Methods of treatment of fractures
Treatment of fractures should be carried out in medical institutions traumatologic profile. There are various methods of eliminating such injuries, one of the ways the doctor chooses depending on the nature of the injury.
The principles of elimination of fractures
The main aim of the doctor is to create optimal conditions for proper Union of bones. To achieve this goal in three ways:
- conservative treatment;
- skeletal traction;
Mandatory components of the treatment of such injuries are reduction, immobilization of a limb and create conditions for the early appearance of callus.
What is the reduction?
Reduction, or reduction is bringing the bone in the optimal position, which will ensure their adequate fusion. It is open or closed. This event is carried out only in the case of injuries with displacement. Thus, a correctly executed fracture reduction allows to achieve elimination of displacement of bone fragments by length, width, and axis.
Before a closed manual reposition the doctor anaesthetises the site of injury, most often by introducing anesthetic into the fracture. Then the surgeon performs certain manipulations (fixation of the limb and subsequent traction) that allow you to associate the peripheral with the Central Outlook.
After completion of the reduction imposed temporary locking of the fixing device and immediately carried out radiological control.
Estimating the position of fragments in the picture, the doctor determines that you have successfully passed the procedure and, if necessary, makes repeated repositioning. When the optimal position of the bone fragments is achieved, the limb is immobilized completely.
How is immobilization?
Under the immobilization to understand the prevention of movement of the bone fragments relative to each other. If the treatment is carried out conservatively, fixation is achieved by application of the plaster bandage. When the fracture can be eliminated by way skeletal traction, and fixation of bone fragments is carried out thanks to the permanent effect of traction. In the case of surgical removal of fractures immobilization is provided by metal structures that hold the bone fragments (needles, pins, screws, plates).
Often patients are concerned about how much time you have to wear a plaster cast. The duration of immobilization depends on the fracture's characteristics, agepatient (in the elderly fractures usually grow longer).
For example, in the case of a fracture of the ankle, the radial bone in a typical place, and the bones of the foot or hand to wear a cast for quite 4 to 8 weeks for injuries of the femoral healing takes 4 - 6 months, so the bandage needs to wear longer. Thus, the wearing time of the plaster can vary from 3 to 4 weeks to 2 - 3 months.
The pros and cons of conservative treatment
One of the main advantages of the conservative treatment of bone fractures, are its simplicity and accessibility. In addition, the patient retains the ability to move independently and to be treated at home. However, this method has its drawbacks:
- In some fractures with displacement, a closed reduction does not achieve bringing the bone fragments into normal position.
- In the case of fracture of the humerus or femur, and Shin bones even after a successful reposition of bone fragments is very often shifted repeatedly.
- Prolonged limb immobilization leads to muscle atrophy, deterioration of joint function, increases the risk of formation of blood clots in veins.
- Observation of soft tissues hidden under the plaster cast, is difficult, which may cause late detection of some complications.
How is skeletal traction?
Such methods of treatment of fractures are also called functional. Their essence lies in the gradual stretching of the peripheral fragment with relaxing the muscles. It can be argued that skeletal traction is a continuous reduction. Most often this method is used for the treatment of fractures of the tibia, femur, cervical Byrd, humerus, complex fractures of the ankle. Moreover, skeletal traction is used in cases, when by a closed manual reposition to eliminate the offset does not work, and surgical operation cannot be performed for some reasons.
For fixing cargo to otlacan use the needle and clip. In bone atlace the doctor makes the hole using a special surgical drill, inserting a needle, fix it to the bracket, and then, using a block system that attaches the brace to the load. Each day the trauma surgeon evaluates the position of the bone fragments, and after 3 to 4 days after the start of the traction x-rayed. If the shows that the normal position of the fragments could not achieve, change the thrust direction and magnitudecargo.
The great advantage of skeletal traction is gradual and high accuracy of reposition of bone fragments. This method often allows to resolve even complex types of displacements, without resorting to full surgery. In addition, your doctor may daily to assess the condition of the limb, assign physiotherapy, and the patient remains able to make some movement in the joints, thus avoiding the violation of their functions.
The disadvantages of this treatment include:
- the need to make holes in the bone otlomkov, which appears the chance of damage to vessels and nerves, development of osteomyelitis, a bone cutting needle;
- the inability to achieve the reduction in some types of fractures;
- the need for hospital treatment and prolonged patient stay in bed.
Operative treatment of fractures in the first place implies an open one-stage reposition, which is impossible to achieve the optimal arrangement of fragments relative to each other, regardless of the complexity of their displacement. During the operation, the surgeon fixes the fragments using special metal accessories. The use of fixing structures make it possible to give the dosage load on the injured limb much sooner than with other methods of treatment, preventing muscle atrophy and deterioration of the joints. However, in certain cases, after the operation there is a need to use additional immobilizing means - plaster splints, or soft casts.
To correct surgically is not any fracture, operative treatment method is only possible for the following reasons:
- open fractures of the long bones the tubular type;
- cases when fragments hurt blood vessels, nerves or internal organs;
- the presence of muscles, ligaments or tendons between atomtime (this makes closed reduction impossible);
- the formation of a false joint;
- inadequate fusion of the fractures, resulting in serious dysfunction.
Surgical operation may be permitted if attempts to hold a closed reduction fails for unstable fractures of the spine, when there is a risk of trauma to the spinal cord, fractures of the neck of the femur and patella.
The biggest advantage of this method of treatment of fractures is the ideal to combine fragments and carefully to commit them. However, surgery always involve some risk, in particular, the osteosynthesis accompanied byadditional traumatization of the soft tissues, the bone marrow in the process of setting the locking design. In addition, there is the risk of developing osteomyelitis. Finally, it is necessary to re-intervention after fracture healing, to remove the locking design.
Special attention should be given to rehabilitation after recovery. Physiotherapy will eliminate major consequences of the treatment of fractures - muscle atrophy and poor joint mobility.