Multiple fractures of femur
Traumatology / / May 08, 2016
femoral fractures often occur as a result of traffic accidents, characterized by their localization to the boundary of the upper and the middle third in the lower part of the femur.Upper diaphyseal fracture, usually a cross, the lower - oblique.This can be explained by a dual mechanism of formation fracture.When zooming in the car and the direct impact in the upper third of the thigh there is a transverse fracture, with the continued action of force, rotating the limb, there is an oblique fracture of the femur below the first fracture.At the same time the turn neck and diaphysis of the same femur is usually readily apparent hip fracture.
main features of the femur fracture
soreness, increase in volume due to edema, hemorrhage and hematoma, deformation at one or more levels of the thigh, the absolute shortening of the limbs, the presence of well-defined mobility for hip, crepitus of fragments, the rotation of the distal part of the limb, pain on axial load, total disruption of limb function,
First aid at the break of the femur
affected Intravenously administered Promedolum (1 mL of 2% solution), analgin (4 mL of a 50% solution), diphenhydramine (1 mL of 1% solution).Produce novocaine blockade of the fracture (100 mL of 0.5% solution), transport immobilization carried Diterikhs bus or stair rails.Before transporting intravenous bolus of 400 ml poured polivinola (zhelatinol), 400 ml of a mixture glyukozonovokainovoy (laktasol, ringerlaktat) during transport pour rapid drops a solution of salt (500 mL).When concomitant massive blood loss volume of infusion therapy should be increased by 2 times.
femur fractures with double and triple hip fracture fixation rods are used.At low T and V-shaped fractures can be applied compression osteosynthesis rod or special plates with screws in a trapezoid shape, eliminating the need for external immobilization and start early motion in the knee joint.When double fractures of the femur with a small intermediate fragment that has lost touch with the surrounding soft tissue, is used in conjunction with plastic osteosynthesis parietal cortical or cancellous bone autograft.After fixation of binary, ternary and krupnooskolchatyh fractures tend necessarily overlap hip cast to eliminate even in minimal mobility fragments.Only when durable osteosynthesis or absence of longitudinal splitting of the intermediate fragment short-term immobilization can be carried out on the functional bus or by placing rollers under the knee.
Transport immobilization for fractures of the hip bus Diterikhs
and - fixing the tire to the torso and upper thigh, and then thrust of the foot (indicated by arrows) is performed stretching limbs;b - complete immobilization of a limb bus;in - technique of traction of the foot by a twisting.
Consolidation with multiple fractures of the femur occur within an average of 5-6 months, and with the same intensity of callus formation at all levels of the fracture, which can be explained by retaining sufficient vascularization of bone fragments and the large fragment due to the presence of a powerful muscle mass around the femur.
average bed-day primary treatment for patients in a hospital with multiple fractures of the femur is 66.5 days.Patients dolechivatsya ambulatory within 6-8 months.The total load on the damaged thigh and walking without crutches after removing the plaster allowed after 1 month after the onset of signs of consolidation on the X-ray control.Employability is restored within the period from 1 to 1.5 years.