Bleeding aggravation: local swelling after fracture may cause internal bleeding by puncturing blood vessels, and random treatment will puncture local blood vessels to cause bleeding, or make the stopped fracture end bleed again. Nerve injury: Long bone fracture of limbs, the fracture end will be as sharp as a knife. In this state, kneading and pressing may not only lead to bleeding, but also stab the fracture end or cut off the peripheral nerve. In severe cases, it may cause nerve paralysis and lead to the loss of local function of limbs. Aggravated shock: When serious fracture, such as thigh, pelvis or multiple ribs fracture with visceral injury, patients may go into shock due to blood loss and pain. If handling bumps are applied again, the vibration will be further aggravated and even lead to the death of the injured. Lead to limb infection: For an open wound, if it is blindly wrapped with unclean dressing, bacteria will be brought into the wound, leading to limb wound infection and even osteomyelitis, with serious consequences. Cause osteonecrosis: If the femoral neck and carpal bone are overturned and lifted after fracture, the only remaining articular capsule blood vessels and nutrient vessels of the backbone can be damaged, resulting in the destruction of blood supply to the femoral neck, which not only makes fracture healing difficult, but also may lead to ischemic necrosis of the femoral head.
Free exercise after fracture is not only dangerous, but also brings many difficulties to normal treatment. Therefore, in case of serious falls and injuries, especially when the patient can't move, the best way is to let doctors or experienced people handle them, or move the injured to a safe place nearby and send them to a professional orthopedic hospital immediately.
How to care for the fracture that just appeared? First, after the plaster fixation of the lower limbs is removed, it should be bandaged with elastic bandage when going down to the ground to prevent swelling of the lower limbs. Second, the plaster cast should be dried as soon as possible. Try not to touch it until it dries. If it is moved, hold it with both hands and forbid fingers. Third, patients who can't get up and exercise should turn over frequently, and often exercise their limbs and muscles in a fixed range to prevent muscle atrophy and joint stiffness. Fourth, the fixed limb should be placed in the horizontal position of the heart. Keep warm in winter. Protect gypsum from dust and urine pollution. Don't bump into objects. If gypsum falls off, it should be plastered with gypsum slurry in time to maintain its firmness. When you feel pain somewhere in the plaster model, you should look for the reason carefully. Before finding out the reason, you can't use painkillers or stuff cotton into it at will. If you fall into a foreign body or the gauze head sticks to the plaster and hurts the part, you should take it out. Six, observe the blood supply of the fixed limb, whether there is swelling at the end, refers to the color, temperature and feeling of the toes. In case of limb swelling, pallor or bruising, chills, numbness and tingling, trunk plaster affecting breathing, etc., you should seek medical attention in time, and if necessary, saw off or remove the plaster and re-fix it.
Various causes of fracture Fracture is the interruption of bone integrity or continuity. Histologically, fracture is the interruption of trabecular bone. There are many reasons for fracture, but the main ones are: 1, trauma: all kinds of trauma lead to fracture through direct or indirect violent transmission. The fracture caused by direct violence occurs in the direct part of violence, such as the fracture of tibia and fibula caused by calf impact, which belongs to direct violence fracture and the surrounding soft tissue is also damaged. The fracture caused by indirect violence does not occur at the injured part, but outside the injured part, such as the palm landing when falling, and the fracture occurs at the distal radius or the upper humerus. Most common fractures in middle-aged and elderly people belong to indirect violent fractures. 2, muscle tension: sudden contraction of muscle can cause avulsion fracture of muscle attachment. The common avulsion fractures are humeral lateral condyle fracture and humeral greater tubercle fracture. 3. Cumulative strain: a certain point of the bone can be stimulated by repeated forces and fatigue fractures occur. Fatigue fractures often occur under the second and third metatarsals and fibula. 4, bone disease: after suffering from various diseases, the bone strength decreases, and fractures will occur when encountering slight external forces. This kind of fracture occurs on the basis of bone diseases and is called pathological fracture. The fracture based on osteoporosis in the elderly is actually a pathological fracture. What is the relationship between types and treatment methods? What are the symptoms of fracture? Fracture refers to a disease in which part or all of the bones are broken due to trauma or pathological reasons. Its main clinic
The manifestations are: local pain and tenderness at the fracture, local swelling and ecchymosis of limbs or functional parts of limbs.
Complete loss, complete bones can still appear limb deformity and abnormal activity. Acupuncture is mainly used for closed fractures. General symptoms (1) Fever symptoms: there is a lot of internal bleeding at the fracture. When the hematoma is absorbed, the body temperature rises slightly, but generally does not exceed. The possibility of infection should be considered when the body temperature of open fracture rises. [2] (2) Shock symptoms: used for multiple fractures, pelvic fractures, femoral fractures, spinal fractures and severe open bones. Patients often go into shock due to extensive soft tissue injury, massive hemorrhage, severe pain or complicated visceral injury. Local symptoms (1) Abnormal activity symptoms: Abnormal activity occurs in the parts where limbs can't move under normal circumstances after fracture. (2) Malformation symptom: The displacement of fracture segment can change the shape of the affected limb, mainly manifested as shortening. (3) Symptoms of bone friction sound or bone friction sound: After fracture, when two fracture ends rub against each other, bone friction sound or bone friction sound can be generated. What are the factors that affect fracture healing? After the fracture is cured, what factors will affect the effect after the cure?
1. Overall factors
The influence of people's age on fracture healing is significant. Infants' fractures heal quickly and rarely occur nonunion. Adolescent fracture healing is easier than that of the elderly, and the fracture healing time of the elderly is prolonged. Patients with severe osteoporosis have poor fracture healing ability. General nutritional status affects fracture healing. Malnutrition, low protein, low calcium and lack of vitamin C and vitamin D naturally delay fracture healing. General health condition is also one of the factors affecting fracture healing. Severe cor pulmonale, diabetes and renal failure are not conducive to fracture healing.
2. Local factors Local factors not only involve local injuries, but also involve the treatment process, which is closely related to fracture healing.
① Local blood supply
Abundant blood supply is the basic condition for fracture healing. Poor or interrupted blood supply will cause delayed healing or nonunion of bone, and even ischemic necrosis of bone. Incomplete fractures or fractures without displacement have little damage to blood supply and are easy to heal. Fracture displacement is obvious, and blood supply damage is great, which affects fracture healing. Fractures in special parts, such as femoral neck fracture, middle and lower tibia fracture13 fracture, scaphoid fracture, ankle fracture, talus fracture, etc., are easy to cause blood supply interruption, and the fractures in these parts are not only difficult to heal, but also often appear ischemic necrosis. Parts with rich blood supply, such as pelvic fractures and distal radius fractures, heal quickly.
② degree of local injury
During fracture, the periosteum is extensively damaged and peeled off, which will inevitably affect the formation of external callus. Severe local soft tissue injury, such as crush injury, and serious blood supply disorder of surrounding soft tissue, affect fracture healing. The soft tissue around the fracture not only provides blood supply to the fracture end, but also transports mesenchymal cells for fracture healing and promotes fracture healing. Severe soft tissue injury will inevitably hinder fracture healing.
3. Therapeutic factors
Correct and reasonable treatment promotes fracture healing, otherwise it will affect fracture healing and even be the main factor causing fracture nonunion. Rough operation in fracture reduction, repeated reduction will aggravate soft tissue injury and further destroy local blood supply. Excessive periosteal peeling and excessive stretching and squeezing of soft tissue during operation are important factors that interfere with fracture healing. Therefore, in principle, external fixation is the first choice for fracture patients, and surgery is not allowed as far as possible. During the operation, periosteal peeling and damage to surrounding soft tissues should be minimized. The requirements for reset should not be excessively pursuing "complete reset". Long shaft fractures do not require anatomical reduction. To some extent, incomplete reduction (such as reduction above 1/3) can fully meet the normal functional requirements after fracture healing. Unnecessary repeated reduction is not conducive to fracture healing.
① The fixation is unreliable. Good fracture end fixation is the basic premise of fracture healing. Good fracture fixation is beneficial to early fiber connection and calcification at the fracture end. Many patients with nonunion of fractures are caused by inaccurate fracture fixation. If the fracture ends are not fixed properly, there will be relative movement between the broken ends, resulting in shear stress and rotational stress. The fracture end is not easy to form fiber connection, but it can be broken after fiber connection is formed, and no bridging callus can be formed. This is one of the main factors causing nonunion. The common reasons for inaccurate fixation are: the small splint is too loose; When steel plate is fixed, the steel plate is too short; Loose screws; Intramedullary needle selection is too fine; Unable to resist the rotation and angular movement of the fracture end; Other unreasonable handling methods. Therefore, it is very important to choose the correct treatment method and careful treatment in fracture treatment. Improper treatment may bring more pain and loss to patients than the fracture itself.
② Fracture end contact. Sometimes the fracture end is embedded with soft tissue, such as muscle, which makes the fracture difficult to heal; Excessive traction treatment, fracture end separation, fracture end will not form a connection. Oblique fracture or spiral fracture is easy to heal because of the large contact surface between fracture segments.
③ Venous gyrus. Poor venous return, even if the arterial blood supply is sufficient, can also lead to fracture nonunion. Poor venous return also means poor local blood circulation and interferes with the normal fracture healing process. It is a common reason that venous reflux is blocked when small splint fixation or plaster fixation is used to compress vein. Soft tissue swelling is also one of the reasons that hinder venous return. After fracture fixation, patients do not do functional exercise and lack the function of muscle contraction "pump", which will inevitably lead to poor venous return. The main manifestation of poor venous return is swelling. If the swelling is obvious after fracture, the cause should be found in time. If the bandage is too tight, loosen it and re-fix it immediately. On the basis of reduction and fixation, middle-aged and elderly fracture patients should actively relax and contract their muscles, raise their posture and avoid limb compression. These are all effective methods to promote fracture healing and prevent venous reflux.
④ Stress stimulation. Affected by muscle contraction, posture and load, the fracture end is often stimulated by forces, including vertical compressive stress, shear stress and rotational stress. Compressive stress reduces the gap at the fracture end and stimulates osteogenesis. Two other kinds of stress can interfere with the formation of new bone. Therefore, compressive stress should be retained and shear stress and rotational stress should be eliminated in fracturing treatment. Patients actively carry out functional exercise, and proper weight bearing can increase the compressive stress at the fracture end and promote fracture healing. At present, the commonly used fracturing treatment methods are not perfect in retaining compressive stress, preventing shear stress and rotational stress. Small splint and plaster external fixation retain the compressive stress at the fracture end, but they cannot prevent rotation and are not suitable for unstable fractures. Steel plate fixation overcomes shear stress and rotational stress, but also eliminates compressive stress. This effect of plate fixation is called stress shielding, which limits the late osteogenesis in the process of fracture healing. Osteoporosis often occurs at the fracture end. Sometimes, when the steel plate is removed, the fracture will happen again. Intramedullary nail fixation retains compressive stress, but the anti-rotation effect is poor. But this is only one aspect of the problem. Good technique and patient's active and correct cooperative treatment are the key to fracture healing.
⑤ Electrical stimulation. Bone is living tissue and charged tissue, which responds to external electrical stimulation. Research table
What fracture patients must know is that fracture refers to a disease in which part or all of the bones are broken due to trauma or pathological reasons. Its main clinical manifestations are: local pain and tenderness at the fracture, local swelling and ecchymosis, complete loss of limb function, complete deformity of bones and abnormal movement.
(1) Etiology and incidence
The main causes of fracture are trauma, such as injury, collision, squeezing, falling, etc. Followed by systemic diseases and diseases of bones themselves. Such as chondroma, scurvy, osteomalacia, bone tumor, bone cyst, acute and chronic osteomyelitis, etc. Some fractures are related to fatigue and occupation, such as foot fracture caused by overwork, hand fracture of machine tool workers and so on.
(2) the patient's performance
After the fracture, the patient's expression was painful and local pain appeared. The child is crying. The fracture site may have swelling, congestion, deformation and dysfunction. When touching the local area, you can feel the bone deformation, obvious tenderness, abnormal activity and bone stubble rubbing sound.
(3) Home care
1. Emergency treatment
(1) If there is any skin wound or bleeding, the visible dirt should be removed, and then the wound should be bandaged with clean cotton or towel under pressure.
(2) When the limbs are bleeding from an open fracture (the broken end of the fracture is exposed through the wound), ropes or steel wires should not be used to bind the limbs. You can wrap the wound with a wide cloth strip and a rubber hose. Don't tie it too tightly to avoid bleeding. Relax for l-2 minutes every 1 hour. The tourniquet should be tied to the upper arm 1/3 to avoid damaging the radial nerve.
(3) Upper limb fractures can be fixed with boards or wooden roots and cardboard, and then hung around the neck with bandages or ropes. Lower limb fractures can be fixed with wooden boards or roots, or both lower limbs can be tied together to achieve the purpose of fixation.
(4) Pelvic fracture, tie the pelvis with a wide cloth. The patient lies on his back with his knees half bent, and puts a pillow or clothes under his knees to stabilize his body and reduce shaking.
2. Nutrition and diet
Fracture patients can cause metabolic changes due to pain, bed inactivity and poor digestive function, the most obvious being the negative balance of protein (that is, the consumption of protein is greater than the intake of protein in diet). Blood loss caused by trauma is also the loss of nutrition in the body. Both fracture healing and soft tissue repair need adequate nutrition supply. If the diet is not well regulated and the nutrition can't keep up, it will not only affect the patient's tolerance to fractures and soft tissue injuries, but also affect the healing of bones and wounds and the rehabilitation of the sick body. Fracture patients need to eat some easy-to-digest, nutritious and light food, and should adopt a diet with high calorie, high protein and high vitamins. They should eat more animal liver, belly, ribs soup, chicken, eggs, fish and bean products, milk, and more vegetables and fruits.
3. Home care
(1) Most fracture patients need to stay in bed for a long time, so they need to take care of themselves in life and think more about physical recovery. So they need patient, meticulous and thoughtful care from their families. Don't show any unpleasantness in front of the patient, so as not to cause misunderstanding. Talk to patients often, give them more comfort, let them feel the warmth and goodwill of their families, and enhance their confidence in recovery.
(2) Skin care is particularly important for patients who have been bedridden for a long time, especially those who are fixed with plaster and paraplegic. Patients with plaster fixation should keep their skin clean and dry, and the sheets should be flat and wrinkle-free. Paraplegic patients should turn over every 2 hours and massage the compressed parts with 50% alcohol or talcum powder to prevent bedsores.
(3) to prevent foot drop, pay attention to maintain the functional position of the injured limb, and prepare a support frame on the bed to prevent local oppression and foot drop.
4. Rehabilitation measures
(1) Strengthen functional exercise. Patients who stay in bed for a long time, such as improper activities, often lead to muscle atrophy, joint stiffness and swelling at the ends of limbs. Therefore, the injured limb should maintain proper functional position and move in bed, such as thigh muscle contraction, toe and ankle movement. You can also tie a rope on the beam, bed or wall of the house to exercise the upper body and upper limbs, and try to let the patients wash and eat by themselves. You can exercise with a grip ring, fitness ball and fitness stick in your hand to achieve the purpose of activities.
(2) Without affecting the fixation and healing of fractures, patients can help others or use crutches, get out of bed early, exercise early, and carry loads at night. The amount of activity is from small to large, so don't be impatient.
(4) Precautions
1. Exercise in time under the guidance of a doctor, mainly after injury 1-2 weeks to exercise muscles and contract and relax rhythmically; Strengthen joint activities in 3-6 weeks, gradually increase the amount of exercise, closely observe the situation of fixed parts and the color and sensory activities of distal limbs, and contact a doctor in time if there is any abnormality.
2. During the treatment, you should obey the disposal of medical staff, take medicine on time, and never do it yourself.
3. Pay attention to hygiene in bed for a long time to prevent the breeding of lice and maggots.
4. Avoid getting hurt again.
(5) common sense of prevention
Some patients can avoid fractures. This requires everyone to pay attention to safety in daily life and work, which can reduce fractures. Children are unstable and easy to fall, especially not to play in high places. Parents and teachers should do a good job in education, don't climb walls and trees, and young people should concentrate on everything when they work and ride bicycles. Be safe. Older people have trouble moving their hands and feet. Try not to go out in rainy days and at night. When going out at night, someone should hold hands or lean on crutches. It is best not to ride a bike in a crowded public place.
In order to promote fracture healing faster and better, fracture patients should also match different dietotherapy according to the early, middle and late stages of fracture healing to promote callus formation or hematoma absorption. △ Early stage (1-2 weeks): swelling and blood stasis at the injured part, obstruction of meridians and qi and blood. At present, the treatment is mainly to promote blood circulation and remove blood stasis. Chinese medicine believes that "blood stasis does not remove, bones do not grow" and "blood stasis removes, new bones grow". It can be seen that detumescence and blood circulation are the most important factors for fracture healing. In principle, the diet is light, such as vegetables, eggs, bean products, fruits, fish soup and lean meat. Don't eat sour, hot and greasy, especially don't give greasy and nourishing products too early, such as bone soup, fat chicken and stewed fish. Otherwise, blood stasis will be stagnant and difficult to dissipate, which will inevitably delay the course of disease, slow down the growth of callus and affect the recovery of joint function in the future. At this stage, the diet can be stewed with Panax notoginseng 10g, Angelica sinensis 10g, pigeon 1g and * * * until cooked, and the soup and meat go hand in hand, once a day for 7-1 0 days. △ Mid-term (2-4 weeks): Blood stasis and swelling are partially absorbed. The treatment at this stage is mainly to relieve pain, remove blood stasis, promote tissue regeneration, set bones and continue tendons. Diet should be changed from light to appropriate high nutrition supplement to meet the needs of callus growth. You can add bone soup, Tianqi stewed chicken and animal liver to the initial diet to supplement more vitamins A, D, calcium and protein. Dietotherapy can use Angelica sinensis 10g, Rhizoma Drynariae 15g, Radix Dipsaci 10g, fresh pork chop or beef sparerib 250g, stew for more than 1h, and add soup meat for 2 weeks. △ Late stage (more than 5 weeks): 5 weeks after the injury, the congestion at the fracture site is basically absorbed, and the callus has begun to grow, which is the late stage of the fracture. Treatment should be supplemented by nourishing liver and kidney, qi and blood, promoting the formation of firmer callus, relaxing tendons and activating collaterals, making the adjacent joints of fracture move freely and restoring their former functions. Taboo can be lifted in diet, and recipes can be supplemented with old hen soup, pig bone soup, sheep bone soup, deer tendon soup, stewed water fish and so on. You can choose Eucommia ulmoides wine, Spatholobus suberectus wine, Tiger Bone papaya wine, etc. Dietary therapy can use Lycium barbarum 10g, Rhizoma Drynariae 10g, Radix Dipsaci 10g and Coicis Semen 50g. Stir-fry Rhizoma Drynariae and Radix Dipsaci to remove residue, and then add the remaining two kinds of boiled porridge to eat. Daily 1 time, 7 days for 1 course of treatment. Every 1 treatment interval is 3-5 days, and 3-4 treatments can be used.