Skeletal traction for a hip fracture: technique of the procedure, weight of the load, duration of bed rest, indications, advantages and disadvantages of the method. Treatment of fractures using skeletal traction. Indications for use. Traction control, complicated

To reduce the healing time of hip fractures (and not only) skeletal traction is used. This is a long-known treatment method, the purpose of which is to carefully align the ends of the damaged bone. Despite high degree efficiency, the method has a number of disadvantages and contraindications. All possible restrictions taken into account by the doctor based on the results of examination and diagnosis.

The essence of the method

In case of a hip fracture, traction (in the photo below is a schematic representation of the structure) is necessary. This method ensures high-quality and complete fixation of a broken bone.

Initially, the doctor determines the area of ​​the damaged area. A Kirschner wire is then passed through it. This medical device, made of metal. Immediately before performing this manipulation, the limb is anesthetized. Then a weight is suspended from one end of the broken bone, the mass of which is calculated in individually. The bone structures are then compared. As a result, all conditions are created for the successful formation of callus.

Indications

In case of a hip fracture, skeletal traction is prescribed very often. Depending on the location of the damage to the bone structures, the technique varies somewhat. Indications for this species Treatments are the following types of fractures:

• Trochanteric. IN in this case the load is suspended from a pin passed through the femoral condyles or the tibial tuberosity.
• Cervical. Skeletal traction is rarely prescribed. If the doctor decides that this method of treatment is most effective and appropriate, the load is suspended through
• Diaphysis fracture. IN similar situations the method can be considered as main or auxiliary. The load is suspended through the tibial tuberosity. Position lower limb during traction, it directly depends on the location of the fracture (the upper third is abduction, the middle third is that the leg should be straight, the lower third is that the limb is bent at the knee at a right angle and a bolster is placed).
• In the area of ​​the condyles. Skeletal traction for a hip fracture in this area is prescribed only in isolated cases. The main treatment for this injury is surgery.

In order to assess the advisability of prescribing traction for a hip fracture, the doctor must take into account several factors. These include: the patient’s age, his general health, the location of the fracture, the presence of complications (including wound infection in open trauma).

Contraindications

Like any other treatment method, skeletal traction for a hip fracture has a number of limitations. It is not prescribed to children under 5 years of age. In addition, the presence of an inflammatory process at the fracture site is a contraindication.

In some cases, it is more appropriate to prescribe alternative methods treatment. For example, for young people with uncomplicated fractures without displacement, it is recommended to apply a plaster cast. As for older people, endoprosthetics or osteosynthesis are the most effective for them.

Advantages

This treatment method has been used in practice for many years. Every year his technique is improved, which allows him to minimize pain both during the process of hanging the load and after the procedure.

The undeniable advantages of skeletal traction for hip fractures in children over 5 years of age and in adults:

• The patient is under the supervision of doctors and medical staff almost around the clock. The victim can call for help at any time, for example, if severe painful sensations.
• The method completely eliminates re-displacement of damaged bone areas. Contrary to popular belief, the design is extremely reliable.
• Skeletal traction is a minimally invasive treatment method. Due to this, the risk of complications is much lower than after surgery.
• Using this method, it becomes possible to significantly reduce the healing time of bone structures.

Separately, it is worth noting that after traction, the duration of the recovery period is minimal. Soon after the weight is removed and the pin is removed, the patient can begin to perform his daily activities.

Flaws

Skeletal traction during a hip fracture is associated with a number of uncomfortable sensations. During the first few days, patients complain of severe pain. aching character in muscle tissue.

The method has several other disadvantages:

• The procedure carries a risk of infection and subsequent formation of purulent exudate. It is worth noting that in medical institutions only a sterile set of instruments is used. In addition, the installation of the spokes and the hanging of the load is carried out exclusively in compliance with all sanitary standards. Every day the doctor examines the area in which the metal instrument is located. Treatment with antiseptic agents is also carried out regularly. In this regard, the risk of infection is rather a disadvantage not of the method itself, but of the medical institution in which such complications are recorded.
• Prolonged bed rest. The patient needs to remain in the supine position for quite a long time. This is associated with the risk of bedsores and muscle tissue contractures. It is necessary to remain in a lying position until the fusion of bone fragments occurs. Only after the formation of a callus is the needle removed.
• Presence of contraindications. In case of a hip fracture, skeletal traction cannot be prescribed to small children and the elderly.

Despite a number of disadvantages, the method is actively used at present.

Cargo weight

When a patient is admitted to the hospital, the doctor makes a decision regarding the advisability of prescribing skeletal traction. At the same time, the initial weight of the cargo is calculated. For this purpose, the patient is weighed and sent for x-ray examination. Traction for a hip fracture (neck and other areas) requires the installation of devices, the weight of which is approximately 15% of the patient’s total body weight.

In order for the muscle tissue to be relaxed, the leg is fixed on a special splint. Thanks to this, the intensity of painful sensations gradually decreases, and the debris bone tissue grow together faster.

Timing of traction

The length of hospital stay directly depends on the severity of the injury and the presence of various types of complications. For a hip fracture, the traction period is about 2 months.

Bone condition is monitored regularly. The doctor assesses the dynamics using x-ray examination. After the formation of a callus, the pin is removed. First, it is shortened on both sides so that its ends are as close to the skin as possible. The limb is then processed antiseptic solution. The next step is to remove the spoke. The resulting wounds are treated with medications, then a sterile bandage is applied to them.

After this, the patient is transferred to the fixation method of treatment.

Finally

In case of a hip fracture, skeletal traction is often the only possible method treatment. This method involves installing a spoke on which a load is subsequently suspended. Thanks to this, the fragments of the structures are evenly fused. The needle is removed after the formation of a callus. The average duration of treatment is 2 months. The patient's condition is monitored using x-ray examination. The method is highly effective, but has a number of contraindications. Traction is not prescribed for elderly people and children under 5 years of age. In such situations, preference is given to surgical intervention.

Injuries to the pelvic bones are formed when it is compressed in the sagittal and frontal plane. The shape of the fracture of the pelvic ring bones depends on many factors, such as:

1. Direction (lateral or rear);
2. Traumatic force (collision with a car, rockfall);
3. Degree of compression (strong push or slow compression);
4. Age. It should be remembered that older people are more likely to be injured than younger people.

1. Industrial injury (compression of the pelvis in the sagittal as well as in the frontal direction);
2. Car crashes;
3. Compression of the pelvis by transport wheels;
4. During landslides;
5. Damage to the symphysis pubis during childbirth;
6. When falling from a height;
7. In children, fractures of the pelvic bones can occur when sledding, rollerblading or skating.

​With some fractures, the function of the leg is completely impaired and the person cannot not only walk, but also stand.​

​lift, walk, move. Otherwise there is no point in the operation. Will not get up, will have bedsores, pneumonia.... activation only.​

Clinical picture

A hip fracture is accompanied by next complex symptoms:

• pain in the groin area, aggravated by palpation, tapping on the heel of the injured limb;
• asymmetry inguinal fold on the damaged side, swelling;
• turning the foot outward;
• the “stuck heel” symptom, in which the victim is unable to lift the heel off the ground.

A pertrochanteric femoral fracture has a similar clinical picture, but all the symptoms are more pronounced. Features of symptoms:

• hematoma and significant swelling can be detected in the hip joint area;
• Outward rotation of the foot is pronounced.

Damage to the femoral diaphysis has its own specific symptoms:

• severe pain and swelling in the area of ​​injury;
• in the presence of an open fracture, severe bleeding is observed;
• decreased sensitivity in the area below the fracture;
• severe hip deformity;
• abnormal mobility at the site of injury;
• impairment of motor activity of the limb.

When the distal part of the femur is fractured, the following is observed:

• pain, swelling, bruising in the knee joint;
• by palpation of the popliteal fossa, crepitus of bone fragments can be determined;
• shortening and external rotation of the thigh.

What types of treatment are used

Depending on the level of damage to the femur, femur fractures are divided into:

1. fracture of the proximal femur;
2. diaphyseal fracture of the femur;
3. distal femoral fracture.

Fracture of the proximal femur. This category includes injuries to the following elements of the proximal femur:

1. Isolated fractures of the pelvic bones;
2. Fractures in the area of ​​the pelvic ring without breaking its continuity;
3. Fractures in the area of ​​the pelvic ring with disruption of its continuity;
4. Double vertical fracture of the pelvic bones (Malgenya fracture);
5. Fracture in the acetabulum;
6. Fractures of the pelvic bones, which are combined with injuries to the internal (pelvic) organs.

Mild fracture pelvic bone often does not require surgical intervention, so treatment is carried out in a conservative style. During the entire period, the victim walks in a special device that fixes the leg in one position.

What is a femoral neck fracture?

​Sergey Sviridov​​Lilechka​

Symptoms and signs

Manifestations of injury are divided into two groups:

• General signs that appear throughout the body.
• Specific. That is, those that appear at the site of damage.

1. If there is a closed fracture of the pelvic bones, then 35% of victims develop traumatic shock, which develops as a result of massive blood loss and damage to the nerve plexuses;

2. The victims take a position that relieves their pain;

3. Headaches and dizziness;

4. Disorders of consciousness, manifested by loss or confusion of consciousness;

5. Noise in the ears;

6. Skin paleness and cold sweat having a sticky consistency;

7. Fall in blood pressure;

8. Increased heart rate;

9. Difficulty breathing intermittently.

The group of specific or local symptoms includes the following manifestations:

• Massive swelling, blue discoloration of the damaged area;
• Excessive pain syndrome, intensifying with any touch to the injured area;
• In case of fractures of the pelvic bones with fragments, crunching sounds will be heard - this is the sound of broken bones;
• Hematomas;

Further symptoms directly depend on which bone is injured.

A pelvic fracture is a very painful phenomenon, and the injury site immediately swells and turns blue.

Usually, when a pelvic injury occurs, a person tries to force himself into a forced position in which his hips and knees are bent, and thus reduce pain.

If a fracture occurs during an accident, or during a fall from a height, the victims, in addition to problems with the pelvic bones, have injuries to the head, chest, abdomen, legs and arms.

In addition, serious bleeding is added, which can cause shock in the victim. Therefore, if a pelvic fracture is suspected, the best thing those around you can do is to stabilize the pelvis and quickly transport the person to the hospital.

It should be noted that among various damages pelvis, the most distinctive are those that indicate its fracture. Damage can be diagnosed using the following symptoms:

• strong pain;
• bruises and hemorrhages at the site of injury;
• traumatic shock;
• bleeding in case of an open fracture;
• dysfunctions of organs in the pelvic area: difficulty urinating, constipation, pain in the lower abdomen, etc.

Symptoms and signs

​fracture)​

​If the patient’s well-being makes it possible to undergo surgery, then fixation is performed with a three-bladed nail, or bone autoplasty is performed.​​Shaft fractures of the femur​

​Immobilization consists of a series of sequential actions:​

​rehabilitation after a hip fracture​

​For older patients with a displaced or intracapsular fracture, many surgeons prefer to perform hemiarthroplasty, replacing the damaged portion of the bone with a metal implant.​

Diagnosis of injury

The main method for diagnosing fractures in traumatology is radiography. The diagnosis is made based on X-ray data. In some cases, they resort to computed tomography, which, due to its resolution, can show a more detailed picture of bone damage.

A fracture of the ischium of the pelvis can only be diagnosed in medical institution. The symptoms are very similar to a fracture of the pubic bone, so to make an accurate diagnosis, the following studies are performed:

• radiography;
• CT scan;
• Magnetic resonance imaging.

Doctors take into account the victim’s complaints and find out a detailed picture of what happened.

To prevent internal ruptures from bone fragments, the following manipulations are performed:

• rectal examination;
• vaginal examination;
• Ultrasound of adjacent organs;
• inserting a catheter into the bladder.

If blood is detected during the research, then depending on the research method used and the location of the bleeding site, it will become clear which organs and tissues are damaged, and a decision will be made on how they need to be treated.

Treatment

Cervical fracture

Most effective method The treatment for this type of fracture is surgery, this is especially recommended for elderly people.

Conservative therapy indicated for impacted neck fractures. The damaged limb is fixed with a Brown or Beller splint. A few days later, a repeat X-ray examination is performed. If reliable wedging of fragments is observed, then the victim is given the opportunity to walk on crutches without putting any weight on the affected leg for 4-5 months.

For a non-impacted fracture, skeletal traction is performed on the tibia (weighing 6-7 kg). On the third day, a control x-ray is taken. If after reposition the fragments remain in place, then the load is reduced to 4-5 kg. After traction, surgical treatment is recommended.

Surgical treatment is performed under general or spinal anesthesia. The fragments are repositioned and subsequently fastened with a three-blade nail or other metal structures. After the surgical wound has healed, the patient is allowed to sit, and can begin walking after 3 weeks.

IMPORTANT! A cervical fracture is an injury that can lead to disability. You should not refuse surgical treatment, especially in old age.

Pertrochanteric

Treatment of pertrochanteric fractures can be carried out surgically or conservatively. Conservative therapy is more often used in people young, since young people have better healing and recovery processes. For older patients it is recommended operational path treatment that does not require prolonged bed rest.

Conservative therapy for a pertrochanteric femoral fracture is carried out by stretching through the tibia or distal femur. The second option is more favorable, as it places less stress on the knee joint. The leg is placed in a splint with 15-30 degrees abduction and the knee and hip joints bent. The choice of degree of abduction depends on the position of the bone fragments.

How long do they lie in traction – 2.5 months. But full load on the limb can be given only after 4 months. Before this, you need to walk on crutches.

Surgical treatment is carried out by osteosynthesis with three-bladed metal rods and a metal plate. But recently, designs with screws have been used, which prevents the nail from wedging towards the acetabular cavity. This method is excellent because walking on crutches is already possible from the seventh day after surgery, and full weight bearing is possible from the sixth week.

Diaphyseal

As mentioned above, fractures of the bone body are most dangerous due to the development of bleeding and massive damage to soft tissues, which can cause a state of shock in the patient. Therefore, first of all, resuscitation measures to prevent the development of shock.

During this period, a conservative treatment method in the form of skeletal traction can be used, and then osteosynthesis is indicated. The wires are passed through the same places as for a pertrochanteric fracture.

On days 5-7, surgical treatment is carried out, but if it is contraindicated, the patient remains on traction for 1.5-2.5 months.

Surgical treatment is carried out by osteosynthesis using plates, nails and external fixation devices. Contraindications to surgery are wounds or pustules on the skin, the presence of inflammatory diseases of the respiratory system.

Distal part

Since most often this hip fracture occurs intra-articularly, it is first necessary to puncture the knee joint, pumping out the accumulated blood from there. Then the patient is infused with 10-15 ml of a 2% novocaine solution.

Closed reduction of the condyles can be performed. To do this, one of the assistants creates countertraction on the lower third of the thigh, the other stretches the ankle joint, and the surgeon manipulates the femoral condyle. The limb is cast for one month.

If closed reduction is unsuccessful, surgical treatment is resorted to, namely osteosynthesis. The condyle fragments are fixed with several screws to common basis. But in this case, after the operation it is still necessary to wear a plaster splint for 2-3 weeks. Full weight bearing on the leg is allowed from the 3rd month.

Edema syndrome

With a hip fracture there is severe swelling in the area of ​​injury, downstream of the limb. The cause of edematous syndrome is damage to the surrounding soft tissues from bone fragments. In this case, microcirculation, venous and lymphatic outflow are disrupted, which inevitably leads to a concentration of fluid in the tissues of the limb.

What to do when severe swelling after a hip fracture:

• Use medicines. An experienced traumatologist will prescribe medications that improve blood circulation (Heparin), local anti-inflammatory drugs (Nise, Ibuprofen, Dolobene), ointments that help restore local vascular bed and fluid metabolism (Normoven, Cycloven).
• Take a massage course. Massage is one of the most effective procedures, which improves local lymph flow. This procedure may be contraindicated if there is a risk of blood clots.
• Use tight underwear or bandages. It has been clinically proven that compression improves and stabilizes the venous bed and pressure in the veins.
• Do exercise therapy. A set of exercises will help restore physical strength muscles atrophied during treatment, thereby improving metabolism in the surrounding tissues.
• Get physical therapy. Electrophoresis, ultraviolet therapy and electrical stimulation will help to further stimulate the problem area of ​​​​tissue, normalizing metabolism and trophism.

How long does swelling last for a hip fracture?

Depending on the severity of the fracture, the degree of damage to the soft tissues, properly prescribed treatment and the individual characteristics of the patient, edema syndrome can be observed from three weeks to several months. Usually the swelling lasts a month from the moment of injury.

Useful video

In this video, a traumatologist explains the nuances of treating a pertrochanteric femoral fracture using osteosynthesis.

To begin with, it is important to anesthetize and examine the patient. Based on the results of the examination, the question of the need for conservative or surgical treatment will be decided. Treatment of ischium fracture conservative method carried out when there are no fragments or displacements. Otherwise, surgery cannot be avoided.

When there are no indications for surgery, the patient is transferred to the ward and placed on a bed, where he will lie in the “frog position”.

Nuance! If the victim is diagnosed with a fracture of not only the pelvic bones, but also the bones of the leg or thigh, then the injured limbs are placed on special splints.

Every patient with such an injury is interested in the question: how long does it take for a fracture to heal? Bone healing can take 7 to 8 weeks. But you don’t need to stay in the hospital all this time. Observation is only necessary for the first few weeks after injury to exclude complications. The following factors also influence healing:

• patient's age;
• state bone apparatus;
• whether the patient receives enough calcium and magnesium.

In case of a displaced fracture, an operation is performed to restore the integrity of the bone - it is secured with metal structures (screws, knitting needles) and small fragments are removed.

The above type of fracture in hip joint needs to keep the patient completely immobile for long period time. It is the effectiveness of compliance with the rules of bed rest that determines how long it takes for a hip fracture to heal.

In addition, one cannot ignore the psychological state of the patient: the time it takes for a hip fracture to heal may also depend on the emotional state and mood. Currently, the majority of people suffering from hip fractures have depressive states and very serious neuroses.

In addition, it should be noted that adherence to bed rest turns out to be quite unfavorable for the general physical condition of the human body.

The most common consequences, which also affect how long it takes for a femoral neck fracture to heal, are the following:

• bedsores;
• development venous congestion;
• the appearance of intestinal atony;
• progression of deep vessel thrombosis;
• development of congestive pneumonia.

Hospital care and treatment directly depend on the type of pelvic fracture. First of all, such a division depends on X-ray diagnostic data.

For victims with marginal type fractures and without disruption of the continuity of the pelvic ring, novocaine blockade is indicated, taking the most comfortable position for the bones in a hospital bed.

In case of disruption of the continuity of the pelvic ring in the form of a rupture of the pubic symphysis, conservative treatment of the “hammock” type is indicated. For deeper injuries and ligament ruptures, osteosynthesis is performed using metal plates with screws.

In a significant proportion of victims, in addition to fractures of the pelvic bones, they also have additional fractures and dislocations. Most often this concerns injuries to the femur. Such patients undergo orthopedic treatment.

To reposition minor displacements in one half of the pelvis, the method of skeletal traction is used with an increasing load of up to 15 kg for an average of one month. Fractures that are not accompanied by displacement are cured by applying a plaster cast to the hip joint.

If there is an open fracture of the pelvic bones, surgeons perform primary processing aimed at prevention bacterial infection and subsequent suppurations. For deep wounds, doctors perform skin reimplantation (they take a piece of whole skin and transplant it to the damaged area).

How long do you have to stay in the hospital?

Victims need to stay in hospital for an average of 70 days. This impressive figure is due to long-term prevention and elimination of complications.

In addition to changing your lifestyle, your diet will also change in the next few months. You should add plenty of calcium-containing foods and vitamin D to your food.

Strengthening is of no small importance protein nutrition, since protein is the building foundation of all living things, including bones. With a rational diet, pelvic bone fractures heal much faster.

The consequences are indeed very dangerous to health. In many cases, they can manifest themselves throughout the affected person's life.

Of course, you need to start with first aid. In case of an open fracture, it is necessary to stop the bleeding as soon as possible and disinfect the edges of the wound.

Analgesics, which can be administered subcutaneously or given to the victim in the form of tablets, will help reduce pain. The main thing is to monitor the patient’s condition, and if signs characteristic of the development of traumatic shock, try to rid the injured person of them as soon as possible.

The speed at which the ambulance arrives often determines how well everything will go further. Transport the victim on our own not worth it, since this requires a special stretcher.

They should be even, and a cushion should be placed under the knees. A splint for this fracture is rarely applied.

Treatment for an uncomplicated fracture usually occurs without surgery. Throughout the entire period, the victim must walk in a special device that fixes the leg in one position.

If necessary, the patient can use crutches when moving. If everything goes without complications, the damaged bone will recover in three to four months.

Throughout this time, the doctor may prescribe painkillers and, if necessary, some vitamin complexes, replenishing the lack of vitamins necessary for good fusion bones.

Recovery from traumatic shock includes, in addition to pain relief, procedures such as blood transfusions and complete immobilization of the impacted bone.

If the problem is closed and marginal, fixation can be performed in a hammock or on a shield. In addition, immobilization can also occur with the help of rollers in the popliteal area or Beler splints.

Skeletal traction is prescribed if cracks or fractures of the pelvic ring occur.

Non-surgical treatment

Stable fractures such as avulsion fractures small piece The pelvic bone, when athletes collide with each other, usually heals without surgery.

The victim is asked to use crutches or a walker to reduce the pressure of body weight on the pelvis and legs. Typically, a person will have to walk like this for three months or until the fracture heals.

Medications include painkillers and drugs that reduce blood clotting, such as aspirin.

​In our case, treatment of a hip fracture involves taking preventive measures to combat traumatic shock. If the victim has lost a lot of blood, he is given a transfusion of blood substitutes and blood components.

At the initial stage, a plaster cast is not used, since it is not able to hold the fragments in the desired position. Basic methods modern treatment– this is skeletal traction, surgery (osteosynthesis) and external fixation devices.

After treatment, it must be completed. In the case of low-grade fractures (Garden types 1 and 2), the standard treatment is to fix the fracture site with screws, sliding screws or plates.

This technique can also be used for displaced fractures after the fracture has been reduced. ​​​Subtrochanteric fracture​.

​A diaphyseal fracture of the femur is a fairly severe injury, which is associated with painful shock and significant blood loss.​

​Injection of the joint with local anesthetics, mainly lidocaine and novocaine are used.​

​Due to decreased immunity, there is a risk of developing other diseases not related to joints. The cardiovascular and respiratory systems are most often affected.

​It all depends on the body. It will be very difficult. Fractures of the lower part of the femur (condylar) Traction for a fracture of the femoral neck is contraindicated due to impaired blood supply to the femoral head.

1. ​As a rule, patients with a hip fracture are older people who have suffered a low-energy injury (fall). They complain of pain and inability to transfer body weight to the leg. Upon examination, the damaged limb is usually shorter than the healthy one and turns outward unnaturally.​

​With direct trauma, splintered, transverse and oblique fractures of the femur appear, while with indirect trauma, helical fractures appear.​

​All of the above groups of hip fractures differ in the mechanisms of damage caused, clinical symptoms, method of treatment and long-term prognosis.​

First aid for a hip fracture

A fracture of the pubic and ischial bones is accompanied by severe pain, so it is necessary to give the victim an anesthetic and call " Ambulance».

Important! The arriving doctor must be told which drug the victim received and in what dosage.

An ice compress can also help relieve pain. You should not apply it directly to the skin; there should be a layer of fabric. It is not recommended to leave such a compress on long time, 15-20 minutes is enough.

It is extremely undesirable to transport a person with a pelvic fracture to the hospital on your own. If transported incorrectly, a fracture of the ischium without displacement can turn into a fracture with displacement, which will significantly complicate the process of treatment and fusion of bone tissue.

Only doctors in an ambulance can transport a person with a fracture of the ischium or pubis. To do this, he is placed on his back on a hard straight stretcher and helped to assume the “frog pose”:

1. Legs bend in knee joints.
2. A cushion made of clothing or other handy materials is placed under the feet.
3. The feet are connected.

In this position, they are taken to the trauma department of the hospital.

1. Stop bleeding;
2. Treatment of traumatic shock;
3. Pain relief (narcotic and non-narcotic analgesics, ketorol);
4. Transport immobilization;
5. Transporting the victim to the hospital.

The scope of primary care for the victim depends on the severity of the condition and type of injury.

The doctor who arrived at the scene of the accident should assess:

1. The patient's level of consciousness;
2. Frequency and rhythm of the patient’s respiratory movements;
3. The presence of foreign bodies in the mouth or throat;
4. Measure blood pressure and heart rate;
5. Availability open injuries and damage;
6. Color skin and mucous membranes;
7. Ripple on peripheral vessels;
8. The presence of subcutaneous emphysema;
9. Presence of signs of external or internal bleeding;
10. Determination of bone fractures;
11. Presence of soft tissue damage.

The doctor should place the victim on a flat and hard surface. Transport in the “frog position”. To maintain this position, a cushion of clothing is placed under the victim’s knees.

Since pelvic injuries are very dangerous, if a fracture occurs, the victim must be urgently taken to the hospital.

The patient should be transported lying on his back, with a bolster placed under his knees.

If necessary, give the victim pain relief.

A pelvic fracture, or rather its consequences, actually poses a great danger to health. As mentioned above, there are cases where they continue to manifest themselves throughout life. This is why urgent treatment is necessary.

One of the main roles, as in any traumatic case, belongs to the provision of first aid. An open fracture requires immediate stopping of bleeding and disinfection of the wound edges.

To reduce pain, you can inject the victim subcutaneously with analgesics, or give them in tablets. It is very important to closely monitor the condition of the injured person in order to help him get rid of them at the first signs of shock.

It often happens that successful treatment depends on the speed of ambulance arrival. But no matter how long it takes for the ambulance to get to the scene of the incident, under no circumstances should you transport the patient on your own.

The reason is in special stretchers that are strictly level. A cushion is placed under the victim's knees.

Adjusting a splint very rarely accompanies this type of fracture.

​usually occurs between the lesser trochanter and the area below it, and may involve the shaft of the femur.​

Possible consequences

The consequences are not as harmless as they might seem. First of all, work may be disrupted internal organs located in this area. If the damage is serious, surgery is necessary. In this case, the victim recovers much longer.

Rehabilitation must be observed in accordance with all recommendations given to the victim by the doctor. If you neglect his advice, do not comply with bed rest and do not maintain immobilization, then this can subsequently lead to the appearance of chronic lameness.

The consequences of disorders in the pelvic area are not as insignificant as many people think. Pelvic injuries can lead to significant functional disorders internal organs.

A serious fracture requires mandatory surgical intervention. This means that the rehabilitation processes will take much longer, and the body will recover more slowly than with a mild case.

Untimely first and professional health care in 15% of cases it leads to disability; non-compliance with doctor’s recommendations during the rehabilitation course, refusal of bed rest leads to chronic lameness.

Preventive measures

Health is very important for every person, so you need to make every effort to preserve and support it.

No person is immune from accidents, and if this happens, it is important not to fall into despair, but to completely trust the professionals and maintain a positive attitude.

Rehabilitation and prognosis for recovery

Since the patient is forced to lie for a long time in an almost immobilized position, it is necessary to restore the tone and ability of the muscles and ligaments to function normally. To do this, they regularly perform a complex consisting of gymnastic exercises selected and prescribed by a doctor.

The load should be minimal at first and increase gradually. Performing exercises should not cause discomfort, much less pain.

Rehabilitation after a pelvic fracture includes:

• physiotherapy;
• massage;
• taking calcium and magnesium supplements.

​Sergey Savchenko​

Skeletal traction is one of the main methods of treating multiple fractures. It is provided with standard instruments and equipment, which are located in a specially designated equipment room in the emergency room. Most often, skeletal traction is used in the treatment of limb fractures (23.4%): for hip fractures - 68%, tibia - 12.3%, shoulder - 4.4%. Every third victim with multiple fractures of the bones of the lower extremities is treated using this method.

Indications for skeletal traction

1. Helical, comminuted, multiple and intra-articular closed and open fractures of the femur, tibia, less commonly - humerus with displacement of fragments.

2. Multiple fractures of the pelvic bones with vertical and diagonal displacement of fragments.

3. Unilateral fractures of the pelvis and femur, femur and tibia (double skeletal traction on one side).

4. Displaced open fractures of the femur and tibia (if simultaneous surgical intervention is impossible and plaster immobilization is ineffective).

5. The need for temporary immobilization of fragments until the victims are removed from a serious condition and prepared for surgical intervention.

6. In case of unsuccessful attempts to achieve reposition and fixation of fragments by other methods.

The characteristics of multiple fractures required a number of improvements in skeletal traction. Standard systems traction is harsh: the patient’s movements in bed, rearranging linen, placing a bedpan cause fluctuations in the traction force. With a load of 10 kg, these fluctuations reach ±2-4 kg, as a result of which peace in the fracture zone is disturbed and pain and reflex muscle tension occur. A spring inserted between the bracket and the block dampens fluctuations in the traction force, eliminating their undesirable consequences.

Options for skeletal traction in the treatment of polyfractures

a - when a central dislocation of the hip is combined with a fracture of the diaphysis;
b - for fractures of the femur and tibia of one limb;
c - with multiple hip fractures;
d - for fractures of the hip and pelvis.

In case of fractures of the lower leg bones, it is advisable to perform traction with a calibrated spring-damper, which is stretched either by a hook with a screw rod, or by a load, while the Beler splint block is moved 4-5 cm to the medial side, which allows maintaining the physiological curvature of the lower leg. Countertraction is provided by a load on a pin passed through the tibial tuberosity, which eliminates the need to lift the foot end of the bed. The spoke also prevents rotational displacements when the patient turns in bed. With multiple oblique fractures of long tubular bones hold the fragments in correct position possible using lateral skeletal traction with bayonet-shaped curved knitting needles.

Skeletal traction system for the treatment of multiple fractures of the tibia (according to V.V. Klyuchevsky)

1 - extension with a calibrated spring and a screw pair;
2 - hanging the foot by calcaneus;
3 - lateral skeletal traction using a knitting needle with an emphasis;
4 - counter-extension;
5 - lateral traction mechanism.

At the time of injury, due to instant muscle contraction, bone fragments are displaced from the normal position of the bone axis. It is called primary and depends on the force that caused the damage. Secondary displacement of fragments occurs due to the traction of spastically contracted muscles, as well as the force and severity of the peripheral parts of the limb. In this regard, to compare bone fragments and hold them in this position until a bone callus forms, limb traction is used, during which gradual relaxation of the muscles occurs.

In traumatological practice, constant adhesive plaster and, more often, skeletal traction have been used. In the first case, traction is carried out with adhesive tapes attached to the skin (cutaneous traction), and it is used when holding fragments does not require much effort, most often in weakened patients and children. Skeletal traction is considered more reliable, in which a load is attached to metal structure, consisting of a staple and a wire passed through the bone. When using a spring-damper system (hence the name damped skeletal traction), this method of treating fractures becomes more functional.

Permanent traction is indicated for unstable fractures of the shoulder, tibia and femur, when after a one-step reposition the plaster cast does not provide the necessary fixation of the fragments. For stable fractures, skeletal traction is indicated in cases of severe or increasing local edema.

Skeletal traction is contraindicated with a large area of ​​soft tissue damage, with inflammation in the fracture area and at the site of the wires, with uncritical behavior of the patient due to intoxication, psychosis or other disorders.

Traction treatment is carried out using special therapeutic splints installed on the bed with a shield (Böhler splint for the leg) or fixed to the patient’s torso (abduction splint for the arm). The limb is placed on a splint in an average physiological state, ensuring simultaneous maximum relaxation of the antagonist muscles.

The application of the skeletal traction system is performed in the operating room under local anesthesia in compliance with all aseptic rules. Using a drill, a needle is passed through the bone. It is fixed in a bracket, to which a load is suspended through a fishing line and a block, which exerts traction along the longitudinal axis of the broken bone. To eliminate displacement of fragments at an angle and width, lateral skeletal traction is used.

Among positive aspects permanent traction It should be noted: 1) ease of implementation of the method, ease of training and technical equipment; 2) the possibility of visual observation of the fracture area and the limb as a whole; 3) availability of examination using special methods, for example, radiography; 4) the possibility of early functional treatment and physiotherapy.

Disadvantage permanent traction is infection of the tissue at the site of insertion of the wire and the occurrence of wire osteomyelitis. To prevent it, it is extremely important to follow the rules of asepsis when applying the system. In the postoperative period, the cleanliness of the balls, which are attached to the needle at the site where it passes through the soft tissue, is monitored, and they are replaced in a timely manner.

Skeletal traction is associated with a long stay of the patient in a forced non-physiological position. This is a risk factor for the development pneumonia, which in most cases causes death.

It is believed that the occurrence of pneumonia is facilitated by hypothermia of the patient during intrahospital transportation and in the ward. Other factors include decreased ventilation due to the elevated foot end of the bed.

So, after surgery, you need to use a rational pain management regimen using narcotic and non-narcotic analgesics. In order to avoid hypothermia, it is necessary to transport the patient on a metal gurney with a mattress and wrap not only the body, but also the injured limb, using at least two blankets. With damped skeletal traction, there is no need to raise the foot end of the bed, since the installation of a box to support the healthy leg and the friction of the patient's body on the bed provide sufficient counter-traction force.

In connection with the prevention of pulmonary complications, the installation of an over-bed metal (Balkan) or wooden frame, as well as special brackets that make it possible to activate the patient and facilitate his care during physiological functions, changing the bed and other manipulations, is of exceptional importance. Finally, adequate physical therapy and breathing exercises normalize lung ventilation, preventing the development of pneumonia.

Long stay patients in the same position contributes to the occurrence bedsores. For their prevention they are used traditional means and methods.

Concerning personal hygiene, then they wash the patient in the ward. To do this, covering the entire bed, put an oilcloth under it, wash your head over a basin, then wash your torso, healthy arm and leg with a washcloth. After drying the patient with a dry sheet or towel, the oilcloth is removed.

Before implementation of physiological functions the patient bends his healthy leg, rises on his elbows, and at this time a bed is placed under him. After completing the natural need, wash the perineum and remove the vessel, performing all movements in the reverse order.

Focal osteosynthesis involves the comparison and retention of bone fragments surgically using a metal rod, pin or wire that is inserted into the medullary canal (intraosseous osteosynthesis), as well as screws, plates, “cerclage” (holding) sutures attached over the bone (extraosseous osteosynthesis).

Disadvantage of extraosseous focal osteosynthesis is the difficulty of creating sufficient fixation of fragments, because by virtue of physical activity Over time, the bone around the screws dissolves. Therefore, with any extraosseous structures, a plaster cast is applied, which determines the specificity of complications and patient care.

Extrafocal compression-distraction osteosynthesis involves fixation of bone fragments using special devices such as those designed by G.A. Ilizarov. This ensures strong contact and immobility of the fragments, as well as the possibility of early functional loading of the limb. The method is indicated for the treatment of fractures, false joints and osteomyelitis, for the development of contractures and for bone growth. Among the most important conditions for the effectiveness of the method is the need to constantly monitor good tension of the spokes, thereby achieving structural strength and adequate retention of bone fragments.

Rehabilitation therapy. Complex treatment during the rehabilitation period includes joint development, the use of massage, mechanotherapy, physiotherapy and exercise therapy to restore limb function. From the very first days of treatment, early functional therapy is carried out, which consists of active contraction of the muscles of the broken limb with the help of careful general physical therapy.

Hygienic gymnastics aimed at increasing the general tone of the patient. This improves blood circulation to working muscles, correct breathing stimulates pulmonary circulation, increasing oxygen consumption and carbon dioxide release. Gymnastic movements improve the general well-being of the patient and reflexively stimulate local reparative processes. Gymnastics is usually done in the morning after sleep. Pre-ventilate the room. Exercises begin with movements in the limbs, gradually involving all muscle groups of healthy and, if possible, diseased arms and legs. The complex includes movements that are accompanied by uniform and deep breathing. Exercises are performed energetically and at the same time at a calm pace with sufficient intervals for rest and free breathing.

Approximate complex exercises looks like this (according to E.F. Dreving).

1. Starting position: one hand on the chest, the other on the diaphragm. Free inhalation and exhalation.

2. Starting position: arms along the body. Spread your arms to the sides (inhale), lift them up and lower them down along your body (exhale).

3. Starting position: arms bent at the elbow, forearms pointing vertically upward, hands clenched into fists. Full flexion and extension of the arms at the elbow joints with simultaneous dorsiflexion of the feet at the ankle joints.

5. Starting position: hands on hips. Raising the healthy leg, bending it at the knee, straightening it and lowering it.

6. Starting position: hands on elbows, hands clenched. Arching the chest upward.

7. Starting position: hands on hips. Raising your leg up, moving it to the side and lowering it down.

8. Starting position: arms on the elbows, hands clenched, healthy leg bent at the knee. Raising the pelvis with support on the elbows, shoulders and legs.

9. Raising up and lowering the straightened leg.

Such a complex involves performing each exercise 5-6 times with a total lesson duration of 12 - 15 minutes.

Balanced diet the patient actively promotes consolidation of the fracture. Prescribe high-calorie foods rich in proteins (130-140 g, 60% of animal origin), vitamin D, calcium salts (1-1.5 g), phosphorus (1.5-2.2 g). In this regard, dairy products (cottage cheese, cheese), eggs, fish, fish oil, and meat become especially important. To balance the diet in the diet, the content of vitamins C, A and group B is increased. Diet N 11 meets these requirements. Food is taken 3-4 times a day in accordance with the schedule of this medical institution. Food should have an appetizing appearance and smell. If the patient has no appetite, you need to show skill and patience to persuade him to take food.

There are skeletal and cutaneous traction. In skeletal traction, traction is performed directly on the bone using a metal knitting needle, screw or rod with a screw thread. Skin traction is carried out by fixing the traction to the skin with medical glue, adhesive tape, and also using special soft cuffs (Fig. 15).

Rice. 15. Traction options:

A - skeletal; b- adhesive plaster; V- cuff

With the constant use of large loads, skeletal traction is optimal, which is most common in adult traumatology. In children, when the loads used are not so large, and causing additional trauma to the growing bone is undesirable, cutaneous (adhesive) traction is also used. Cuff traction is more often used in orthopedics, when it is necessary to create unloading of the joint (for example, with deforming osteoarthritis).

Skeletal traction has few contraindications. The basic principles of skeletal traction are:

Relaxation of the muscles of the damaged segment;

· gradual elimination of displacement of bone fragments;

· maintaining reposition due to constant traction in the desired direction.

The advantage of skeletal traction is, first of all, the possibility of wide access to the area of ​​injury for monitoring, dressings, medical procedures, and research. Constant adjustable traction is possible in almost any direction, which allows not only to keep bone fragments in the desired position for a long time, but also to correct it if necessary.

The technique of applying skeletal traction is not complicated, but it requires precision and strict adherence to the rules of asepsis and antisepsis. Inflammatory and infectious complications, up to the development of so-called “spoke osteomyelitis”.

This manipulation must be performed in an operating room or a specially equipped sterile dressing room. The presence of abscesses, abrasions, and ulcers is a contraindication to inserting needles in this place.

The most common skeletal traction is using a Kirschner wire (length 310 mm, diameter 2 mm), which is passed through the bone with a hand or electric drill, fixed and tensioned in a special bracket (Fig. 16).

Rice. 17. Calculation of the points for carrying out the wires for skeletal traction through the supracondylar zone of the femur (A), tibial tuberosity (b), supramalleolar region (V), calcaneus (d), olecranon (d)

· trochanteric region– specific point - used for fractures of the floor of the acetabulum with central dislocation of the hip

· supracondylar zone of the femur: the needle is passed from the inside outwards, the insertion point is 1.5 - 2 cm above the upper edge of the patella and in the middle of the anteroposterior diameter of the femur (in children under 18 years of age, the insertion point is located 2 cm more proximally so as not to damage the growth zone);

· tibial tuberosity: the needle is passed from the outside inward, the insertion point is 1 cm distal and 1.5 cm dorsal to the apex of the tuberosity (in children, the needle is not passed through the tuberosity, but through the metaphysis of the tibia to avoid its eruption);

· supramalleolar region: the wire is inserted perpendicular to the axis of the lower leg from the side of the inner ankle 1 - 1.5 cm proximal to its most protruding part;

· calcaneus: the needle is inserted at the point of intersection of the diagonals of a square whose sides are perpendicular from the apical edge of the outer malleolus to back surface shins and on the plantar surface (another method for determining the point of insertion of the needle: the foot is placed at a right angle, a line is drawn behind the outer ankle to the sole and the segment of this line to the level of the top of the ankle is divided in half);

· olecranon: when bent at right angles elbow joint limbs, the wire is held 2 - 3 cm distal to the apex of the olecranon process.

The knitting needle must always be drawn strictly perpendicular to the axis of the segment. Otherwise, migration of the spoke, its cutting through, and ineffective traction are possible. If the wire is passed close to the cortex, it may cut through. If the wire is not tensioned enough in the staple, it will bend, cut through the skin and can lead to suppuration. If the spoke is over-tensioned, it may break. The points where the needle exits the skin are covered with gauze balls moistened with alcohol, which are secured with rubber stoppers placed on the needle.

When stretched behind the nail phalanges of the fingers foot or hand (according to Clapp), a thick thread or thin wire is passed through these phalanges using a needle, from which a loop is then formed and traction is carried out with rubber stretch marks over a metal arch fixed to the limb with plaster (Fig. 18).

Rice. 18. Skeletal traction of the nail phalanges of the fingers according to Clapp

The weight of the load for skeletal traction is calculated based on body weight. Thus, the mass of the load during a fracture of the tibia is about 1/7 of the body weight, the hip - 1 /6 , pelvis – 1/5. This load is average and can be correlated individually. Weight adequacy can be determined using control radiographs or clinically by measuring absolute or relative segment length. The size of the load also depends on the degree of displacement of fragments along the length, the age of the fracture, muscle mass patient.

You cannot suspend the entire design load at once, since a sharp stretch of the muscles can cause a persistent contraction in response. First, hang 1/3-1/2 of the estimated load, gradually (1 kg every 1-2 hours) increasing it.

Placing a limb for traction has great importance to achieve a good result. At traction of the lower limb The patient is placed in a bed with a hard board under the mattress. It is necessary to balance the pull of antagonist muscles. This is achieved using Beller tires (Fig. 19).

For effective traction, traction must be carried out strictly along the axis of the segment, otherwise significant losses are inevitable in accordance with the parallelogram of force distribution. A damper spring, mounted between the bracket and the load, dampens random shocks that, without a spring, are transmitted from the splint and bed directly to the knitting needle and bone.

To prevent the patient from sliding under the load, raise the foot end of the bed or install a counter support for the healthy leg (Fig. 19).

Rice. 20. Skeletal traction of the olecranon process: A- on the CITO outlet bus; b - on a Balkan frame with side support

Stages of traction treatment. First you need to achieve repositions bone fragments. The basis of reposition is the elimination of displacement along the length using traction along the axis of the segment. Traction is carried out with a gradual increase in load so that the muscles that resist stretching become fatigued. The shift in width may disappear due to compression of the fragments in the muscle sheath. Displacements in width, as well as rotational ones, are eliminated by manipulating the position of the staple with a knitting needle fixed in it or using additional rods: plaster or bandage pads, additional knitting needles with thrust pads. Reposition in traction is carried out gradually, in several stages, with clinical (measurement of segment length, palpation) and radiological control. This period takes up to 7-10 days. If reposition is successful, it is necessary fixation achieved position. The load is gradually reduced to 1 / 2 from the initial one (overstretching of fragments with the formation of diastasis cannot be allowed, which is most often acceptable in transverse fractures, where the risk of fracture nonunion is high). Such immobilization, which is achieved with a circular plaster cast, cannot be achieved with skeletal traction. However, small rocking movements in the fracture area, causing the formation of microhematomas, only stimulate osteogenesis. Then, after the formation of a fibrous callus, it becomes possible to remove the traction and apply an external fixator (plaster cast or orthosis) until the fracture is completely consolidated. IN in some cases an external bandage is not applied, then traction is the only immobilization method used during the treatment process.