1, what is a fracture?
Fracture refers to a disease in which part or all of the bones are broken due to trauma or pathological reasons. Fractures are usually divided into closed fractures, open fractures and pathological fractures.
2. Is the bone broken?
A fracture doesn't mean the bone is broken. From the concept of fracture, we can easily know that no matter whether the bone is broken or cracked, it belongs to fracture. So strictly speaking, fractures and broken bones cannot be completely equated.
3. Causes of fracture
1, traumatic fracture, violence can cause bone integrity damage, called traumatic fracture. This is the most common cause of fracture. According to the different ways of violence, it can be divided into three types:
(1), direct violence: violence directly acts on the fracture site.
(2) Indirect violence: violence acts on the parts far away from the fracture, which is conducted through bones, joints, muscles or ligaments, leading to fractures in some parts.
(3) Repeated violence: Repeated violence on the same part can gradually lead to fractures, also known as fatigue fractures. Such as fractures of the second and third metatarsals, tibia, femur, fibula or femoral neck after long-distance marching or repeated exercise.
2. Pathological fracture: A fracture caused by systemic or local pathological changes of the bone itself is called a pathological fracture.
4. What if the bone is broken?
Once a fracture is found, at least the following three points should be done.
1. reduction: it is to restore the displaced fracture end to normal or close to the original anatomical relationship, thus restoring the scaffold function of the bone. The reduction methods include closed reduction and surgical reduction.
2. Fixation: After fracture reduction, it is easy to move again because of instability, so different methods should be used to fix it in a satisfactory position and make it heal gradually. Commonly used fixation methods include: small splint, plaster bandage, external fixation bracket, traction braking fixation and so on. These fixation methods are called external fixation. If it is surgical incision, it is fixed with steel plate, steel needle, intramedullary needle, screw, etc. This is called internal fixation.
3. Functional exercise: through the muscle contraction of the injured limb, the blood circulation of the tissues around the fracture is increased, the fracture healing is promoted, and the muscle atrophy is prevented; through active or passive movement of the unfixed joint, the joint adhesion and joint capsule contracture are prevented, so that the function of the injured limb can be restored to the normal state before the fracture as soon as possible.
5, fracture prevention
1, to develop good living habits: people who smoke for a long time, drink too much, exercise less and sit more and eat low calcium are prone to osteoporosis in their old age. So don't smoke, drink less, drink strong tea and eat more high-protein food.
2. External protector: Recent reports show that external hip protector can effectively reduce the chance of hip fracture caused by falling. This is also a preventive measure for fractures.
3. Encourage more activities: On the one hand, moderate exercise can enhance bone strength, on the other hand, it can maintain muscle strength and good balance and reduce the chance of falling. This is also one of the prevention methods of fracture.
4. Family safety: 75% of falls occur in your own home, especially in the bathroom, kitchen and other places. It is very important to provide a safe family environment to reduce the occurrence of fractures. Prevention of this kind of fracture is quite common.
6. Detailed explanation of fracture risk
1, oscillation.
Severe trauma, fracture or damage to important organs lead to massive bleeding.
2. Fat embolism syndrome.
It occurs in adults because the tension of hematoma in the medullary cavity of fracture is too high, the bone marrow is destroyed, and fat drops enter the ruptured venous sinus, which can cause fat embolism in lung and brain. Some people think that it is due to the stress of trauma that chylomicrons in normal blood lose their emulsifying stability and combine into fat globules with a diameter of 10-20vm to become emboli, blocking pulmonary capillaries. At the same time, when the lung is not well perfused, the cells in the lung at the end of the bubble produce lipase, which hydrolyzes the plastic fat droplets in the fat embolus into glycerol and free fatty acids, releases catecholamine, damages the capillary wall, and causes protein-rich liquid to leak into the interstitial lung and alveoli, leading to pulmonary hemorrhage, atelectasis and hypoxemia, respiratory insufficiency, cyanosis and extensive lung consolidation on chest radiograph. Arterial hypoxemia can cause restlessness. Sleepiness, even coma and death.
3, important internal organs damage:
A. Rupture of liver and spleen: Severe lower chest wall injury may not only lead to rib fracture, but also lead to rupture and bleeding of left spleen or right liver, leading to shock.
B, lung injury: when the rib fracture, the fracture end can damage intercostal blood vessels and lung tissue, resulting in pneumothorax, hemothorax or hemopneumothorax, causing severe dyspnea.
C bladder and urethra injury: pain and swelling of lower abdomen and perineum, hematuria and dysuria caused by pelvic fracture.
D, rectal injury: can be caused by sacrococcygeal fracture. Abdominal pain and rectal bleeding occurred.
4, important surrounding tissue damage:
First, important vascular injury: common supracondylar fracture of femur, the distal end of the fracture can cause arterial injury. Fracture of upper tibia, extended supracondylar fracture of humerus and injury of anterior or posterior tibial artery near the fracture end are easy to cause brachial artery injury.
B, peripheral nerve injury: especially in the area where the nerve is closely adjacent to its bone, such as the middle and lower bone junction 1/3, it is easy to damage the tottering nerve walking near the humerus. Fracture of fibular neck is easy to cause common peroneal nerve injury.
C. Spinal cord injury: it is a serious complication of spinal fracture and dislocation, which is more common in the cervical and thoracolumbar segments of the spine. Paraplegia occurred below the injury plane. At present, although there are many studies on the regeneration of spinal cord injury, no breakthrough has been made. Paraplegia caused by spinal cord injury can lead to lifelong disability.
5. Osteofascial compartment syndrome. That is, a series of early syndromes caused by acute ischemia of muscles and nerves in the osteofascial compartment formed by bone, interosseous membrane, muscular septum and deep fascia. Most common in forearm palms and calves. Often due to hematoma and tissue edema of traumatic fracture, the volume of its indoor contents is increased or the external dressing is too tight, and local compression makes the volume of femoral osteofascial compartment effective, which leads to the increase of the pressure in the osteofascial compartment. When the pressure reaches a certain level (8.7kpa(65mmhg) in the forearm and 7.3kpa(55mmhg) in the calf), the arteries supplying muscles can be closed, forming a vicious cycle of ischemia-edema-learning blood, which is caused according to the degree of ischemia.
A, on the verge of ischemic muscle contracture-early ischemia, timely treatment to restore blood supply, can not occur or only a very small amount of muscle necrosis, can not affect limb function.
B, ischemic muscle contracture-short-term or severe incomplete ischemia, most of the muscles are necrotic after blood supply is restored. The contracture deformity is formed, which seriously affects the function of the affected limb.
C, gangrene-extensive and long-term complete ischemia, a large number of muscle gangrene, often need amputation, if a large number of toxins enter the blood circulation, it will also cause shock, arrhythmia and acute renal failure.