Intra articulate a change – a change which line of a break completely or partially is located in a joint cavity. For a number of reasons it is distinguished from other injuries of a skeleton and demands special approach to diagnostics, treatment and rehabilitation. Distinctive features of such changes are involvement in pathological process not only the injured bone, but also all joint, possible violation of congruence of articulate surfaces, and also high probability of development of contractures and rigidity in the remote period. Damages can result from falling, blows, motor transportation incidents, industrial accidents and so forth. Distinctive signs is hypostasis, pain and . The diagnosis is exposed on the basis of symptoms and a radiographic picture, sometimes it is required to joint KT and MPT. Treatment can be both conservative, and quick.
Intra articulate change
Intra articulate a change – injury of a bone in the articulate capsule. It is the difficult trauma requiring special attention from the traumatologist and special approach to treatment as the volume of movements depends on that, articulate surfaces were how precisely restored. Can arise in any joints, both large, and small. Owing to the possible remote consequences intra articulate fractures of large joints of extremities have the greatest clinical value.
The joint consists of two or the ends of bones which were more suiting one another in a form which connect among themselves by means of the capsule and sheaves. The capsule forms the cavity isolated from other anatomic educations. In and outside of the capsule sheaves which hold bones settle down, without allowing them to be displaced too strongly. The ends of bones are covered with a smooth cartilage thanks to which bones can slide freely from each other. In a joint a small amount of liquid – the lubricant facilitating sliding and delivering nutrients to cartilaginous tissue contains. All anatomical structures together form a peculiar hinge.
At intra articulate changes pathological process extends to everything or almost to all structures. Along with a bone integrity of an articulate cartilage is broken. Blood from otlomk streams in a joint cavity, arises . The capsule stretches and inflames. Besides, the capsule and sheaves can directly be broken off at the time of the injuring influence or be damaged by bone fragments. Because of action of the injuring force and draft of muscles of an otlomka of a bone are displaced and become incongruent (incoincident, not suitable to each other in a form). If not to get into condition or restore the articulate ends insufficiently precisely, in the subsequent it will lead to restriction of movements. Besides, insufficient smoothness of articulate surfaces in combination with consequences of damages of other structures can become the reason of development of arthrosis.Please Help us - click on the advertisement
The most significant changes
Any intra articulate the change demands serious approach to treatment. However owing to prevalence and weight of possible consequences changes in large joints have the greatest clinical value: elbow, knee, coxofemoral and talocrural. Weight of fractures of elbow joint is caused by its difficult configuration, a large number of typical intra articulate damages which are among as usual changes (chrezmyshchelkovy changes, a change of an elbow shoot, a beam head change), and perelomovyvikh (a change of Montedzha, Montaigne's change), and also difficulties at a repozition and deduction of otlomk.
Among skeletal injuries of a coxofemoral joint special danger is constituted by fractures of a neck and a head of a hip – this area krovosnabzhatsya badly therefore otlomk do not grow together, and only "grab" among themselves cicatricial fabric. Weight of changes in knee and talocrural joints is explained by their difficult configuration and importance of complete functional recovery of these segments. Intra articulate changes in a shoulder and luchezapyastny joint are, as a rule, simpler in a repozition and less often come to an end with formation of contractures. Nevertheless, in some cases, especially at a large number of otlomk and considerable shift of bone fragments, similar damages can also present difficulties in treatment and rehabilitation.Please Help us - click on the advertisement
Home or sports injury (falling, twisting of an extremity, indirect influence or direct stroke), and road incident, falling from height, natural disaster or a production trauma can become the reason as. In all cases, except for a home and sports injury, there is a high probability of the combined or combined damages. Intra articulate changes can be combined with other fractures of bones of extremities, a stupid injury of a stomach, a craniocereberal trauma, basin changes, a trauma of urinogenital bodies and injuries of a thorax.
Fractures of a neck and head of a humeral bone, as a rule, arise at elderly people and are a consequence of falling on the taken-away hand, a shoulder or an elbow. Injuries of an elbow joint can be observed at any age, but meet at children and young patients leading active lifestyle more often. Falling on the straightened hand or the bent elbow becomes the reason usually. Changes in a luchezapyastny joint can also arise at people of all age, however, an overwhelming part of patients – children or elderly people. The typical mechanism of a trauma – falling on the straightened hand with a support on a palm.
Fractures of a neck and head of a hip are characteristic of people of advanced age and are result of falling. Injuries of a knee joint meet at athletes and people of working-age more often, the mechanism of a trauma can be various, from falling on a knee to a podvorachivaniye and direct stroke. Fractures of anklebones are observed at patients of all age and usually arise at a leg podvorachivaniye.Please Help us - click on the advertisement
Symptoms and diagnostics
As well as at other changes, at such damages there is intensive pain, hypostasis and dysfunction of an extremity. Mobility of otlomk comes to light not always that can be caused both by features of a trauma, and inaccessibility of intra articulate structures (for example, an intercondyloid eminence at a fracture of a tibial bone) for a direct research. Besides the general signs deformation of a joint and violation of relationship between bone ledges (identification points) is characteristic of intra articulate changes. At changes in large joints is defined . Expressiveness of each of the listed symptoms can vary and depends on type and localization of damage, degree of shift of bone fragments, weight and many other factors.
The diagnosis is exposed on the basis of clinical and radiological signs. For specification of the plane of a break and the provision of otlomk, along with pictures in standard projections, quite often carry out roentgenograms in special laying and tangential projections. In need of the patient direct to KT of a joint, MRT of a joint and an arthroscopy.Please Help us - click on the advertisement
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
In most cases hospitalization in office of traumatology is required. Treatment is based on the principles of the most exact recovery of the normal anatomic provision of otlomk and minimum possible term of fixing. At fractures of a knee joint at the initial stage carry out one or several punctures. At injuries of other joints of a puncture usually are not required. The plaster bandage is applied more often at changes without shift. At the shift of fragments, as a rule, impose skeletal extension or make surgical intervention. Preference is usually given to operational techniques as they allow to resume early the movements and to avoid development of immobilized (fiksatsionny) contractures.
Due to the variety of intra articulate changes the treatment method is always chosen taking into account concrete pathology. During rehabilitation of the patient surely direct to LFK and physical therapy. Indications to massage define individually as in certain cases, especially at children, this method of treatment can provoke formation of an excess bone callosity.