open fracture
Introduction
Introduction to open fracture In the case of a fracture, the skin and subcutaneous soft tissue injury that covers the fracture site is broken, and the fracture end is connected with the outside world, which is called an open fracture. Open fracture is a common and frequently-occurring disease in traumatic orthopedics. With the development of society and the use of modern high-speed tools, the open fractures are becoming more and more serious, the disease is more complicated and the treatment is more difficult. basic knowledge The proportion of illness: 0.025% Susceptible people: no specific population Mode of infection: non-infectious Complications: muscle atrophy, hemorrhoids, deep vein thrombosis
Cause
Open fracture cause
Direct violence: When violence directly affects a part of the bone and causes fractures in the part, it often causes fractures in the injured part, often accompanied by different degrees of soft tissue destruction. For example, the wheel hits the lower leg and the humeral shaft fracture occurs at the impact.
Indirect violence: Indirect violence occurs through longitudinal conduction, leverage or torsion to fracture in the distance. When the foot falls from a height, the trunk flexes forward rapidly due to gravity, and the vertebral body at the junction of the thoracolumbar spine is affected. A compression fracture (conduction) occurs due to the action of the folding force.
Prevention
Open fracture prevention
Some patients can avoid fractures, which requires everyone to be safe in daily life and work. - Attention can reduce fractures at all times, children are unstable, easy to fall, especially in high places, education And optimistic about children, to avoid falls, teenagers play more, curiosity, parents and teachers should do a good job in education, do not climb the tree, young and middle-aged people should concentrate on work and cycling, pay attention to safety everywhere Old people's hands and feet are inconvenient to move, snow and rain and nights try not to go out. When going out, someone needs to support or hold a cane. When going out at night, there must be lighting tools. It is best not to ride a bicycle on the street, not to crowded public places.
Complication
Open fracture complications Complications Muscular atrophy Acne Lower extremity deep vein thrombosis
Common complications and treatment
1. Swelling: Swelling occurs locally after trauma, peaking after 72 hours, after which the swelling gradually subsides. After swelling occurs, the affected limb should be raised, preferably above the plane of the heart, and appropriate ice should be given to promote swelling.
2. Gypsum compression: After simple fractures are fixed by cast gypsum fixation, as the swelling of the limbs gradually increases, gypsum compression will occur, resulting in obvious swelling, bruising, numbness, etc. at the ends of the limbs such as fingers and toes. The mechanism releases the decompression to avoid limb compression and necrosis.
3. Joint stiffness: The affected limb is fixed for a long time, the vein and lymphatic reflux are not smooth, the fibrous exudation of the serous fluid and fibrin deposition in the joint cavity, fibrotic adhesion occurs, and the soft tissue contracture around the joint leads to joint movement disorder. 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.
4. Muscle atrophy: Muscle atrophy occurs when the limb is fixed or lacks exercise. The active search of the muscle can reduce the degree of muscle atrophy. The specific method is: if the joint can move, you can do the isometric contraction of the muscle (ie muscle force but The limb does not produce motion) and isotonic contraction (muscle force and action). If the joint is fixed, it can be exercised in equal length.
5. Cleft pneumonia: It occurs mostly in patients who have been bedridden for a long time due to fractures, especially those with frail fractures and old and frail patients, sometimes jeopardizing the lives of patients. Patients should be encouraged early. Get out of bed.
6. Acne: 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.
7. Lower extremity deep venous thrombosis: 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. Active exercise should be strengthened, and equipment such as elastic stockings and plantar venous pumps can be applied to prevent it from happening.
Symptom
Open fracture symptoms common symptoms persistent pain joint swelling hematoma formation persistent fever low blood volume shock
Anderson classifies open fractures into "type 3" according to the degree of soft tissue injury. Type I: wounds no more than 1 cm, wounds clean; type II: tear lengths over 1 cm, but no extensive soft tissue damage or skin avulsion; III Type; there are extensive soft tissue injuries including skin or flap lacerations, multiple fractures, traumatic amputations, and any injuries that require repair of blood vessels [1]. In 1984, gustilo found this classification in clinical application, and III The type is divided into 3 subtypes; that is, IIIA: there is still sufficient soft tissue coverage at the fracture site, the fracture is multi-segment or comminuted, IIIB: extensive soft tissue defect, periosteal exfoliation, severe fracture of the fracture, extensive infection; IIIC: including concurrent Arterial injury or open joint dislocation [2]. The classification of anderson-Gustilo is currently one of the most commonly used methods in the world.
Whole body performance
(1) Fever symptoms: general fractures after normal body temperature, fractures with large bleeding volume, when the hematoma is absorbed, the body temperature is slightly increased, but generally does not exceed 38 ° C, when the open fracture body temperature rises, the possibility of infection should be considered. (2) Symptoms of shock: The main cause of shock caused by fracture is hemorrhage, especially pelvic fractures, femoral fractures and multiple fractures. The bleeding volume can reach more than 2000ml. Severe open fractures or complicated internal organ damage can also cause shock.
Partial performance
Supracondylar fracture of the humerus
1. The general manifestations of fractures are local pain, swelling and dysfunction. At the time of fracture, the bone marrow, periosteum and surrounding tissue rupture and hemorrhage, hematoma formed at the fracture site, and edema caused by soft tissue injury, causing severe swelling of the affected limb, and even tension blisters and subcutaneous ecchymoses, which may be purple due to decomposition of hemoglobin. , cyan or yellow. Severe pain occurs locally in the fracture, especially when moving the affected limb. Local swelling and pain limit the activity of the affected limb. If it is a complete fracture, the active function of the injured limb can be completely lost. 2, the unique features of the fracture (1) deformity: the displacement of the fracture segment can change the shape of the affected limb, mainly characterized by shortening, angulation or rotation. (2) Abnormal activity: In normal conditions, the part of the limb cannot move, and abnormal activity occurs after the fracture. (3) Bone rubbing or bone rubbing: After the fracture, when the two fracture ends rub against each other, a bone squeak or bone rubbing feeling may be generated.
Examine
Open fracture examination
X-ray inspection
X-ray film examinations should be performed routinely for patients with fractures, which can show incomplete fractures, deep fractures, intra-articular fractures and small avulsion fractures that are difficult to detect clinically, even if they have clinically manifested as obvious fractures. X-ray film examination is also necessary to understand the type and specific conditions of the fracture, which is of guiding significance for treatment.
X-ray films should include positive and lateral slices, must include adjacent joints, and sometimes need to add X-ray films of oblique position, tangential position or corresponding part of the healthy side.
2. CT examination
CT examination can be performed for those with unclear fractures but who cannot be excluded, those with spinal fractures that may compress spinal nerve roots and complex fractures. Three-dimensional CT reconstruction can make fracture classification more intuitive and convenient, and it is very helpful for treatment options. It is currently used clinically.
3. MRI examination
Although the fracture line is not as good as the CT examination, it has unique advantages for the display of spinal nerve root and soft tissue injury, and has been widely used for the examination of spinal fractures.
Diagnosis
Open fracture diagnosis
Diagnostic points
1. History: There is a clear history of trauma.
2. Signs:
Chinese scholar Wang Yizhen believes that this classification method has too many reference factors and is inconsistent with each other, which is easy to be misleading. He recommended classification of open fractures according to the classification of trauma mechanisms according to the reasons for open wound formation: (1) open fractures from the inside out; (2) open fractures from the outside to the inside; (3) potential open fractures. Zhu Tongbo divided the open fracture into 3 degrees according to the size of the wound, the severity of the soft tissue injury, the degree of contamination and the exposed end of the fracture. Open fracture of degree I: The skin is pierced from the fracture end from the inside to the outside, the wound is below 3cm, the soft tissue contusion is slight, no obvious pollution and the fracture end is exposed; the second degree open fracture: the wound is 3~15cm long, and the fracture end is exposed. Moderate soft tissue injury, obvious pollution; III degree open fracture: the wound is more than 15cm, the fracture end is exposed, the soft tissue is damaged, often combined with nerve and blood vessel damage, and the pollution is serious.
According to years of clinical practice, the authors classify fresh open fractures according to the characteristics of local injuries of the fractures, and classify the open-ended fractures by three levels. Class I open fracture: fracture at the fracture site is less than 3cm, the wound is lightly polluted; grade II open fracture: the fracture at the fracture is more than 3cm, the wound is heavily polluted, or the fracture end is exposed, or there is skin avulsion, skin defect; Sexual fractures: open fractures with blood vessels and nerve damage. In short, no matter how to classify, it is to better guide clinical treatment; therefore, only by accurately grasping the clinically different characteristics of open fractures can a reasonable choice of treatment methods be made.
