Limb trauma. First aid. Directory. Injuries and diseases of the upper and lower extremities Characteristics of injury to the extremities

INJURIES AND DISEASES OF THE UPPER AND LOWER LIMB

Upper limb injuries.

Upper extremity injuries are common.

Closed injuries of the upper limb:

Stretching and tearing of tendons, muscles and ligaments,

Fractures and dislocations of bones.

Soft tissue injuries of the shoulder and forearm

Mechanism of injury: Occur when falling on the area of ​​​​the joint or hitting it. The most common injuries are of the shoulder and elbow joints.

Clinic: Joint bruises are accompanied by a prolonged pain syndrome, sharp pain on palpation of the joint and especially during movements and dysfunction of the joint , there is a hemorrhage in the tissue above the joint and often in its cavity, abrasions over the joint and its swelling. The function of the joint is limited due to pain, especially with hemarthrosis, the contours of the joint are smoothed.

Diagnostics: To rule out an intra-articular fracture, an X-ray of the joint should be performed.

Treatment conservative: immobilization of the limb for 1-2 days, the appointment of analgesics, cold on the 1st day, and after 24 hours heat on the bruised area, anti-inflammatory drugs, after 2-3 days. light massage, mechanotherapy. Pain may persist for 1-2 weeks. In the presence of hemarthrosis, puncture of the joint is indicated.

Sprain and rupture of the ligaments of the shoulder, elbow, wrist joints

Mechanism of injury: occur with strong, sharp movements in the joints.

Clinic: accompanied by severe pain, swelling due to soft tissue edema and hematoma (possible hemarthrosis), joint dysfunction for 1-4 weeks or more.

Treatment conservative. In the acute period, limb immobilization, analgesics are prescribed, followed by physiotherapeutic procedures for a long time. With insufficient treatment, there may be a limitation of joint mobility (contracture).

Rupture of muscles and tendons

Occurs infrequently. There is mainly a rupture of the biceps muscle of the shoulder and its tendon, less often - the deltoid and muscles of the forearm.

Clinic: Accompanied by severe pain, extensive hemorrhage, dysfunction of the limb (flexion of the forearm), diastasis between fragments of the separated ends of the muscle.

Treatment operational.

FRACTURES OF BONES OF THE SHOULDER AND UPPER LIMB

Immobilization for a broken shoulder

Shoulder fractures

Mechanism of injury: usually occur with a fall on an outstretched arm and a blow to the shoulder. They can be in the region of the head and anatomical neck (intra-articular), as well as in the region of the metaphysis (extra-articular) and diaphysis.

There are:

simple fractures,

Complicated (more often with damage to the radial nerve),

Adduction (angle open inwards)

Abduction (angle open outward).

Clinical picture: depends on the location of the fracture.

Intra-articular fractures:

-hammered(not giving offset). The fracture is detected radiographically.

Non-impacted (Metaphyseal with offset)

diaphyseal

Clinic: fractures are accompanied by shortening of the arm, deformity, pain at the fracture site, severe pathological mobility and crepitus. The patient cannot raise his arm. First aid: consists in immobilization of the limb in an average physiological position and anesthesia in order to prevent secondary injuries and shock.

Treatment: conservative, or operational, it depends on the type of fracture.

- plaster immobilization,

-skeletal traction on special splints

-surgical(open reposition, fixation with metal structures). It should be noted that during immobilization of the limb, it is necessary to give the average physiological position.

Forearm fractures

Meet very often. There are fractures of both bones
and one (radial or ulnar).

There are:

intra-articular fractures

Extra-articular at various levels

in the metaphyses and diaphysis.

According to the mechanism, they are isolated:

Fractures due to direct trauma

Indirect (when falling on an outstretched arm) fractures.
Clinical picture the presence or absence of bias.

When both bones are broken:

local pain,

Severe deformity of the forearm with its pathological mobility throughout,

Crepitus, shortening of the forearm,

Inability to flex at the elbow joint

Sharp pain on exertion.

Fracture of one bone predominantly occurs in the region of the beam, especially in the distal metaphysis (typical location). It is characterized by a bayonet-like deformity with a displacement of the distal fragment to the back (with an extensor fracture) with a displacement of the hand towards the beam. Sometimes these fractures are impacted. Pathological mobility is possible with fractures of both bones in the area of ​​the diaphysis.

Treatment conservative - closed reposition, plaster immobilization.

In case of unsuccessful reposition- operational (open reposition, metal osteosynthesis with knitting needles, plates, screws).

dislocations

Shoulder dislocations occur most frequently.

Etiology is:

- in the anatomical device of the shoulder joint(this joint belongs to the spherical ones, which creates conditions for a wide range of movements, the cartilaginous surface of the head is in contact with the glenoid cavity of the scapula for a short distance)

- fall onto an abducted limb. The head of the shoulder is in the axillary region. The acromial and sphenoid processes of the scapula prevent upward displacement.

Shoulder dislocations can be: congenital, acquired and habitual, chronic.

clinical picture.

- the patient complains of severe pain in the joint,

The impossibility of active movements, passive, sharply limited.

With a healthy hand, he tries to create peace for the damaged one.

The hand is in a state of abduction.

When brought to the body the limb springs.

The area of ​​the shoulder joint is flattened,

The acromion protrudes.

With a lower dislocation, the head is palpable in the armpit, the limb is relatively elongated.

Diagnostics: radiography of the joint in two projections.

Treatment. Shoulder dislocation is subject to urgent reduction under general or local anesthesia. In general anesthesia, short-acting relaxants are used to relax the muscles.

Local anesthesia is achieved by introducing into the joint cavity 10 ml of a 2% solution of novocaine and subcutaneous injection of a narcotic analgesic. Anesthesia occurs in 10-15 minutes.

Dislocation reduction methods : Hippocrates, Janelidze, Kocher. Before the board and after it is obligatory to do x-ray examinations.

Hippocratic method. The patient is placed on a couch or on the floor. The surgeon sits on the side of the dislocated shoulder and inserts his heel into the armpit. Takes the patient's hand with both hands by the hand. Produces smooth yet energetic tract by the hand and at the same time the surgeon with his heel rests on the head of the humerus, pressing it back into place.

Position of the patient during dislocation

Janelidze method.

1. The patient is laid sideways on the table from the side of the dislocated limb. The arm should hang over the edge of the head end of the table.

2. The patient's head is placed on a bedside table, at the same height as the table, or an assistant supports it. In this position, the patient should be 10-15 minutes. to relax the muscles of the upper shoulder girdle.

3. Then the surgeon takes the patient's forearm with both hands and, bending the arm at the elbow joint at an angle of 90%, produces a smooth and vigorous tract of the shoulder down with rotation outward, and then inward.

4. The reduction is accompanied by a slight click and the resumption of active and passive movements.

Kocher method complicated and used by qualified traumatologists. After reduction, X-ray control is performed, the limb is fixed with a Dezo plaster cast for 3-4 weeks. Then physiotherapy procedures and physiotherapy exercises and massage are prescribed. Ability to work is restored after 3-4 weeks. after reduction. With irreducible dislocations and in combination with fractures, they resort to surgery.

Dislocations of the forearm

They occur 2-3 times less often than dislocations of the shoulder.

Mechanism of injury: observed when falling on an outstretched hand. During dislocation, a rupture of the joint capsule and lateral ligamentous apparatus occurs. There are dislocations of both limbs of the forearm posteriorly or in combination with outward or inward subluxation, can be combined with fractures of the bones of the forearm, damage to nerves and blood vessels.

clinical picture.

- The injured arm is slightly bent at the elbow joint, with a healthy arm the victim supports the injured arm by the hand.

Active movements are impossible, passive ones are sharply limited due to pain and springy resistance.

Deformity, elbow joint,

Edema, hemorrhage.

The forearm looks shortened, the shoulder, on the contrary, seems to be elongated.

Diagnosis confirmed by X-ray.

Treatment.1.Reduction of the joint. 5-10 ml of 2% novocaine solution is injected into the joint cavity. Reduction can be performed in a sitting or lying position of the patient. With posterior dislocations, the surgeon grasps the lower part of the shoulder in such a way that the first fingers are located at the top of the olecranon, and the rest on the front surface of the shoulder. The assistant makes a longitudinal tract behind the forearm with simultaneous smooth bending in the elbow joint. The surgeon at this time presses on the olecranon with his thumbs.

2. After reduction of the dislocation, a posterior plaster splint is applied for 2-3 weeks.

3. Then physiotherapy exercises, physiotherapy are prescribed.

4. Fresh irreducible dislocations with soft tissue interposition are treated surgically (open reduction).

5. Fracture-dislocations are treated with both conservative and surgical methods.

Dislocation of the first finger. This is the most common dislocation of the fingers.

Dislocation mechanism: strong pressure or impact on the palmar surface of the finger, resulting in hyperextension and rupture of the joint capsule. The main phalanx is displaced to the rear of the metacarpal bone. The thumb takes the form of a gun trigger. There are no active or passive movements.

Treatment. Up to 5 ml of a 2% solution of novocaine is injected into the joint cavity. To reduce the dislocation, the assistant grabs the area of ​​the wrist with both hands, the surgeon fixes the main phalanx, unbends the joint and simultaneously shifts the base of the surface of the metacarpal bone. Having shifted the main phalanx from the head of the metacarpal bone, flexion is performed in the interphalangeal. After the control radiograph, the finger in a state of slight flexion and abduction is fixed for 12 days with a plaster cast.

Fractures of the femur

These fractures are classified as severe injuries. There are fractures of the femoral neck, diaphyseal fractures, epiphyseal, metaphyseal fractures of the distal and proximal end of the femur.

Fracture of the neck of the femur. Occurs in older people (mainly women) when falling on the greater trochanter. Distinguish:

- medial (intra-articular)

- Lateral fractures of the neck.

Peculiarity medial fractures in that this fracture (intra-articular) practically does not grow together without surgical treatment (osteosynthesis).

Lateral fractures:

Through the whirlpool

Intertrochanteric, driven in and offset. As a rule, lateral fractures are cured using conservative methods.

clinical picture. Are celebrated

Pain in the area of ​​the injured joint

Limb function is impaired.

In fractures of the femoral neck, there is foot rotation outside. The foot is adjacent to the bed with the outer edge, the victim is unable to lift it.

In displaced fractures, the limb is shortened, and increased pulsation of the femoral vessels under the pupart ligament is visible. - There is swelling and hematoma in the hip joint.

Diagnosis confirmed and specified according to the radiograph of the hip joint in two projections.

Treatment. For medial fractures with displacement, the only method of treatment is surgical: they produce osteosynthesis of the femoral neck with a three-bladed nail under X-ray control. The nail is removed after 1 year.

For lateral fractures fusion of bone fragments is possible during immobilization with a derotational boot or skeletal traction. The operation is indicated when it is impossible to reduce and hold the fragments with the help of skeletal traction, and also if the patient is unable to endure prolonged bed rest. Fusion of femoral neck fractures occurs within 6 to 8 months.

Fractures of the diaphysis of the femur. The displacement of the peripheral and central fragments depends on the level of the fracture and, therefore, on the muscle traction for these fragments. Shortening of the limb due to displacement along the length, deformation due to displacement along the width or at an angle are noted. The higher the hip fracture, the greater the displacement of the central fragment as a result of abduction and flexion. With fractures of the diaphysis of the femur, a significant hemorrhage into the soft tissues, a large area of ​​pathological nervous impulses often lead to severe traumatic shock.

clinical picture. Immediately after the injury, severe pain occurs at the fracture site, pathological mobility in the fracture zone is determined; shortening of the limb can reach 12 cm. The nature of the fracture is specified according to radiographs taken in two projections. The general condition of the patient should be assessed, since severe traumatic shock is possible. Patients with a fracture are transported only after immobilization of the limb with a Dieterichs tire.

Treatment: In case of displaced fractures, skeletal traction is applied for the tuberosity of the tibia or femoral condyle. The reduction of fragments is periodically monitored radiographically. After repositions skeletal traction impose a coxite plaster bandage or carry out intramedullary osteosynthesis. After reliable consolidation fracture zones, the nail is removed after a year.

Fractures of the bones of the leg. There are various types of fractures of the bones of the lower leg: fractures of the condyles of the tibia, diaphyseal fractures of two bones or isolated fractures of the tibia and fibula, ankle fractures isolated and in combination with fractures of the distal tibia. Fractures occur with direct as well as with indirect trauma. Bone fractures can be transverse, oblique, helical, comminuted.

clinical picture. There is significant pain at the fracture site. The movements of the limb are painful, its function is impaired, edema, hematoma, and deformity in the area of ​​the fracture are observed. Palpation of the bones and the load along the axis are painful, bone crepitus is determined. With a fracture of the diaphysis, pathological mobility is expressed.

Diagnosis confirmed by x-ray. During transportation, immobilization is carried out with Cramer tires: one tire is placed on the back surface of the lower leg, foot, the other two are placed on the lateral surfaces of the lower leg. Tires are laid with a layer of cotton wool and fixed with soft bandages.

Treatment. For fractures without displacement, a plaster cast is applied, capturing the foot and reaching the middle third of the thigh. Long-term immobilization for 6-8 weeks, after that the bandage is removed, massage and physiotherapy exercises are prescribed. In case of fractures with displacement after anesthesia, skeletal traction for the calcaneus is applied. Reposition is carried out with a load of up to 6 kg. Periodically control the standing of the fragments. After the formation of soft callus, a plaster cast is applied, with which the patient walks on crutches, then with a stick. After 4-6 weeks, the bandage is removed, massage, physiotherapy exercises are prescribed. With open fractures, interposition of soft tissues, the impossibility of holding fragments, surgical treatment is indicated: intramedullary osteosynthesis nail or fixation of bones with a metal plate. Additionally, for immobilization, a plaster bandage or splint is applied. With fractures of the bones of the lower leg, a good therapeutic effect is provided by compression osteosynthesis using an apparatus for extrafocal osteosynthesis (Ilizarova, Gudushauri).

Ankle fractures

This is one of the most common types of injury, especially in winter. Ankle fractures result from indirect trauma. Depending on the nature of the injury, fractures of the outer and inner ankles, two ankles, ankles and the posterior edge of the tibia, the so-called trimalleolar fractures, are distinguished.

Fractures of two ankles and fractures of three ankles are combined with outward subluxations of the foot.

Clinic: Soreness, deformity and swelling in the ankle joint, pathological mobility, crepitus of bone fragments are noted.

Diagnosis clarified with the help of radiographs of the ankle joint in two projections.

Transport immobilization for ankle fractures is performed with Kramer splints.

Treatment: Anesthesia of the fracture site with a 2% novocaine solution is required. For fractures without displacement, a posterior plaster splint or plaster boot is applied for 4 weeks. In case of a displaced fracture, it is necessary to reposition the fragments and fix them with the help of the posterior and Y-shaped plaster splints. A few days after the edema subsides, the temporary bandage is changed to a permanent plaster boot or reinforced with circular bandages. The reduction of two- and three-malleolar displaced fractures often presents significant difficulties and is performed under general anesthesia.

Hip dislocations

The mechanism of dislocations is based on falls on a limb and direct trauma. The most common (80-85%) are iliac hip dislocations.

clinical picture. The main symptoms of traumatic dislocations are deformity in the area of ​​the damaged joint and the position of the limb typical for each type of dislocation.

Normally, the greater trochanter is located on the Roser-Nelaton line (a conditional line connecting the anterior superior iliac spine and the top of the ischial tuberosity). In posterior dislocations, the greater trochanter is above this line. With all types of hip dislocations, patients do not have active movements in the hip joint. Diagnostics.X-ray of the joint complements the data of the clinical study.

Treatment. The reduction is performed under general anesthesia with muscle relaxants or under spinal anesthesia.

After reduction, a control radiograph is taken, then the patient is placed on the bed, the limb is placed on the Beler splint and skin traction is applied for 5-6 days. In the future, therapeutic exercises, massage are carried out. After 4 weeks, the patient can walk with crutches.

Dislocations of the foot

Dislocations of the foot are very diverse and are always accompanied by ankle fractures.

Diagnosis is not difficult, since there is a characteristic deformation and dysfunction of the foot. An x-ray is needed to clarify the nature of the damage.

The reduction of the dislocation is performed after anesthesia. Immobilization in a plaster splint for up to 4 weeks. Possible isolated dislocations of the talus, calcaneus, dislocations in the intertarsal or tarsal joints (Lisfranc joint), as well as dislocations of the first toe. In all cases, reduction is indicated, followed by immobilization of the foot and lower leg.

tendovaginitis

tendovaginitis- inflammation of the synovial membranes of the tendons most characteristically occur on the hand.

They are divided into two groups: crepitant and stenotic.

Etiology:

Chronic injury when repeating the same movements in typists, violinists, great muscle tension in blacksmiths and miners.

With crepitating tendovaginitis, serous impregnation of the perivaginal fiber of the tendons and fiber between the muscle fascia is found.

With stenosing tendovaginitis, sclerosing inflammation is observed with the growth of connective tissue; a fibrous ring is formed, through which the tendon passes with difficulty. The most common legalization of crepitating tendovaginitis is the back of the forearm, the front surface of the lower leg, the back of the hand and foot, the area of ​​the Achilles tendon. With stenosing tendovaginitis, the tendon sheaths of the 1st finger at the edge of the styloid process of the radius are most often affected. Clinical picture. With crepitating tendovaginitis, acute pain is noted during movement, sometimes throbbing at night. In the course of the affected tendon sheaths, swelling, slight hyperemia, and local fever develop. With palpation and simultaneous movements, gentle crepitus is determined. With stenosing tendyuvaginitis - pain of a aching nature with irradiation, performance is impaired. By palpation, it is possible to determine the compaction and soreness in the area of ​​​​the tendon sheath. When moving, there is a feeling of an obstacle being overcome in the form of a click.

Treatment. Rest, baths, thermal procedures, half-alcohol compresses or with Vishnevsky ointment, immobilization with a splint or plaster splint. With crepitating tendovaginitis, conservative therapy gives a good result. At

stenosing tendovaginitis, if conservative measures are ineffective, an operation is performed - excision of the thickened area of ​​the tendon sheath

Felon- Purulent inflammation of the fingers.

Depending on the localization of the process and the stage of the disease, panaritium is divided into the following forms:

1) skin;

2) subcutaneous;

3) bone;

4) articular;

5) tendon (tendovaginitis);

6) paronychia (periungual roller is involved in the process); 7) subungual;

8) pandactylitis (damage to all tissues of the finger).

Clinical picture: depends on the form of panaritium.

For cutaneous: local area of ​​hyperemia, local soreness, slight swelling of the skin.

For subcutaneous the finger is somewhat enlarged due to edema, movements in it are limited, severe throbbing pain appears, due to which patients do not sleep, fever, leukocytosis.

With bone form panaritium in the initial stage of the disease, the clinical picture is the same as in the subcutaneous form. In the future, the affected phalanx acquires a cone-shaped shape. X-ray determined bone destruction.

With articular shape the joint becomes spindle-shaped, skin hyperemia appears. After the destruction of the ligamentous apparatus, pathological mobility develops.

With a tendon the finger is swollen, half-bent, along the tendon there is marked pain (determination is made with a scary probe). When you try to straighten your finger, the pain intensifies.

With paronychia the periungual roller is edematous, hyperemic, painful. In the later stages, when pressing on the roller, pus is released from under it.

With pandactylitis purulent inflammation of the entire finger is observed, purulent fistulas appear, the finger is deformed, increases in volume, is swollen, the skin is thickened and compacted, there are no movements in the finger.

Prevention. It is necessary to pay serious attention to microtraumas and their timely treatment.

Treatment. In the cutaneous form, a section of the dead epidermis is excised. Sometimes this reveals a fistulous passage into the subcutaneous tissue (panaritium in the form of a "cufflink"). In these cases, treatment is carried out in the same way as with subcutaneous panaritium. In other forms of panaritium, conduction anesthesia is performed according to Lukashevich-Oberst, a skin incision is made longitudinally along the lateral surfaces through the focus of inflammation, necrotic tissues are removed, a rubber graduate and turunda with a hypertonic solution are introduced. With bone, articular and tendon forms of panaritium, after anesthesia, two incisions are made along the lateral surfaces of the finger, along - incisions according to Klyapp. When the process is localized on the nail phalanx, the incision is made in the form of a club. With pandactylitis, not amenable to treatment, the finger is removed.

Phlegmon brush

With phlegmon of the palm, soreness and swelling of the central or lateral parts of the palm are determined. The skin over the site of inflammation is tense, swollen. Edema is also observed on the back of the hand. The movements in the fingers of the hand are limited, painful. The fingers are half-bent, their passive extension is impossible. The general condition may suffer significantly.

Treatment operational, as well as all purulent diseases of the skin and subcutaneous tissue. The wounds are washed with an antiseptic solution, drainage is introduced. The hand and forearm are immobilized with a plaster splint or Cramer splint. Showing warm baths with antiseptic solutions, physiotherapy during the healing of wounds.

T E R M I N O L O G I A

Hemorrhage-

Hemarthrosis-

Immobilization-

Contracture-

adduction fracture-

abduction fracture-

Impacted fracture-

diaphyseal fracture

metaphyseal fracture-

Skeletal traction

Reposition-

Osteosynthesis-

Fixation-

Fracture Consolidation-

Phlebeurysm

Phlebeurysm- pathological, usually

irreversible expansion of the lumen of the veins with dystrophic - sclerotic changes in their walls,

The formation of valve insufficiency and impaired blood flow. It is most commonly seen in the lower extremities.

Etiology:- congenital or acquired weakness of the muscular elements of the vein wall and insufficiency of its valves,

Increased hydrostatic pressure in the veins due to pregnancy, abdominal tumors, high intra-abdominal pressure due to constipation, cough, difficulty urinating, obesity (static phlebohypertension),

Distinguish:

Primary

Secondary (compensatory, or symptomatic) varicose veins of the lower extremities with thrombosis of the main veins of the leg, thigh and pelvis (post-thrombophlebic syndrome), circulatory failure and other conditions.

The system of the great saphenous vein of the leg is usually exposed to varicose veins, both vein systems are often affected. The dilated vein has the appearance of a rounded, often tortuous, bluish cord rising above the skin with numerous nodes. The protrusion of the dilated veins disappears in the supine position and increases in the upright position, with coughing, straining, holding the breath. Varicose veins progress, spreading to the communicant, and then to the deep veins of the lower limb. The clinical picture of the disease, its manifestations, the state of venous circulation and the patient's ability to work depend on the severity of the pathological process. With the expansion of only superficial veins, there is heaviness in the calf muscles and bursting, slight swelling by the end of the day in the ankle joint, itching and sometimes cramps at night in the calf muscles. With the expansion of both superficial and communicating veins, the manifestations are more pronounced (dull pain, expansion in the lower leg), the edema becomes larger, cyanosis of the limb appears, often pigmentation of the skin of the lower third of the lower leg. When examining varicose nodes on the anterior surface of the lower leg with a finger, depressions (dips) in the skin and subcutaneous base are determined, corresponding to the mouths of the dilated communicating veins. At this stage, trophic disorders are possible - sclerosis, skin ulcerations, chronic venous insufficiency. With a total expansion of the veins, swelling of the lower leg and thigh occurs, which often does not go away even overnight. There is constant pain in the legs. In the vertical position of the body, cyanosis, dilation of small skin veins, often trophic disorders in the form of pigmentation, sclerosis, dryness, dermatitis and ulcers are noted. Of the special methods of examination, phlebography is of primary importance. In the diagnosis of the prevalence of varicose veins and its nature, special tests are used according to Troyanov-Trendelenburg, Delbe-Perthes (marching test), as well as three- and multi-wire tests according to Sheinis and others.

Troyanov-Trendelenburg test. After emptying the superficial vein in the horizontal position of the patient, the large saphenous vein in the area of ​​​​the mouth is pressed down with a finger or squeezed by applying a tourniquet at the base of the thigh and the patient is quickly transferred to a standing position. Stop compressing the vein. If the dilated vein quickly fills with blood, the test is considered positive and indicates insufficiency of the mouth valve. If the vein slowly fills, the sample is considered negative.

The state of the valves of deep and communicating veins is determined using March test on Delbe-Perthes.

A patient in an upright position (in a state of filling the veins) is put on a tourniquet on the area of ​​​​the upper or middle third of the thigh and asked to walk for 5 minutes. With sufficient function of the valves of the deep and communicating veins, the superficial veins empty after walking, and if they fail or obstruction of the deep veins, the superficial veins remain filled. To judge the level of damage, five tourniquets are applied - 2 on the thigh and 3 on the lower leg. The release of veins even in one gap indicates the preservation of valves at this level. Treatment varicose veins are predominantly surgical: injection-sclerotherapy and surgical removal of dilated veins. Conservative measures are used only at the initial stage: the exclusion of a static posture during work, walking, swimming, contrasting wiping of the extremities with water (room temperature and cold), wearing elastic stockings. Permanent wearing of an elastic stocking or bandaging of a limb is recommended when surgical intervention is contraindicated. The limb is bandaged up to the knee joint so that each subsequent round of the bandage overlaps half of the previous one. The compression created by the bandage improves blood circulation in the deep veins, stops the further development of varicose veins, but does not lead to a cure.

Thrombophlebitis

Thrombophlebitis- inflammation of the vein (phlebitis),

associated with thrombosis. This is a common disease of the veins of the lower extremities.

The causes of thrombophlebitis are numerous: infectious lesions of the vein wall, allergic, toxic, metabolic-dystrophic processes.

clinical picture. Thrombophlebitis is manifested by the formation of dense painful strands along the course of the vein. The skin above them is hyperemic, hot. Often the process extends to the surrounding tissues (periflebitis). This is usually observed with infectious thrombophlebitis, which sometimes leads to purulent fusion of the vein wall. The manifestations of thrombophlebitis depend on its etiology, the prevalence of the process and the nature of the reaction of the patient's body to the process. Pain in the limb occurs, motor activity is disturbed, body temperature often rises to subfebrile numbers, itching and cramps in the calf muscles are sometimes observed. With purulent thrombophlebitis, fever is hectic or intermittent in nature, the functions of the cardiovascular and other systems are impaired, and sepsis is possible. Thrombophlebitis (thrombosis) of deep veins occurs with septic and general infectious and toxic diseases, physical inactivity, injuries, tumors. Most often develop in the deep veins of the legs. Pain in the calf muscles, impaired walking, swelling of the foot and lower third of the leg, hot pale skin are noted. With phlebitis of the femoral vein or femoral-iliac segment, there is a sharp pain in the limb and swelling. The skin of the affected limb is pale or cyanotic due to simultaneous spasm of the arteries. There is fever, severe general condition.

Treatment thrombophlebitis is carried out by conservative and surgical methods. With thrombophlebitis of the deep veins of the thigh and iliac-femoral segment, patients are operated on at an early stage. In other cases, they are first treated with conservative methods: bed rest; elevated position of the limb (better on the bus Beler); anticoagulants; alcohol compresses. Bed rest with deep vein thrombophlebitis lasts 7-10 days. Patients with thrombophlebitis in varicose superficial veins are operated on after the subsidence of acute phenomena.

Thrombophlebitis of the deep veins of the lower leg, thigh and pelvis is often complicated by pulmonary embolism. Therefore, patients need timely hospitalization -

Raynaud's disease

Raynaud's disease or symmetrical gangrene of the extremities -

chronic disease of the hands and feet characterized by

paroxysmal disturbance of their arterial blood supply. The disease belongs to angiotrophoneurosis.

In the mechanism of its development, the role is played by both hereditary characteristics of the body, in particular the innervation of blood vessels and their increased sensitivity, and harmful exogenous and endogenous effects (cooling; trauma nervous system, including mental; infection; smoking; alcohol

Trauma is the result of mechanical or thermal factors affecting the body as a whole or any part of it: a bruise, a wound, a bone fracture, a dislocation in a joint, a burn, frostbite, an electrical injury. A significant injury from the moment of its occurrence becomes a traumatic disease. Injuries are divided into 2 groups: production (industrial, agricultural) and non-production (transport, street, household, sports). Soft tissue damage. Soft tissues are often injured.

Bruises and hematomas.

Bruises and hematomas of soft tissues without violating the integrity of the skin occur upon impact, fall. With a bruise, the subcutaneous fat, muscles, and blood vessels are partially destroyed. Clinic: the main symptoms of a bruise are: pain in the bruised area, hemorrhage. In the presence of a hematoma, fluctuation is determined. Treatment: rest; cold for 2-3 days per limb; tight bandaging. From the 4th day, thermal procedures are prescribed: a heating pad, warming compresses, physiotherapy. At suppuration of a hematoma opening of an abscess is shown.

Closed muscle injuries.

Closed muscle injuries can occur at different levels: at the level of the muscle belly, at the point of transition of the muscle into the tendon, at the place of its attachment to the bone. The most common injuries are to the biceps brachii and gastrocnemius muscles. Injuries result from a direct blow. Treatment: incomplete muscle ruptures are treated conservatively: immobilization, cold, and after 3-5 days thermal procedures are prescribed. With a complete rupture of the muscle, surgical treatment is indicated - stitching the muscle.

Tendon injuries.

Complete and partial subcutaneous ruptures and tendon avulsions. Complete and partial subcutaneous ruptures and tendon ruptures often occur as a result of a sharp muscle contraction when lifting weights in athletes. Injuries to the tendons of the biceps muscle of the shoulder Clinic: pain at the time of muscle contraction; patients note a "crunch", the strength of the muscle is weakened, with active contraction of the muscle, its contour is deformed - with a rupture in the proximal section, the shortening is displaced in the distal direction, with separation of the distal tendon - in the proximal one.

Damage to the Achilles tendon (due to direct trauma, muscle tension) Clinic: pain at the time of injury, “crackling”, limb support is reduced, load on the forefoot is impossible. A defect is defined at the level of damage. Treatment: in case of damage to the tendon of the biceps muscle of the shoulder - surgical treatment. When the distal end of the tendon is torn off, it is fixed to the radius, when it is torn off from the place of attachment, the tendon is fixed to the coracoid process. When detached at the point of transition to the muscle belly - U-shaped seams. Within 3-4 weeks - immobilization of the limb, then massage, therapeutic exercises.

In traumatic ruptures of the Achilles tendon, it is sutured end to end. In case of tendon rupture along or at the place of transition to the muscle belly - plastic restoration according to Chernavsky, tendon alloplasty. Circular plaster immobilization of the limb for 2 months. Full load on the limb after 3.5-4 months. Joint injuries (bruises, sprains and ruptures of ligaments, hemarthrosis, meniscus ruptures)

Clinic: a bruise is accompanied by pain in the joint area, hemorrhage. Treatment: simple bruises are treated with a pressure bandage, cold, thermal procedures.

Ligament sprains.

The ligaments that strengthen the joint are strongly stretched during sudden excessive movements. If the tension of the ligament exceeds the limit of physiological elasticity, then a rupture may occur. Treatment: plaster splint for 8-12 days, thermal procedures, physiotherapy. Hemarthrosis of the knee joint (accumulation of blood in the joint cavity) Diagnosis: the contours of the joint are smoothed, its circumference is increased, balloting of the patella. Treatment: under local novocaine anesthesia, the joint is punctured, blood is removed. Assign UHF, plaster immobilization, therapeutic exercises. Walking is allowed after 15 days without weight bearing.

Damage to the meniscus of the knee joint. It is more common in older males. The medial meniscus is damaged more often than the lateral one. Treatment: with a fuzzy clinic of meniscus damage, conservative therapy is carried out: for hemarthrosis - joint puncture, immobilization with a plaster splint for 10-15 days, then massage, thermal procedures. With the "blockade" of the knee joint, it is eliminated or surgically treated. When the meniscus is damaged, an operation is performed - a meniscus ectomy. Damage to the bones of the extremities.

Fractures.

A fracture is a violation of the integrity of the bone under the influence of a single-stage action of a traumatic force. Signs of broken bones. Pain occurs during a fracture due to damage to the nerve trunks by bone fragments, compression by a hematoma, tissue edema. The deformation is due to the displacement of fragments, edema. Violation of function and support ability accompanies all fractures. With fractures of long tubular bones with displacement, the victim cannot move due to pain.

pathological mobility. It is accompanied by bone crunch (crepitus), which appears when the bone fragments are displaced.

Shortening of the limb.

It is caused by the displacement of bone fragments due to muscle contraction. The limb is compared with the healthy side. With open fractures, there is damage to the skin through which bone fragments protrude, blood flows out. There is tissue swelling.

First aid for fractures. It should be aimed at creating rest of the limb, stopping pain, preventing shock, displacement of bone fragments. With open fractures, a temporary stop of bleeding is necessary. At the site of injury, assistance begins with the release of the body of the victim, if possible, painkillers should be administered. In case of an open fracture, perform temporary hemostasis: pressure bandage, tourniquet, hemostatic clamp.

Immobilization to ensure rest and prevent displacement of fragments, to reduce pain. At the scene, immobilization is carried out with improvised means: plywood, cardboard. The upper limb is fixed to the body, the leg is fixed to the healthy leg. Transport immobilization should provide maximum rest, immobility of the injured limb during transportation. Before immobilization, painkillers should be administered (1 ml of a 2% solution of promedol, 2 ml of a 50% solution of analgin). For closed fractures, splints are placed over shoes and clothing. With open fractures, the reduction of fragments is unacceptable; the wound is closed with a sterile dressing.

At least 2 joints are fixed, and in case of damage to the hip and shoulder - 3 joints. Cotton wool, a towel, grass are placed under a hard tire to prevent compression of blood vessels and nerves. Apply standard tires Kramer, Dieterikhs, CITO tires. In case of damage to the lower extremities, a wooden standard Dieterichs splint is used. It consists of two sliding bars of different lengths, a wooden footrest for stretching and a twist stick.

For hip fractures, three stair splints can be used: two are tied together so that they fix the leg from the armpit to the outer edge of the foot, and the third from the gluteal crease to the toes. In case of damage to the collarbone or scapula - a scarf, Deso bandages, rings

In case of fractures of the humerus in the upper third, a cotton-gauze roller is placed in the armpit and bandaged to the chest. The forearm is hung on a scarf. Ladder splint is used for fractures of the diaphysis of the shoulder. It fixes 3 joints (shoulder, elbow, wrist). In case of fractures of the forearm, the elbow and wrist joints should be fixed. The elbow joint should be bent at a right angle.

In case of damage in the area of ​​the wrist joint and fracture of the phalanges of the fingers, ladder tires, plywood are used. Therapeutic immobilization is reduced to the imposition of plaster bandages. Hot water (40-50°C) is used to harden the gypsum. A plaster bandage is applied to the skin, without lubricating it with anything. Dressings are circular, longet, fenestrated, combined. A circular bandage is applied without tension.

If signs of compression of the limb appear, it is urgent to cut the bandage. Fractures of the upper limb. Clavicle fractures. Most often, fractures occur at the border of the outer and middle thirds. Usually, the peripheral fragment is displaced downward and forward, and the central fragment is displaced upward and backward. Diagnostics. In the area of ​​the fracture - swelling, hemorrhage and deformity, pain. Be sure to examine the pulse on the radial artery and sensitivity. An x-ray is taken.

Treatment. For fractures without displacement - an eight-shaped bandage, Kuzminsky's splint, Cramer's splint, Kaplan's splint. In case of a fracture of the clavicle with a pronounced displacement, with the threat of skin perforation, large diastasis, with the threat of damage to the neurovascular bundle, an operation is performed - open reposition and osteosynthesis with a pin. In case of fractures with displacement in children, comparison is carried out by diluting and raising the shoulder girdle, holding the eight-shaped bandage. Immobilization after surgery - 4 weeks.

Humerus fractures.

There are fractures of the proximal end, fractures of the diaphysis of the humerus, distal metaepiphysis. Fractures of the head and anatomical neck. Clinic: hemarthrosis, pain when feeling the head of the shoulder and axial load on the bone. Fractures of the head and anatomical neck are similar in clinic.

An X-ray of the shoulder is taken in two projections. Treatment: for fractures of the head of the humerus without displacement - immobilization for 4-5 weeks. From the 3rd week - therapeutic exercises. In case of a fracture of the anatomical neck with displacement - closed reposition under anesthesia. In case of fractures with a significant displacement - surgical treatment with a metal pin, knitting needles. Humerus diaphyseal fractures (spiral, oblique, transverse, comminuted, with displacement, without displacement) Clinic: swelling, hematoma, deformity at the level of the fracture, palpation of bone fragments, dysfunction of the limb.

Treatment of diaphyseal fractures is mostly conservative. In case of transverse fractures, reposition and fixation with a thoracobrachial plaster bandage are performed. An abduction splint (airplane) and skeletal traction for the base of the olecranon are also used. External percutaneous compression osteosynthesis with the Ilizarov apparatus; osteosynthesis with two wires and a Kirschner arch. Fractures of the bones of the forearm (isolated fractures of the radius and ulna, fractures of both bones, fractures-dislocations), fractures of the radius in a typical location Clinic: in fractures with displacement - pain, swelling, hematoma, bayonet deformity in the area of ​​the wrist joint.

The function of the bone is preserved.

Treatment: for fractures without displacement - plaster immobilization from the head of the metacarpal bones to the elbow joint for 2-3 weeks. In case of displaced fractures, simultaneous manual reposition and the application of a plaster splint are performed. In case of failure, reposition using the Ilizarov apparatus is indicated.

Pelvic fractures.

Occur when falling from a great height, with compression of the pelvis in the sagittal or frontal plane, motor vehicle accidents. In 30% of cases, it may be accompanied by shock and massive bleeding from spongy bones. The main cause of severe shock is massive blood loss (1.5-2 liters). Damage internal organs accompanied by the appearance of complications (peritonitis, urinary streaks).

Fractures of the pelvic ring without breaking its continuity. Clinic: 1) pain in the area of ​​the fracture, aggravated by movement of the limbs; 2) swelling or hematoma in the area of ​​the fracture. Treatment: 1) intrapelvic novocaine blockade according to Selivanov-Shkolnikov (0.25% solution); 2) laying the patient in the "frog" position - with rollers in the popliteal region and divorced knees.

Pelvic ring fractures with discontinuity.

Discontinuous pelvic ring fractures are clinically similar to fractures without discontinuity. The diagnosis is confirmed radiographically. Treatment: anesthesia (intrapelvic novocaine blockade); hammock; skeletal traction. A fracture of the pubic bones is characterized by a symptom of a “stuck heel”: the patient cannot raise his leg on his own due to the sharp pains that appear. If the acetabulum is damaged in the area of ​​the hip joint, pain appears, its function is impaired.

Fractures of the femur, fracture of the femoral neck.

Medial fracture of the femoral neck, valgus fractures, or abduction, impaction and varus (adduction). Clinic: with impacted fractures of the neck, pain in the inguinal region is disturbing, aggravated by walking, axial load; soreness is moderate. Movement in the joint is preserved. A pathognomonic sign is an increase in pain in the joint when trying to lift the leg up with resistance (pressure on the knee area).

With a vagal fracture of the neck, active movements in the hip joint are impossible, a symptom of a “stuck heel”, the limb is in the position of external rotation. Treatment: in case of an impacted fracture - immobilization with Whitman's circular plaster bandage. Traction is applied on the tire with a load of 3 kg. For vagal fractures, extra-articular osteosynthesis is performed with a three-bladed Smith-Peterson nail.

Fractures of the diaphysis of the femur (subtrochanteric, fractures in the upper, middle and lower third and supracondylar fractures) Clinic: pain in the area of ​​the femoral fracture, swelling, mobility of fragments, shortening of the limb. Treatment: skeletal traction for the femoral condyle. Cargo - 8-12 kg. Surgical treatment (intraosseous osteosynthesis with a metal rod).

The lower extremities are constantly exposed to heavy loads and exposure to dangerous factors. Their injuries are the most common among all injuries of the musculoskeletal system. It can be as simple bruises and damage to the skin, as well as dislocations, muscle tears and serious fractures.

Leg injuries rarely pose a threat to life, but are always characterized by sharp, severe pain and can lead to disability. Timely and competently provided assistance will help shorten the recovery period, as well as prevent serious inevitable consequences for the musculoskeletal system.

Consider the most common injuries of the lower extremities, their characteristic symptoms, and how you can help the victim before the arrival of the medical team.

This injury is typical for older people, most often women. May occur when falling and or receiving a minor bruise. Such a fracture often occurs due to the presence of osteoporosis in the victim. Surgery is often required within a year of the fracture. If the operation is not performed, then the injury leads to a lying lifestyle, and death.

The following symptoms indicate an injury:

• At rest, the pain syndrome is not strong. It can only occur while moving.
• Tapping on the heel causes pain in the groin or thigh.
• The shape of the hip may change. The leg on the side of the injury is slightly shortened due to the displacement of the bone.
• When you try to roll over, you can hear a crunch at the site of a hip fracture.

First aid consists only in anesthesia and ensuring the immobility of the lower body. To prevent and relieve panic in the victim, any analgesics are suitable. However, remember that older people may have comorbidities and allergies to certain drugs. If the person is conscious, find out which pills are contraindicated for him.

It is necessary to immobilize the injured limb by applying a splint. It can be made from a long stick or board. To avoid damage to the skin, it is recommended to wrap it with any soft cloth. From the outside, a splint should be applied starting from the armpit and ending with the ankle. From the inside of the thigh, we impose along the entire length of the leg, starting from the inguinal region.

Do not let the person make sudden movements. Transport only when lying down.

A fracture of the pelvic bones is characterized by the fact that the victim is forced to be in the “frog” position (with half-bent legs spread apart to the side). Movement is significantly limited. Sharp pain in the pelvic area, which increases when trying to bring or spread the legs. Often with such an injury there is a noticeable hematoma, a significant swelling.

A pelvic fracture can be complicated by damage to internal organs: the bladder, urethra. This is indicated by abdominal pain, blood in the urine, painful and/or uncontrolled urination.

The shock of pain and trauma leads to an extremely serious condition of the victim. Before the doctors arrive, it is necessary to reduce the pain syndrome with any painkillers. A roller should be placed under the pelvis, which can be made from clothes or a blanket. You can also tighten the pelvic area with a towel, but do not overdo it. This will help reduce the potential for internal bleeding and pain.

If it is necessary to move, the transfer is possible only in the “frog” position. In this case, the person should be placed on a round hard object (shield). Transport only in the lying position.

How to recognize this type of lower extremity injury? Before you pay attention to the following symptoms:

• Pain can occur both at the time of injury, and after a few hours. However, if you touch the injured place, then there will be a strong, sharp pain. This feature is typical only for small fractures that occur without displacement of the bone.
• Also, on palpation of the ankle, a slight crunch is a reliable sign of a fracture. It is accompanied by severe pain.
• Changes in the skin - swelling, swelling, bruising and loss of sensation.

The danger of such an injury lies in the fact that if you do not provide assistance, then the victim will experience a traumatic shock after a while. It is characterized by pale skin, pressure surges, "heavy" breathing.
To prevent this condition, you need to give the victim analgesics. Immobilize the injured limb by any available means. Cold compresses or ice may be applied to relieve pain. Make sure that the person does not make sudden movements and does not try to get up.

If the fracture is open, then cover the wound with a clean cloth. Apply a tourniquet, above the injury, with arterial bleeding. By placing a roller under your foot, you will provide an elevated position. It will reduce bleeding and relieve pain.

Do not attempt to repair a broken ankle on your own. Only a traumatologist can do this correctly.

Such an injury is characterized by a state of shock. Usually it corresponds to 1-2 degrees of severity. Edema, hematoma and deformity occur in the area of ​​injury. Soreness during exercise, blood supply worsens, which leads to a decrease in the temperature of the limb. On palpation of the thigh, mobility of the bones or their fragments can be detected. motor functions are completely broken. On the foot, the pulsation of the arteries becomes worse.

First aid is to bring a person out of a state of shock. To do this, conduct analgesic therapy with medications and immobilization (immobilization) of the injured limb. Pain shock can cause heart rhythm disturbances. In this case, you can give a person heart medications (validol, motherwort).

Fixation should be carried out immediately 3 joints. We start to apply a splint from the hip area, then we fix the knee joint, and finish with the ankle joint. If there is nothing suitable for the tire at hand, then you can bandage the sore leg to the healthy one. You can only move the victim using a rigid stretcher.

Dislocation of the lower leg

A dislocation is a displacement or separation of the articular ends of bones. It may be complete or incomplete. It can be caused by sudden movement, impact, injury, or movement that goes beyond the normal functioning of this joint.

The main features include:

• Sharp, severe pain.
• Restriction of mobility.
• Swelling in the area of ​​injury.
• Leg deformity.

Only a doctor can correct dislocations. Before going to the trampoint, it is recommended to fix the joint and apply ice.

The meniscus is a cartilaginous structure that is necessary to stabilize the knee joint. Such a diagnosis as a meniscus tear is often made in athletes. However, such an injury is also possible in older people due to arthrosis. It occurs with a sharp movement or constant flexion - extension of the knee.

When it is damaged, there is a sharp pain and swelling. The mobility of the knee is severely limited. In addition, the damaged area may feel warmer to the touch, and a clicking sound may be heard when moving. In young people, a blockade of the joint may occur, in which it is impossible to change the position of the knee. A person may experience painful discomfort when using stairs or playing sports.

You can alleviate the condition with a cold compress, which is recommended to be kept for about half an hour. The knee joint should also be immobilized or limited in its mobility. If the tear is incomplete, an elastic bandage will do. If you do not turn to a specialist in time, then a neglected meniscus tear may require surgery and a long period of rehabilitation.

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Dislocations in the shoulder joint are common hand injuries. A dislocation is recognized by the forced position of the arm and a change in the contours of the joint. The victim keeps his arm bent at the elbow joint and slightly abducted from the body.
The configuration of the shoulder joint is disturbed due to the fact that the head of the humerus is displaced anteriorly and downwards in relation to the articular cavity and a failure forms in its place. Attempts to move the joint cause sharp pain, the shoulder "springs" (Fig. 43).

Dislocations of the bones of the forearm in the elbow joint are less common. At the same time, a pronounced deformity of the elbow joint with a sharp protrusion posteriorly of the olecranon is noticeable. Movement in the elbow joint is sharply limited and painful.
First aid. It is necessary to hang a hand on a scarf and deliver the victim to a medical institution in a timely manner. It is impossible for a non-specialist to correct a dislocation.
Dislocation of the hip occurs with quite a lot of violence. The limb seems to be shortened due to the displacement of the thigh upwards (Fig. 44). A caregiver who does not have a medical education cannot accurately determine whether it is a dislocation of the hip or a closed fracture of its neck, which is much more common than a dislocation. With a fracture of the femoral neck, the leg will not be turned inwards, as is the case with a dislocation, but thrown back and turned outward, while mobility in the hip joint is much less limited than with a dislocation.
The victim should be transported on a stretcher, making the immobilization of the limb.
Dislocations in the knee joint are rare. They are recognized by a pronounced bayonet-like deformity of the knee joint with a protruding and standing at an angle to the axis of the limb patella. There is a sharp swelling and hemorrhage in the joint area due to rupture of soft tissues and damage to blood vessels.
First aid. Apply a splint from the fingertips to the groin and take the victim to the hospital.
Fracture of the collarbone occurs when struck directly on the collarbone, as well as when falling on the hand laid aside. At the site of the fracture, pain, deformation due to the displacement of fragments and hemorrhage appear. When feeling at the fracture site, the mobility of fragments and a crunch are determined. Hand movements become impossible.

Rice. 45.

Transport immobilization in case of a fracture of the clavicle can be achieved with the help of cotton-gauze rings, which are put on the area of ​​the shoulder joints and tightened behind with a rubber tube (Fig. 45).
The cotton-gauze tourniquet from which the rings are made must be thick enough, with a diameter of at least 5 cm, which ensures uniform, painless pressure on the shoulders. The inner diameter of the ring is made 2-3 cm larger than the volume of the shoulder joint.
For temporary fixation of the fracture, you can also use the eight-shaped scarf bandage. In the sitting position, the shoulder joints of the victim are retracted and fixed with a scarf. A cotton-gauze pillow is placed between the shoulder blades under the bound ends of the scarf, which contributes to an even greater retraction of the shoulder joints and stretching of the clavicle fragments. After immobilization with an eight-shaped bandage and cotton-gauze rings, you should hang your hand on a scarf.
Often, clavicle fractures are fixed with a Deso bandage. At the same time, the shoulder is slightly retracted, a bean-shaped cotton roll is placed in the axillary fossa, and the elbow joint is bent at a right angle. The hand in this position is bandaged to the body. First, several tours of the bandage clockwise bandage the torso and shoulder, then the bandage is removed from the axillary fossa of the healthy side, it is led through the chest to the sore shoulder girdle, it is lowered from behind along the shoulder blade to the elbow joint, it is wrapped around it from back to front, the bandage is brought out to the front surface of the forearm, it is carried out through the axillary fossa on the back, which the bandage crosses obliquely from the bottom up, and through the shoulder girdle of the injured side is lowered down along the shoulder, under the elbow joint back onto the back. Such tours are repeated several times. A broken collarbone can be fixed for a short time with a stick placed behind the back. The arms, bent at the elbow joints, are pulled back and held in this position with the ends of the stick (Fig. 46). All manipulations must be done without gross violence, remembering that there are large blood vessels under the collarbone that can be damaged.

Rice. 46.

A closed fracture of the humerus can occur in its various departments. Active shoulder movements are almost impossible and sharply painful.
With a fracture of the shoulder in the middle third, a more pronounced deformity and shortening of the limb due to the displacement of fragments are observed. The shoulder in the area of ​​the fracture is thickened, abnormal mobility and a crunch of fragments rubbing during movement are determined. Attempting to move a limb to check for a crunch is dangerous and contraindicated.
First aid. Even if a fracture is suspected, a splint or immobilizing bandage should be applied with a scarf or bandages. In case of a fracture of the shoulder, it is necessary to fix three joints: the shoulder, elbow and wrist.
The basis for providing first aid for fractures is to create immobility (immobilization) of the ends (fragments) of the damaged bone, for which splints are used, which can be made from any available material - plywood, boards, metal wire (in the form of a mesh or ladder), etc. .d. The tire must be applied so that immobility is achieved in the two joints adjacent to the fracture site (above and below the fracture site). A soft pad of cotton wool or fabric is placed under the splint in places of bone protrusions. The tire is covered with cotton wool and wrapped with a bandage to relieve its pressure on the fracture area, and then bandaged to the injured limb.

Rice. 47.

From improvised means for a fracture of the shoulder, you can use strips of thick cardboard, as well as twigs of a bush. In the absence of improvised means, the injured limb can be hung on a scarf and bandaged to the body, while a dense ball of cotton should be placed in the armpit.
Transport immobilization for a shoulder fracture is best and easiest to do with a Cramer ladder splint (Fig. 47) if available.

The bus is pre-modeled on a healthy hand. Stepping back from one end of the splint to the total length of the forearm and hand, the splint is bent at a right angle, leaving enough space at the top of the angle for a soft lining that protects the splint from pressure on the elbow joint. Then the shoulder length is measured and this length is increased by 2-3 cm, bearing in mind the thickness of the cotton-gauze lining. Carefully model the section of the tire adjacent to the shoulder joint. To do this, the splint is bent at an angle of 115° and slightly twisted along the axis so that it fits snugly against the shoulder joint and repeats the shape of the interscapular space, ending at the edge of the opposite scapula. The segment of the tire lying on the shoulder joint, and the one that supports the forearm, are bent in the form of a gutter. This is achieved by alternately bending the transverse thin bars of the tire. They also make a bend that eliminates tire pressure on the neck.
It is convenient to bend the tire, resting it against the edge of the table. After preparing the tire for application, the shoulder is somewhat taken aside, a cotton-gauze roller is placed in the axillary fossa, having the shape of a bean measuring 15 x 10 x 5 cm. bandage. The arm, bent at the elbow joint at a right angle, is placed on the splint. To the corners of the end of the tire, located on the back, two ribbons made of a bandage are previously tied. The front ribbon is thrown over a healthy shoulder girdle and tied to the front corner of the lower end of the tire. The back ribbon is carried under the arm and tied to the inner corner of the tire. The neck and shoulder girdle are protected with cotton-gauze pads. The tension of the ribbons should be such that the arm is kept bent at the elbow joint at a right angle.
The tire is bandaged from the brush. It should be tightly fixed in the area of ​​the shoulder joint. The tours of the bandage in this area are arranged in an eight-shape, passing through the axillary fossa of the intact side. The upper end of the tire must be fixed so that it does not slide down on the back of the victim's head. This is achieved by throwing the tours of the bandage over the shoulder girdle anteriorly and be sure to draw them around the body (Fig. 48).

Rice. 49.

Forearm fractures. The forearm is made up of two bones: the ulna and the radius. Their fractures can be very diverse: isolated one bone or two at once at the same or different levels. The most typical fracture of the radius in the area of ​​the wrist joint. Such fractures are often observed in drivers from hitting the crank due to recoil when starting the engine. To avoid damage, do not clasp the handle with your thumb, but place all fingers on one side of it.
Signs of a fracture of the radius in a typical location: pain, localized in the lower part of the beam, and bayonet deformity of the forearm due to the displacement of fragments (Fig. 49).
In case of a fracture of the forearm, two joints must be fixed - the elbow and the wrist. To immobilize a fracture of the forearm, as well as a fracture of the shoulder, it is best to use a Kramer splint. The elbow of the injured arm must be bent at a right angle, and the forearm must be turned with the palmar surface towards the body. The Kramer tire is bent at a right angle at such a level that the forearm and hand fit freely on it. The transverse bridges of the tire are bent in the form of a groove, which helps to fix the forearm in the correct position - with the palmar surface facing the body. A rather thick cotton ball in the form of a ball is placed under the palm, which is bandaged to the brush covering it. The tire is applied from the fingertips to the upper third of the shoulder. She is bandaged and her hand is hung on a scarf. In the absence of wire tires, you can use improvised means - plywood or cardboard. Cardboard soaked in water and bent in the shape of the shoulder and forearm is fixed with a bandage.
With a fracture of the radius in a typical place, one can limit oneself to immobilizing the forearm with a plywood splint from the fingertips to the elbow. The hand and wrist joint are given a physiological position, a cotton pad is placed under the palm.
Hand injuries complicated by damage to bones and joints also require immobilization. At the same time, it is necessary to remember the important and diverse functions of this body. In the rest position, the wrist joint maintains a slight dorsiflexion, and the fingers remain in a half-bent position. The thumb is abducted and has the ability to oppose all other fingers - this provides a grasping function of the hand. When immobilizing the hand, it is necessary to maintain its functionally advantageous position.
hip fracture. The femur is the largest bone in the human body, it is surrounded by a whole array of muscles in which large blood vessels and nerves pass. When the femur is fractured, the surrounding soft tissues are also destroyed at various lengths.
Damage to the vessels is accompanied by significant hemorrhage. Blood accumulates in the cavities formed during muscle ruptures. Internal hemorrhage and severe irritation of damaged nerve endings often cause a general painful reaction of the body to injury - shock.
Hip fracture occurs with a sharp impact of significant mechanical force, which is most often associated with a collision with vehicles, a fall from a height, a strong blow to the leg with a heavy object.
The victim complains of severe pain in the area of ​​the fracture, the inability to step on his foot. In the area of ​​the fracture, curvature, abnormal mobility and a crunch of rubbing fragments are determined. Depending on the nature of the displacement of bone fragments, the femur can be shortened and bent at an angle.

Rice. fifty.

First aid. The victim must be given painkillers and immobilize the limb. Immobilization of a hip fracture significantly reduces additional tissue trauma and is of great importance, as it prevents severe complications associated with the transportation of the victim. Among these complications, traumatic shock is the most common.
Proper immobilization in many cases eliminates the compression of blood vessels, improves blood circulation in the affected area and thereby increases the resistance of injured tissues to infection. Rest plays an important role in the preservation of blood clots that clog damaged vessels, which helps prevent secondary bleeding.
For immobilization of hip fractures at the scene, it is often necessary to use improvised materials (Fig. 50).
Two tires are made from improvised means: the inner one - from the groin to the heel and the longer one - the outer one, from the armpit to the groin. Both splints are tied to the leg and torso with a trouser belt and bands torn from clothing.
In extreme cases, when there are no objects that can be used as splints, it is necessary to tie a broken one to a healthy leg.
Fractures of the lower leg vary in nature and severity. The most severe are fractures of both bones, at the level of the middle or lower third of the leg.
No less severe are fractures of one tibia at the same levels.
Isolated closed ankle fractures are considered milder.
Signs of a fracture of the middle part of both bones of the lower leg: severe pain, deformity of the lower leg, thickening, curvature of it, pathological mobility and a crunch in the area of ​​the fracture. On the anterior face of the tibia, a protrusion of one of the fragments is often felt.
With a fracture of one tibia, the same phenomena are noted, but the deformity is less pronounced, since the preserved fibula serves to some extent as an “internal splint” and prevents a sharp displacement of fragments of the damaged tibia. The tibia is covered in front only by skin, which is easily pierced by the sharp end of the broken bone and the fracture can become open.
When the ankle is fractured, pain occurs in the area of ​​​​the outer or inner ankle, swelling, hemorrhage, a sharp limitation of movement in the ankle joint and the inability to step on the foot.
First aid. Put on a splint, give an anesthetic.
Metatarsal fractures occur when hit by heavy objects falling on the foot, when hitting the wheel of a wagon or car, etc.
Signs of a fracture: pain in the dorsum of the foot, a rapid increase in edema and hemorrhage, the inability to stand on the toes.
First aid. Immobilize the foot and ankle joint. In the absence of improvised means for immobilizing the foot, you can use a scarf.
Wounds of large joints (hip, knee, shoulder, elbow) are a severe injury, very often leading to disability, and pose a threat to the life of the wounded. The most severe are wounds with a large destruction of the articular surfaces, complicated by infection.
A joint injury is recognized by pain during movement, swelling in the joint area, smoothness of its contours, and a sharp limitation of movement.
First aid: apply a sterile dressing to the wound, give an anesthetic and immobilize the joint well.

Video: First aid for eye damage.

Traumatic injuries of bones and joints are observed due to the influence of certain factors environment. In medicine, such injuries are divided into several types. Therapy for violation of the integrity of the joints and bones of the limbs depends on the type of damage diagnosed in the patient. A cast, tight bandage, or splint may be used.

Types and symptoms of injuries

Articular damage

In medical practice, it is customary to classify injuries of the joints of the extremities as follows:

• Soft tissue injury. Patients note the appearance of pain, hematoma. In the place where the muscle tissue has torn, a retraction appears.
• Tendon injury. When a muscle contracts, a person notices a sharp and severe pain. In addition, a crunch appears in the injured limbs, muscle tissue is weakened.
• Joint damage. Patients complain about pain in the area of ​​the joint. Sometimes there is hemorrhage.
• Sprain. There are severe pains in the affected area, the joint swells, but its function is not disturbed.
• Meniscus injury. Patients experience pain in the joint. Possible hemorrhage. At the same time, the contours are smoothed, during probing and movements, the pain syndrome intensifies.

Bone injury

If we talk about damage to the bones of the limbs, then they are classified depending on the origin:

Trauma to the musculoskeletal system may be the result of childbirth.

• Congenital. They develop when the fetus is in the womb. They are associated with imperfect bone formation.
• Acquired. They can be observed both during childbirth and during life.

In addition, bone damage is divided into the following types based on the causes:

• Traumatic. Develop due to strong mechanical impact.
• Pathological. The reason is various neoplasms, metabolic failures, purulent-necrotic process in the bone and bone marrow, the appearance of cavities in the spinal cord.

According to the condition of the integumentary tissues in the fracture area, bone damage is classified as follows:

• open;
• closed.

With a fracture, there is severe pain in the injured limb. Edema appears, sometimes the bones can move. Disturbance of the work of the legs or arms occurs during each fracture. In exceptional situations, doctors diagnose limb shortening, which is associated with displacement of bone fragments due to muscle contraction. If the fracture is open, the skin is injured, through which bone fragments and blood protrude, swelling appears.

Causes of damage to bones and joints of the limbs

Lifting heavy objects can injure tendons or ligaments.

If we talk about hematomas and bruises of soft tissues, then they appear when falling, hitting. Injury to the tendons and ligaments is noted with a sharp contraction of the muscle, most often due to the lifting of heavy objects. Athletes and porters suffer most from this. The following factors can provoke fractures of the bones of the limbs:

• household injuries;
• falling from a height;
• car accidents;
• weight loss on limbs.

Diagnostic measures and treatment

In case of damage to the limbs, it is important not to delay a visit to a medical facility. First of all, the traumatologist will interview the patient, after which he will send him for an X-ray examination, which will distinguish between joint injury and bone fracture. Sometimes a patient needs to undergo a CT scan.

If there is no opportunity to visit the hospital in the near future, and soft tissue damage is observed, in such a situation, first aid is required:

1. Leave the injured limb alone.
2. Apply ice to it.
3. Bandage tightly.

After four days, you can apply a warm heating pad to the damaged area.

After these manipulations, you will need to visit a doctor as soon as possible or call an ambulance. The specialist will prescribe treatment, which includes the use of warm compresses and a heating pad, when 4 days have passed after the injury. Often the patient is sent for physical therapy. If suppuration of the hematoma occurs, then the abscess will need to be opened.

When the muscle is completely torn, they resort to surgical intervention and sew it together.

In case of joint damage, a plaster cast is applied for 2 weeks, after which physiotherapy and heat treatment are prescribed. If there is a fracture of the limb, first of all, she will need to create peace and stop the pain syndrome, for which it is recommended to use painkillers. During an open type of injury, you will need to stop the bleeding. Do this with a tight bandage or tourniquet. After that, the limb should be immobilized in order to prevent displacement of bone fragments and reduce pain. For these purposes, even improvised means, for example, boards, are suitable. The arm is fixed to the body, and the leg is fixed to the healthy leg. Then the patient is taken to a medical facility, where a plaster cast is applied to the injured limb. The duration of stay in it depends on the location of the fracture and its severity.