What damage fractures belong to the musculoskeletal system. Damage to the musculoskeletal system. Abducted big toe

Damage to the musculoskeletal system.

General characteristics of damage to the musculoskeletal system

Injury, or damage, is called anatomical and functional disorders of tissues and organs resulting from the action of environmental factors.

Mechanisms of action of traumatic agents. Impacts can be mechanical (impact, compression, stretching), physical (heat, cold, electricity), chemical (action of acids, alkalis, poisons), mental (fright, fear). The severity of damage depends on the strength and time of exposure to these factors. Most often, damage is caused by the direct action of mechanical force (impact, compression, stretching) on ​​the tissues of the body. Mechanical damage can be closed and open. Closed injuries are those in which there is no violation of the integrity of the skin and mucous membranes. These include bruises, sprains, subcutaneous ruptures of organs and soft tissues (muscles, tendons, blood vessels, nerves).

Open injuries (injuries) are accompanied by a mandatory violation of the integrity of the skin or mucous membranes (wounds, open bone fractures). Injuries resulting from a single, sudden, strong impact on the tissues of the body are called acute trauma. Damage arising from constant and repeated impacts of low force, unable to inflict injury with a single action, is called chronic injury ( occupational diseases). Any injury, in addition to local tissue disorders, causes certain general changes in the body: of cardio-vascular system, respiration, metabolism.

Traumatism and its types. The set of injuries in certain populations that occur over a limited period of time is called traumatism. Distinguish industrial injuries, household, sports, children's, road and military. The fight against injuries is one of the main tasks of the health and safety authorities.

Injury

A bruise is damage to tissues or organs without violating the integrity of the skin and mucous membranes. The mechanism of injury is the direct action of a blunt object on a particular part of the body. It can be either a fall or a blow with an object.

Clinic. Pain, bruising, swelling, dysfunction of the bruised organ or area. Under the action of a large tangential force, extensive detachment of the skin is observed. If a large nerve is bruised, shock or paralysis of the area innervated by this nerve may develop, if the joint is bruised, its function is impaired; bruises of internal organs (brain, liver, lungs, kidneys, heart) can lead to severe disorders throughout the body and even death.

Urgent care. The action of the paramedic in the diagnosis of a bruise (its localization is called): first of all, it is necessary to create rest for the damaged organ. It is necessary to apply a pressure bandage to the bruised area, to give this area an elevated position, which helps to stop further hemorrhage into the soft tissues. To reduce pain and inflammation, cold is applied to the site of injury for 2–3 days, then warming procedures (UHF, solux, dry heat, ozocerite applications). With minor bruises of soft tissues, especially the limbs, as a rule, hospitalization is not required, the patient is sent to the emergency room. With extensive bruises of the chest, abdomen, joints - hospitalization in a trauma or surgical department to exclude fractures, dislocations, and damage to internal organs. With bruises of the extremities - the introduction of a solution of analgin 50% - 2.0 / m or baralgin 5.0, no-shpy 2% 1.0 (you can add diphenhydramine 1% - 1.0) intramuscularly. With bruises of the trunk, it is better not to administer painkillers so as not to lubricate the clinic of damage to internal organs.

Sprains and ruptures of ligaments

Sprains and ruptures of ligaments occur, as a rule, with sudden movements in the joint that exceed its physiological volume. The clinic is characterized by the appearance of sharp pains, the rapid development of edema in the area of ​​injury and a significant dysfunction of the joint.

Urgent care. First aid for sprains is the same as for bruises. Hospitalization to a hospital, as a rule, is not required, the patient is sent (transported by car) to the emergency room.

Crash Syndrome

Crash syndrome is a very severe injury in which parts of the body are compressed (usually limbs) with the subsequent development of general disorders in the body. Such damage occurs during natural disasters, accidents, landslides, bombardments. The compression is accompanied by the development of shock, and subsequently by the poisoning of the body by the decay products of the compressed tissues, in particular, by myoglobin, which blocks the renal tubules, causing acute renal failure. This condition is called the syndrome of prolonged compression (crash syndrome).

Urgent care. The main task during compression is to organize measures for the immediate extraction of the victim from under gravity. Cover injured limbs with ice packs or a cloth soaked in cold water. Mandatory immobilization of the limbs with the help of splints or other improvised means (board, stick). To prevent shock, drugs are administered intravenously or intramuscularly: promedol 2% - 1-2 ml; omnopon - 1-2 ml, morphine 1% - 1-2 ml; plentiful drinking is given, if possible, infusion therapy is prescribed: intravenously - solutions of polyglucin, 400.0 or reopoliglyukin, 400.0; 5% glucose, 500.0, vitamins of groups B, C, sodium hydroprocarbonate 7.5% - 100 ml. In general, almost any solution for infusion is suitable, the main goal in this case is the prevention and initiation of treatment for shock. The patient lying down is immediately hospitalized in a surgical hospital.

Dislocation

A dislocation is an injury in which there is a displacement of the contacting articular surfaces, one in relation to the other. The dislocation can be complete, when the articular surfaces cease to touch each other, and incomplete (subluxation), when there is partial contact between the articular surfaces. Dislocations occur mainly under the influence of indirect trauma, for example, hip dislocation is possible when falling on a bent leg while simultaneously turning the leg inward, shoulder dislocation - when falling on an outstretched arm.

Clinic. Symptoms of dislocation are pain in the limb, mainly in the joint, a sharp deformity in the joint area (as if retracted), the absence of active and the impossibility of passive movements in the joint, with a careful attempt to passive movement in the joint, it seems to spring. The limb is fixed in an unnatural position, its length changes, more often there is a shortening.

Urgent care. Help from a paramedic: to reduce pain - cold on the area of ​​dislocation, intramuscular injection of analgesics, with severe pain and dislocation of large joints (shoulder, hip) - narcotic drugs. The immobilization of the limb is performed in the position that it took after the injury. The upper limb is hung on a scarf, the lower limb is fixed with a splint or improvised material. You should not try to set the dislocation, because sometimes it is difficult to establish whether it is a dislocation or a fracture, especially since dislocations are often combined with them. The reduction of a dislocation is a medical procedure, so the victim is transported to the hospital (traumatology department) sitting or lying down, depending on the location of the dislocation.

bone fractures

Violation of the integrity of the bone, caused by violence or a pathological process (tumor, inflammation) is called a fracture. The main complications of fractures:
Damage to the sharp ends of fragments of large vessels, which leads to the development of either external bleeding with an open fracture, or intra-articular hemorrhage (with closed fractures) with the development of hemarthrosis (blood in the joint).
Injury to the nerve trunks from a piece of bone, which can cause shock or paralysis.
Fracture infection and development of phlegmon, osteomyelitis or sepsis.
Damage to vital organs (brain, liver, lungs, spleen).

Fracture classification:
Traumatic and pathological.
According to the condition of the skin and mucous membranes at the fracture site - open and closed; with displacement of fragments and without displacement (in width, at an angle, in length, etc.).
By localization - epiphyseal, metaphyseal and diaphyseal.
According to the features of the fracture line - into transverse, oblique, helical, comminuted, impacted.
Primary and secondary.

Fracture clinic. A fracture is characterized by: a sharp pain that increases with any movement and load on the limb, a change in the position and shape of the limb, a violation of its function, swelling at the fracture site, shortening of the limb, pathological (abnormal) bone mobility. On palpation of the fracture area - a sharp pain, often bone crepitus (crunching of broken bones). Palpation of the limb should be carried out very carefully, with both hands, trying not to cause unnecessary pain, and especially not to cause complications (damage to fragments of blood vessels, muscles, skin, nerves).

With an open fracture, fragments of bones are visible in the wound, often one or more of them protrude outwards. In this case, palpation is prohibited. Correct and timely first aid is one of the most important moments in the treatment of fractures.

Urgent care. The main first aid measures for bone fractures:
Creating immobility of the bones in the area of ​​the fracture - immobilization.
Implementation of measures aimed at combating or preventing shock.
Organization of the fastest delivery of the victim to medical institutions.

Immobilization of a limb during a fracture reduces pain and is one of the main points in preventing shock, displacement of fragments, injury to blood vessels, nerves, and muscles. Immobilization is achieved by applying standard tires (Kramer, Dietrichs, Abolina) or using improvised tires from improvised materials (boards, skis, sticks, cardboard, guns, rods).

Splinting should be done directly at the scene and only after that the patient should be transported. Any corrections, comparisons of fragments are not recommended. The patient must be carried carefully, the limb and torso should be raised at the same time, all the while keeping at the same level.

In case of an open fracture, before immobilization, the skin around the wound must be treated with an alcoholic solution of iodine or other antiseptics and an aseptic dressing should be applied. For a strong immobilization of the limbs, it is necessary to have at least two splints that are applied to the limbs from two opposite sides. In the absence of splints and auxiliary material, immobilization should be carried out by bandaging the injured limb to a healthy part of the body: the upper limb to the body with a bandage or scarf, the lower limb to the healthy leg.

Rules for carrying out transport immobilization:
Tires must be securely fastened and fix the fracture area well;
The splint should not be applied directly to a bare limb; the tire, the limb must be covered with cotton wool, wrapped with a bandage;
It is obligatory to fix two joints with a splint: above and below the fracture, and in case of hip fractures, all joints of the lower limb should be fixed.

In severe, complicated fractures, it is necessary to anesthetize the victim by intravenous administration of promedol solutions (2% - 1-2 ml); morphine (1% - 1-2 ml in a 40% glucose solution - 10 ml) or isotonic sodium chloride solution (0.9% - 10 ml). With simple fractures, it is possible to confine ourselves to intramuscular administration of solutions of analgin with diphenhydramine. If there is no damage to the abdominal organs, then you should give plenty of fluids. In case of severe fractures, intravenous polyglucin 400 ml or reopoliglyukin 400.0 is prescribed, which is the beginning of the treatment of developing traumatic shock.

Transportation in case of fractures of the bones of the lower extremities, pelvis, spine - lying down; upper extremities - sitting, or in a hospital with a trauma department, or in a trauma center.

Multiple and combined injuries (injuries)

Combined and multiple injuries are among the most severe injuries with high mortality both at the prehospital stage and in the hospital. Combined are such injuries in which, along with damage to the organs of the abdominal or chest cavities, the brain, there are damage to the musculoskeletal system. Such injuries are called multiple when there are two or more injuries within the same system of organs and tissues (multiple fractures of the ribs, fractures of two or more limb segments). Such injuries occur when a traumatic force of a large area, weight or moving at high speed is applied (falling from a great height, car and plane crashes, natural disasters, earthquakes, floods).

Clinic. Symptoms can be very diverse and depend both on the localization of damage, and on the presence of traumatic shock, blood loss, craniocerebral disorders, acute respiratory failure, which almost always complicate the course of a concomitant injury. The clinical picture is determined by the leading damage, which poses the greatest threat to the life of the victim. There can be several leading injuries, and in accordance with them, the combined injury is classified as follows:
a) combined trauma of the skull; b) combined trauma of the musculoskeletal system.

With a combined trauma of the skull, there is an injury of the skull of a moderate or severe degree, which is accompanied by fractures of the bones of the limbs, pelvis, spine, and fractures of the ribs. Here, clinically, cerebral disorders in the form of stupor and coma come to the fore. To brain disorders are added circulatory and respiratory disorders, accompanying shock, which is always present in concomitant trauma.

Combined trauma with abdominal injury may be accompanied by symptoms of internal bleeding or damage to internal organs.
Trauma to the musculoskeletal system can be the leading one only in cases of massive pelvic injuries, spinal fractures with spinal cord injury, and limb avulsions.

In case of trauma, it is necessary to identify leading injuries, as well as the presence of life-threatening conditions - shock, acute blood loss, acute respiratory failure. The examination is carried out simultaneously with the start of therapeutic measures, quickly, carefully, without fuss. Assessing the condition, the paramedic should first of all rely on the following parameters: consciousness (stunning, stupor, coma), blood circulation (pulse, blood pressure), respiration (number of respiratory movements, the presence of pathological types of respiration, foreign bodies in the oral cavity, pharynx, which impede or stop breathing ).

Urgent care. The victim is placed on a stretcher (preferably hard). Respiratory disorders can occur due to obstruction of the airways by vomit, blood, dentures, as well as when the lower jaw and tongue are retracted. The oral cavity and pharynx are cleaned either by suction, or with gauze napkins on a clip, or by wrapping a finger with a napkin. If necessary, the mouth is opened with a mouth expander. Then, artificial respiration is started either with devices (such as KI-ZM) or mouth-to-mouth (in the absence of spontaneous breathing). With the above measures correctly carried out, independent breathing is restored, often after this the victim regains consciousness.

Simultaneously with artificial respiration, a jet injection of polyglucin (400 ml intravenously or 400 ml of ropoliglucin), prednisolone (from 60 to 300 ml), hydrocortisone (125–250 mg) is started; when large arteries are injured, a tourniquet is applied. If the condition remains extremely severe, the pulse and blood pressure are low, the second vein is punctured and 100 ml of 40% glucose with 10 units is transfused. insulin, also continuing the jet injection of polyglucin with hormones. With some stabilization of blood pressure at the level of 70-80 mm. rt. column and the appearance of a pulse in the periphery (radial artery) begin to immobilize fractures of the femur, lower leg, shoulder, forearm, as well as intra-articular injuries of the knee, ankle, elbow and wrist joints. Spending time on splinting fractures of small bones is not worth it.

Sterile dressings are applied to extensive wounds, strengthening them with mesh bandages, and sterile napkins are applied to small wounds, strengthening them with adhesive tape. In the absence of trauma to the abdominal organs, promedol 2%, 1-2 ml is administered intravenously; omnopon and morphine are contraindicated in traumatic brain injury, because they cause respiratory depression. In this case, analgin 50% - 2-4 ml should be administered; baralgin, 5 ml; maxigam, 3–5 ml; trigan, 3–5 ml, intravenously. If, with a combined injury, there are absolute signs of damage to the organs of the abdominal cavity (falling into the wound of a loop of the intestine, omentum, outflow of urine, bile, etc.), drugs can and should be administered. Hospitalization of victims with multiple and combined injuries is carried out in the intensive care unit. During transportation continue intravenous infusion of blood substitutes. In the absence or violation of breathing - mechanical ventilation through a mask. If possible, the paramedic calls for a specialized resuscitation ambulance team.

Among the injuries of the musculoskeletal system, bruises, damage to the capsular-ligamentous apparatus, sprains, ruptures of muscles, tendons and fascia, bone fractures, subluxations and dislocations in the joints are most common.

Bruises - closed mechanical damage tissues or organs that are not accompanied by a visible violation of their anatomical integrity. Bruises are the result of a blow with a blunt object (for example, a boot, a club) or a blow from a falling, rapidly moving athlete on a stationary object (ground, ice, tree, etc.), as well as a blow during a collision between players.

With bruises, a reflex spasm of blood vessels is first observed, which is then replaced by their expansion, leading to congestive hyperemia and serous impregnation of tissues. More often bruises are accompanied by multiple ruptures of small vessels with hemorrhage from them. Depending on the depth and localization of the bruise, the soft tissues are impregnated with blood or their stratification is formed by a hematoma. Severe bruising combined with damage to blood vessels can cause crush injury or traumatic tissue necrosis.

A bruise leads to tissue tension, compression and irritation of nerve endings, which causes pain and dysfunction. A characteristic sign of superficial bruises is bruising (impregnation of the skin and subcutaneous tissue with outflowing blood), which appears in the first minutes or hours after the injury. With bruises of the muscles, periosteum, bruising is detected later (2-3 days or even later), sometimes far from the site of the bruise: the blood that has poured out under the influence of gravity enters the intermuscular gaps.

With mild bruises that are not accompanied by bruising, swelling and soreness disappear after 1-2 days; with bruising, they persist for up to 6-12 days.

The bruise gradually resolves, changing its color from red (through different shades) to green and yellow. When the muscles are bruised, the blood poured out of the vessels impregnates the soft tissues or accumulates in the intermuscular spaces in the form of hematomas. Improper treatment (or the use of heavy loads) can lead to a sharp proliferation of connective tissue and even to its ossification.

Bruises of the periosteum are observed in those places where there is no or little pronounced muscle cover or insufficient protective layer of subcutaneous adipose tissue. Such areas are the anterointernal surface of the tibia, the anterior surface of the sternum, the back surface of the hand and foot. Depending on the strength of the blow, hemorrhages may appear, impregnating the periosteum, or a hematoma, exfoliating it from the bone. Periosteal hematoma is characterized by limited swelling, sharp pain with a light, even sliding touch. There is no pain and bone crunch during movement of the damaged segment (unlike fractures).

When the joints are bruised, the vessels in the surrounding soft tissues, and sometimes in the synovial membrane, are torn, which leads to hemorrhage into the joint cavity - hemarthrosis. It develops within 1-1.5 hours after injury; the contours of the joint are smoothed out, there is a sharp pain during movement.

First aid for bruises is to irrigate the injury site with chlorethyl in order to stop capillary bleeding and relieve pain. Irrigation is carried out at a distance of 30-40 cm from the site of damage for 1-2 minutes until a slight whitening of the skin and a burning sensation appear. Then apply a pressure bandage or teip. In more severe cases, a pressure bandage should be applied and cold should be applied to the site of injury for 2-3 hours: a bubble with ice, snow or cold water. By the end of the first day after injury, various thermal procedures can be applied. Massage and physiotherapy exercises are carried out only under the supervision and with the permission of a doctor.

For the prevention of bruises in some sports great importance have the correct insurance and self-insurance, the ability to "group" and fall, and in others - the use of protective devices provided for by the rules: shields, knee pads, elbow pads, etc.

Injuries to the capsular-ligamentous apparatus of the joints in terms of frequency occupy one of the first places among sports injuries. The mechanism of these injuries is usually caused by excessive movements in the joint, leading to a sharp tension in the area of ​​the fibrous capsule of the joint and the ligaments that strengthen it, which together limit the movements in the joint when they reach a certain limit. Further movement in the joint can lead to pathological displacement of the articular ends.

Most often, the ligaments of the knee and ankle joints are injured, somewhat less often - the elbow, shoulder, clavicular-acromial, etc.

There are three degrees of ligament damage. At the first degree, there is a true sprain without anatomical damage to the collagen fibers. This is manifested in moderate soreness and slight swelling of the soft tissues. In the second degree, a partial rupture of the ligament occurs, characterized by severe pain, rapid hemorrhage into soft tissues, the development of hemarthrosis, edema, and dysfunction of the joint. In the third degree, a complete rupture of the ligament occurs, accompanied by severe pain, and sometimes crackling; hemorrhage into the tissue surrounding the joint, the phenomena of hemarthrosis and edema are pronounced, the function of the joint is sharply disturbed, the axis of the limb changes. Ligaments are torn at the point of attachment to the bone or along their length.

When providing first aid, the damaged area is irrigated with chloroethyl or an ice pack (cold water) is applied, then a pressure bandage is applied and the joint is well (reliably) fixed. In case of ruptures of the ligament and joint capsule, immobilization with a splint is performed. Further treatment for incomplete ruptures and sprains of the capsular-ligamentous apparatus is conservative, and for complete ruptures, only surgical.

In order to prevent these injuries, it is necessary to conduct a proper warm-up before classes and competitions, systematically strengthen the musculoskeletal apparatus (especially in the cervical spine, knee, elbow and ankle joints), improve the technical skills of athletes.

Muscle stretching is a term, although generally accepted, but inaccurate, since in the Force of elasticity it is impossible to completely stretch them. With any stretch or distortion, the muscle fiber, if it does not tear, restores its original length. In fact, we are talking about stretching, tears and ruptures of the supporting apparatus of the muscles (sarcolema, remysia, etc.), as well as ruptures of the smallest blood vessels. With such injuries, pain occurs in the muscles, which disable the athlete only for a short time, measured in hours or days. Sprains can be localized in the area of ​​​​the muscle belly or in the area where the muscle passes into the tendon. With deep palpation in a limited area of ​​\u200b\u200bthe muscle, a zone of increased sensitivity is usually determined. The range of motion in the joint, as a rule, is not disturbed.

After providing first aid (irrigation with chlorethyl, application of tape), the athlete can continue to participate in the competition, however, he must stop physical exercises if pain reappears.

Tears and ruptures of muscles occur at the time of their sharp uncoordinated contraction. In this case, severe pain occurs, and sometimes a characteristic sound is heard. Hemorrhage is always observed, usually significant, with the formation of a hematoma. Movement in the joint is very difficult or even impossible due to pain in the area of ​​damage. On palpation, increased tissue density is determined due to the presence of painful reflex contracture and hemorrhage. With a significant rupture of the muscle, a depression forms under the skin, which increases with active tension. More often than others, the quadriceps and biceps muscles of the thigh (in football players), the upper third of the adductor muscles of the thigh (in football players, jumpers, hurdlers) and the calf muscles (in acrobats and gymnasts) are injured.

Tears and ruptures of the tendons occur at the time of a sharp and strong contraction of the muscle. Injuries are localized at the point of transition of the muscle into the tendon or at the point of attachment of the tendon to the bone, as well as along it. The rupture is usually preceded by diseases of the tendon (tendonitis) or its sheath (tendovaginitis), or the surrounding tissue (paratenonitis).

At the time of injury, the victim experiences severe pain. The gap is accompanied by a characteristic sound. Complete loss of muscle function. For example, if the Achilles tendon is torn, the athlete cannot stand on his toes. On palpation, a depression is determined between the ends of the torn tendon. The corresponding muscle changes its shape and shifts, which is especially clearly visible when trying to strain it.

Rupture of the fascia most often occurs due to a blow with a blunt object when it is tense. At the moment of rupture, pain is felt, later swelling and a slight hemorrhage appear. Muscle function is usually not affected. When palpating, an oval-shaped gap is detected, through which a muscular hernia can subsequently form.

First aid in case of damage to muscles and tendons in order to reduce hemorrhage and relieve pain involves irrigation with chlorethyl, the imposition of a pressure bandage, a bladder with ice or cold water. In case of tear or rupture, immobilization of the joint is necessary to bring the points of attachment of the muscle as close as possible. For example, with a rupture of the biceps muscle of the shoulder, the forearm bends at an acute angle at the elbow joint; when the quadriceps femoris is ruptured, the limb is fixed in the extension position.

Ruptures of muscles and tendons are among the most severe injuries of the musculoskeletal system. Their treatment should be carried out in a surgical hospital: with complete ruptures, an urgent operation is necessary, with incomplete ones, conservative treatment.

The means of prevention include: good general and special physical fitness of an athlete, mastery of technical techniques, proper warm-up, the use of a special set of exercises that strengthen the muscular-tendon apparatus, especially the posterior thigh muscles, the use of massage, sauna, barotherapy, etc.

A dislocation is an abnormal, permanent displacement of the bones at a joint when the articular surfaces no longer touch. With a dislocation, as a rule, the joint capsule, ligaments are torn, and soft tissues are damaged. Dislocations are complete and incomplete (under d in s-dislocations), in which there is a partial displacement of the articular surfaces.

Dislocation is usually caused by excessive movement of the limb segment or a direct blow, the force of which exceeds the strength of the capsular-ligamentous apparatus of the joint. Most often, dislocations are observed in the clavicular-acromial, shoulder (in wrestlers) and elbow (in gymnasts) joints.

At the moment of dislocation, the victim experiences severe pain; the limb takes a forced, unnatural position. An attempt to change it causes exacerbation of pain and springy resistance. The shape of the joint changes: the articular surface of the displaced bone forms a well-palpable protrusion, and a recess appears in its usual place.

First aid for a dislocation is to ensure that the injured limb is completely immobile with a fixing bandage or splint. The victim must be sent to a medical facility immediately.

An attempt to reduce a dislocation by a coach or comrades is completely unacceptable, as this can lead to additional injury and complications.

A bone fracture is characterized by a violation of its integrity under the influence of acute mechanical trauma. In a fracture, as a rule, the surrounding muscles, fascia, nerve endings and blood vessels are damaged. Fractures are the most severe injuries that put an athlete out of action for a long time. There are fractures complete and incomplete (cracks), open (with damage to the skin) and closed (without damage to the skin), with and without displacement of fragments. If bone fragments are embedded one into another, the fracture is called impacted.

According to the shape of fragments, fractures are divided into transverse, oblique, helical, or spiral (occur at the time of violent twisting, rotation of the limb, for example, in a slalomist), comminuted (the bone is crushed) and compression (when the vertebrae are squeezed).

The causes of fractures can be blows, falls, collisions, compression, twisting, bending, separation of bones from the place of attachment of the muscle. There are fractures specific to athletes (for example, a helical fracture due to twisting of the bone under the influence of the traction of the muscles of the girdle of the upper limb during grenade throwing, an avulsion fracture of the iliac crest in gymnasts).

The victim often determines for himself that he has a bone fracture, as he feels at the time of the injury a characteristic sound, a sharp pain that intensifies when he tries to make the slightest movements.

On examination, swelling is visible due to hemorrhage, curvature or shortening of the limb due to displacement of fragments. As a rule, there is unnatural mobility at the fracture site, accompanied by a crunch (crepitation of fragments). With open fractures, bone fragments, damaging the soft tissues and skin, protrude from the wound. The most accurate method for diagnosing fractures is radiography (Fig. 49).

First aid for closed fractures is the correct immobilization of the limb. This is very important, as it reduces pain, prevents the displacement of fragments, reduces the risk of damage to them by the sharp edges of blood vessels, nerves, muscles, and facilitates the transportation of the victim to the hospital. With open fractures, in addition to immobilization, it is necessary to stop bleeding, lubricate the edges of the wound with a 5% iodine solution and apply a sterile bandage. The patient needs urgent hospitalization.

If a fracture of the spine is suspected, in no case should the victim be planted or put on his feet. It is necessary to lay it in a strictly horizontal position on a plywood shield or boards and transport it to a medical institution in this position.

In case of a fracture of the pelvic bones, the victim should also be laid on a hard surface, his legs bent at the knee and hip joints, his hips slightly apart (the "frog" position), put a cushion under his knees from a pillow, blanket, coat, etc. and in this position transport to the hospital.

The most severe complication of trauma is traumatic shock - a formidable symptom complex that occurs as a result of a peculiar reaction of the body to the impact of extreme stimuli, caused by a sharp violation of the nervous regulation of life processes and expressed by severe disorders of hemodynamics, respiration and metabolism. Most often, traumatic shock occurs with a fracture of the pelvis (in 20% of cases), trauma to the abdomen (in 15%), chest, spine, thigh (5%) and lower leg (2-3%). For the occurrence of shock, the background against which mechanical injury occurs is of great importance: mental depression or nervous overexcitation, hypothermia or overheating, starvation.

Shock is characterized by a more or less pronounced depression of the victim's psyche; consciousness is preserved, but inhibited, the pupils react sluggishly to light. The maximum blood pressure is only 80-100 mm Hg. st, heart rate - 120 beats / min or more, breathing is rapid, shallow. Severe hypothermia.

Saving the life of the victim is possible only with the urgent, vigorous implementation of long-term complex therapy: the introduction of strong painkillers, the use of various kinds of novocaine blockades. Anti-shock measures that reduce the flow of irritation in the nervous system include immobilization.

The most common and valuable anti-shock measure is intra-arterial and intravenous transfusion of blood and blood substitutes, of which dextran and polyvinyl alcohol, synthetic substances of large molecular structure, are especially recognized.

In order to normalize impaired blood circulation in severe hypotension, it is recommended to administer intravenously pressor substances (norepinephrine or mezaton), tonic and cardiac agents, as well as water-soluble vitamins and glucose, which enhances the therapeutic effect of vitamin and hormonal preparations, improves the functioning of the heart muscle, normalizes the activity of the central nervous system.

Persons in a state of shock should be placed in a dry and warm room. In the absence of contraindications, a hot sweet drink is recommended.

Since damage to the locomotor apparatus in athletes is a fairly common phenomenon, it is difficult to overestimate the role of the coach and teacher in providing first aid to the victim and in restoring his sports performance. Therefore, the coach and teacher need to know the following basic principles of complex rehabilitation of athletes after injuries of the musculoskeletal system.

The urgency (urgency) of providing qualified inpatient care in the first minutes and hours after injury. Practice, unfortunately, shows that this principle is not always observed, as evidenced by the data on the duration of hospitalization.

A clear stage of complex rehabilitation treatment: immobilization, restoration of the function of the injured locomotor link, restoration of the general (professional) working capacity of a person and, finally, restoration of sports performance. Each of these stages has its own goals and objectives, as well as a clear sequence. The transition to the next stage should be carried out only after the completion of the previous stage. The strictest observance of the principle of phasing of restorative treatment is unthinkable without a clear continuity in the conduct of all medical diagnostic and restorative measures.

The strictest medical control at all stages of rehabilitation treatment over the reaction of the injured link of the locomotor apparatus, as well as the general reaction of the body to injury: assessment of the general condition of the body, general and local temperature reaction, skin color, reaction of the lymph glands, deformation, local pain, etc.

The strictest individualization in the selection of restorative means for each athlete, taking into account the nature of the injury, the general and local reaction of the body to it (severity), the time elapsed since the injury or operation, the age and qualifications of the athlete, his personal characteristics, as well as the general and local reaction body on the applied restorative agents.

The gradualness and dosing of physical activity, taking into account the severity of traumatic injury. Currently, dosing of physical activity is the most important issue; a qualified solution to it, in essence, is one of the main points in the prevention of repeated injuries and overstrain of the musculoskeletal system.

Strict observance of the deadlines for the admission of athletes to training sessions after injuries (see Table VIII of the Appendix).

Nervous system trauma

Most sports injuries of the skull are accompanied by brain injuries, which are divided into concussion, brain contusion and brain compression. Any of these injuries causes to some extent damage to the medulla, hemorrhages (ruptures of capillaries, small arteries and veins), vascular disorders (stasis, edema), leading to hypoxia, ischemia and necrosis of brain areas, as well as reactions from the vestibular apparatus , brain stem and cortex.

The most common symptom of a concussion is loss of consciousness. It can be very short (only a few seconds) or last for a long time (many hours or even days). The longer the loss of consciousness, the more severe the degree of concussion. Upon regaining consciousness, the victim complains of heaviness in the head, dizziness, headache, nausea, vomiting, general weakness; at the same time, pallor of the face, cold sweat, sluggish, slow speech, and sometimes vomiting are noted. There may be a so-called retrograde amnesia - the victim does not remember what happened to him before the injury.

A brain contusion is a more severe injury, since the destruction of the medulla occurs, hemorrhage, swelling of the brain and soft meninges, and reflex vascular disorders occur. This injury, in addition to the symptoms characteristic of a concussion (but more pronounced), is characterized by focal lesions of the brain in the form of paresis, paralysis, convulsions, sensitivity disorders on the side opposite to the bruise, as well as speech. If the hemorrhage continues for a long time due to damage to a large vessel, a large hematoma occurs, which compresses the brain.

With compression of the brain, a constant increase in these symptoms is noted. At the time of injury, the symptoms may be similar to a mild concussion, but a little later, headache, nausea, vomiting, stupor occur, which gradually increase and lead to loss of consciousness, paresis of the limbs, bradycardia, respiratory and circulatory disorders appear and increase.

The traumatic brain injury in boxing deserves special attention. Knockout, knockdown, the state of "groggy" when hit in the head in the vast majority of cases is nothing more than a traumatic brain injury (see IX.4.1).

When providing first aid for traumatic brain injuries, it is necessary to give the victim a position with a slightly raised head and put cold on his head, give ammonia to sniff. In such cases, urgent hospitalization of the victim is necessary.

After a mild concussion, athletes (except boxers) are allowed to train after 4-5 weeks, and to participate in competitions - not earlier than after 1.5 months. After a moderate and severe concussion, the resumption of training is allowed 2 and 3 months after the injury, respectively, if there are no abnormalities in the neurological examination.

Boxers-masters of sports and sportsmen after a knockout are allowed to train in a month, older boys - after 4 months, younger - after 6 months. Adult boxers who have suffered 2 knockouts can start training after 3 months, and those who have suffered 3 knockouts can start training one year after the last knockout (if there are no neurological symptoms).

To prevent knockouts, the technical training of boxers, perfect mastery of defensive techniques, as well as clear refereeing and timely termination of the fight with a clear advantage of one of the boxers, the mandatory use of protective helmets in training and competitions are of great importance to prevent knockouts.

In order to prevent brain injuries, it is necessary to keep a strict record and a thorough analysis of their causes, strictly observe the treatment regimen, the timing of the start of training and participation in competitions. It is also necessary to ban training without protective helmets in sports such as hockey, water skiing, Nordic combined.

Injuries of the spinal cord in athletes are observed in the form of concussions, bruises, compression, hemorrhages, tears and complete ruptures of the substance of the brain or its membranes. Injuries include: overstretching of the spinal cord with excessive flexion and extension of the cervical spine; compression or rupture of the spinal cord in case of fractures and dislocations of the cervical, thoracic or lumbar vertebrae (when hitting the head against the bottom of the pool, falling on the head, performing various wrestling techniques, etc.).

With a concussion of the spinal cord, there are no deep anatomical changes, only slight hemorrhages and swelling of the tissues are observed. For a concussion of the spinal cord, symptoms of a temporary violation of the conduction of nerve impulses, a slight weakness of the muscles of the limbs, mild disturbances in the sensitivity and function of the pelvic organs are characteristic. These symptoms appear immediately after the injury, quickly begin to smooth out and disappear after 1-3 weeks.

With a spinal cord injury, hemorrhage, edema, softening of individual sections of the nervous tissue occur, causing severe functional loss. Violation of the conduction of nerve impulses occurs immediately after injury and lasts for a long time. Usually in the first days there is paralysis below the level of contusion, anesthesia, urinary retention, defecation. Depending on the severity of the injury, in some cases, the treatment ends with a complete restoration of the brain, in others, pathological changes remain for life.

Compression of the spinal cord can occur due to pressure from bone fragments in a spinal fracture or epidural hematoma when a blood vessel ruptures. The compression of the spinal cord increases as the hematoma increases, which is characterized by an increase in motor and sensory disorders below the level of injury, as well as pelvic disorders. Prolonged compression of the spinal cord can lead to irreversible changes.

With closed fractures and dislocations of the spine, a partial or complete rupture of the spinal cord is observed, characterized by paraplegia or tetraplegia. Below the site of damage, all types of sensitivity are absent, the victim does not feel the release of urine and feces, he quickly develops bedsores, edema, contractures of the lower extremities, etc.

First aid for spinal injuries is limited to careful laying of the victim on the shield and transportation to a medical facility. In no case should you plant the victim or allow him to do it himself (due to the risk of spinal cord compression).

P spinal cord injuries in most cases lead to disability.

To Peripheral nerve injuries include bruises and nerve sprains.

As an isolated lesion, nerve contusion is rare and usually occurs in association with muscle and other soft tissue contusions. An example of a relatively isolated nerve contusion is a contusion of the radial or ulnar nerve during saber fencing. Signs of nerve injury are prolonged pain in the area of ​​injury, the spread of pain along the nerve trunk, violations (decrease or increase) of sensitivity.

Nerve stretching can be observed during gymnastics, acrobatics, athletics and other sports. Most often, the sciatic nerve is stretched - when performing various stretching exercises, sharply swinging with a straight leg, jumping, doing splits, etc. Stretching of the brachial plexus is observed when twisting on gymnastic equipment, performing some techniques in wrestling, etc. When the nerve is stretched, it occurs , pain, which then decreases somewhat or remains for a long time; sensory disturbances and a decrease in muscle strength in the area corresponding to the branching of the damaged nerve.

Injuries of internal organs

Strong blows to the abdomen, chest, lumbar region, perineum, especially if they are accompanied by fractures of the ribs, sternum, pelvic bones, can lead to damage to the liver, spleen, intestines, heart, lungs, pleura, kidneys, bladder.

Injuries to the abdominal organs occur at the moment of impact to the hypochondrium (with a football boot, projectile for throwing, when hitting surrounding objects, etc.), falling from a great height (during jumping into water) and by the mechanism of counter-strike against the spine and ribs (when skiing). These injuries are accompanied by phenomena of shock, expressed to one degree or another. Usually, rapidly increasing internal bleeding is noted (especially with ruptures of the parenchyma and capsule of the liver and spleen), pallor of the skin and mucous membrane, thready pulse, confusion or loss of consciousness, and a sharp tension in the muscles of the abdominal wall.

When the intestines are damaged, inflammation of the peritoneum develops - peritonitis, which is an extremely dangerous complication.

When providing first aid to the victim, it is necessary to provide him with complete rest, put cold on his stomach and immediately take him to a medical facility for surgical care.

Injuries to the pleura and lungs occur with bruises of the chest, squeezing it, fractures of the ribs and sternum, wounds with fencing weapons and track and field spears.

Closed pleural injuries (no skin damage) are usually applied at the end of a broken rib. Blood vessels are often damaged, and blood is poured into the pleural cavity (hemothorax).

When its amount is small, significant violations of respiratory functions do not occur. If, in addition to the pleura, lung tissue is damaged, hemoptysis appears, and if a large vessel is damaged, pulmonary bleeding occurs. In this case, hemothorax can be significant (up to 1000-1500 ml), as a result of which the mediastinum is displaced, breathing and blood circulation are difficult.

Penetrating wounds of the chest (fencing weapons, spears) are accompanied by accumulation of air in the pleural cavity (open pneumothorax), compression of the lung, and a sharp violation of respiratory function.

With open and closed injuries of the lungs and pleura, there is a sharp pallor (sometimes cyanosis) of the skin, frequent pulse, clouding or loss of consciousness, and shallow breathing.

First aid for chest injuries consists in applying a wound-sealing bandage and immediate hospitalization of the victim.

Injuries to the kidneys and bladder are possible when struck in the lumbar region, abdomen (suprapubic region), when falling from a height on the buttocks. In the latter case, the kidneys suffer from impact on the spine and lower ribs.

Damage to the kidneys is accompanied by a state of shock, the appearance of blood in the urine (hematuria) or the formation of a perirenal hematoma (bleeding from the vessels of the damaged kidney). This may develop an acute kidney failure, for the treatment of which hemodialysis with the help of an artificial kidney is now used.

The rupture of the bladder is accompanied by urinary retention, which quickly pours into the perivesical tissue. The state of shock is deepened by the phenomenon of intoxication. First aid: cold on the relevant areas, rest, anti-shock measures, urgent hospitalization for surgery.

Summary

Injuries of the musculoskeletal system are one of the most frequent injuries in industrial and transport accidents, as well as in the focus of natural disasters. According to WHO statistics, severe mechanical injuries among the causes of death are second only to tumors and cardiovascular diseases, especially in people under 45 years of age. Having a long history, the theory and practice of treating victims with skeletal injuries in the twentieth century is developing at an accelerated pace. This is due to the fact that, on the one hand, the development of civilization has led to a significant increase in the number of injuries to the musculoskeletal system and the aggravation of the nature of injuries, on the other hand, the advances in science and technology have significantly expanded the possibilities for providing assistance to the category of victims in question. The introduction of physical, chemical, instrumental methods of diagnosis and treatment has not only improved the functional results of treatment, but also saved the lives of many victims whose injuries were previously considered incompatible with life. In this regard, in the last two decades, a new direction in medical science has loudly declared itself - the problem of polytrauma.

The information explosion on this issue originates from the Third All-Union Congress of Orthopedic Traumatologists (1975), and discussions on the pages of domestic and foreign medical journals about terminology, classification, and treatment methods continue to this day. In general, polytrauma appeared as a qualitatively different (compared to monotrauma) pathological condition requiring new ways to successful treatment. The most rational, in our opinion, is the following classification (Fig. 1):

- monotrauma, or isolated damage, is damage to one organ or one segment within one anatomical and functional system (hereinafter referred to as the system);

- multiple trauma - damage to two or more segments or two or more organs within the same system;

- combined injury - damage to two or more systems;

- combined injury - damage caused by the action of two or more etiologically heterogeneous factors.

Next, we will consider the most common injuries in emergency situations - injuries of the musculoskeletal system. What is the musculoskeletal system? This is an anatomical and functional system of the body that provides the functions of support and movement. What anatomical and functional elements are included in this system? These are the bones of the skeleton, joints, ligaments, muscles and tendons. Musculoskeletal injuries include:

- bone fractures;

- dislocation at the level of the joints;

- damage to the bag-ligamentous apparatus of the joints;

- damage to muscles and tendons.

There are many classifications (both academic and purely practical) of fractures. From the point of view of the volume of medical care provided in emergency situations, i.e. in conditions of a large number of victims, it is advisable to distinguish the following groups of fractures:

- closed fractures;

- secondary open fractures;

- open fractures;

- Gunshot fractures.

Closed fracture - violation of the integrity or structure of the bone without damage to the skin in the area of ​​the fracture. Secondary open fracture - a fracture, as a result of which there is a rupture of soft tissues and skin from the inside by displaced bone fragments. An open fracture is a communicating injury to the skin, soft tissues, and bone caused by the direct action of an external force.

The Kaplan-Markova classification is generally accepted. One of the main advantages of this classification, given in Table. 1 is the consideration of soft tissue damage, which sometimes, when providing emergency medical care in conditions of mass admission of patients, has a greater effect on treatment tactics than the nature of bone damage.

Clinical picture damage to the musculoskeletal system is represented by the following symptoms: pain, swelling, deformity at the level of damage and impaired function of the injured segment. Depending on the severity of the damage, a response compensatory reaction of the body is expressed to a greater or lesser extent - traumatic shock. The most shockogenic are: hip fractures, spinal fractures and pelvic injuries. In addition, it should be borne in mind that the development of shock may be due to the presence of damage to several less significant segments. Moreover, in conditions of polytrauma or combined trauma, the effect of potentiation, or the so-called phenomenon of mutual burdening, is observed. In other words, the severity of changes in the body's homeostasis is more pronounced than with a simple summation of changes caused by each specific damage.

The pathogenetic factors causing the development of traumatic shock are pain and blood loss. Bleeding in case of damage to the musculoskeletal system can be both external (open injuries) and internal. Moreover, overestimation, as a rule, of external blood loss is accompanied by an underestimation of internal bleeding. It is not possible to determine the deficit in the volume of circulating blood in the conditions of mass admissions of patients, especially in the focus of emergency situations. Therefore, data on the approximate volume of blood loss in closed fractures are extremely important.

The presented data (Table 2), although they are approximate, provide significant assistance in determining the amount of infusion antishock therapy. It is also necessary to take into account the fact that in case of bone fractures, especially the epimetaphyseal zone, bleeding usually lasts for three days, so the deficit in circulating blood volume without infusion therapy increases over time.

Local symptoms of damage to the musculoskeletal system, as a rule, make it possible to identify an injury to the limbs without much difficulty and provide appropriate assistance. It should be noted the need for special attention to the diagnosis of closed injuries of the great vessels. The clinical picture is represented by the following signs: absence of a pulse in the peripheral segments of the limbs, pallor of the skin and a decrease in temperature distal to the injury site, lack of active movements, and after a few hours - joint contractures. The following types of vascular injury are possible:

- gap;

- contusion followed by thrombosis;

- compression of the vessel by displaced bone fragments.

Particular attention should be paid to fractures and dislocations of the bones at the level where the arterial trunks most closely adhere to the elements of the musculoskeletal system. Most often, trauma to the main arteries accompanies the following skeletal injuries:

- fracture of the clavicle - damage to the subclavian artery;

- fracture of the shoulder and dislocation of the forearm - damage to the brachial artery;

- fracture of the lower third of the thigh and fracture dislocation at the level of the knee joint;

- damage to the popliteal artery.

Victims with suspected damage to the main arteries should be immediately evacuated to specialized departments, since the lack of blood circulation in the distal extremities for more than four hours may lead to the need for their amputation.

Diagnosis of spinal injuries, especially at the prehospital stage, is quite difficult. The only symptom with uncomplicated damage may be pain, aggravated by movement. However, in emergency situations, often the victims themselves, and even medical personnel, do not attach much importance to this feature. Certain assistance in the diagnosis can provide clarification of the mechanism of injury. So, for example, a sharp bending or tilting of the head at the time of injury can lead to rather severe injuries at the level of the cervical spine; falling from a height onto straightened legs, fractures of the calcaneal bones are often accompanied by damage to the lumbar spine. Therefore, in this situation, preference should be given to overdiagnosis.

Assistance to victims with injuries of the musculoskeletal system at the prehospital stage

Medical assistance to victims with damage to the musculoskeletal system in the focus of a disaster includes the following elements:

- termination of the traumatic factor;

- stop external bleeding;

- antishock therapy;

- the imposition of an aseptic bandage;

- immobilization.

Extraction of the victims from under the rubble, destroyed transport is often an additional injury. A surge of additional pain impulses when changing the position of the body in victims with injuries of the musculoskeletal system, the resumption of stopped bleeding, the ingress of toxic products into the bloodstream in patients with prolonged crush syndrome can lead to a sharp deterioration in the condition of the victim. Therefore, a preliminary assessment of the nature and severity of injuries, as well as anesthesia, are necessary elements of medical care at this stage. After removing the victim with existing external bleeding, it is necessary to stop him. Among a small arsenal of techniques and means used for this purpose, preference is given to applying a tourniquet or pressure bandage, if there are tools, applying a clamp or ligation of an artery in a wound. It should be noted that the application of a tourniquet in many cases is unjustified:

- firstly, the indication for the application of a tourniquet is damage to the large main arteries - the brachial, femoral and popliteal, open injuries of which are extremely rare. In all other cases, it is sufficient to apply a pressure bandage;

- secondly, the use of improvised means as a tourniquet leads to the imposition of the so-called venous tourniquet, which, creating venous stasis with normal arterial inflow, leads to significant blood loss even from small superficial wounds.

After stopping the bleeding, an assessment of the severity of the general condition of the patient is carried out, if necessary, infusion anti-shock therapy begins, the main elements of which in traumatic shock are pain relief and restoration of circulating blood volume. Both general anesthesia with narcotic and non-narcotic analgesics and local blockades with weak solutions of anesthetics in the fracture area are possible.

For infusion therapy, the use of any solutions, both saline and blood substitutes, is indicated. At this stage of medical care, the principle of restoring the volume of circulating blood is important. The main indicators of the adequacy of anti-shock therapy are a decrease in the frequency of respiratory movements, a decrease in tachycardia, and stabilization of blood pressure.

When applying aseptic dressings, it is advisable to use the so-called wound preservatives, which is the aerosol preparation cimesol, or ointments on a water-soluble basis - levosin, levomikol. The use of these drugs delays the development of infection in the wound up to 24 hours, which allows you to delay the toilet of the wound or the operation of primary debridement.

Anesthesia is one of the main elements of antishock therapy. At this stage, the use of parenteral analgesics, both narcotic and non-narcotic, is mandatory. Along with central analgesia, it is also possible to use local anesthesia in the fracture area with weak solutions of anesthetics. An indicator of the correctness of the injection site of the anesthetic is the flow of blood into the syringe from the hematoma formed at the fracture site.

Immobilization, stopping or reducing the mobility of fragments at the level of damage, reduces pain impulses, reduces the risk of additional injury to soft tissues, blood vessels and nerves by bone fragments.

In our country, perhaps the only means used for immobilization during transportation of victims is the Cramer ladder splint. A rather primitive and easy-to-handle Cramer splint, however, when properly applied, provides reliable immobilization necessary for transporting the victim. For immobilization of the lower extremities, tires of Thomas, Dieterichs can be used. Abroad, pneumatic tires are widely used, which are put on a limb in the form of a stocking, followed by inflation using chemical reactions. It is also possible to use improvised tires. In addition, in the absence of standard and improvised means for immobilization, the method of fixing one injured lower limb to another and fixing the upper limb to the body is used. The main rule and necessary condition for transport immobilization in traumatic limb injuries is the fixation of two joints adjacent to the damaged segment. For example:

- hip fracture: immobilization of the hip and knee joints;

- fracture of the lower leg: immobilization of the knee and ankle joints;

- fracture of the shoulder: fixation of the shoulder and elbow joints;

- fracture of the forearm: fixation of the elbow and wrist joints.

It is especially necessary to dwell on immobilization in the so-called forced positions of the limbs. Such positions are usually found in dislocations. So, for example, with axillary dislocation of the shoulder, the upper limb is raised above the head and held in this position with a healthy hand; with the most common posterior hip dislocation, the lower limb is bent at the hip and knee joints, adducted and rotated inwards; with obturator dislocation of the hip, it is retracted outward to 90 degrees and rotated outward. In such situations, in no way should one try to restore the normal position of the limb, but immobilization should be carried out in the existing forced position of the limb.

Immobilization in case of damage to the spine and pelvic bones is carried out by laying the patient on his back on a flat hard surface. If the cervical spine is damaged, the patient is placed with his head slightly thrown back (roller under the back of the neck) to give the cervical spine an extension position.

In case of damage to the pelvis, the lower limbs should be in the position of flexion in the hip and knee joints at an angle of 30-40 degrees (the so-called frog posture), which leads to maximum relaxation of the muscles attached to the pelvic bones and a decrease in pain. Technically, this position is achieved by placing a roller of the appropriate size under the knee joints.

Transportation of patients with injuries of the musculoskeletal system, especially if it lasts for a long time, must necessarily be accompanied by analgesia (repeated injections of analgesics or repeated novocaine blockades), as well as, if necessary, infusion therapy.

Assistance to victims with injuries of the musculoskeletal system in a specialized hospital

Upon admission of a patient to a specialized hospital against the background of ongoing anti-shock therapy (if necessary), an assessment of the severity of existing injuries is carried out, X-ray diagnosis of fractures is carried out. In the course of a traumatic disease, two periods should be distinguished: hypocoagulation and hypercoagulation.

In the first three days there is a hypocoagulation syndrome. This is due to the fact that after an injury, heparin is released from damaged tissues. In addition, a decrease in the absolute number of coagulation factors (due to their consumption for thrombosis of injured vessels) is superimposed on a decrease in their concentration in the circulating blood due to massive infusion therapy.

From the 4th-5th day, the state of hypercoagulability increases, i.e. tendency to thrombosis, which can cause thromboembolic complications.

This specificity of the course of the post-traumatic period should be taken into account in drug therapy. If in the first days it is necessary to use drugs that improve blood clotting, then from the 4-5th day - anticoagulants.

All existing methods of treatment of fractures are presented in Fig. 2.

The system of treatment of isolated injuries of the musculoskeletal system is currently quite fully developed and is discussed only in terms of the preference given by one or another school to one or another method of treatment.

With regard to polytrauma, there is still no unified approach to the tactics of treating fractures. This is related to the presence a large number specific factors:

- a serious condition of the victim upon admission, which continues after removal from shock;

- the need to combine two tasks - saving lives and rational treatment of fractures;

- frequent occurrence of local and general complications;

- the need to ensure the mobility of the victim for repeated diagnostic and therapeutic measures related to the shifting and transportation of the patient;

- the level of technical equipment, experience of medical personnel and drug supply;

- compliance of the number of victims with the forces and means of the medical institution.

Conservative methods of treatment in conditions of polytrauma have limited performance.

Recently, even in conditions of isolated fractures, especially long tubular bones, preference is given to the surgical method of treatment, which has a number of advantages:

- the possibility of an ideal comparison of fragments, which is especially important for intra-articular fractures;

— the possibility of rapid rehabilitation of the injured limb, i.e. restoration of function in the joints;

— reduction of terms of bed rest and inpatient treatment.

Having significant advantages, the surgical method of treatment has a significant drawback - the risk of purulent complications, which, if they occur, can lead to serious consequences for both the injured limb and the victim as a whole. In our opinion, the main indication for surgical treatment of isolated fractures should be the impossibility of adequate reduction and retention of fragments in the reduced position in a conservative way.

Conservative treatments include skeletal traction and a plaster cast. Skeletal traction can be successfully used for fractures of the femur, humerus, and lower leg bones. Providing the possibility of a good comparison of fragments, the method allows for early development in the joints adjacent to the fracture site. In addition, traction can be used as a method of gradual reduction of fragments, followed by the application of a plaster cast (fracture of the lower leg, calcaneus, etc.).

Plaster immobilization as a method of fracture treatment can be used in two cases:

- fractures without displacement or impacted fractures;

- fractures in which simultaneous manual reduction is possible.

The disadvantages of one of the most ancient methods of treatment (immobilization) include the possibility of secondary displacement of fragments, as well as immobilization contractures in the joints.

Five-year experience in the treatment of patients with injuries of the musculoskeletal system in the polytrauma department of the 4th State Clinical Hospital named after prof. Meshchaninov showed the preference for early (urgent) use of the surgical method for treating fractures. This is due to the following factors:

- operational stabilization of fragments is an anti-shock measure, since it allows you to reduce pain impulses, stop the existing internal bleeding;

– the modern level of anesthesiology and resuscitation, with the necessary provision of medicines and instruments, allows for surgical interventions in the required volume even in conditions of severe polytrauma;

- the general condition of patients with combined and multiple trauma in the immediate post-traumatic period is aggravated by the frequent development of general and local complications, which makes it impossible to carry out delayed surgical interventions on the organs of the musculoskeletal system;

- patients with polytrauma require repeated diagnostic and therapeutic manipulations associated with shifting the patient, which causes significant difficulties in conservative treatment of fractures.

Surgical tactics for open and closed fractures has its own characteristics. So, with open bone injuries of type IIB-IIIB (according to the Kaplan-Markova classification), extrafocal stabilization of fragments is indicated, since the risk of purulent complications is quite high. In a situation where it is possible to simultaneously eliminate existing displacements, preference is given to rod devices, which have a number of advantages over Ilizarov devices:

- quick and easy application;

— the possibility of one-sided passage of the rods, which significantly reduces the risk of additional injury to soft tissues, blood vessels and nerves;

– rod-based external fixation devices provide optimal care for an open fracture wound.

In addition, ensuring the fulfillment of the main task in urgent conditions - fracture stabilization, the rod apparatus, if necessary, in the post-traumatic period can be replaced by the Ilizarov apparatus.

Treatment of open fractures is carried out in compliance with all the basic principles of wound treatment. The operation of primary surgical treatment is aimed at excision of non-viable tissues, reducing the risk of purulent complications, creating conditions for healing the wound of an open fracture by primary intention. In cases where it is impossible to close the wound due to a large soft tissue defect, open management of wounds under ointment dressings is indicated. Preference should be given to ointments on a water-soluble basis (levosin, levomikol), especially in the first phase of the course of the wound process.

With closed fractures of the bones of the extremities, surgical stabilization of fragments is carried out using bone or intramedullary osteosynthesis. The latter has great advantages in diaphyseal transverse fractures of the femur, since, by providing sufficient stability, it allows early loading of the operated limb. Bone osteosynthesis with metal plates has now gained popularity all over the world. Plates of various lengths and shapes allow achieving adequate reposition and reliable fixation of fragments in fractures of any location.

Particular issues of treatment of injuries of the musculoskeletal system in a specialized hospital

The choice of treatment method in a patient with injuries of the musculoskeletal system in each case is based on personal experience and the skill of a specialist, since a huge number of factors influence the decision-making:

- high variability of damage to the musculoskeletal system, their combination with each other and with damage to other organs and systems;

- the severity of the condition of the victim;

- the time elapsed since the injury;

- the age of the victim;

- the availability of the necessary conditions and tools for the implementation of a particular method of treatment;

- Qualification of the person providing assistance.

Nevertheless, we consider it appropriate to consider the most common injuries of the musculoskeletal system, to characterize the indications and contraindications for certain methods of treatment.

Upper limb injuries

Clavicle fracture. In the vast majority of cases, conservative treatment is performed using Delbe rings or an eight-shaped bandage as immobilization. The only absolute indication for open reduction is the threat of perforation of the skin by displaced bone fragments or damage to the elements of the brachial plexus and subclavian vessels.

Shoulder dislocation requires urgent closed reduction, which should be carried out under conditions of general anesthesia, followed by fixation with a Deso bandage.

Humeral fractures respond well to conservative treatment with permanent skeletal traction or functional plaster casts. However, in conditions of polytrauma, it is advisable to use surgical treatment. Fixation of fragments is carried out, as a rule, with plates. Another indication for open reduction is damage to the radial nerve at the level of the fracture, as well as intra-articular fractures of the distal metaepiphysis of the humerus with displacement.

Dislocation of the forearm. Urgent closed reduction is shown under general anesthesia, followed by fixation with a posterior plaster splint.

Fractures of the bones of the forearm. A fracture of one of the bones of the forearm, if closed reduction is possible, is immobilized with a plaster cast. In case of fractures of both bones, especially in the middle third, with displacement, it is advisable to use an operative method of treatment. Given the high functional significance of the segment and the need for early restorative treatment, it is preferable to perform bone osteosynthesis, which does not require additional external immobilization.

Lower limb injuries

Dislocation of the hip. It is necessary to eliminate the dislocation closed under conditions of general anesthesia with muscle relaxation, followed by unloading traction. In a situation where there are no clear clinical (at the time of closed reduction) or radiographic data on the elimination of dislocation, one should think about a possible soft tissue or bone (in the case of fracture dislocation) interposition requiring open reduction.

Fracture of the femur. Fractures of the upper third of the femur, comminuted or oblique fractures of the middle and lower thirds are successfully treated with permanent skeletal traction. If it is necessary to stabilize the fracture surgically, preference should be given to plate osteosynthesis. Transverse fractures of the femoral shaft are an ideal localization for intramedullary osteosynthesis. Simple and fast in execution, this method of osteosynthesis allows in the early post-traumatic period to carry out the load on the injured limb. An absolute (from the point of view of the functional result of treatment) indication for open reduction is a comminuted, intra-articular fracture of the distal femoral metaepiphysis. Osteosynthesis in this situation is carried out with metal plates (L-shaped or straight), which makes it possible to avoid additional external immobilization, to begin early restoration of the function of the knee joint.

A fracture of the patella without rupture of the extensor apparatus needs only immobilization. If the extensor apparatus is damaged, surgical treatment is indicated. The generally accepted technique of osteosynthesis is the Weber operation, which allows, without immobilization in the postoperative period, to develop movements in the knee joint, to carry out the load on the injured limb.

Damage to the ligaments of the knee joint is an indication for their prompt restoration in case of isolated damage. In patients with polytrauma, an immobilization method of treatment can be used with postponing the decision on the surgical restoration of the ligamentous apparatus for 2-6 months.

Fracture of the bones of the leg. As a rule, in the case of isolated damage and the possibility of closed removal of the displacement, a plaster cast is applied. It is possible to use skeletal traction as a method of gradual reduction of fragments within 3-7 days, followed by the application of a plaster cast. Comminuted intra-articular fractures of the proximal and distal metaepiphysis of the tibia with displacement are an indication for open reduction and metal osteosynthesis. The latter can be produced with both screws and plates. In the surgical treatment of diaphyseal fractures of the tibia, preference should be given to stable methods of osteosynthesis: bone and intramedullary. Repositioning osteosynthesis with screws can serve as the method of choice for oblique and helical fractures. With multi-comminuted, as well as open fractures of the lower leg, extrafocal fixation is indicated, which can be carried out both with Ilizarov apparatus and with rod apparatus.

Fracture of the calcaneus. As a rule, in urgent conditions, it needs plaster immobilization. It is possible to use the method of skeletal traction followed by the application of a plaster cast.

Spinal column injuries

From the anatomical-functional and therapeutic-diagnostic points of view, three sections should be distinguished in the spine: cervical, thoracic and lumbar.

Pronounced physiological mobility in all planes at the level of the cervical spine determines the possibility of damage even with a slight mechanical injury. In addition, the anatomical feature of the structure of the cervical vertebrae determines the possibility of dislocations, which in other parts of the spine are casuistry. Without going into the subtleties of the variety of possible injuries at the level of the cervical spine, it should be noted that from a therapeutic point of view, it is necessary to distinguish between stable and unstable injuries. Unstable injuries include fractures, fracture-dislocations and dislocations of the cervical vertebrae, which tend to secondary displacement. If with stable injuries at the level of the cervical spine, immobilization with a Shants collar is sufficient, then with unstable injuries, long-term immobilization with a thoracocranial plaster cast or surgical treatment is necessary.

Damage at the level of the thoracic spine, as a rule, is stable. Usually these are compression fractures of the vertebral bodies, requiring only bed rest (with 2-3 degrees of compression on reclining ridges) followed by the use of semi-rigid corsets as immobilization.

At the level of the lumbar spine, both stable injuries (compression fractures of the vertebral body, fractures of the spinous and transverse processes, isolated fractures of the articular processes) and unstable injuries are also possible. With stable injuries, bed rest is observed (if necessary with reclination) for 6 weeks. In case of unstable injuries, it is advisable to use operational stabilization of the damaged segment.

In addition to the above, indications for surgery at any level of the spinal column are complicated spinal injuries, i.e. injuries that result in spinal cord injury.

Pelvic fractures

Stable and unstable pelvic ring injuries should be distinguished. Stable fractures include: marginal fractures, avulsion fractures of the spines, fractures of the anterior semicircle of the pelvis (fracture of the ischium, pubic bones on one or both sides) without damage to the posterior semiring, isolated fractures of the sacrum or ilium. Such injuries do not require additional immobilization, subject to bed rest. It is advisable to use disciplinary traction in the position of maximum relaxation of the antagonist muscles - the position according to Volkovich - Dyakonov (frog posture).

Unstable pelvic injuries include vertical or diagonal pelvic fractures, synphyseal tears, and sacroiliac joint ligament injuries. Such injuries, especially in conditions of polytrauma, require reliable stabilization, which can be carried out by applying a rod apparatus, using various types of orthoses, and metal osteosynthesis can also be used. In case of dislocations or fracture-dislocations of the pelvis, skeletal traction with large loads is indicated, and after the displacement has been eliminated, external or internal stabilization of existing injuries is indicated.

In conclusion, I would like to note that injuries of the musculoskeletal system are the leading disabling factor in patients with polytrauma. Therefore, timely and adequate treatment, especially in urgent conditions, will significantly reduce the number of adverse outcomes.

bruises.

Damage to tissues and organs without violating the integrity of the skin is called bruises. Depending on the strength of the blow, bruises are light, medium and severe. With mild bruises, small hemorrhages occur with the formation of bruises. With medium ones, there are more significant hemorrhages with the formation of a bruise. Severe bruising can cause life-threatening internal bleeding.

When bruised, not only superficial tissues can suffer, but also internal organs- liver, kidneys, etc. The concussion of the brain is especially dangerous. Even a short-term loss of consciousness during a fall or vomiting after it requires immediate medical attention. Walking is contraindicated for such a patient, it is better to take him to the emergency room on a stretcher.

First aid measures for a bruise are primarily aimed at reducing pain and internal bleeding. For this purpose, cold is used. A bubble with cold water or ice is not recommended to be applied directly to the body: it must be wrapped in cloth.

Sprain.

In case of injuries, violent or awkward movements, when the displacement of the bones in the joint is greater than the permissible value or does not correspond to the usual direction, damage and sprain of the ligaments occur. Around the damaged joint, swelling soon develops and severe pain occurs. Often sprains are accompanied by damage to blood vessels and hemorrhages.

If the ligament is sprained, the injured joint must be cooled. To do this, a rubber heating pad or a plastic bag with a little cold water or snow can be used, and if this is not possible, just a wet cloth. After 15-20 minutes, the joint should be tightly bandaged, and the victim taken to a medical facility.

Dislocations of the joints.

With significant sharp movements in the joints, the matter is not limited to sprains. In these cases, it is possible to displace the ends of the bones that form the joint - dislocation: the head of one bone can partially or completely come out of the articular cavity of the other. As a result, the contact of the articular surfaces is disturbed. The slightest movement causes acute pain in the damaged joint. First aid should consist in the application of cold, ensuring complete rest of the injured limb and immediate delivery of the victim to a medical facility.

Bone fractures.

A complete or partial break in the integrity of a bone is called a fracture. If the skin and muscles are not broken, fractures are classified as closed, and if violated - to open. Distinguishing a fracture from a bruise can be quite difficult. Signs indicating the presence of a fracture are as follows: acute pain when trying to change the position of the damaged part of the body, the appearance of mobility in places where it should not be.

With open fractures, you must first stop the bleeding and treat the wound, apply a bandage. You should not try to give the bones their natural position, as the broken ends of the bones can damage soft tissues, rupture a blood vessel, and damage a nerve. The affected part of the body must be given immobility, that is, fix it.

If an arm or leg is injured, a splint is placed on it. To do this, use either special medical tires, or improvised means - planks, cardboard. The tire must capture at least two adjacent joints. The tire is applied from the side of uninjured tissue areas. Under the tire should be a soft cloth - cotton wool or clothing. You cannot put a splint on a naked body. The tire is not bandaged very tightly: it should not put pressure on the damaged surface.

In case of a fracture of the bones of the shoulder, forearm and hand, it is advisable to bend the arm at the elbow and, in addition to the splint, fix the arm with a scarf. You can tie the ends of the scarf around the neck and put a hand with a tire in it. If there is no scarf, you can attach the floor of the jacket on the side of the affected arm with a pin to the lapel of the jacket and put your hand into the resulting fold

In case of a fracture of the femur or bones of the lower leg, a splint is applied along the outstretched leg. In extreme cases, you can bandage the diseased leg to a healthy one.

If the bones of the chest (ribs, sternum) are fractured, the splint cannot be applied. The victim is offered to hold his breath in the exhalation phase and apply a tight bandage. After that, he is allowed to breathe, but not deeply, and taken to the emergency room.

In case of spinal injuries, the victim is placed face down on a flat floor. It is impossible to plant, and even more so transport or carry the victim in a sitting position.

In case of injuries of the skull, the victim is placed on his back. The head is fixed with a roller of clothes or a blanket. The roller is laid in the form of a horseshoe so that the head is motionless. The face of the victim should be turned to the side, in case of vomiting. You can't put your head on a pillow.

QUESTIONS

Damage to the musculoskeletal system

Type of damage	Characteristic features	First aid
Sprain	Sharp pain in the joint during movement, its swelling; at break - bruising	Pressure bandage, cold
Dislocation	Severe pain, stiffness of the joint, change in the shape of the joint	Provide rest to the joint, apply a splint, cold; painkiller
fractures
Closed	Sharp pain, extensive bruising, swelling, inability to move, or abnormal movement or deformity of the bone	Immobilize - put a splint; painkillers
Open	Sharp pain, damage to the skin, possibly fragments of bone are visible from the wound. Do not set bone fragments!	In case of bleeding - apply a tourniquet; sterile gauze bandage ( remember the rules of asepsis and antisepsis); tire; painkillers

Severe sharp pain in the left leg, swelling. Abnormal movement of the leg. There is swelling and pain in the ankle joint.

Determine the diagnosis. Help; determine transportation.

№2 Aching pain in knee joint (right leg). Swelling develops gradually, pain during movement. In addition, the victim complains of pain in the shoulder (right) after a fall, but although the movements of the arm are painful, no other external signs are observed. Determine the diagnosis. Help. Determine the method of transportation.

After a sharp jump and falling on his side, the victim feels severe pain in his right thigh, it is impossible to move his leg. The left joint (ankle) was very swollen and turned blue. Assume the type and extent of damage. Provide assistance; transportation method.

№4 The victim fell on his outstretched hand. The right elbow joint is swollen, feels severe pain. Puffiness also on the index finger of the right hand. Help. Suggest a method of transportation.

The victim complains of pain in the forearm. Fragments of bone protrude from the wound. The patient periodically loses consciousness.

Determine the type of damage.

Help.

Suggest a method of transportation. ** The correctness of the task is assessed by a medical worker, “dressing specialists from other teams”.

Additional follow up questions:

1. Why are fractures less dangerous in youth than in old age? (In youth, there is still a lot of cartilaginous tissue in the skeleton, and organic substances in the bones, so the bone tissue is quickly restored).

2. Why does a tumor appear when sprained or ruptured ligaments? (Articular fluid flows out, hemorrhage occurs - an inflammatory effect).

3. What is “habitual dislocation”? Who has it? (Athletes. There is a very large load on the joints, so the ligaments lengthen and the bones come out of the joints).

1. On a multi-day hiking trip in the taiga, a tourist sprained his foot. The ankle joint quickly swells and acute pain does not allow stepping on the sore leg. Specify first aid measures. How to help the victim in the following days?

(The cold will help the injured tourist from acute pain. To do this, the leg can be placed in a forest stream or a plastic bag with cold water can be applied. It is necessary to put a tight bandage on the ankle joint, ensure peace. It is advisable not to walk. This is most likely a sprain.)

2. After a fall from a bicycle, a boy began to complain of pain in his shoulder joint. The patient can raise his left arm, but pain, redness, and swelling are indicative of injury. What would you diagnose?

(If the joint has retained its mobility, it is impossible to raise the arm with a dislocation, as with a fracture, most likely the victim has a sprain or bruise of the joint, ruptures of the articular bag and ligaments are possible).

3. A group of tourists, having walked a long distance, find a place to rest on a wooded bank of the river. Dropped heavy backpacks. The youngest, the most impatient, taking off their clothes as they go, run to the river. One of them jumps upside down into clear, transparent water. But why did he stay underwater for a long time? And then a strangely limp, as if inanimate body emerges. Comrades rush to the rescue and pull the diver ashore. What happened?

(Apparently, the young man dived and hit his head either on the bottom of the reservoir, or on some object that was under water. Probably, a fracture and dislocation occurred cervical vertebra. This is a very serious injury. In 70% of cases, such injuries are fatal. If the victim can be saved, then he often remains disabled. The diver must be picked up under the armpits, turned back to himself, attached to the hip and swim to the shore. Keep your head under water. On the shore, lay him on his back on a hard, flat surface. It is impossible to turn and tilt the head; it must be immobilized. Call an ambulance. Before diving, find out the depth of the reservoir, examine its bottom. Remember, your life and safety depend on your caution.)

Testing.

In what sequence should first aid be provided for a dislocated joint?

A. Take the victim to a doctor.

B. Immobilize the limb.

B. Apply cold to the damaged area.

D. Tightly bandage the damaged joint.

What are your steps in helping a person with a fractured ulna?

A. Apply a splint.

B. Send the victim to a doctor.

B. Cover the limb with soft material.

G. Bandage the splint to the limb.

4. Checking the mastery of first aid skills for skeletal injuries. (Group work on completing assignments-tasks with subsequent protection of answers.)

A man has a fracture of the ribs of the chest. Describe your actions and justify them.

A person has an open fracture of the tibia of the extremities. Describe your actions and justify them.

A man has a fractured humerus. Describe your actions and justify them.

(Demonstrate methods of rendering assistance on dummies of a person. A school doctor participates in checking the performance of work.)

Similar information.

An injury is a sudden impact on the human body of environmental factors (mechanical, physical, chemical, etc.), leading to a violation of the anatomical integrity of tissues and functional disorders in them.

There are the following types of injuries: industrial, household, street, transport, sports and military.

There are acute injuries that occur after a strong simultaneous impact, and chronic injuries that occur after repeated exposure to a damaging factor of low strength on a certain part of the body. Injuries can be accompanied by damage to the skin or mucous membranes - these are open injuries (wounds, fractures); can be without damage to the integument - these are closed injuries (bruises, sprains, ruptures, dislocations, bone fractures).

The most common injuries of the musculoskeletal system as a result of exposure to mechanical force: bone fractures, sprains and muscle ruptures or “knits, dislocations.

With a slight impact of the damaging factor, local symptoms of injury prevail: redness, swelling, pain, dysfunction. With extensive damage, along with local symptoms, disturbances in the activity of the central nervous, cardiovascular and respiratory systems, gastrointestinal tract, excretory organs and endocrine glands occur.

The totality of general and local pathological changes in the body when the organs of support and movement are damaged is called; traumatic illness.

Traumatic illness can begin with the development of traumatic shock, collapse or fainting.

Fainting (syncope). Sudden loss of consciousness due to insufficient blood circulation in the brain. With fainting, dizziness, nausea, ringing in the ears, cold extremities, a sharp blanching of the skin, and a decrease in blood pressure are observed.

Collapse. A form of acute vascular insufficiency. It is characterized by a weakening of cardiac activity as a result of a decrease in vascular tone or circulating blood mass, which leads to a decrease in venous blood flow to the heart, a decrease in blood pressure and hypoxia of the brain. Collapse symptoms: general weakness, dizziness, cold sweat; consciousness is preserved or clouded.

Traumatic shock. A severe pathological process that occurs in the body as a response to a severe injury. It is manifested by increasing inhibition of vital functions - due to a violation of the nervous and hormonal regulation, the activity of the cardiovascular, respiratory, excretory and other body systems. There are two phases in the development of shock: erectile and torpid.

The erectile phase (excitation phase) is characterized by psychomotor agitation, anxiety, talkativeness, increased heart rate and blood pressure.

After 5-10 minutes, the state of excitation is replaced by depression - the torpid phase of shock develops. In this phase, there is an inhibition of the activity of all body systems, increased oxygen starvation, which ultimately can lead to the death of the victim. The development of traumatic shock depends on the extent, nature of the injuries and their localization.

Most often, shock develops with injuries of the pelvic bones and lower extremities, which is associated with damage to large nerve trunks, blood vessels and muscles.

Timely and competently provided pre-medical and medical assistance can prevent the development or deepening of shock.

After removing the patient from the state of shock and starting treatment, a traumatic disease develops, which has its own specifics and symptoms.

Prolonged bed rest and immobilization of the damaged body segment, usually used for injuries of the musculoskeletal system, improve the patient's condition, reduce the intensity of pain. However, long-term maintenance of a forced position (lying on your back), associated with traction, a plaster cast, etc., leads to the fact that a large number of unusual impulses enter the central nervous system, which cause increased irritability of patients and sleep disturbance. Reduced motor activity (hypokinesia) during bed rest has a negative impact on the functional state of various body systems of the victims.

In a forced position in patients, the excursion of the chest decreases; congestion develops in the lungs, which can lead to the development of pneumonia.

Hypokinesia causes changes in the activity of the cardiovascular system. There are congestion in the systemic circulation, which can lead to the formation of blood clots, and in the future - to thromboembolism.

Dysfunction of the gastrointestinal tract is associated with a decrease in intestinal motility; constipation, flatulence are observed. At the same time, the evacuation of processed food slows down, and the decay products are absorbed into the blood, which causes intoxication of the body.

All these negative phenomena are manifested to a greater extent if anesthesia was used during the surgical method of treatment.

Prolonged immobilization of the damaged segment of the musculoskeletal system causes a number of specific local changes. In the immobilized muscles, atrophy develops, which manifests itself in a decrease in size, strength and endurance.

Prolonged absence or insufficiency of axial load in injuries of the lower extremities contributes to the development of osteoporosis - a decrease in bone density as a result of a decrease in the amount of bone substance or loss of calcium. Further; this can lead to bone deformity and pathological fractures.

With prolonged immobility, pronounced degenerative-dystrophic changes also occur in the tissues of the joint and in its surrounding formations, which is accompanied by limited mobility in the joints - the formation of contractures. Depending on the participation of a particular tissue in the formation of contractures, dermatogenic (skin, formed as a result of contraction of the skin), desmogenic (wrinkling of aponeuroses), tendogenic (shortening of the tendons) and myogenic (shortening of scars on the muscles) contractures are distinguished. As a result of damage to the joint, ankylosis can occur - a complete lack of mobility in the joint, caused by bone fusion.

Fractures are a violation of the anatomical integrity of the bone caused by mechanical action and accompanied by damage to surrounding tissues and impaired function of damage to a segment of the body.

Fractures that are the result of a pathological process in the bones (tumors, osteomyelitis, tuberculosis) are called pathological.

There are open fractures, accompanied by damage to the skin, and closed ones, when the integrity of the goats is preserved.

Fractures can be extra-articular and intra-articular.

Depending on the localization, fractures of tubular bones are divided into diaphyseal, metaphyseal and epiphyseal.

In relation to the axis of the bone, transverse, oblique, longitudinal, helical, impacted fractures are distinguished.

If the bone is damaged with the formation of fragments, then comminuted fractures occur.

When a large number of small fragments of bones are formed, fractures are called shattered.

Under the influence of an external force and subsequent traction of the muscles, most fractures are accompanied by displacement of fragments: in width, length, at an angle, along the periphery, around the axis (rotational).

With a slight force of the traumatic agent, fragments can be held by the periosteum and not displaced - these are subperiosteal fractures.

In bones that have a spongy structure (spine, calcaneus, epiphyses of long tubular bones), in case of injury, the mutual introduction of broken trabeculae occurs - a compression fracture occurs.

The diagnosis of a fracture is made on the basis of relative (pain, swelling, deformity, dysfunction) and absolute (abnormal mobility, crepitus) signs. The conclusion about the presence and nature of the fracture is obtained on the basis of the radiograph.

Treatment of fractures includes restoring the anatomical integrity of the broken bone and the function of the damaged segment. The solution of these problems is achieved due to: early and accurate comparison of fragments; strong fixation of reduced fragments - until their complete fusion; creating a good blood supply in the fracture area; timely functional treatment of the victim.

For the treatment of diseases and injuries of the musculoskeletal system, two main methods are used: conservative and operative. Despite the development of surgical methods of treatment in traumatology, the conservative method has been the main one until recently.

In the conservative method of treatment, two main stages are distinguished: fixation and traction. The means of fixation can be plaster bandages and corsets, splints, various devices, etc.

A properly applied plaster cast holds well aligned bone fragments and provides immobilization of the injured limb. To achieve immobility and rest of the injured limb, a plaster cast fixes 2-3 nearby joints. The variety of plaster casts (Fig. 6) is divided into plaster splints and circular bandages.

The main principles of skeletal traction are the relaxation of the muscles of the injured limb and the gradual increase in load in order to eliminate the displacement of bone fragments and their immobilization (immobilization). Skeletal traction is used in the treatment of displaced fractures, oblique, helical and comminuted fractures of long bones, some fractures of the pelvic bones, upper cervical vertebrae, bones in the ankle joint and calcaneus. At present, traction with the help of a Kirschner wire stretched in a special bracket is the most common (Fig. 7). The needle is passed through various segments of the limb - depending on the indications. A load is attached to the bracket with a cord, the value of which is calculated according to a certain method. After removing the skeletal traction, after 20-50 days (depending on the patient's age, location and nature of the damage), a plaster cast is applied.

In the surgical treatment of fractures, osteosynthesis is used - the surgical connection of bone fragments in various ways. To fix bone fragments, rods are used (Fig. 8), plates, screws, bolts, wire sutures, as well as various compression devices (Ilizarov apparatus, etc.) (Fig. 9).

The advantage of the surgical method of treatment is that after the fixation of fragments, it is possible to make movements in all joints of the damaged body segment, which is impossible with a plaster cast, which usually captures 2-3 nearby joints.