Splintered change – violation of integrity of a bone with formation of three and more otlomk. Is one of the most difficult types of changes, usually is followed by the shift of fragments, can be closed or opened, out of - or intra articulate. Influence on a bone axis becomes the cause of a splintered change usually, however also damage at perpendicular application of force is possible. The diagnosis is exposed on the basis of characteristic clinical signs (unnatural position of an extremity, a krepitation, pathological mobility etc.) and given to a X-ray analysis. Depending on a type of damage perhaps conservative or expeditious treatment.
Splintered change – a change at which more than two bone otlomk are formed. Can arise in any anatomic area, however long tubular bones suffer more often: tibial, humeral, elbow, beam and femoral. Usually is difficult damage, is followed by the shift of otlomk. In comparison with other types of changes which meet in traumatology at such injuries the probability of interposition of soft fabrics, a sdavleniye or damages of vessels and nerves increases.
Quite often because of a large number of otlomk there are difficulties during a repozition as fragments do not manage to be compared or held properly by means of a plaster bandage. This problem becomes especially significant at a repozition of intra articulate splintered changes as at similar damages for full functioning of a joint it is necessary to restore a configuration of articulate surfaces very precisely. Owing to the listed problems and complications at such damages surgical intervention is often shown. Traumatologists are engaged in treatment of splintered changes.
Splintered changes of a humeral belt and top extremities
Splintered fractures of a clavicle usually occur at adults. In most cases integrity of a bone is broken in an average third, at the same time fragments are displaced because of draft of muscles. The patient complains of pain, the movements are limited, in the field of damage deformation and hypostasis is defined. At the shift of otlomk shortening is possible. At injury of nerves sensitivity violations come to light. At damage of large vessels perhaps massive bleeding. The palpation at similar injuries has to be the most careful and careful as pressure upon a bone can become the reason of shift of small otlomk and a gap or a sdavleniye of earlier intact vessels and nerves.
For confirmation of the diagnosis the clavicle X-ray analysis is appointed. Medical tactics depends on the provision of bone fragments. In the absence of complications the closed repozition with imposing of rings of Delbe (is made at insignificant shift), Smirnov-Vanstein's bandage, an eight-figurative bandage or Seyr's bandage. At damage of a humeral texture, and also existence of the fragment directed by the sharp end towards vessels and nerves expeditious treatment – a clavicle osteosynthesis is shown by a spoke, a plate, a pin or Bogdanov's nail.
Splintered fractures of a humeral bone can arise in any departments of a segment. Falling on a hand becomes the reason usually, is more rare – blow or a reversing of a hand. At damage of the top third (head changes, shoulder neck fractures) hypostasis and deformation of a shoulder joint is observed. The movements in a joint are sharply limited, the krepitation can not come to light. Changes of proximal departments, as a rule, proceed rather favorably. Usually good result manages to be achieved with use of conservative methods – a repozition and the subsequent fixing. At impossibility to compare otlomk the shoulder head osteosynthesis by screws or an osteosynthesis of a surgical neck of a shoulder a plate or spokes is carried out.
At splintered changes of a diaphysis of a shoulder deformation, hypostasis, a krepitation and pathological mobility comes to light. Perhaps sdavleny or violation of integrity of a beam nerve or, more rare, arteries. At damages of the lower departments (changes of an intercondyloid eminence, a golovchaty height and the block) the elbow joint is edematous, deformed, the movements are impossible. At changes of a diaphysis and the lower third of a shoulder quite often there are difficulties in the course of comparison of otlomk.
Tactics of treatment is chosen taking into account complications and data of a X-ray analysis of a humeral bone. At injury of an artery urgent operation is shown. In other cases carry usually out a repozition or impose skeletal extension. If otlomk do not manage to be compared, carry out an osteosynthesis of a diaphysis of a humeral bone a plate or spokes. Surgical intervention on restoration of a nerve is usually made in the remote period. In the absence of a tension the nerve seam, in other cases – plasticity of the damaged nervous trunk is shown.
Splintered fractures of bones of a forearm can be inside - and extra articulate, located in the lower, average and top third of a segment. Among intra articulate changes – a splintered change of an elbow shoot, a change of a head of a beam and damage Malgenya (a change of an elbow shoot in combination with dislocation of bones of a forearm). At all listed types of damages hypostasis and deformation of a joint is observed. The movements are sharply limited or impossible. Tactics of treatment is defined with data of a X-ray analysis of an elbow joint. Often surgical intervention is required: osteosynthesis of an elbow shoot plate, spokes or screws, resection of a head of a beam bone.
Splintered diafizarny fractures of bones of a forearm are rather widespread trauma. Are followed by visible deformation, pathological mobility, a krepitation, hypostasis, violation of an axis of an extremity. Deduction of otlomk after a repozition at such injuries becomes frequent a complex challenge even in case of simple cross or slanting changes as fragments are repeatedly displaced because of draft of muscles. In the presence of otlomk the task becomes complicated even more therefore often it is necessary to resort to expeditious treatment. Tactics of surgical intervention is defined taking into account data of a X-ray analysis of a forearm. The osteosynthesis a plate or a pin is possible, in certain cases carry out an osteosynthesis of bones of a forearm Ilizarov's device.
Splintered changes of a beam in the typical place are also frequent. Shift of otlomk is usually observed. The Luchezapyastny joint is deformed, edematous, the movements are sharply complicated. Krepitation is uncharacteristic. On a X-ray analysis of a luchezapyastny joint the change with existence of various quantity of fragments comes to light. In most cases shift manages to be eliminated during the closed repozition, the osteosynthesis of a disteel metaepifiz of a beam screws, spokes or a plate is in some cases necessary.
Splintered changes of a basin and bones of the lower extremities
Splintered changes of a basin arise at the intensive injuring influence (a road trauma, falling from considerable height), are often combined with violation of a continuity of a pelvic ring and are the heavy damage accompanied with development of traumatic shock. Damage of a back and forward half ring, side mass of a sacrum and vertluzhny hollow is possible. The expressed pain syndrome comes to light. The movements are limited, the support on legs is impossible, the compelled position of extremities depending on a type of a change is observed. The diagnosis is exposed on the basis of data of a X-ray analysis of a basin. At shift skeletal extension is carried out.
Splintered fractures of a hip, as a rule, arise in the lower or average third, is more rare – in the field of a spit. Splintered cervical changes are observed very seldom. Damage is followed by pain, deformation, hypostasis and emergence of pathological mobility. The support is impossible. At injuries of the lower and average third the krepitation often comes to light. At intra articulate damages is defined . The diagnosis is specified on the basis of data of a X-ray analysis of a hip, at vertelny changes – a X-ray analysis of a coxofemoral joint, at damages of the lower third – a X-ray analysis of a knee joint.
Treatment of vertelny changes more often conservative, with use of skeletal extension. At unstable damages the osteosynthesis of vertelny changes is carried out by a curved plate, a three-blade nail or spongiozny screws. Treatment of diafizarny splintered changes can be conservative (skeletal extension) or quick. Surgical intervention is shown at impossibility to adequately compare otlomk owing to interposition of soft fabrics. Now even at quite good results of conservative treatment of operation are often carried out for early activization of patients and prevention of post-traumatic contractures. The osteosynthesis of a diafizarny fracture of hip is carried out by a plate or a pin. Treatment of splintered changes of the lower third more often quick, the indication is incongruence of articulate surfaces owing to rotation of condyles, interposition of soft fabrics or a large number of otlomk. The osteosynthesis of condyles of a hip is carried out by bolts, a plate or screws.
Splintered fractures of a shin are a widespread trauma, are formed owing to a jump from height or blow in a shin. Quite often turn out to be consequence of road incidents (the bumper change). Damages to the lower departments arise at an extremity podvorachivaniye more often. At intra articulate changes of the top third (including at changes of condyles of a tibial bone) pain, , considerable hypostasis and deformation of a knee joint is noted. Krepitation can be absent. Diafizarny changes are followed by sharp pain, deformation, violation of an axis of an extremity, krepitatsiy and pathological mobility. At changes in the lower third (injury of anklebones) deformation and the expressed hypostasis of an ankle joint comes to light; the krepitation is observed not always.
Treatment of changes of the top departments more often surgical, is carried out for restoration of congruence of articulate surfaces. The osteosynthesis of condyles of a tibial bone is carried out by a plate or screws. At diafizarny changes imposing of skeletal extension for 4 weeks, in the subsequent – an aftercare in a plaster bandage is possible. However because of complexity of conservative comparison of a significant amount of otlomk and need of prevention of contractures today at similar damages operational techniques are even more often used: imposing of the device of Ilizarov, osteosynthesis of bones of a shin plate, screws or pins. At fractures of anklebones, as a rule, adhere to conservative tactics. If fragments do not manage to be compared during the closed repozition, resort to an osteosynthesis of anklebones a plate, screws or the pulling loop. Sometimes carry out transarticulary fixing by spokes.