Break that injury of the upper limbs. Traumatic dislocation
THEORETICAL LESSON PLAN
Date: according to the calendar-thematic plan
Number of years: 4
Topic: VIVIHI, BROKES THE BOTTOM OF THE UPPER AND LOWER KINTS.
Primary occupation type:
a lesson in the development of a new initial materialType of initial occupation:
lecture, explanationTsіlі navchannya, razvitku that vyhovannya: give knowledge on the topic.
Forming: knowledge about vivihi and fractures of kintsivok, their clinic, diagnostics, PMP, insight and principles of excellence. .
Rozvitok: svidomosti, thought, memory, mov, emotions, will, respect, vitality, creativity.
Vihovannya: pochuttіv that osobistnosti (momentary, Narva, aesthetic, labor).
After mastering the initial material of the academic responsibilities: nobility clinical manifestation of vivihiv and fractures of kintsivok, principles of their diagnostics, application of PMP, insight and principles of excellence;
remember to give PMP in case of injuries of the kіntsіvok, to prepare before the operation and zdіysnyuvati postoperative management of patients.
Material and technical support of initial employment: equipping the surgery room of the college (presentation, tables 66-78 from vivivi; from fractures - 81, 142, 143, 167), situational task.
Interdisciplinary and in the middle of disciplinary links: anatomy, physiology, traumatology, pharmacology
Actualize and understand that purpose: vivices and fractures of the bones.
HID ACTIVITIES
1. Organizational-spiritual moment: rechecking turnout for employment, old look, save the zahista, dress, familiarize yourself with the plan of the lesson 5 whilin.
2. Training of students - 10 whilin.
3. Knowing the topic, nutrition, setting the initial goals and tasks - 5 whilin;
FOOD:
Vivihi povny and not povny, simple and complicated, vіdkritiy;
Born, fresh, stale, old;
Vivihi clavicle, shoulder, front shoulder, quilt, feet, fingers, lower slit;
Peculiarities of vivivivi in children. Congenital vivix stegna. dispensary;
mechanism of injury;
Clinical and instrumental methods of follow-up in trauma.
The main ambush of rejoicing. Volume of the first medical help. Transportation.
Organization of the nursing process
4. Presentation of new material (conversation) - 50 hwilin
5. Fixing the material - 5 whilin:
6. Reflection - 10 minutes.
7. Homeworker - 5 whilin. Together: 90 whips.
Homework:, store 308-348; , Store 329-337, 707-728; , page 272-273, 274-281, vlasny abstract, materials for the site www.site
Literature:
1. L.I. Kolb iz spivavt. Assistant: "Private Surgery"
2. I.R.Gritsuk "Surgery".
3. L.I. Kolb iz spivavt. Assistant: "The sister is on the right at the surgery."
4. Workshop: "Surgery in tests and tasks"
6. BDMK website: www.site
7. Special website of the vikladach: www.moy-vrach.ru
II/III-1 VIVICHI, BROKEN THE BONES OF THE UPPER AND LOWER KINTS.
Vivih- Damage to the congruence of the subglobular surfaces of the brushes, as a result of damage to the integrity of the subglobal capsule (as a rule!), So without damage, under the influence of mechanical forces (trauma) or destructive processes in the subglobular (arthrosis, arthritis).
The reason for the vivihu: the test of ruhіv in sugly does not show any physiological possibilities.
Classification
Behind the stage of adoption:
Vivih can be equal (there is a difference between the snowy slopes) and incomprehensible - subdivided (the snowy surface is left behind in the private zone). The distal (far away from the tubule) part of the kink is taken into account. Call Vivihu!
Vinyatki to become:
ridge - vivikhnutim vvazhaetsya thicker ridge.
clavicle (dividing the sternal and acromial end of the clavicle, but not dislocating the scapula).
the shoulders are separated by the anterior, the lower and the posterior. Zalezhno v_d usunennya brushes.
For a hike
Recognize congenital and nabuti vivihi:
Vrodzhenі
Such failures are blamed on the wrong intrauterine development of the fetus; underdevelopment of the loamy depression of the head of the stegna (dysplasia). Congenital vivice is most often indicated pelvic loins(2-5 per 1000 newborns), rіdshe - rivihi of the knee, knee mound. Congenital vivix stegna. In infants, the wiggle stipe shows asymmetry of folds along the inner surface of the stegon, the borders of the introduction of the legs are thin; if a child starts to walk and p_znіshe - kulgavіst and appreciably shortened one of the lower ends, with a two-sided vivihu - "kachina" walk. The birth of a dislocated knee is manifested by pains, a new unruliness of the gloom, yogo inflamed, hemarthrosis; it is bad for children to walk, often to fall. The treatment of congenital vivihu stegn (adjustment, application of special tires or plaster casts) may start earlier - the best results are given in children 3 months, but it is possible and up to 2 years. With the ineffectiveness of such treatment in 2-4 years - a surgical operation. Prevention: orthopedic obstezhennya new people. It is not possible to speak tightly (and then call more), forcibly straighten the legs, put the child in front of the hour (earlier, the child will stand on the legs herself).
Prydbany
The stench is blamed for injuries - traumatic or for illnesses (osteomyelitis, poliomyelitis and other) - pathological, or mimic.
mechanism of injury;
Traumatic dislocations in most cases are caused by an indirect injury, if the force is stagnant in the distance from the ear loam (for example, if you fall on the wrist of a twisted arm, you will see a twist at the shoulder loam). The cause of a traumatic vivice may be a sharp shortness of the m'yaziv, which is called a turn, which goes beyond the boundaries of the normal friability of the loam (for example, the rupture of the lower slit in the supra-mundane vіdkrivannі rota). Significantly, it is more appropriate to blame the vivihi for direct injuries - a blow near a driftwood plot. In children of ages 1-3, they are so called “vivihi vіd vityaguvannya”, which is blamed on the swamps (shoulder, elbow) for a sharp pull of a child by the hand (if you lead by the hand, you stumbled). Viyavlyayutsya severe pain in the dilyantsі suglob, deformity, damaged or second damage.
When vivikha, you may always need to open the capsules of the suglobs, you can have a shkodzhenі tendon, m'yazi, brushes, judges and nerves; such vivikhs are called aggravated. Vivihi can be closed - without shkiri over the loam and open, if the wound is established, it penetrates the empty loam. Sometimes, after a significant stretching of the bag of snow and a tie at vivihu, and also without the correct jubilation of vivikha, you will be blamed again for a small zusill. This is the title of the primary vivix (the most common in the shoulder joint).
Pathological dislocation is often blamed on the hip joint shoulder swamps sound in the aftermath of the ruynuvannya of the sallow surfaces in the aftermath of the pathological process; Paralytic vivix is associated with paralysis or paresis of otochuyuchih suglobiv m'yazyv. Tsі vivihi blame without a commemorative zastosuvannya zovnіshnoї force, nіbi mimely, for example, at the hour of walking, turning into a lizhku thinly.
Clinical and instrumental methods of follow-up in trauma.
Clinic:
Bіl u suglobі
Deformation
Exchange of rubbish. Another characteristic against the background of the fencing is the spring ruhi.
Swollen in the swamp
Can buti synci, hematomas and hemarthrosis
Change of dozhini kintsivka
Celebration
Vivihi clavicle, shoulder, front shoulder, quilt, feet, fingers, lower slit;
persha dopomoga
Fixation of the poshkodzhenoy kintsivka with a braid, with a thin tire (immobilization). Cold on the affected area. Delivery to the likuvalny mortgage for the restoration of the vivihu.
Small wives can be set independently, as a result of which the presence of the broken brushes is instilled. Repositioning back to the mechanism of injury. Correction of suglobovyh kіntsіv be carried out only by a doctor, in order to eliminate the additional traumatization of tissues in the wake of the establishment of a diagnosis of further immobilization; nadali - functional exuberance (gymnastics, massage toshcho). In case of old vivices (3 days after bad day) - surgical operation. In case of pathological vivikha - exuberant illness, which led to vivikha. For the restoration of the function, a surgical operation is required.
Repositioning methods
The correction of the vivuhu is simpler, the more the swamp is dryer, that it is corrected. Іsnuє kіlka of the most wide-ranging methods of repositioning vivivivi. For example, a dislocated shoulder, as one of the most widespread injuries of this type.
Method of Hippocrates - Cooper.
Kocher's method.
Way of Dzhanelidze.
In a whole ninth qi, methods of directing the spiving of the brushes in the loam with additional repetition in the reverse order of the path, which passed through the twisted brush. That is, as if twisting the shoulder, standing after a fall on the open arm and the shoulder brush shifted upwards and medially, then to correct the twisted lіkar, I apply force so that the brush shifts down and laterally, so that it repeats its path in the reverse order.
It is important to correct the vivihu stegna without stagnation of muscle relaxants, or the presence of one or two physically mental helpers. The M'yazova group is the most massive among the kulshovy loam, which makes it easier to adjust.
Transportation. Div. little ones like lectures
Rehabilitation
The order of rehabilitation visits is determined by the doctor depending on the severity of the injury. As a rule, physiotherapy is prescribed. Prescribed golovkolyuvannya, low frequency promenі, massage m'yazіv electric discharges. I will have to take a course of resurrection, at least a month later. For a simple person, it is necessary to turn into a normal state of driftwood with patience and diligence for no more than a month. For professional athletes, you need more attention. The first month was followed by the maximum change in the number of vanishing on the battlefield. After the likuvannya go to the step-by-step approach to the swamp, tobto: Zvichayne wrapped in swamp. Two days later, you can move on to gymnastics from vagami. You can take a milk, a vag of 1 or 3 kilograms and zdіysnyuvat tі ruhi on a stake, which is in the first two days. Step by step, with a stretch of the day, go to more serious vag (add 1 kg per day, marveling at what vag you came out of) and, with permission, go to the right on the crossbar.
For the cob, you just need to hang on it. So, just like on the cob of rehabilitation, for two days it’s ready to go to such an adventure. For a stretch of two days, it is necessary to lightly roam. Try pidtyaguvannya. Ale just try, don't finish until the end. On the third day, you can gently pull up. No more than three times for pidkhid. Incrementally increasing the vanity, to bring three approaches in the end of the month, with the first two 3 times, and the rest 7. To make things easier, you can buy a shoulder orthosis. Sold at sports shops. On the third day, you can advance to the skin approach for a day, adding to all of them once. The fourth week passes just like that. Move up to 15 times for pidkhid, you can work folding right.
Forecast
The prognosis of illness is susceptible. For adequate therapy, there is a need for more renewal of practice.
Break the brushes of the upper and lower ends
FRACTURE - tse damage to the integrity of the cyst, viklikana physical force (traumatic fracture) or pathological process (pathological) fracture. There are two mechanisms responsible for traumatic fractures: direct and indirect.
CLASSIFICATION OF FRACTURES
FROM LIKE fractures are divided into:
- born,
- Prydbani.
a) traumatic
b) pathological.
For the presence of POSHKODZHEN M'YAKIKH FABRICS:
- Vіdkritі,
- Close.
FOR THE CHARACTER OF THE POSSIBLE BRUSH:
- Look,
- inconsistent (fractures, subdocumentary fractures on the “green streak” kshtalt, margins, dirchasts.
Z STRAIGHT LINE FRACTURE:
- Transverse,
- braid,
- Late,
- sparsely,
- gvintopodibni,
- beaten.
- compression.
For the obviousness of the change of the cystic ulamkiv:
- zі zmіshchennyam (by width, dovzhinі, pіd kutom, rotation),
- without sleepiness.
FOR THE POSSIBILITY OF VIDDILA KISTKA:
- diafizarnі,
- metaphysic,
- Epiphyseal.
For quantity:
- Alone,
- multiple.
ROZVITKA SETTLEMENT:
- aggravated (traumatic shock, fat embolism. Poshkodzhennya internal organs, nerve damage, development of early surgical infection),
- Don't make it hard.
FOR THE STAGE OF FOLDING POSHKOZHENNYA:
- sorry,
- folded (accompanied by the opening of ligaments, capsules, or by the adoption of cystic ridges).
CLINICAL SYMPTOMS
Divided into absolute terms.
ABSOLUTELY- all symptoms, the manifestation of one of which is sufficient for establishing a diagnosis. Before absolute symptoms lie:
- pathological friability,
- crepitation of cystic ulamkivs,
- deformation along the axis of the tip (change of configuration, rotation, raising or shortening of the tip, as well as palpation of the usunennya of the cystic ulama).
VISIBLE CLINICAL SYMPTOMS J:
- bіl, which is to be of a constant character and is strong in Russia and in case of navantage along the axis,
- hematoma at the fracture site,
- A bunch of soft fabrics,
- Vimushene position kintsivka,
- Impaired function of the tip (painful rupture and rupture, the patient cannot stand relying on the tip, tearing it off the surface of the bed).
Skin fracture may have local and systemic consequences. Up to local heritage
- ushkodzhennya shkir, which destroys the mechanism of infection against the infestation of pathogenic bacteria,
- meaning poshkodzhennya m'yazіv, scho leading to the destruction of the bleeding of the brush,
- Intrata cystic substance leading to a defect in the cyst,
- rupture of the nerve - to the destruction of motor skills and sensitivity,
- opening the judge - before spending the end
SYSTEMS OF INSTRUCTIONS of fractures are assigned to us in front of the loss of blood. The amount of blood loss to lie down depends on the complexity of the fracture, its location and the usunennia of the cystic ridges.
FIXED FRACTURES
traumatic shock
Fat embolism
Bleeding
In case of a fracture of the stenocyst, the blood loss reaches 2000 ml,
- homilka brush - 600-1000 ml,
- shoulder brushes - 300-700 ml,
- brushes beforehand - 100-300 ml
Poshkodennya nerves
Development of wound surgical infection
PRIVATE FOOD BREAKING:
Shoulder
Before the name
Penzlik
Stegna
Shiyka stegna
Gomilka
Foot
FIRST MEDICAL SUPPORT.
- Carry out a blood test,
- make wounds, apply aseptic dressings,
- Carry out an analgesic (introduce analgesics or robiti case blockade),
- put on immobilization tires,
- cold on the fracture site,
- Carry out anti-shock therapy.
LIKUVANNYA BROKES
In healing fractures, 4 stages are seen:
- reposition,
- retention,
Immobilization
- rehabilitation (restoration of functions)
In case of COMPRESSION-DISTRACTION OSTEOSYNTHESIS, needles are inserted through the tubular parts of the cyst after the fracture zone in different planes. The spokes are fixed on the rings and pins of the Ilizarov apparatus.
WHEN OPERATIONAL RESTORATION, fractures of the usunennia of the cystic ulamkiv are made for the help of various metal structures. For osteosynthesis, vikoristovuyutsya metal spokes, wood splints, plates with bolts, screws, flowers. After 8-12 months, during a repeated operation, the brushes of the construct are removed.
Distinguish between symptoms and reliable (insane) clinical signs of fractures. Painfulness, swelling, deformity, impaired function can be seen to the point of possible signs. To reliable - pathological fragility and crepitation of the ulamkiv. Bil - a constant subjective sign - blames, as a rule, for a fracture, which can be strengthened during tests to the point. To fix the pain, fix the retal palpation with one finger, carefully, on the front of the fracture. Pain is localized in one area and is an important sign. Її can be attributed to light tapping on the axis of the tip, for example, with a slight blow on the five ailments, it can be seen in the case of a fracture of the leg or homil. The swelling is bubbling with hemorrhage, hematoma, broken blood, lymphatic tissue, swollen tissue. Colo kіncіvki zbіlshuєtsya against healthy іnоdі in 1]/2 times. When looking around, the deformation of the kіntsіvka is visible, to lie down in the form of a usunennya ulamkіv under the hood. It is possible to twist the ending of the shortened її. The peripheral end of the end can be rotated at the other side (rotational adoption). The damage to the function is judged by how much the preservation of active damage is. As a rule, in the face of injuries, ailments can not collapse with a stroke, but partly through expressions of pain. To a recumbent ailing person, pronounce the robit with the foot, with a penzle, or bend the tip in the suglob (elbow, knee, shoulder). Indulge in a test of the rush, calling out the expression of the bіl. Pathological fragility is a reliable sign of a fracture. Viyavlyat її it is necessary to be careful, so as not to cause an unnecessary fracture of the tissue. Even more protectively protect the periphery of the kіntsіvki and watch for fragility near the fracture zone. Swinging ruhi in the area of the stegna, shoulder, gomilka, front shoulder indicate the presence of a fracture. Creation of the ulamkiv is signed by hands. Fix the tip higher and lower the fracture and move it to one side, then to the other side. Appearing a crunch of ulamkіv, rubbing one against one, is an absolute sign of a fracture. Through the trauma of the tissues until the manifestation of these two symptoms, they should go into the vignonous depressions. Vіrogіdnі signs of vivihu: - Deformation of suglob. Tsya sign is especially pronounced, as if the vines were in the loam, sharpened by a small amount of soft fabrics: kolіny suglobі, in homilk-stop suglobi, vivix of the clavicle; in case of dislocation of the shoulder, sound on the eye, remembering the trapping of soft tissues at the projection of the shoulder hump. - damage to the axis of the tip: in case of dislocation of the shoulder, the sprat is left sounding; at the posterior vyvihu in the coulter loam, it was stegly introduced and rotated to the middle. - Spring fixation of a twisted kink in case of passive damage, which is accompanied by pronounced pain: in case of a shoulder rupture, the hand is sharply ill, the hand after trying the insertion takes a lot of position.
More after the topic number 5 Dostovirnі and imovіrnі signs of fracture and vivihu.
- № 100 Reliable signs of internal bleeding at the stages of medical evacuation.
- № 129 Reliable signs and symptoms of penetrating injuries of the chest, various types of pneumothorax.
- № 131 Classification of hemothoraxes, reliable signs and signs of hemothorax.
- № 6 Complication of closed fractures and vivious, their prevention.
- 9. SEE MECHANICAL POSSIBILITIES: SADIN, BLOOD TECHNIQUE, WOUND, VIVIHI, FRACTURES, RESEARCH OF INTERNAL ORGANIES
- № 122 Carrying out of medical sorting, examination of the first medical and qualified medical assistance suffered from closed and severe fractures of the bones of the kintsivok, traumatic dislocations.
Hammer shoulder. Biggest common cause direct injury.
clinical picture. Skargi for bіl near the dilyantsі suglob, obezhennya active ruhіv; passive savings in total obsyazheni. When looking around, there is swelling of the soft tissues, followed by hematomas, on palpation - diffuse soreness in the area of the snow. X-ray cystic changes do not appear. With internal nodular hematoma (hemarthrosis), the nodular fissure is expanded.
Likuvannya. Apply a Deso dressing for 2-3 days. In the first place, to the area of snow, apply mihur with ice, then carry out physiotherapeutic procedures (solux, diathermy), and liquor physical culture. For the presence of hemarthrosis, puncture of the loam, pumping blood and introducing 10-20 ml of 2% novocaine into the empty loam are indicated. With a slight accumulation of blood in the globule, the puncture is repeated.
Stretching and tearing the ligamentous apparatus of the shoulder joint. Most of all, they are afraid of falling on the hand that is pulled out.
The clinical picture is to lie down in the river ushkodzhennya. When stretching the ligaments, there is local pain in the projection zone of the ligaments (sound the anterior surface of the humeral glottis), and there is an exchange of active ruptures. X-ray cystic changes do not appear.
Likuvannya. At the zone of ushkodzhennya, inject novocaine. Bandage Dezo zdіysnyuyut immobilization of the hand. In case of significant failures, the tip is placed on the tire, which should be introduced. After 3-4 days, physiotherapy procedures (solux, diathermy) are prescribed, and liquor gymnastics is dosed.
Fracture the shoulder brush. Watch out for direct injuries, as well as when you fall on a twisted tip.
Fallow, equal to the fracture, there are internal and angular fractures (fracture of the head of the shoulder and fracture of the anatomical neck), postarugular (through tubercular fractures and epiphysiolosis in children); fractures of the surgical neck, a fracture of the diaphysis of the shoulder, and in the lower third of the shoulder - supraventral and supramyoclar fractures, fractures of the lateral and internal supraventral fractures, fractures of the supraspinatus (lateral and internal), T- and V-like fractures.
According to the nature of the fractures, they are transverse, oblique, splintered and driven in.
For the last few views of the sky, there are shifts of the ulamkiv along the width and along the axis, or less along the length.
The clinical picture is to lie down in the localization of the fracture and the type of usunennya of the cystic ulamkiv. In case of internal nodular fractures, the head is free to lie in the nodule. The distal (peripheral) trick for the rahunok of the thrust of long-term m'yazіv poddyazhnuty burn down, for short one-segment m'yazіv of guidance and rotation of the name. When the great mound is blown, the rest of the shoulder is pulled forward and called, and the shoulder itself moves to the front and in the middle. In case of blowing a small tubercle, the sound is right at the gate.
In case of post-arbitrary fractures of the upper third, adductive and abductive fractures are distinguished. In case of adductive fractures, the central cunning takes the position of the introduction and the outer rotation, and the peripheral one shifts to the middle, in the proximal (central) direction, to the front and rotates in the middle. Having offended the ulamki, they make the kut, open the dose and to the middle (Fig. 172). With abductive fractures, the central coaxing of adductions and rotations is in the middle, and the peripheral one is in the position of introduction (Fig. 173).
In case of a fall on the elbow, fractures can be caused, if the peripheral cystic cunning goes into the central one.
There are no indications of any regularities in the dislocated cystic ulamkiev in diaphyseal fractures. Placement to lie in the line of the fracture, the cystic ridges and the force that caused the fracture.
In the fallow, the mechanism of injury of supraspinal fractures is divided into extension and flexion. An extensor fracture is caused by a fall on the palm of the hand when it is bent in the ulnar globule of the kіntsіvtsі. With this fracture, the plane of the fracture goes from the front and from the bottom to the back and uphill. Peripheral cystic tricks move backwards. In case of a flexion fracture, the fall goes to the maximum bending of the loamy loam, the area of the fracture goes from front to top, back to bottom. The distal trick is shifting to the front.
If there are clinical symptoms, then in case of fractures of the displaced cystic ulama, absolute signs of fractures are observed: tip deformity, crepitation of the cystic ridges, pathological friability and shortening of the kink. In case of fractures without displacement of the cystic ulamkiv (killed and beaten), these signs may be visible. Visible signs of fractures (damage to the function of the kink, local pain, hematoma and pain in the area of udder)
At vnutrіshnyosuglobovih fractures obov'yazkovo hemartorosis is indicated.
Likuvannya. Ailments from internal and global fractures without significant displacement of the cystic ulama, driven in and beaten fractures rejoice at the method of fixing the tip on the wedge-shaped pillow. Should I start a functional therapy earlier. From the first day of illness, it is guilty to carry out active hands with the fingers of the hand and in the promenade-wrist loam, and after a sprat of days - in the elbow and shoulder loam. After 2 days, the wedge-shaped pillow is removed and the ailments begin to heal the active ruhi from the great obsession. 
In case of adductive and abductive fractures in case of malignant diseases, it is possible to adjust the cystic ulamkiv with an advanced fixation of the upper tip on the insertion of the CITO splint (Fig. 174).
In cases of impossibility, at the same time, put in the cystic urethra, and also in case of diaphyseal fractures, for the formation of the cystic urethra, it is necessary to put in the neck or a skeletal vein.
The term of fixation of the upper tip in fractures of the surgical neck in adults becomes 4-5 tizhniv, in children - 2-. 2!/g tyzh, with fractures of the diaphysis of the shoulder - 6-7, 3-3Va tizh.
In case of failure conservative exuberance shows the operation of osteosynthesis.
The treatment of supra-growth fractures without displacement of the cystic ulamkiv is carried out on the overlays of the posterior plaster splint. In case of fractures of the displaced cystic ulamki, the cystic ulamki are folded on the back. In case of an extensible fracture, traction is carried out behind the front with one-hour flexion in the ulnar loam at a 90° angle and one-hour displacement of the central cystic ulamka backwards. After the setting of the cystic ulamkіv near the ulnar loam, the tip is folded at a 60-70 ° cut and this position is applied to a deep back plaster cast (longuet). In case of a flexion fracture, the braces should be broken in front of the shoulder, with an overly folded liquor loam with a one-hour supply of the central ulamka forward. On the vityagnuta kіntsіvka put a deep posterior gypsum splint. 
The middle term of fixation is 4-5 tyzhniv. Nadalі zastosovuyt likuvalnu physical culture and massage.
In times of impossibility to equalize the mitt of the bones, the tricks to stomp the skeletal winding of the elbow with the strings (Fig. 175). In case of failure of skeletal traction, carry out promptly likuvannya- Osteosynthesis.
In case of fractures of the veins and vertebrae, they are repaired, and then a V-like gypsum splint is applied to the shoulder area. In case of failure, prompt fixation with metal screws is recommended.
Break the brushes in front of you. Depending on the localization, there are such types of fractures: fracture of the ulnar joint, fracture of the crown joint, fracture of the head or neck promenev brush, diaphyseal fractures of the bones in front of the shoulder, fracture of the promenade in typical misc. Fractures can be blamed for both direct and indirect injuries.
Clinical picture. In case of a fracture of the ulnar bud, bil, bloody, swelling are indicated. When pal-paci ї mizh ulamki signify diastasis, rozginannya obmezhene. To clarify the diagnosis, x-rays in two projections are needed.
In case of a fracture (fracture) of the crown growth in the area of the ulnar fold, there is swelling, sometimes hemorrhaging, the maximum fold in the ulnar loam is covered.
In case of fracture of the head and neck of the promeneutic cyst, a local pain, swelling and hematoma in the external projection, scaling of the ruh in the ulnar humus, especially rotational ones, are observed. A radiograph is required in two projections.
In case of diaphyseal fractures of two bones of the anterior plate, pathological fragility, deformation of the anterior plate and all visible symptoms of fractures are observed. Diagnosis is not difficult. In case of an isolated fracture of the ulnar or promeneutic cyst, the cyst, which has taken away, viconated the supporting function, has a link with which the deformation of the tip and the disruption of the function are not clearly pronounced. Great diagnostic value may be local pain in the fracture zone during rotation (circular movement along the axis of the anterior plate).
In some cases, a combination of fractures and dislocations in different localizations is suspected. Most of them: 1) fracture of the promenopausal cyst, which is accompanied by dislocation of the head of the ulnar cyst (fracture of Galeacia); 2) fracture of the ulnar cyst and dislocation of the head of the promeneutic cyst (Montegi's fracture). The clinical picture in these types of fractures is composed of a combination of symptoms of fractures and vivious localization.
A fracture of the promenade in a typical area (the distal end of the promenitis cyst) is divided into two types: the extensor-distal fold shifts to the body and radially, the flexion - the distal fold shifts to the longitudinal side. In case of fractures without significant displacement of the ulama, local sickness and swelling are indicated. In case of a significant displacement, a characteristic stalk-like deformation is characteristic, straightened to the right side or the long side of the fallow in the form of a fracture.
Likuvannya. In case of fractures of the ulnar socket without displacement of the cystic ulama at the position of maximum expansion, a posterior plaster splint is applied for 2-3 days. Nadali assign likuvalnu physical culture. At the time of impossibility, the cystic cunning goes up to the surgical exaltation - the subdiffusion of the cystic cunning to the elbow brush.
In the case of the wind of the crown wind, it is possible to achieve the maximum recovery in the lichen loam with an advanced fixation of the soft or the plaster cast; fixation term 2-3 tyzh. Then we will carry out likuvalnu physical culture and thermal procedures. Massage is not indicated for patients with unsafe development of asymptomatic myositis. It’s impossible to repair the brush’s tricks, you can see it, so yak Vіn zavazhatime zginannya in lіktovomu suglobі.
At fracture of the head or neck of the promeneutic cyst without displacement brush ulamkіv robyat mіstseve nebolyuvannya i kіntsіvku fix when її zginannі in lіktovomu suglobі under direct kutom. In front of the shoulders, put the middle position between supination (the bellows are brutally burnt down) and pronation (the dales are brutally down). Fixation is carried out by the term on the 2nd day. Zastosovuyut likuvalnu physical culture for a year. In case of misplaced cystic ulamkiv, they are corrected. For whom, the hand in the elbow loom is opened and placed at the position of the significant introduction of the front name. Natikayuchi on the fragment, set yogo. Kіntsіvka vanish again and shatter її fixation. In case of failure of the correction, it is shown promptly - correction with fixation, and in case of fragmentation of the head - removal.
In case of diaphyseal fractures due to displacement of the cystic ulama, it is necessary to fix them. The hip is used with a rotational use of the distal ulamkiv, then the use of the width and width of the back. Two gypsum longuets are applied (tilna and dolonna), and on them - on round fingers (siskins), as they are pressed into the gypsum in order to open the brushes in front of the plate. The longuet is fixed with circular plaster bandages. Fixation is vibrated for 7-8 strokes. As if to repair the cysts, the tricks do not go in, to stop the operative treatment - osteosynthesis (in case of a fracture of one cyst - with one pin of Bogdanov, two brushes - two). The metal shears are removed after the hardening of the garnoy callus.
In case of a fracture of the promenade in a typical case after the mystical nephritis, the repositioning of the cystic ulamkivs is observed. For whom, it is necessary to delay the traction in front of the hand by the hand (the 1st finger and the other 4 fingers are clapped together); in front of someone to be on the table. The penzel bends down in the promeneo-carpal loom over the edge of the table. The surgeon with his hand holds the bone fragment to the beast to the bottom. For fixation, fix the back of the plaster splint. Term of fixation 3 tyzh.
Poshkodzhennya brushes brushes and fingers. Such ushkodzhennya traplyayutsya often. It is especially necessary to re-establish the anatomical integrity of the cystic apparatus, as in the other case of ailments one becomes disabled due to the impaired function of the cyst.
Fractures of the chovnopodіbnoi kistki are divided into two types - a fracture of the body and a fracture of the tuberosity.
Clinically, there is swelling and soreness in the area of the promeneo-zastkovy glomerulus, at the yogo radial edge. Sharply expressed local morbidity in the zone of "anatomical tobacco-kerki". Outwardly, the clenching of the hand into a fist is impossible through the pronounced sickness. To clarify the diagnosis, it is necessary to carry out an X-ray image in two projections with a single laying: the brush is placed at the position of the ulnar insertion and a small flexion (folding); with such a position, the chovnopodіbnіbіbіbnі brush is visible on the whole length. 
Do not rehearse. Impose a circular plaster bandage on the anterior shoulder and hand of the extension of the fingers from the capture of the main phalanx of the first finger in the position of small flexion and radial insertion of the hand. The term of fixation is 3-4 months, in case of fracture of the tuberosity of the sphenoid cyst - 2 tizh. The remoter is recommended to have a splendid physical culture.
Break the p'yastkovyh brushes. The most likely cause is a fracture of the 1st metatarsal cyst. The typical type of fracture is an internal subglottic marginal fracture of the proximal end of the leg (Benett's fracture). At the same time, the tricot form of the ulamkiv is introduced, which is abandoned in the field, at that hour, as it is clear, the brush shifts in a tiled-promenade direction, appeasing the movement.
Clinically, the smoothness of the contours of the "anatomical snuffbox", deformity of the bulge in the left side in the area of the 1st metacarpal-carpal joint, local soreness are observed. Rukhi obezheni. A radiograph is required. Fracture of other bones is often associated with direct trauma. Diagnosis is confirmed radiographically.
Responsibility to fight against miscarriages. The area of the promeneo-zastkovy swamp is covered with fingers with such a rosary, so that the first finger is robbed of a vice on the affected p'iast brush when the first finger of the ailing is inserted. Fixation is applied with a plaster bandage with a stretch of 7-10 days. In case of fractures of other metatarsal brushes, traction is carried out by the upper finger and the wrist path is used to force the brushes. Fixation with a splint or a plaster cast for 3 days.
Break the phalanges of your fingers. The cause of the fracture is most often direct trauma. Fracture the phalanges of the fingers subdivide on the inner joint, on the outer joint and the body of the phalanx.
The clinical picture is folded with swelling, bloody, and when the cyst fragments are displaced - deformities. Outwardly, the spread of the finger is impossible. X-ray є obov'yazkovaya. Reposition is performed under anesthesia according to Lukashevich. On the upper surface of the finger and brushes, a splint is applied and fixed with a bandage. Then we will carry out the bending of the finger at once from the splint with a complete correction of the cystic ulamkivs. After reduction, carry out additional fixation with soft bandages (Fig. 176) in case of internal and angular fractures with a stretch of 5-7 days, body - 2 days.
Etiology of fractures
As a rule, fractures are blamed on the back of the divine force. In case of pathological changes in the structure of the cyst, normal pressure can lead to a fracture (spontaneous fracture). In case of a simple fracture, the skin in the area of the fracture becomes non-shocked, otherwise we can speak of an aggravated fracture.We will especially distinguish the type of fractures in children - a fracture on the “green nail” kshtalt, in which case the okista is saved, and the young cyst appears to be broken.
Clinic of fractures
Strong bіl, bloody and impaired function of the injured body of the body. Deformation, pathological looseness and crepitation of the cystic ulama indicate a fracture. Residual vysnovok shkodo fracture can be done on the basis of x-ray follow-up, if it is carried out no less, lower in two projections.Celebration of fractures
Likuvannya, in principle, is carried out at the next sequence:- reposition of the cystic ulamkivs according to their ability to have a normal position
- fixation of the refurbished board
- immobilization of yoga on the necessary term for growing
- Carrying out jubilant gymnastics.
Reposition and fixation of the ulamkiv are carried out both conservatively and promptly. Reposition, sing, vibrates under general anesthesia, and in other instances, under general anesthesia. The widest way of fixing the repositioning of the cystic ulamkiv is the application of plaster casts.
In case of operative repositioning of the cysts, the ridges can creak behind the help of rotten circular sutures, by way of insertion into the cystic-cerebrocanal shearing canal, or by applying plates to the ridges of the brushes; moreover, if you reach such a rank of kіstkove z'єdnannya (osteosynthesis), you can put on the overlays, so you don't need to put on plaster casts farther away. Kіntsevіst in such vipadkah can save frivolity, but it is not guilty to know the vanity, to wind the mass of the wet body over the rahunok. In case of minor and superficial fixation of the cysts and their fragments, we can speak about stable osteosynthesis. On the leg, for example, you can transfer part of the mass of the body until the hardening of the callus and without plaster casts.
In case of immobilization, for the help of plaster casts, it is necessary to take care of it, so that the fabrics, which were spun in the plaster sharpening, bled well and took care of sensitivity and fragility. Exactly, the anatomical alignment is sometimes impossible, even though a fracture is likely to occur with an incorrect position of the cystic ulama. As a result, mothers may have incorrect static pressure, which can lead to an early wear of the pelvic ligament homilkovostopnogo suglobiv, as well as the spinal stovp (static scoliosis), as a result the defect outweighs the main parameters: shortening of the legs more lower by 3 cm, expansion along the axis greater lower by 10 °. In such cases, in order to prevent the development of degenerative changes, a corrective osteotomy is carried out, or orthopedic supplements and orthopedic surgeries are installed, as well as special inserts for wide sale.
Pseudarthrosis
Under pseudoarthrosis, pathological fragility between two wedges due to an undeveloped fracture is considered.Etiology of pseudoarthrosis
The causes of this pathology may be insufficient immobilization, vitamin and hormonal deficiency. As a result of bacterial infection (osteomyelitis), the penile area of the cyst may be ingested by the body or may be melted. Tse vede to break the contact between the distal and proximal cystic ridges. So utvoryuetsya hibniy suglob.Clinic of pseudoarthrosis
In the area of pseudarthrosis, there may be fragility between bone fragments, which does not cause pain. Immature cystic fragments of the lower ends protrude under the scruff of the neck when nagging.Treatment of pseudoarthrosis
Likuvannya is carried out more importantly promptly: by way of refreshing the kіntsіv of the cystic ulamkіv, їх retelny zіstavlennya, and navіt naіynoї immobilization. Molding of the callus can take a few months.It is possible to zastosovuvaty special orthopedic care, and the most pleasant moment is to be quickly delivered.
vivihi
Vivih є povnym zmіschennyam suglobovyh kintsіv, yak, as a rule, are accompanied by poshkozhennym suglobovoї capsule.Etiology of vivihiv
Vivihi is more importantly blamed for the influx of outrageous strength (true vivi) due to trauma. In case of this, there is an overstretching of the sugular capsule, tendon and m'yazyv, after which slug head it is no longer possible to fix nadіyno at the snowy depression. In certain vipadkas, vinikaє vivih (zvičnі vivihi) at the most significant ruhs. Cream of that given pathology can be tied with congenital waters to the development of brushes or soft fabrics, which fix the brushes in the snow.Clinic of Vivihiv
Likewise, in case of fractures of the bones, pain and swelling are blamed, the function of the lobe is destroyed. On the vіdmіnu vіd fracture near the suglob at vivihu the kincіvіk is fixed in the wrong position. Vivihi can come up with fractures of the bones near the snow.Jubilee vivikhiv
Vivih is guilty of buti repositioning as much as possible style terms. For whom it is necessary to have relaxation of the mind, which is more possible under general anesthesia. After the repositioning of the vivihu kіntsіvka and the snowdrift immobilized for additional tires or a plaster cast for about 2 days. After their removal is carried out gymnastics. In case of primary vivices, there may be a need for operative methods of treatment (tendon-m'yazova or cystic plasty).Orthopedics in Moscow
Lapinin Petro Volodymyrovich
Accepted price: 1650 rub.
Sign up for an appointment 1650 rubles. Daher Ziad Rashid
