Download TASHKENT MEDICAL ACADEMY Department of Orthopedics and

TASHKENT MEDICAL ACADEMY
Department of Orthopedics and Traumatology,
Field surgery with a neurosurgeon
"APPROVED"
Dean of preventive health
prof. TMA work,
Professor FI SALOMOVA
"___" ___________ 2012 "
"APPROVED"
Rector for Academic
TMA faculty,
O.R.TESHAEV
___" ____________ 2012
LECTURE
"
EXAMINATION PATIENT WITH COMBINED AND MULTIPLIED INJURY .
For students of the course of treatment IV
and preventive health departments.
Compiled by:
Head. Univ. MD Karimov M.
Tashkent - 2012
Discussed at a faculty meeting. Protocol № ___ "___" _______ 2012.
Been approved by the SSC on surgery.
Protocol № _1_ "_10__" in September 2012.
Chairman: prof.___________________
(Name and signature)
I NAME OF LECTURES
EXAMINATION PATIENT WITH COMBINED AND MULTIPLIED
INJURY
On examination, you need to measure the value of a bruise measuring tape. The
rapid increase in the hands of the trauma suggests a large venous or arterial vessel
and requires emergency medical assistance. Restriction of the function to a greater
extent observed with bruises in the joints. The load on the bone bruises are usually
painless.
Positional compression syndrome of the upper limb compressions is of special
interest. Most often, the injury is the result of crushing hands the body during sleep
under deep influence of alcohol. Is compression of soft tissue hand, resulting in
impaired blood circulation and skin sensitivity. The victims complain of
"numbness" limb dysfunction. Initially dominated by local symptoms. On
examination determined pallor or cyanosis. When the feeling is striking decrease in
skin temperature - certainly cold to the touch, the pulse at the radial artery is not
defined or is very weak. Due to rapidly developing edema of heart rate becomes
impossible. Skin sensitivity drastically reduced, no active movement, passive, are
possible, but are severely restricted. In what may come irreversible changes
(necrosis). There's also the general reaction in the form of various degrees of shock
and acute renal failure, which prolonged compression of the patient's lifethreatening.
Sprains and torn ligaments occur in indirect violence. This is due to a sudden and
sharp movement in the joints, which exceeds the limits of his mobility. Bundles
little stretched, and their microscopic discontinuities occur, partial or almost
complete break. The patient complains of pain in the injured joint, limitation of
movement. On examination determined swelling at the injury due to damage to
ligaments, blood and lymph vessels. Bleeding may occur in the joint space, such as
the elbow, then talk about. When measuring the volume of the joints to increase.
On palpation the insertion of ligaments - bone of the upper limb - is determined by
tender. A complete break ligaments revealed nonexistent in normal mobility of the
underlying segment. For example, damaged the lateral ligament of the elbow
forearm deviates or radial direction. Fractures of the upper limb is about 50% of all
fractures. Fractures of the humerus are the result of a blow or fall on the hand.
Fractures occur in surgical or anatomical neck, the length of the bones - in the
diaphysis and shoulder. At the turn of surgical or anatomical neck there are
changes in the shoulder joint. On examination revealed swelling of the arm in the
shoulder joint. Palpation (humerus Feelings available all over) determined by pain
at the fracture site. Palpation should begin with healthy areas towards the patient,
then the victim is clearly pointing to the most painful place. When impacted neck
fractures shoulder rotation around the long axis of the upper arm in the shoulder
joint movements are determined by a large mound of humerus. If the shift occurred
or fracture fragments, then at the slightest movement in the shoulder can be heard
crackling (crunch) in the fracture. Dramatically affected the function of damaged
hand which keeps the patient healthy, protecting it from the movements.
For fractures of the humerus in the middle third and fractures with displacement of
bone fragments can damage blood vessels and nerves. Therefore, the study should
end with the study of the radial artery pulse and skin sensitivity brush.
If the damage of the radial nerve in the wrist is flexion in the wrist joint, and the
patient can not straighten it. Disturbed and sensitivity on the back surface of
insensitivity I, II and part III fingers, and on the surface - I finger.
If damaged wrist is in the extension in the wrist joint, and the tips of the fingers - in
bent position. Brush called. Violation of the sensitivity occurs on the back surface
of V, IV and III partially finger and palm surface - V and IV of the finger. The
patient could not actively flex wrist in the wrist joint. If the damage of the median
nerve violated pronation (ie, the patient can not turn the hand palm side down) and
bend the brush that is slightly deflected in the side. I finger flexion violated. Is a
violation of the sensitivity of the rear surface of the II and III of the finger; on the
surface - nail phalanxes II and III fingers. Identification of the above damage is the
basis for immediate hospitalization of the victim. Study of fracture in the elbow
starts with the inspection. When viewed from the axis defined by changing the arm
and forearm. Normally axis arm and forearm, seen from the front on a fully
straightened arm form an angle, open outwards, which ranges from 1 to 9o. For
fractures of the angle increases or disappears. Sometimes it can even be opened
inwards. Palpation in the elbow observed the following changes: a violation of the
normal relationship axis arm and forearm, reshaping the elbow. To do this,
examine the elbow joint as possible from all sides, comparing with the healthy
side. With fractures detected on examination shoulder retraction, which is located
at 3-4 fingers above the. When fractures especially fractured the elbow begins
bleeding into the surrounding tissues, the contours of the joint with smoothed
disappear marking point. Examination of the elbow should end the study of skin
sensitivity and radial pulse. Palpation of the elbow joint is the methodical study of
specific locations, where the norm should be bony prominences - the inner and
outer. When not finding them in the usual places they wanted in the ground, typical
shift. When the extensor fractures fragments displaced backwards and upwards. On
examination determined pallor or cyanosis. When the feeling is striking decrease in
skin temperature - certainly cold to the touch, the pulse at the radial artery is not
defined or is very weak. Due to rapidly developing edema of heart rate becomes
impossible. Skin sensitivity drastically reduced, no active movement, passive, are
possible, but are severely restricted. In what may come irreversible changes
(necrosis). There's also the general reaction in the form of various degrees of shock
and acute renal failure, which prolonged compression of the patient's lifethreatening. Sprains and torn ligaments occur in indirect violence. This is due to a
sudden and sharp movement in the joints, which exceeds the limits of his mobility.
Bundles little stretched, and their microscopic discontinuities occur, partial or
almost complete break. The patient complains of pain in the injured joint,
limitation of movement. On examination determined swelling at the injury due to
damage to ligaments, blood and lymph vessels. Bleeding may occur in the joint
space, such as the elbow, then talk about. When measuring the volume of the joints
to increase. On palpation the insertion of ligaments - bone of the upper limb - is
determined by tender. A complete break ligaments revealed nonexistent in normal
mobility of the underlying segment. For example, damaged the lateral ligament of
the elbow forearm deviates or radial direction. Fractures of the upper limb is about
50% of all fractures. Fractures of the humerus are the result of a blow or fall on the
hand. Fractures occur in surgical or anatomical neck, the length of the bones - in
the shoulder. At the turn of surgical or anatomical neck there are changes in the
shoulder joint. On examination revealed swelling of the arm in the shoulder joint.
Palpation (humerus Feelings available all over) determined by pain at the fracture
site. Palpation should begin with healthy areas towards the patient, then the victim
is clearly pointing to the most painful place. When impacted neck fractures
shoulder rotation around the long axis of the upper arm in the shoulder joint
movements are determined by a large mound of humerus. If the shift occurred or
fracture fragments, then at the slightest movement in the shoulder can be heard
crackling (crunch) in the fracture. Dramatically affected the function of damaged
hand which keeps the patient healthy, protecting it from the movements.
For fractures of the humerus in the middle third and fractures with displacement of
bone fragments can damage blood vessels and nerves. Therefore, the study should
end with the study of the radial artery pulse and skin sensitivity brush.
If the damage of the radial nerve in the wrist is flexion in the wrist joint, and the
patient can not straighten it. Disturbed and sensitivity on the back surface of
insensitivity I, II and part III fingers, and on the surface - I finger.
If damaged wrist is in the extension in the wrist joint, and the tips of the fingers - in
bent position. Brush called. Violation of the sensitivity occurs on the back surface
of V, IV and III partially finger and palm surface - V and IV of the finger. The
patient could not actively flex wrist in the wrist joint. If the damage of the median
nerve violated pronation (patient can not turn the hand palm side down) and bend
the brush that is slightly deflected in the side. I finger flexion violated. Is a
violation of the sensitivity of the rear surface of the II and III of the finger; on the
surface - nail phalanxes II and III fingers. Identification of the above damage is the
basis
for
immediate
hospitalization
of
the
victim.
Study of fracture in the elbow starts with the inspection. When viewed from the
axis defined by changing the arm and forearm. Normally axis arm and forearm,
seen from the front on a fully straightened arm form an angle, open outwards,
which ranges from 1 to 9o. For fractures of the angle increases or disappears.
Sometimes it can even be opened inwards. Palpation in the elbow observed the
following changes: a violation of the normal relationship axis arm and forearm,
reshaping the elbow. To do this, examine the elbow joint as possible from all sides,
comparing with the healthy side. With fractures detected on examination shoulder
retraction, which is located at 3-4 fingers above the. When fractures especially
fractured the elbow begins bleeding into the surrounding tissues, the contours of
the joint with smoothed disappear marking point. Examination of the elbow should
end the study of skin sensitivity and radial pulse. Palpation of the elbow joint is the
methodical study of specific locations, where the norm should be bony
prominences - the inner and outer epicondyles. When not finding them in the usual
places they wanted in the ground, typical shift. When the extensor fractures
fragments
displaced
backwards
and
upwards.
For fractures of the head and neck of the radius dramatically more difficult and
becomes painful forearm supination (brush can not be rotated palm up). To do this
with one hand to take up the elbow joint, and the other - for the wrist and gently
rotate a forearm, which can cause pain and (crunching) on the outer surface of the
elbow joint.
Fractures of the forearm can be accompanied by displacement of bone fragments in
length and angle. It is found during the inspection, which revealed swelling and
deformity of the forearm at the level of the fracture. When measuring the length of
the forearm from the shoulder to the of the process of the ulna and radius revealed
shortening length compared with the healthy side. When measuring the
circumference of the forearm at the symmetric parts as compared to the healthy
side as determined by an increase in volume. It should be borne in mind that the
fracture of the ulna in the middle third of the offset can occur and dislocation of the
radial head. In such cases, palpation of the elbow it marked tenderness. In fractures
of the radius in the middle third of the head can occur dislocation of the ulna at the
wrist joint. Damage in the wrist joints is a fall on the hand in the position of
extension. On examination revealed changing contours of the joint.
In fractures of the radius in a typical place with an offset brush deflected into the
back or side of the palm. To draw an axis III finger on the forearm, then found its
violation. Normally axis III finger extended upward on the forearm, is the same
distance from the edges of the radius and ulna. Brush axis is shifted to I finger.
When damaged finger bones defined swelling at the injury. When fractures with
displacement of bone fragments defined deformation of fingers, tenderness,
dysfunction.
Open fractures call these fractures, at which the violation of the integrity of bone
and skin, skin wound communicates with the site of the fracture of the bone. Most
often, open fractures are in direct collision with an object on the limb segments. In
cases of direct traumatic force is significant damage to the soft tissues. Last
crushed, smashed. At the site of damage is found during the inspection wound
observed bleeding of varying intensity, deformation, which depends not only on
the displacement of bone fragments, but significant damage to the soft tissues. In
addition to this mechanism, it may damage the skin from the inside sharp end
Sweep fragments. In such cases, a wound may be small or even a point. If there is
no major damage to the vessel, the bleeding is minor. If the damage blood veins is
dark. If the damage is significant arterial bleeding, the blood is bright red. In open
fractures of the upper extremities can be damaged and the nerves. Therefore, after
a survey of damage, check pulse of peripheral vessels, and skin sensitivity. refer
the child to the hospital for further diagnosis and appropriate treatment. Upper limb
in the elderly have their own characteristics. Due to the age-older pronounced
vascular sclerosis, which loses its elasticity, often injured in fractures. At the site of
the fracture having extensive bruising, swelling rapidly increases the affected limb.
In connection with senile osteoporosis Coast dominated fractures with minor
injuries. The elderly are more likely than older people, there are fractures, such as
fractures of the radius in a typical place and hip fractures. It must be remembered
that elderly patients often that is poorly responsive to the pain of fractures.
Therefore, the danger of "view" of such a fracture suffered more. Damage to the
ligaments
of
the
upper
limb
Wrist ligament damage Wrist ligaments are located on its sides and perform the
function of strengthening the joint. Most often damaged the lateral ligament of the
ulna. This occurs in the fall of man, when it is based on an outstretched hand.
There is pain and swelling in the wrist joint and the rear of one of the side surfaces
of the brush. On X-rays show no traumatic injuries. Treatment involves applying a
removable plaster cast or a special lock on the wrist for a week. Then remove the
blindfold and prescribe physiotherapy (application of paraffin and mineral wax,
baths, massage). Treatment duration of up to three weeks. Ligament damage first
joint, First joint is in the attachment of the thumb to the wrist bones, that it is a
base of the thumb. Damage to the joints occurs at a force along the axis of the
thumb, which may occur in the fall, with a focus on the finger, or a game of
volleyball, when a direct hit with the force of a finger on the ball.
Patient worries pain when moving the thumb, especially when trying to take your
finger
away.
In
the
joint
there
is
swelling
and
edema.
Treatment. Slug finger joints bend and fix plaster splint for 10 days. After the cast
is removed appointed physiotherapy. Term treatment for 2 to 3 weeks.
For fractures of the head and neck of the radius dramatically more difficult and
becomes painful forearm supination (brush can be rotated palm up). To do this
with one hand to take up the elbow joint, and the other - for the wrist and gently
rotate a forearm, which can cause pain and (crunching) on the outer surface of the
elbow joint.
Fractures of the forearm can be accompanied by displacement of bone fragments in
length and angle. It is found during the inspection, which revealed swelling and
deformity of the forearm at the level of the fracture. When measuring the length of
the forearm from the shoulder to the of the process of the ulna and radius revealed
shortening length compared with the healthy side. When measuring the
circumference of the forearm at the symmetric parts as compared to the healthy
side as determined by an increase in volume. It should be borne in mind that the
fracture of the ulna in the middle third of the offset can occur and dislocation of the
radial head. In such cases, palpation of the elbow it marked tenderness. In fractures
of the radius in the middle third of the head can occur dislocation of the ulna at the
wrist joint. Damage in the wrist joints is a fall on the hand in the position of
extension. On examination revealed changing contours of the joint.
In fractures of the radius in a typical place with an offset brush deflected into the
back or side of the palm. To draw an axis III finger on the forearm, then found its
violation. Normally axis III finger extended upward on the forearm, is the same
distance from the edges of the radius and ulna. Brush axis is shifted to I finger.
When damaged finger bones defined swelling at the injury. When fractures with
displacement of bone fragments defined deformation of fingers, tenderness,
dysfunction.
Open fractures call these fractures, at which the violation of the integrity of bone
and skin, skin wound communicates with the site of the fracture of the bone. Most
often, open fractures are in direct collision with an object on the limb segments. In
cases of direct traumatic force is significant damage to the soft tissues. Last
crushed, smashed. At the site of damage is found during the inspection wound
observed bleeding of varying intensity, deformation, which depends not only on
the displacement of bone fragments, but significant damage to the soft tissues. In
addition to this mechanism, it may damage the skin from the inside sharp end
Sweep fragments. In such cases, a wound may be small or even a point. If there is
no major damage to the vessel, the bleeding is minor. If the damage blood veins is
dark. If the damage is significant arterial bleeding, the blood is bright red. In open
fractures of the upper extremities can be damaged and the nerves. Therefore, after
a survey of damage, check pulse of peripheral vessels, and skin sensitivity. refer
the child to the hospital for further diagnosis and appropriate treatment. In the
elderly have their own characteristics. Due to the age-older pronounced vascular
sclerosis, which loses its elasticity, often injured in fractures. At the site of the
fracture having extensive bruising, swelling rapidly increases the affected limb. In
connection with senile osteoporosis Coast dominated fractures with minor injuries.
The elderly are more likely than older people, there are periarticular fractures, such
as fractures of the radius in a typical place and hip fractures. It must be
remembered that elderly patients often that is poorly responsive to the pain of
fractures. Therefore, the danger of "view" of such a fracture suffered more.
Damage
to
the
ligaments
of
the
upper
limb
Wrist ligament damage Wrist ligaments are located on its sides and perform the
function of strengthening the joint. Most often damaged the lateral ligament of the
ulna. This occurs in the fall of man, when it is based on an outstretched hand.
There is pain and swelling in the wrist joint and the rear of one of the side surfaces
of
the
brush.
On
X-rays
show
no
traumatic
injuries.
Treatment involves applying a removable plaster cast or a special lock on the wrist
for a week. Then remove the blindfold and prescribe physiotherapy (application of
paraffin and mineral wax, baths, massage). Treatment duration of up to three
weeks. Ligament damage first joint, First joint is in the attachment of the thumb to
the wrist bones, that it is a base of the thumb. Damage to the joints occurs at a
force along the axis of the thumb, which may occur in the fall, with a focus on the
finger, or a game of volleyball, when a direct hit with the force of a finger on the
ball. Patient worries pain when moving the thumb, especially when trying to take
your finger away. In the joint there is swelling and edema.
Treatment. Slug finger joints bend and fix plaster splint for 10 days. After the cast
is removed appointed physiotherapy. Term treatment for 2 to 3 weeks.
About 80% of all injuries are injuries of the musculoskeletal system, and about half
of them - injuries of the upper extremities. Proper treatment depends on a qualified
first aid. Injuries to the upper extremities may be different in nature. It should
always be borne in mind that injuries can damage not only the top, but the lower
extremities. Therefore, when the initial examination of the scene damage diagnosis
begins with an examination of the victim, identifying gross deformities. In their
absence, after questioning about the pain in the affected parts of the body produce
careful palpation (feeling) the injury. We should not forget that one patient can be
damaging not only to the limbs and trunk, and internal organs. All injuries of the
upper extremities can be divided into closed and open. By the close of upper limb
injuries include, compression, tension and tears, sprains and fractures.
Bruising - is damage to the soft tissues without affecting the integrity of the skin. It
usually occurs by direct violence (kick, fall). Patients complain of pain at the site
of injury, disorders of varying degrees. Diagnosis of injury in the early stages is
difficult because of the absence in the early hours of the bruise. There pastoznost
and swelling of tissues. A few hours after the injury on examination revealed
bruising due to bleeding in the soft tissue. Depending on the length of the color
bleeding bruise can be purple, yellow, blue or green (the destruction of
hemoglobin). The magnitude of the bruise can be judged on the amount of injury.
Bruising and bleeding there are bone fractures, but in the latter case, they are more
extensive and characterized by a certain location. Thus, at the turn of the neck
shoulder bruise is in the lower half of the upper arm.