Multiple fractures of the wrist
Traumatology / / May 07, 2016
Multiple brush fractures are common, especially in work-related injuries.Brush as a unique, highly differentiated human body work currently allocated to targeted specialized study, treatment and rehabilitation.Create specialized centers brush, development of its classification, the widespread introduction of distraction techniques and chreskostnogo extrafocal osteosynthesis External fixation devices, the use of microsurgical techniques, as well as the improvement of the classical methods of treatment and rehabilitation have led to significant progress in the rehabilitation of patients with multiple and combined injuries of the hand.
main signs brush
injury Severe swelling, hemorrhage, hematoma spilled on the back of the hand, a shortening of the metacarpal region, sharp pain and crepitus with direct pressure in the fractures, sharp pain when the load on the fingers along the axis.Recognition phalangeal fractures, intra-articular fractures are usually difficult due to pronounced edema, hemorrhages, he
diagnosis much easier if there are shortening, thickening and curving fingers.Pain is always significant.
First aid for fractures of the wrist
anesthesia reach intramuscular promedola and performing wire brush novocaine blockade.Procaine (0.5% solution of 10.8 mL) was added to intercostals spaces on the back surface of the brush along the line I passing through the joint metacarpophalangeal brush perpendicular axis.
Transport immobilization is damaged brush (a, b) and fingers (in)
transport immobilization is carried out wire bus.Brushes attached to the position of flexion in the back of a small (up to 120 °) and ulnar (up to than 150 °) direction, is placed in the palm of the victim to wrap cotton-gauze ball, hand and fingers fixed in position clenched fist.In this position, with the palm side pribintovyvayut bus from the fingertips to the elbow.The ends of the fingers must be open for circulation control.
- Multiple rib fractures
- Multiple fractures pelvis
- Multiple fractures of foot
- Multiple fractures of femur
- Multiple fractures of the tibia
- Multiple fractures ankle
- Multiple fracturesthe bones of the knee joint
- multiple fractures of the bones and the bones of one segment
- clinical picture of multiple fractures pelvis
- Combined treatment of injuries
- treatment of multiple rib fractures
Principles of treatment brush
fracturesFor injuries brush treatment should be mostly operational.Osteosynthesis phalanges and the metacarpal bones carry needles in diameter 0,7-2,2 mm.Spokes administered transdermally electric drill.In diaphyseal fractures of the phalanges of the most appropriate introduction of a cross-shaped spokes (extra-articular), and the metacarpals polifrakturah - kosopoperechnoe introduction spokes through fragments and intact neighboring metacarpal bones.At transonic and intra-articular fractures of the good results reliably provide only distraction external fixation devices.
Immobilization plaster splint after osteosynthesis is carried out up to 2 weeks, and then designate the movement in the operated segment of the brush.In the intact joint motion must be maintained permanently in the maximum allowable amount.Knitting needles are removed from the terminal phalanges after 3 weeks, the average - 6 weeks, basic - after 4 weeks, metacarpal bones - after 5-6 weeks.
In open fractures with great destruction of soft tissue debridement should be divided into two stages.The first is a careful toilet wound excision clearly nonviable tissue, hemostasis, holding intense local antibacterial therapy.The first stage of surgical treatment of end cover wounds preserved skin and wipes impregnated with antiseptic solutions.Brush fix plaster bandage in langetnoy srednefiziologicheskom position.After a day on the dressing make the final decision on the scope and nature of the reduction (or reconstructive) surgery.The second (recovery) stage surgery was performed on 2-4 day in a planned manner.By this time definitively established the boundaries of tissue viability is restored the local blood supply, improves the general condition of the victims.
Recovery operations include the fixation of bone fragments, stitching damaged tendons and nerves (with the use of microsurgical techniques), skin grafting: a free - for defects on the dorsum, not free - at defects on the palmar surface, the plastic local tissues is carried out with small defects, Italianplastic - with extensive patchwork defects, especially circular ( "scalped").
recovery of hand function is impossible without the restoration of the skin.Therefore, to prevent scar contractures require primary cutaneous plastic posttraumatic defects.In the absence of even the skin all over the last pin can be saved by emergency plastics.