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Gemartroz – hemorrhage in a joint. Arises owing to a rupture of the vessels supplying with blood intra articulate structures. It is more often observed in a knee joint. Can be traumatic or not traumatic. Traumatic always develops at intra articulate changes and quite often accompanies slighter injuries (anguishes and ruptures of sheaves, ruptures of meniscuses, bruises of joints). Not traumatic can appear at the diseases connected with violation of fibrillation or the increased fragility of a vascular wall – at a scurvy, hemophilia and hemorrhagic diathesis. At a gemartroza the joint increases in volume and becomes spherical, there is pain and fluctuation (zybleniye). The diagnosis is exposed on the basis of survey. For specification of the reason of a gemartroz the X-ray analysis, MPT, KT and other researches can be appointed. Treatment – punctures of a joint and imposing of a plaster bandage.

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Gemartroz

Gemartroz – a blood congestion in a joint. Most often develops at injuries. Takes the second place on prevalence at hemophilia. Hemorrhage can arise in any joint, however in the majority of joints it, as a rule, small also resolves independently, without holding special medical events. The exception – a knee joint, at emergence of a gemartroz in such cases is required special treatment.

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Reasons

The mechanism of a trauma can be practically any. Gemartroz at bruises of a knee joint, as a rule, results from falling or (more rare) than direct stroke. Gemartroz at a rupture of sheaves and a rupture of meniscuses often turns out to be consequence of a sports injury. Gemartroza at intra articulate changes can arise both as a result of usual falling on a knee, and owing to larger incidents: road and transport accidents or falling from height. At serious incidents the combination to other injuries is possible: injuries of a thorax, spinal fractures, basin and bones of extremities, ChMT, stupid injury of a stomach and damages of urinogenital system.

More or less expressed congestion of blood is characteristic also of the postoperative period at various planned surgical interventions on a knee joint, for example, during removal of a meniscus, sewing together of crucial ligaments, an osteosynthesis of condyles of a hip screws, an osteosynthesis of condyles of a tibial bone plates or screws. At hemophilia, a scurvy and hemorrhagic diathesis can develop even after the minimum trauma. In a row traumatic influence happens so insignificant that the patient cannot even remember it.

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Symptoms

At the first degree of a gemartroz (the volume of the streamed blood to 15 ml) the joint is slightly increased in volume. Symptoms of the main trauma prevail (usually a bruise of a knee joint). There is no pain – local in the field of damage, the holding apart joint pains. The support on a leg free or is a little limited. At the second degree of a gemartroz (the volume of the streamed blood) the joint increases to 100 ml in volume, becomes spherical, its contours smooth out. During a palpation fluctuation is defined. At a considerable congestion of blood in a knee joint the noticeable vybukhaniye on perednebokovy surfaces outside and from within from a patella is observed. At the proceeding bleeding and the third degree of a gemartroz (the volume of the streamed blood more than 100 ml) skin can become cyanotic, and soft fabrics – very hard, intense. Increase in local temperature is in certain cases noted.

If it is caused by a bruise or has not traumatic character (arose owing to hemophilia, a scurvy, etc.), the patient complains of the moderate holding apart joint pains which are especially expressed at an izlitiya of a large amount of blood. The support on a leg is possible, the movements are a little limited. At the gemartroz caused by heavier damages (a rupture of sheaves or a rupture of meniscuses, changes) the symptomatology characteristic of this or that trauma comes to light. So, at injury of ligaments instability of a joint will be observed, at a change there will be a sharp morbidity, and the support on a leg will be impossible etc.

For lack of timely treatment a small amount of blood in a joint can independently resolve. At the expressed gemartroz blood in the subsequent becomes more liquid why swelling in a joint "is softened". The joint as if becomes swollen, vybukhaniye on its side surfaces "slip" from top to bottom at change of position of a body. Along with it, formation of clots which in some cases can be felt under fingers at palpation is possible.

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Complications

Because of a blood congestion in a cavity of a joint of fabric are squeezed, their blood circulation is broken that can become a push for development of dystrophic changes (especially at repeated gemartroza). Subsequently blood cells begin to break up, products of disintegration get to fabrics, and it exerts the negative impact on a hyaline cartilage and the capsule of a joint too. In fabrics the capsule accumulates (the pigment which is formed at destruction of blood cages), because of it, the cartilage and ligaments become less elastic. On the surface of a cartilage there are small centers of destruction, the cartilage loses integrity and becomes less smooth. It, in turn, becomes the reason of a further travmatization of cartilaginous surfaces during the movement that can lead over time to development of arthrosis.

In certain cases products of disintegration of blood cages cause an inflammation of a sinovialny cover of a joint. The cover begins to mark out the increased amount of inflammatory liquid, in a joint there is an exudate, aseptic develops sinovit. If pathogenic organisms get to inflammatory liquid hematogenic (through blood) or limfogenny (through lymphatic vessels) way, sinovit can become infectious. At distribution of process on a fibrous membrane of the articulate capsule and surrounding fabrics purulent arthritis can develop.

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Diagnostics

The diagnosis of a gemartroz is exposed on the basis of clinical data and the clinical record. To exclude injuries of bones, all patients with suspicion on direct to a X-ray analysis of a knee joint. If necessary (for example, at suspicion to a rupture of sheaves or injury of a cartilage) other additional researches can be appointed: KT of a knee joint or MRT of a knee joint, arthroscopy etc. Suspicion on not traumatic gemartroz is the indication for consultation of the hematologist.

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treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

At emergence of symptoms of a gemartroz it is necessary to address as soon as possible to emergency station to receive timely treatment and to prevent development of complications. At a pre-hospital stage it is necessary to provide extremities rest, having put it on a horizontal surface with a small pillow under a knee joint. It is possible to put to a joint cold (a hot-water bottle with cold water or the bag with ice wrapped in a towel).

At the first degree of a gemartroz the puncture is not carried out as such amount of blood resolves independently. On a leg impose plaster to steak, 1-2 days recommend to put cold, to keep sublime position of an extremity and to limit loading. In the subsequent appoint UVCh. The term of an immobilization depends on the main trauma.

If the amount of blood in a joint exceeds 25-30 ml, the puncture is necessary. The puncture is carried out under local anesthesia. At first on external - the side surface of a joint, slightly below than a patella enter a thin needle to anesthetize soft fabrics and the capsule. Then the needle is changed on special, thicker and long. Blood is deleted, the cavity of a joint is washed out novocaine. If necessary enter a hydrocortisone or . Then apply a hard bandage a joint and carry out an immobilization of longety. Sometimes blood in a joint accumulates again therefore in 1-2 days appoint repeated survey. If necessary the puncture is repeated. There is usually enough 1-2, 3 punctures are more rare. Sublime position of an extremity and walking on crutches is recommended. Immobilization term, as well as in the previous case, is defined by the main trauma.

Gemartroz of the third degree, as a rule, accompanies severe injuries. In such cases of patients hospitalize in traumatologic office and perform treatment of the main damage. Punctures carry out in process of accumulation of blood in a joint. If the third degree arises in the absence of heavy damages, it also is a reason for hospitalization in traumatologic office. Along with standard medical actions in such cases detailed examination is conducted: definition of coagulability of blood, MPT, KT, surveys of other experts etc.

Persistently recidivous is also the indication for profound inspection as repeated congestions of blood can be caused by injury of cartilages which is not looked through on roentgenograms. Usually in such cases of the patient direct to an arthroscopy of a knee joint – this medical and diagnostic method allows not only to specify the reason of repeated bleedings, but also in some cases to carry out all necessary medical manipulations. For example – to remove the damaged pieces of a cartilage or the broken-off part of a meniscus.

Gemartroz at hemophilia, along with standard medical actions, demands transfusion of plasma of blood and intravenous administration of anti-hemophilic globulin. Treatment is carried out in hematologic office.

The forecast at a traumatic gemartroz usually favorable, especially in case of the timely appeal to medical institution. Recuring , and also at severe injuries and hemophilia can become the reason of development of complications and the subsequent formation of arthrosis of a knee joint.

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Gemartroz - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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