comminuted fracture
Introduction
Introduction to comminuted fracture Comminuted fracture is a complete fracture. The fracture of the finger bone is more than three pieces. It is also called t or y type fracture. The open fracture refers to the fracture of the skin or mucous membrane at the fracture site, and the fracture end is connected with the outside. A comminuted fracture of the femur can cause a person to become a scorpion. There are localized pain and tenderness in the fracture, local swelling and ecchymosis, limb function or complete loss, and complete bone deformity and abnormal activity. basic knowledge The proportion of illness: 0.06% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock peripheral nerve injury spinal cord injury hemorrhoids deep vein thrombosis
Cause
Cause of comminuted fracture
Trauma factors (45%):
A fracture is a disease in which bone is partially or completely broken due to trauma or pathology. Most of the trauma is a sprain or a fall. Sometimes the patient feels that the injury is light, and it is not very painful. It is considered that it is a big injury to the muscles, and it causes a fracture after walking.
Osteoporosis factor (35%):
As the body ages, the metabolism of the bones will slow down, the calcium absorption capacity will decrease, and the calcium in the bones will gradually lose. Estrogen stimulates the formation of bone and inhibits the breakdown of bone. Women will accelerate osteoporosis if they stop or reduce their secretions due to oophorectomy or menopause. Insufficient calcium intake or eating high-protein, high-salt foods, or smoking, alcohol.
Prevention
Comminuted fracture prevention
Usually pay attention to avoid damage in life. To prevent osteoporosis, you should balance nutrition and moderate exercise. The diet should contain sufficient calcium, vitamin D and other nutrients. Calcium and vitamin D are essential nutrients for increasing and maintaining bone quality, while proteins and other nutrients such as phosphorus, sodium and magnesium are also Maintaining bone health plays an important role. Exercise can significantly accelerate blood circulation throughout the body and bones, and muscle contraction and relaxation can directly stimulate bones, which can prevent and slow the progression of osteoporosis.
Complication
Comminuted fracture complications Complications Shock peripheral nerve injury Spinal cord injury Acne lower extremity deep vein thrombosis
Early complications
(1) Shock: severe injury, caused by major bleeding or major organ damage.
(2) Fat embolism syndrome: occurs in adults, due to excessive tension in the hemorrhage of the sacral cavity in the fracture, fat drops into the ruptured sinus, can cause lung and brain fat embolism.
(3) Important internal organ damage: 1 liver and spleen rupture. 2 chest and lung injury. 2 bladder and urethral injury. Intestinal damage.
(4) Important surrounding tissue damage:
1 important vascular injury; common such as straight rib exploration fracture, proximal fracture end is easy to cause aortic injury, pre-cavity or posterior luminal artery injury, upper femoral fracture, distal fracture end can cause Take arterial injury.
2 peripheral nerve injury: especially in the area where the nerve is closely adjacent to the bone, such as the fracture at the middle and lower 1/3 of the rib, it is easy to damage the nerve that is close to the skin, and the fracture of the rib is easy to cause total nerve damage.
3 spinal cord injury; a serious complication of spinal fracture and dislocation, more common in the cervical spine and thoracolumbar segment, paraplegia can occur.
(5) Osteofascial compartment syndrome: a series of early syndromes caused by acute ischemia in the muscles and nerves of the fascia formed by bone, interosseous membrane, intramuscular septum and deep fascia. Most commonly found in the volar and calf of the forearm, often caused by hematoma and tissue edema of the fracture to increase the volume of the indoor contents or over-tightening, local pressure forced the volume of the compartment of the fascia to decrease, resulting in increased pressure in the compartment of the fascia .
2. Late complications
(l) Fallen pneumonia: It occurs mostly in patients who have been bedridden for a long time due to fractures, especially those who are frail and have chronic diseases. Sometimes they can endanger the lives of patients, and encourage people to get out of bed early. .
(2) Hemorrhoids: After severe fracture, the patient is bedridden for a long time, the body bone is compressed, and local blood circulation disorder is easy to form hemorrhoids. Common parts include bone, broken, and heel.
(3) deep venous thrombosis of the lower extremity: more common in pelvic fractures or lower limb fractures, long-term braking of the lower limbs, slow venous return, combined with blood hypercoagulability caused by injury, prone to thrombosis. Activity should be strengthened to prevent it from happening.
(4) Infection: Open fractures, especially those with heavy pollution or severe soft tissue injury. If the debridement is not complete, the residual necrotic tissue or soft tissue coverage may be poor, and infection may occur. Improper handling can cause suppurative osteomyelitis.
(5) Injury ossification: also known as ossifying myositis. Due to joint sprain, dislocation or fracture near the joint, periosteal peeling forms a subperiosteal hematoma. Improper treatment makes the hematoma enlarge, mechanized and extensive ossification in the soft tissue near the joint, causing severe joint activity dysfunction. Especially seen in the elbow joint.
(6) Injurious arthritis: intra-articular fracture, joint surface is destroyed, and it can not be accurately reset. After the bone is healed, the joint surface is not flat. Long-term wear and tear can easily cause arthritis of the injured part, resulting in pain during joint movement.
(7) Joint stiffness: the limbs are fixed for a long time, the veins and lymphatic drainage are not smooth, the fibrous exudation of the serous tissue and fibrin deposition in the tissues around the joints. Fibrous adhesions occur, accompanied by joint changes and peripheral muscle contractures, resulting in joints. Activity barriers. This is the most common complication of fractures and joint injuries. Timely disassembly and active functional exercise are effective ways to prevent and treat joint stiffness.
(8) Acute bone atrophy: disease osteoporosis near the joint caused by injury, also known as reflex sympathetic bone dystrophy c occurs after hand and foot fractures, typical symptoms are pain and vasomotor disorder.
(9) ischemic osteonecrosis: the fracture causes the blood supply to a fracture segment to be destroyed, and the ischemic necrosis of the fracture segment occurs. Common is arrhythmic necrosis of the proximal fracture after a scaphoid fracture.
Symptom
Comminuted fracture symptoms Common symptoms Persistent pain comminuted fracture
The main clinical manifestations of comminuted fractures are: localized pain and tenderness in the fracture, local swelling and ecchymosis, partial or complete loss of limb function, and complete deformity and abnormal activity of the complete bone.
Systemic symptoms
(1) Fever symptoms: There is a large amount of internal bleeding in the fracture. When the hematoma is absorbed, the body temperature is slightly increased, but it is generally not exceeded. When the open fracture temperature rises, the possibility of infection should be considered.
(2) Symptoms of shock: for multiple fractures, pelvic fractures, femoral fractures, spinal fractures, and severe open bone. Patients often suffer from shock due to extensive soft tissue damage, massive bleeding, severe pain, or complicated visceral injuries.
Local symptoms
(1) Abnormal activity symptoms: In normal conditions, the parts of the limbs are inactive, and abnormal activities occur after the fracture.
(2) malformation symptoms: the displacement of the fracture segment can change the shape of the affected limb, mainly showing shortening.
(3) Bone rubbing or bone rubbing symptoms: After the fracture, when the two fracture ends rub against each other, bone squeak or bone rubbing may be generated.
Examine
Examination of comminuted fractures
CT examination, X-ray examination. X-ray plain film (including positive, lateral and bone axis slices) can generally be diagnosed. CT scan or MRI can be performed in patients with difficult diagnosis. Especially CT scan plays a major role in the diagnosis and prognosis of fracture classification. Complicated pelvic fractures or suspected intraspinal fractures should be performed on a slice or CT examination as appropriate.
Diagnosis
Diagnosis and diagnosis of comminuted fracture
1. Compression fracture: Compression fracture cancellous bone is deformed by compression, such as vertebral body and calcaneus.
2, fractures (medical: crack fractures): crack fractures are a relatively mild type of fractures, and are often overlooked. However, if the small problem is not treated in time, it may turn into a big problem. If the fracture is not properly treated, it will shift, causing more trouble. Crack fracture, also known as fracture of the bone, cannot be given enough attention because there is no obvious displacement. It is generally caused by direct blows, impacts, and the like.
3, avulsion fracture: the upper jaw fracture of the humerus is common in sports injuries such as falling or throwing on the ground. When the fall, the forearm extends and abducts, and when the forearm flexor contractes fiercely, the upper jaw of the humerus is pulled by the flexor muscles to cause avulsion fracture.
4, spiral fracture: spiral fracture is a complete fracture. Complete fracture refers to the complete interruption of the integrity or continuity of the bone. After the fracture of the tubular bone, it forms a distant, nearly two or more fracture segments.
