Fractures of the bones of the arm and forearm
Traumatology / / May 12, 2016
Fractures of the shoulder and forearm are more common in elderly patients.The mechanism of injury is typical: the fall in the street or in a room with a support on the arm, causing fractures occurred in the most delicate and fragile bones metaepiphyseal areas.
In men, the main cause of injury - hit his hands in running machines.According to the anatomical localization of the most frequent surgical neck fractures of the distal shoulder and metaepiphysis radius, at least - fractures of the surgical neck of the humerus and the olecranon, the diaphysis of the humerus and forearm bones.
main signs of bone fractures of the shoulder and forearm
Diagnostics combined shoulder and forearm fractures is not always easy, especially in children, where diagnostic errors sometimes reach 50-60%.Often not recognized forearm bone fractures due to the fact that the initial evaluation of the patient's complaints are focused on a more serious fracture of the humerus.
Usually treatment defects are detected later, after r
First aid for fractures of bones of the shoulder and forearm
severity of the condition affected corresponds to the shock I-II degree.At the scene intravenous 4 ml of a 50% solution of dipyrone (promedola, 1 mL of 2% solution), 1 ml of a 1% solution of diphenhydramine.Procaine blockade produce fractures shoulder seats (80 ml of 0.5% solution), forearm (60 ml of 0.5% solution).In open fractures of the forearm and closed - shoulder can be limited only to "futlyarnoy" shoulder blockade (100 mL of 0.5% solution).If the shoulder is imposed tourniquet (crush injury, damage to the brachial artery) proximal to harness carry novocaine blockade of the cross-section (100-120 ml of 0.5% solution).
available wound dressings close and produce transport immobilization.The assistant holds the hand of the affected area of the elbow joint (with moderate distraction arm) and wrist with a partial seizure of the lower third of the forearm (with moderate distraction of the forearm).In this case the arm at the elbow bend 90 °, output anterior shoulder 30 °, the brush mounted in the supine, so that combined with the palmar surface of the front surface of the forearm.Initially immobilized otmodelirovannoy stair rail forearm and hand, then carried shoulder immobilization standard ladder rail, pre otmodelirovannoy "on themselves."
Transport immobilization with injuries of the shoulder and arm, and - the first stage (immobilization of fragments of bones of the forearm);b - second phase (immobilization of the humerus).
intravenous transfusion (jet) is one of the saline solution (400-500 ml) and glyukozonovokainovuyu mixture (400-600 mL), continuing infusion (drip) during transport.The victim transported lying down with head raised stretcher end (possible injuries chest, head).
Principles of treatment of fractures of the shoulder and forearm bones
for closed reduction using the following method: first make reduction and immobilization of the forearm bones, and then, after the hardening of the gypsum - reposition of fragments of the humerus;craving for exercise armpit sheets, rolled into a bundle up and backwards on the shoulder axis bent (in front) and moderately extracted from the body;protivotyagu exercise forearm (in the cast), bent at the elbow.shoulder distraction perform 2 assistants under the supervision of responsible trauma, which is itself directly repositioned in fragments.External immobilization is carried out a total plaster splint (from a healthy shoulder) or splint for Turner.It is also possible shoulder fracture treatment on skeletal traction tire outlet.
combined treatment arm and forearm injuries - skeletal traction for elbow otlomok and circular plaster bandage for forearm
Durable fixation of the humerus can be achieved using different designs depending on the nature and level of the fracture.Application of Ilizarov frame speeds up rehabilitation of patients at 4-6 weeks compared with other treatments.In the treatment of multiple fractures of the upper extremity contracture of the elbow occur very quickly and is a staunch character, so immobilisation periods be extremely shortened ensuring durable fixation, especially epimetafizarnyh fractures.
In diaphyseal fractures of the forearm bones and shoulder immobilization lasts an average of 10 weeks.Robust consolidation of these fractures occur no earlier than 12 weeks.Employability is restored within 4-9 months.The elimination of contractures of the elbow and shoulder joints occurs gradually - not earlier than 3-7 months.