Chair of the general surgery, children's surgery of medical faculty and
surgical illnesses of mediko-preventive faculty
The Tashkent Medical Academy
Lecture for students of a 3-course of mediko-preventive faculty on a
theme: Crises of bones and dislocations of joints
The lecturer: д.м.н., professor Ergashev U.J.
Composers: д.м.н., professor Ergashev U.J.
TASHKENT 2007
Crisis name full or partial infringement of integrity of a bone as a result
of mechanical force.
At crises большей or smaller degree suffer and surrounding soft
fabrics.
Classification of crises
1. By origin:
•
Congenital
•
Got
2. For the reason occurrence crises happen:
The Traumatic
The Pathological
4. In a direction of influencing force
n
The Straight line
n
Indirect
By the form influencing force crises happen:
n
At bending
n
At twisting (rotation)
n
At сдавлении (compressions)
n
From blow
n
Otryvnoj crisis
5. In зависомости the relation external among crises shares on:
- Open crises of bones
- The closed crises of bones
On localisation a crisis place:
n
Epifizarnye crises
n
Metafizarnye crises
n
Diafizarnye crises
After infringement of integrity of a bone crises share on:
n
Full
n
Incomplete (трешина)
In a direction of a line of crisis:
n
Cross-section
n
Longitudinal
n
Slanting
n
Spiral
n
Shattered
9. After number a place of crises:
Individual crises
Multiple fractures
10. Simple crises
n
The Complicated crises
n
Sochetannye crises (политравма)
n
Difficult crises
Mixture bone отломков
The reasons mixture:
n
Excessive force of injuring effort
n
Draught спастически the reduced muscles
n
Gravity дистальной extremity parts
Kinds displacement bone отломков
n
Displacement at an angle
n
Lateral displacement
n
Rotational displacement
n
Displacement on length
Differ also primary and secondary mixture bone отломков
Primary mixture occurs at the moment of a trauma.
The reasons secondary mixture bone отломков is:
n
1. Wrong репозиция bone отломков
n
2. A wrong immobilisation of the compared bones
n
3. Early removal of plaster bandages
n
4. Premature removal skeletal extension or devices
n
5. Poor-quality imposing of plaster bandages
n
6. Early loadings on the damaged extremity
Pathological change at crises and in consolidation.
Pathological change at crises are divided into three stages:
n
Damages caused by a trauma
n
Formations of a bone callosity
n
Changes occurring in архитектонике bones
During a trauma in the field of crisis are observed:
1. Hemorrhages
2. destruction of cages of a connecting fabric
3. A hypostasis and an aseptic inflammation
4. Migration of leukocytes
5. Инфильтрация and экссудация
6. Slow рассасывание the damaged cages and fabrics
7. Reproduction of founders of a bone callosity - остеобластов
8. Formation of a primary bone callosity within the first 3 weeks
Sources of a bone callosity:
n
Periostalnyj a layer
n
Endostalnyj a layer
n
Intermediarnyj a layer
n
Paraossalnyj a layer
Primary bone make callous - 3-6-нед
Secondary bone make callous - 5-6-нед
Clinic of crisis of bones:
1)
The Pain
2)
Deformation
3)
Infringement of function of extremities
4)
Pathological mobility
5)
Shortening of extremities
6)
The Hypostasis and a hemorrhage
7)
Krepitatsija
Treatment of crises
1)
Repozitsija
2)
Fixing and an immobilisation
3)
Funktsionalnoe treatment
4)
Stimulation of formation of a bone callosity
Indications for operative treatment of crises:
The absolute:
Damages of large blood vessels, nerves, head and a spinal cord and an
internal.
The relative:
1)
Open crises
2)
The Shattered crises
3)
Otryvnye crises
4)
Interpozitsija of soft fabrics
5)
Crisis of a neck of a hip
6)
Inveterate crises
7)
In the absence of effect of conservative treatment
8)
Not Grown together crises (псевдоартрозы)
9)
Incorrectly accrete crises
Contra-indications to the operative
To treatment:
n
The Heavy general conditions of patients: shock, sharp кровопотеря
n
The General or local surgical infection
n
Heavy, accompanying diseases (the Tuberculosis, a cancer)
Dislocations
Proof pathological mixture of articulate surfaces of bones under the
relation to each other is called as a dislocation.
Classification of dislocations:
1. Congenital
2. Got (traumatic, pathological)
On degree mixture:
n
Full
n
Incomplete (incomplete dislocation)
On dislocation localisation:
1. A dislocation of a humeral bone.
2. A femur dislocation.
Clinical display:
1)
The Pain.
2)
The Compelled position of an extremity.
3)
Restriction of movements in a joint.
4)
Extremity Shortening.
5)
A joint Swelling.
6)
Joint Deformation.
7)
Hypodermic hemorrhages (sometimes).