Fracture with a displacement of the cause, treatment, rehabilitation

Fracture with displacement is a serious injury, at the moment of which the bone breaks, and the fragments diverge relative to each other. As a result of a change in the correct anatomical position, the limb is deformed toward shortening or lengthening, which is accompanied by severe symptoms. The diagnosis is specified after radiography and MRI. Treatment is carried out in various ways: simultaneous reposition, skeletal traction or surgical intervention.

Injury description

Fracture is a complete or partial violation of the integrity of the bone. As a result of damage, fragments are formed that may not change their position or diverge in different directions. This occurs under the influence of traumatic force at the time of injury or as a result of traction of muscle fibers.

Displacement of fragments can occur in different parts of the bone, but in most cases they accompany diaphyseal fractures of large tubular bones (femur, tibia, bones of the upper limb), as well as fractures near the joints and inside them.

Fracture with displacement can be isolated with damage to surrounding tissues, or combined with other injuries:

  • chest damage;
  • rupture of ligaments, tendons;
  • dislocation or subluxation;
  • blunt trauma to the anterior abdominal wall;
  • rupture of the bladder;
  • traumatic brain injury;
  • damage to the kidneys and others.

In severe cases, the damage is accompanied by compression of the nerve trunks or rupture of blood vessels.

Causes

Injury occurs when exposed to an external force that exceeds bone strength.

A common cause of a fracture is:

  • unsuccessful landing when falling from a height;
  • swipe;
  • criminal incident;
  • technological disasters;
  • industrial and domestic accidents;
  • traffic accident;
  • after the rubble of houses.

In addition to traumatic injuries, pathological injuries exist. They are more common in older people. For various reasons, the bones lose their flexibility and strength, as a result of which the bone structure becomes fragile and is damaged even with minor impacts.

The causes of a pathological fracture with a displacement include:

  • osteoporosis;
  • osteomyelitis;
  • osteomalacia;
  • lack of calcium and other minerals after prolonged use of drugs.

What is an offset

The displacement of bone fragments refers to the frequent manifestations of violation of the integrity of the bone. The degree of violation of the position of bone fragments can be of varying degrees of severity: from a slight shift to a significant deviation from the anatomical axis. In this case, the injured limb is deformed due to a change in length.

In practical orthopedics, primary and secondary displacement are distinguished. Primary occurs at the time of injury. The secondary is caused by the pull of muscle fibers, which reflexively contract and “stretch” bone fragments in different directions. In addition, displacement may occur if the victim is improperly transported to a trauma center.

There are several types of displacement directions:

  • Oblique – characterized by the formation of an angle in the displacement region. Most often occurs with a fracture of the body (diaphysis) of the bone, as a secondary complication.
  • Lateral – it is diagnosed when the fragments diverge to the sides. This form mainly accompanies fractures with the formation of a transverse fault line.
  • Longitudinal – displacement along the length of the bone occurs when one part of the bone slides relative to the other. Appears under the influence of muscle contraction and leads to shortening of the limbs.
  • Helical – observed when one of the fragments rotates along a spiral-shaped trajectory.

Varieties

Fractures with displacement are classified depending on the mechanism of impact of the damaging force on the bone:

  1. During compression or compression, one of the fragments is wedged into the other. Frequent localization of such damage is the area at the border of the diaphysis and pineal gland (near the joint). As a result of significant displacement, it may not be observed, but the surfaces of bone fragments with crushing are destroyed.
  2. Fractures as a result of flexion can lead to incomplete damage, when cracking in different directions forms at the fracture site. If the bone structure does not withstand and collapses, then a large bone fragment with an acute angle is formed, which is located between two large bone fragments.
  3. A spiral movement, when one pineal gland remains in a fixed state, and the other makes a rotation around its axis, leads to a helical fracture. The cause of such damage can be twisting of the upper limb, and also, if the foot or hand remains clamped under or between hard surfaces, and the forearm or lower leg continues to move rapidly in a spiral.
  4. In some cases, when a rupture of ligaments and tendons occurs, a bone fragment breaks off and is removed over a long distance. In most cases, self-convergence is not possible.

Fracture with a shift can be accompanied by a breakthrough of the skin and the formation of an open wound surface.

Damage in which the integrity of the skin is not violated is called closed. Open fractures are divided into primary (at the time of injury) and secondary, when the sharp edges of the fragments damage the skin during careless transfer or transfer of the patient.

Given the direction of the fault line:

  • transverse – a kink occurs at an angle of 90 degrees relative to the axis of the bone;
  • longitudinal – damage is characterized by a parallel kink;
  • helical – with a spiral trajectory of damaging force;
  • oblique – when the fault passes with the formation of an angle of less than 90 degrees.

Bone can damage in any part. Depending on the location of the damage, fractures are divided into:

    Epiphyseal – a fracture occurs ins >

clinical picture

Offset fracture is characterized by severe symptoms:

  • the appearance of piercing pain at the site of damage;
  • over time, the strength of the pain syndrome subsides, but the high intensity persists;
  • protruding bone fragments are visible under the skin;
  • if the integrity of the skin is violated, bleeding is possible;
  • extensive subcutaneous hematomas appear on the injured area, which can appear immediately or appear gradually over several days;
  • the limb is severely deformed with the formation of pathologically mobile areas;
  • severe swelling appears after 2-3 hours, which leads to increased pain;
  • at the time of the injury, the victim may hear a crunch of breaking bones;
  • crepitus, as an absolute symptom of a fracture, is determined by palpation or while listening through a phonendoscope.

Any kind of displacement leads to increased symptoms. An exception is intraarticular (epiphyseal) damage. Such injuries do not cause unbearable pain, which can mislead the patient.

With damage to nerve fibers, neurological manifestations join the main signs:

  • violation of skin sensitivity;
  • periodic tingling, burning;
  • sensation of “running goose bumps”;
  • numbness of fingers or arms.

Frequent complications

According to the observations of doctors, the more the bones diverge as a result of the fracture, the greater the length of time it will take to return it to normal life. Complications can arise for various reasons:

  • poor metabolism;
  • late call to the doctor;
  • non-compliance with recommendations during treatment.

As a result of improper fusion of bone fragments, a false joint can form when bone mobility is observed in a place where there is no articulation. Other complications include:

  • bone deformation with a deviation of part of the limb in an unnatural direction;
  • contracture or ankylosis with intraarticular fractures;
  • shortening the injured bone;
  • filling the articular bag with blood (hemarthrosis);
  • arthrosis, arthritis, degenerative changes in bone tissue;
  • violation of nerve conduction with damage to nerve trunks.

Diagnostics

Clarification of the type and severity of damage is carried out by a traumatologist based on the results of examination and X-ray examination. External signs, supplemented by patient complaints, make it possible to make a preliminary diagnosis. To determine the treatment tactics, the time of the incident and the circumstances of the injury are important.

X-ray examination is carried out in several projections. A picture is drawn up with a definition of the type of damage, the type of displacement and the severity of the injury. To compile a complete picture of the fracture, magnetic resonance imaging is prescribed. Based on the results of the examination, a therapeutic and rehabilitation patient is compiled.

Therapeutic activities

The main goal of the treatment is to restore the functionality of the limb. In a fracture with a displacement, therapeutic actions are initially aimed at connecting fragments of bone.

The more accurately this is done, the greater the chance of avoiding secondary pathologies. Bone restoration can be carried out simultaneously or in several stages, using and without surgical intervention.

Therapies

  1. Simultaneous anatomical restoration of bone fragments is carried out by general or local anesthesia. Connection methods are selected depending on the type of injury. After fastening the fragments, a fixing bandage of gypsum or polymer bandages is applied. Monitoring of the process of fusion of damaged tissues, the formation of bone marrow is carried out using x-rays.
  2. For gradual reposition by a closed method, the skeletal traction technique is used. A needle is inserted through the bone of the injured limb, followed by suspension of the load, the mass of which depends on the functional state of the patient. A regular check of the condition of the bone is carried out by X-ray examination. If necessary, the mass of the load or the position of the leg is adjusted to restore the correct ratio of bone fragments. This will avoid limb deformation.
  3. The operation is prescribed for pinching between fragments of muscle tissue, nerve trunks or blood vessels. Indications are incorrectly fused fractures, ankylosis, joint contracture. Surgery is performed under general anesthesia. The comparison of the processes is carried out through a trepanation window (incision). The surgeon connects the fragments with his hands, fastening them with medical braces, screws, knitting needles and other structures.

Correct adhesion during fracture with displacement is ensured by wearing a rigid fixation bandage. With simple injuries, wearing a splint (an orthosis that provides immobility of the bone) is allowed. The duration of immobilization is determined by the attending physician. Most often, gypsum is from 1 to 4 months, the formation of bone callus is of decisive importance.

The following drug groups are prescribed as drug therapy:

  • Painkillers – Baralgin, Ketoprofen, Nurofen.
  • Antibiotics to prevent infection – Erythromycin, Cephalexim, Ampicillin.
  • Angioprotectors to improve metabolism and blood flow to damaged areas – Actovegin, Vestibo.
  • Chondroprotectors for improving the quality of metabolic processes in bone and connective tissue – Structum, Teraflex, Don.

Recovery period

Rehabilitation activities begin immediately after removal of the cast. To restore the functionality of a limb, an integrated approach is used:

  • physiotherapeutic procedures;
  • massage;
  • physiotherapy.

After forced hypodynamia in the injured area, blood circulation and tissue nutrition deteriorate, muscle atrophy develops. Each of the recovery methods improves microcirculation in the damaged limb, restores muscle tone, and promotes tissue regeneration.

Massage is carried out by a qualified specialist. After 10 sessions, the state of muscle fibers improves, blood flow and trophic reactions are restored. Therapeutic exercises are prescribed in the early period. The complex of exercise therapy is compiled by the attending doctor in conjunction with a rehabilitologist.

If the patient has a long bed rest, exercises are performed to prevent pneumonia. Subsequently, the regular implementation of the treatment complex helps to strengthen skeletal muscles and restore the motor function of the injured limb.

During the rehabilitation period, physiotherapeutic procedures are prescribed:

  • electrophoresis;
  • UHF;
  • applications with paraffin;
  • mud baths;
  • magnetotherapy;
  • laser beams;
  • ultrasound exposure.

The duration of the recovery period depends on the severity and type of fracture with displacement. On average, a patient recovers from 6 months to 1 year.

Prevention

It is possible to prevent a fracture with displacement by following simple recommendations:

  • be careful not to neglect the safety rules in everyday life and on the street;
  • wear comfortable shoes;
  • Exercise to strengthen muscles and develop stamina;
  • Healthy food;
  • when keen on extreme sports, use preventive bandages to prevent injuries.

If the fracture could not be avoided, you should immediately consult a doctor for diagnosis and proper treatment.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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