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Fractures. Health care

Fundamentals of First Aid (OPMP)

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fracture is a complete or partial violation of the integrity of the bone, accompanied by damage to the tissues surrounding the bone.

The classification of fractures according to their types is extensive. Fractures are divided into congenital, which are based on a violation of the processes of bone formation, and acquired. Acquired Distinguish traumaticarising under the action of a significant traumatic force, and pathological, which can develop even under normal load, with any bone diseases (bone tumor, purulent process in the bone - osteomyelitis, etc.).

Distinguish fractures complete (over the entire diameter of the bone) and incomplete (breaks).

Complete fractures are without displacement of the fragments formed during the fracture of the bone, and with their displacement. The displacement of fragments occurs due to the traction of the muscles that attach to the bone. In connection with the attachment of muscles to the bone in the same places, the displacement of fragments depending on the level of the fracture is always typical. There are displacement of fragments along the length, along the width, at an angle, along the axis, and - more often - mixed displacement of fragments.

Fractures are also divided into closedwhen the integrity of the integument (skin, mucous membranes) is maintained, and openwhen a traumatic force or bone fragment breaks the integument.

In the direction of the fracture line, fractures are distinguished oblique, transverse, T-shaped, spiral, comminuted (with the formation of several fragments). In cases where one fragment is introduced into another, they speak of impacted fractures.

Children's bones break much less frequently due to their elasticity, flexibility, thickness of the periosteum, and small body weight of the child. The following types of fractures are typical for children: fractures (fracture like a green branch), periosteal fractures, epiphysiolysis (separation of the cartilaginous part of the bone - the epiphysis from the spongy part - the metaphysis). Under the action of a traumatic factor of great force, other types of fractures are also possible.

Evidence. There are two groups of fracture symptoms. The presence of these symptoms allows you to accurately diagnose immediately at the scene. The absence of these symptoms does not rule out a fracture, as they are mild in some fractures.

Signs of a fractured limb

Credible Relatives

Abnormal mobility in the area of ​​the suspected fracture

Cracking or clicking sound in the bones at the time of the injury

Crepitus (characteristic crunching when palpated)

Pain at the fracture site under load (pressure) along the long axis of the bone

Unnatural position of the limb (for example, the heel or hand is turned out)

The presence of bone fragments in the wound in case of an open fracture

Limb deformity

Pain in the area of ​​the fracture on palpation

Impaired function of the injured limb



With open fractures, there is a wound, bleeding from it, bone fragments are visible in the wound, it is possible that the fragment protrudes above the wound. Fractures are severe injuries, with them at the time of injury, serious complications often occur: pain shock, severe bleeding, damage to vital organs (heart, lungs, kidneys, liver, brain), as well as large vessels and nerves. Sometimes a fracture is complicated by a fat embolism (the penetration of pieces of fat from the bone marrow into the venous and arterial vessels and the closure of their lumen by a fat embolus).

Later, with fractures, a number of complications can occur: poor healing of the fracture, lack of healing and the formation of a false joint at the fracture site, abnormal healing with unrepaired displacement of fragments, osteomyelitis (purulent inflammation of the bone and bone marrow), which develops more often with open fractures, when through a wound causative agents of purulent infection penetrate into the bone.

First aid consists of several consecutive steps. These include:

  • anesthesia - intramuscular or subcutaneous administration of analgesics; in their absence, analgin, acetylsalicylic acid, etc. are given orally;
  • transport immobilization - the creation of immobility in the area of ​​the fracture for the period of transportation of the victim to the hospital;
  • stop bleeding and apply a sterile dressing for open fractures;
  • warming the victim in winter and preventing overheating in summer.

Transport immobilization - the most important measure of first aid for fractures, it prevents additional displacement of fragments, provides rest to the injured part of the body, and prevents the development of traumatic shock. Carry out transport immobilization using standard tires: metal ladder or mesh, plywood splints, Dieterichs wooden tire or Thomas-Vinogradov metal tire, pneumatic inflatable) tires (Fig. 42).

Fractures. Health care

Fig.42. Pneumatic tire

In their absence, improvised means are used: boards, skis, ski poles, thick cardboard, books, thick tree branches, etc. (Fig. 43).

Fractures. Health care

Fig.43. Immobilization of the lower leg with the help of improvised means

Autoimmobilization is also used - fixing a broken limb to healthy parts of the body (the arm is bandaged to the body, the broken leg to the healthy leg) (Fig. 44).

Fractures. Health care

Fig.44. Autoimmobilization by foot-to-foot method

When performing transport immobilization, the following rules must be strictly observed:

1. Pain relief.

2. Giving the affected limb a mid-physiological position, in which the tension of the flexor and extensor muscles is balanced: a slight abduction is created for the arm in the shoulder joint, flexion in the elbow joint to an angle of 90-100 °, the average position of the forearm between supination and pronation (the forearm should rest on ulna), slight dorsal abduction in the wrist joint and flexion of the fingers; for the leg, its straightened position is provided with flexion at the knee joint at an angle of 5-10 ° and dorsiflexion at the ankle joint up to an angle of 90-100 °; during manipulations with a broken limb, it is necessary to carefully pull it along the length of the foot or hand in order to avoid additional displacement of fragments and increased pain.

3. Selection and modeling of a transport splint: a splint of such length is selected that it fixes the fracture site and captures one joint above and below the fracture site, then the splint is shaped into an immobilized limb; the fit of the tire is carried out along the healthy limb of the patient or the assisting person bends the tire on his own; the tire is wrapped with cotton wool and gauze, put on the patient over clothing; cotton pads are placed on the area of ​​\uXNUMXb\uXNUMXbbone protrusions; the tire is fixed to the limb with bandages, scarves or improvised means (towel, sheet, wide braid, etc.).

4. When applied, the splint should protrude beyond the fingertips of the upper and lower extremities to ensure rest, however, they must be left free from the bandage so that the state of the tissues of the fixed limb can be monitored.

Depending on the fracture site, the application of a transport tire, in addition to the general rules, has its own characteristics.

With a fracture humerus the tire should go from the shoulder joint on the healthy side through the back, the shoulder joint of the diseased side and through the entire arm. The tire is bent so that it repeats the average physiological position of the upper limb. After applying the splint to the hand, both ends of it are tied so that it does not move. In the axillary region, under the olecranon, cotton pads are placed in the brush; the tire is fixed on the arm with a bandage, after which the hand in the tire is additionally fixed with a scarf. The scarf lies on a healthy shoulder girdle with one long angle, the second long angle is thrown over the arm and directed to the sore shoulder girdle and the back of the neck, where it is tied at a right angle; a short angle covers the elbow joint from back to front and is fixed with a safety pin (Fig. 45).

Fractures. Health care

Fig.45. Transport immobilization with a ladder splint for shoulder fracture

Fracture forearms it is splinted in the same way, only the length of the tire is much less: from the fingertips to the middle third of the shoulder. In case of a fracture of small bones, the length of the splint should be from the fingertips to the middle third of the forearm; the position of the hand and fingers is straightened or the fingers are half-bent, in the wrist joint the hand is slightly bent to the back. After applying the tire, the hand is fixed to the body with a scarf so that the palmar surface of the forearm touches the body (Fig. 46).

Fractures. Health care

Fig.46. Transport immobilization with a ladder splint for a fracture of the forearm

Fractures hip and knee area immobilized more often with a wooden Dieterichs tire or wire ladder tires. The Diterichs wooden splint allows you to fix the limb and carry out traction along the length, therefore it is called a distraction splint (Fig. 47).

Fractures. Health care

Fig.47. Transport immobilization of a hip fracture with a Dieterichs splint

Three tires are prepared to fix the thigh with ladder splints. The rear splint should run from the level of the shoulder blade through the hip joint along the back of the leg through the heel to the toes. The tire is slightly bent at the level of the knee joint and at an angle of 90-100° at the level of the ankle joint. The inner tire runs along the inner surface of the leg from the inguinal region to the end of the heel, turns at a right angle to the plantar surface of the foot. The outer splint is placed from the armpit through the lateral surface of the torso and leg to the end of the heel, where it meets the inner splint and is secured with tape. Cotton-gauze pads are applied to the area uniting the lateral surfaces of the hip, knee and ankle joints and the heel. The tire is fixed to the lower limb with gauze bandages, scarves or other improvised means.

Fracture shin bones fixed in the same way. First, the rear tire is applied, then the U-shaped one - so that the crossbar of the letter P is located on the sole, and its long sides run along the inner and outer surfaces of the leg. The splint is applied from the fingertips to the middle third of the thigh (Fig. 48).

Fractures. Health care

Fig.48. Transport immobilization of a tibia fracture with a ladder splint

With a fracture foot bones и one of the ankles only the rear tire is superimposed - from the fingertips to the middle third of the lower leg.

Fractures spine can be at different levels: in the cervical, thoracic, lumbar regions. In case of damage in the cervical spine, a collar made of cotton wool and soft cardboard is applied to the victim, which is wrapped around the neck and fixed with spiral bandage moves (Schanz collar) (Fig. 49).

Fractures. Health care

Fig.49. Immobilization of a fracture of the cervical spine with a cotton-gauze collar Shants

Transport the victim lying on his back. In cases of spinal fractures in the lower thoracic and lumbar sections, the injured person is placed on his back on a stretcher shield, with a 6-8 cm high roller under the fracture area, or evacuated on a conventional stretcher in the prone position - with a large roller under the chest.

With fractures pelvis the victim is placed on a stretcher on his back, with a large roller under the area of ​​​​the knee joints. The legs should be bent at the hip and knee joints and abducted in the hip - the "frog" pose.

In the absence of special shield-stretchers, they are equipped with improvised means (boards, doors, countertops, plywood, etc.).

Fractures of the lower and upper jaws fixed with a bandage bandage that supports the lower jaw. You can first put a flat board or ruler between your teeth.

Fracture immobilization clavicle more often performed with the help of cotton-gauze rings, three scarves. Cotton-gauze rings or kerchiefs rolled up in the form of rings are put on the areas of the shoulder joints, the victim raises the shoulder girdle and brings the shoulder blades together: in this position, the rings are tied with a kerchief on the back with each other. It is possible to carry out transport immobilization by pressing the upper limb of the injured side to the body and fixing it with a Dezo bandage (see Fig. 64, b).

Required equipment: analgesics, typical transport or improvised splints, Dieterichs splint, bandages, scarves, individual dressing bags, cotton or cotton-gauze pads, sanitary stretchers.

Authors: Aizman R.I., Krivoshchekov S.G.

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