling of the elbow joint, a sharp dysfunction of the joint. In case of fractures of the olecranon, active extension of the forearm,
  2. Fractures of the foot bones
    Fractures of the metatarsal bones, often open, usually occurring under the influence of a direct injury, are more often observed. CLINICAL PICTURE The load along the axis of the finger causes pain in the area of ​​the swelling of the back foot, which coincides with the local pain during palpation of the metatarsal bone. In case of multiple fractures of the foot bones, an attempt to walk due to sharp pains is impossible. Diagnosis is often difficult due to severe
  3. Bone fractures
    By bone fracture (fracturae ossium) is meant a partial or complete disruption of the anatomical integrity of the bone, accompanied by damage to the soft tissues. Etiology. The direct causes of fractures are various mechanical injuries. These are all kinds of blows, falls, hitting vehicles, gunshot wounds, violent pulling out of a stuck limb, sharp muscle
    There are producing and predisposing causes of fractures. The various mechanical effects should be attributed to the producing causes - bruises, sharp muscle contractions, forced release of the injured limb, etc., and predisposing causes - pathological and physiological changes of the bone tissue - vitamin deficiency, osteomalacia, rickets, pregnancy, etc. Full closed
  5. Fractures of the bones of the skull
    Fractures of the bones of the skull should be subdivided into convexital and basal ones, and it must be remembered that in severe craniocerebral injury, cracks starting in the region of the calvarium may also spread to its base. Depending on the nature of the fracture, there are cracks, splintered fractures, fractures with a defect in the bone - perforated fractures. With traumatic brain injury
  6. Bone fractures
    By etiology, traumatic fractures caused by mechanical trauma and pathological ones caused by any pathological process (tumor, tuberculosis, etc.) are distinguished. All fractures are divided into open, with a violation of the skin, and closed, without violating the integrity of the skin. For children are characterized by the so-called fractures of the "green branch", in which fragments
  7. Fractures of the bones of the skeleton
    Fractures are characterized by partial or complete violation of the integrity of the bones. Clinical picture The clinical picture of a fracture depends on its location and the nature of the damage. To determine the required volume of emergency care, all fractures are divided into the following groups: 1) open (with a violation of the integrity of the skin) and closed (with preservation of the integrity of the skin); 2) complete and incomplete
  8. Fractures of the pelvic bones
    Fractures of the pelvic bones most often occur in road traffic accidents, falls, when there is compression of the pelvis. Often, there is a violation of the continuity of the pelvic ring with damage to the large vessels, nerves, internal organs (bladder, rectum, uterus, etc.). The most common unilateral fractures of the anterior pelvis. CLINICAL PICTURE Forced Position
  9. Fractures of the lower leg bones
    Fractures of the bones of the lower leg diaphyseal occur more often than others under the influence of both indirect and direct injury. CLINICAL PICTURE The patient cannot walk, there is swelling (hematoma) and deformity of the tibia (angular, rotational), often with shortening of the leg. The volume of movements is drastically reduced due to pain with a load along the axis of the lower leg (careful pressure or pulling on the heel). Often there are ends under the skin.
  10. Fractures of the pelvic bones
    Fractures of the pelvic bones are serious injuries. Often they are accompanied by damage to the urethra and pelvic organs. Signs: change in the shape of the pelvis, inability to stand, walk, lift the leg. Victims often take the “frog” position - they lie on their backs with their legs bent, half bent at the knee and hip joints. Possible shock. First aid.
  11. First aid for bone fractures
    First aid for bone fractures should include hemostasis, anesthesia, dressing in the presence of a wound and transport immobilization. Immobilization is the creation of conditions for the immobility of the damaged part of the body. Immobilization must be applied for fractures of bones, joints, damage to nerves, large vessels, extensive muscle damage, large burns.
  12. The syndrome of damage to the bones of the pelvis (fractures)
    Leading symptoms: • pain on palpation in the area of ​​the fracture; • pain at the fracture site when the pelvis is squeezed laterally at the level of large pelvis skewers; • a symptom of "stuck heel" (inability to raise a straight leg or legs); • forced position: legs are bent and brought (at a symphysis rupture); legs bent at the knees and retracted - the position of the "frog" (with a change in the pubic bones of the pelvis).
  13. Fractures of the bones of the skull
    Mechanism: - moving object in contact with the skull; - moving skull in contact with the subject; - the skull is clamped m / s from 2 objects; Fracture: - skull; - grounds; - grounds and set; Views: shell;
  14. Fractures
    Fractures of the clavicle. During childbirth, a clavicle fracture most often occurs during the passage of the shoulder girdle during cephalic presentation and during abduction of the arms during pelvic presentation of the fetus. The main symptoms of a clavicle fracture include the absence of free arm movement on the side of damage, crepitus and bone deformation on palpation and sometimes - depigmentation of the skin. Missing on the side of the fracture
  15. Fractures
    Fracture is a violation of bone integrity. There are open fractures, when the integrity of the skin is broken, and closed. Signs: pain, change in the shape of the limb (curvature, shortening), abnormal mobility of the bone at the injury site, a crunch from the friction of bone fragments one about the other. First aid. Fracture of the bones - severe damage requiring immediate first aid. The victim is given
  16. Fracture of long tubular bones
    Fracture - a violation of the integrity of the bone under the action of traumatic force. Fractures of the long tubular bones occur most frequently - the femur, humerus, forearm bones, and lower leg bones. Fractures of the long tubular bones on the localization are divided into diaphyseal, metaphysary and epiphyseal. Types of fractures Fractures can be acquired and congenital. Acquired fractures occur in
  17. Ankle Fractures
    Ankle fractures occur most often as a result of indirect violence (tucking the foot inwards, outwards), which leads to a fracture of one or two ankles, rear edge and the anterior section of the tibia, mostly in combination with subluxation (rarely dislocation) of the foot. Fractures of the external ankle are most frequent. CLINICAL PICTURE Pain when trying to move, walk, swelling and deformity
  18. Fractures of the skull
    Morphological classification: cracks, slit fractures, comminuted fractures, perforated fractures, divergence of the seams of the bones of the skull. Fractures of the cranial vault. 1. Linear fractures (cracks) of the cranial vault: • without damage to the brain and its structures; • with damage to the brain and its structures: concussion, contusion, compression (sub- or epidural hematomas, intracerebral hematomas).
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