Injuries in the home and at work
Traumatology / / August 12, 2017
Falls from height are found mainly in the home (34%).The location and nature of the damage depends on the height of the fall, the situation at the time of the incident, "landing", the stiffness of the relief space, "landing."Falling straight legs accompanied usually bilateral symmetrical calcaneal bone fractures, incident on one leg are multiple lesions that are localized mainly on the same limb.Often accompanying domestic injury drunkenness brings an element of variety in the "flight" and "landing" of victims, but almost always at the same time suffers and the head (45%).In the fall back without support or on a support with one or both hands arise spine fractures (19.6%) of the pelvis (22.4%) of the forearm bones (26%).Falling to one side is usually accompanied by fractures of the lumbar spine, pelvis, femur, tibia.A very complex mechanism are falling forward with support on the hand in which damaged and the head and chest, and spine, and limbs.
should be noted that when dropped from a height of skull
impaction often affected occur at falling heavy objects on them.This localization of multiple fractures depends on the application area and the nature of the traumatic force.By sliding the top blow damaged upper and lower segments of the skeleton, rather distant from each other.The fall of a heavy load on the back is accompanied, as a rule, vertebral fractures, pelvis and extremities.Most often from compression of various objects having multiple fractures of the limbs.Severe polytrauma occurs when the compression of the affected buffers between rail cars, as well as between the car (or left out of the car) and the wall.At the same time, depending on the localization of traumatic forces are multiple fractures of the ribs or pelvis combined with fractures and dislocations of the extremities.
Occupational injuries are characterized by a typical localization mainly in the upper extremities, and on each hand fractures occur two or three segments.The most frequent causes of injuries at work are getting into the hands of the rotary transmission in machines, winches.Analysis of multiple fractures of the mechanism shows that they can occur in one and the same victim:
1) simultaneously (for single acting force to the symmetrical bone torso and extremities or the whole skeleton as a whole);
2) sequentially (as "unfolding" the traumatic impact of different power points);
3) combined (by simultaneous exposure to the underlying cause and consistent - from extra).
Isolation of patients with a certain character and severity of polytrauma is of great practical importance, since each group is characterized by their typical combination of injuries that require a well-defined tactics and methods of treatment.Even very valuable advice given by regardless of the specific trauma situations, lose their meaning and can become dangerous.A large number of patients with injuries of limbs, ribs, spine and pelvis require mainly orthopedic approach to the treatment of patients.The presence of severe traumatic brain injury complicates masks and pushes the timing of specialized orthopedic treatment of fractures in each of the third victim.The interaction of different type and contradictory in nature, severity and localization of the damage concentrated in one patient, in severe cases is a complex problem, whose main tasks are:
1) first aid and transportation;
2) diagnosis and resuscitation;
3) treatment of injuries that threaten the life of the victim;
4) treatment of multiple fractures and rehabilitation of victims.
polytrauma The clinical picture can be divided into 3 periods:
a) the period of the general phenomena associated with multiple body trauma, shock, hemorrhage, asphyxia, disturbance of function of damaged organs, early complications, etc .;.
b) during local events, mainly related to injury musculoskeletal system;
c) the period of the consequences of polytrauma.
first period lasts an average of 2-3 weeks, during which the struggle for the life of the victim, diagnose all the damage, identify and eliminate the dysfunction of organs that support a serious condition of the patient.During this period usually exhibit all the symptoms of severe and early complication of polytrauma its (brain edema and pulmonary posttraumatic pneumonia, fat embolism, acute renal failure, and so on. D.).In non-severe polytrauma that period may be limited to the time required for first aid or hospitalization.The second period starts also from the injury, but manifested mainly after normalization of the general condition of the victim and continues throughout the time inpatient and outpatient treatment.Third period - the period of disability, which may last until the end of life of the patient.This schematic division of a single clinical polytrauma due to the peculiarities of the tactics and methods of treatment in different periods of her.
- Transosseous osteosynthesis external fixation
- tourniquet assistance program to victims with polytrauma
- Transportation injury
- struggle with pain in injuries
- Plaster bandages
- Bilateral dislocations of hip
- Bilateral fractures of the fibula
- Bilateral fractures of the foot
- bilateral calcaneus fractures
study of clinical data on the nature of the healing fractures identified a number of laws: every bone in multiple fractures retains its peculiar her termsand the nature of consolidation;no direct relationship slow consolidation of the number of fractures in the victim;multiple fractures of the bones of the body, usually fused at the usual time;delayed consolidation of limbs due mainly local causes disturbances formation of callus (open, double, triple fracture of one bone, poor adaptation of fragments, fragile fixation of bone fragments of metal constructions, bad or insufficient time-bound external plaster immobilization and so on. d.).Delayed consolidation usually observed at double tibial fractures (usually at the distal fracture), bone fractures at two or three segments of one limb.This is due to circulatory deterioration (swelling of tissues), decreased metabolism and trophism nervous violation, and to a greater extent - in the distal segment.
Indirectly violations of mineral metabolism indicates X-ray picture of osteoporosis in distal bone fragments, especially in the field of fracture, has the most "peripheral" when monostatic polifrakturah.A slight slowdown in callus formation is observed at dimelicheskih symmetrical fractures of the lower limbs (femoral, tibial, calcaneal bone), which is associated in some cases with a reduction in terms of the outer immobilizing plaster bandages (the desire for early rising, to the early activation of patients), while others, on the contrarywith excessive delay functional treatment.Slowing consolidation observed in 11-15% of patients with multiple fractures of limbs, of which 70% - at fractures of shin bones, 20% - the hip, 15% - forearm, 4% - shoulder.Thus, the average time of bone fracture healing at the individual polifrakturah should be considered more prolonged compared with the time of healing of single fractures.