Etiology

The immediate causes of fractures are various mechanical injuries. These are all kinds of blows, falls, collisions with vehicles, gunshot wounds, forcible removal of a stuck limb, sudden muscle contractions, for example, due to electrical injuries, and others.

Contributing factors are: mineral and vitamin deficiency, bone diseases, as well as some physiological conditions such as pregnancy and old age.

Classification of fractures

1. According to the time of occurrence, fractures are divided into congenital and acquired.

Congenital ones occur during the uterine period as a result of injuries to the mother or as a result of strong contractions of the uterus. Intrauterine pathological changes in the skeletal system - rickets, fetal developmental anomalies, maternal osteomalacia - predispose to such fractures.

Acquired fractures occur either at the time of birth, for example, during obstetrics, or, most often, after birth throughout life. They are divided into: traumatic and pathological (or spontaneous), because they usually occur without visible mechanical forces.

2. According to the nature of the damage, fractures are divided into open and closed.

In open fractures, the sharp ends of the bones damage soft tissues and the skin or mucous membrane, resulting in direct or indirect communication between the bones and the external environment.

At closed In fractures, soft tissue is also often damaged, but the integrity of the skin is preserved.

Open fractures pose the greatest danger, since they are easily infected by pathogenic microflora and are often complicated by phlegmon, osteomyelitis and even gangrene. Closed fractures are almost always aseptic.

• 3. Based on their anatomical nature, fractures are divided into diaphyseal, epiphyseal or intra-articular and metaphyseal. In the course of the disease, the most unfavorable are epiphyseal fractures, as they can lead to dysfunction of the joint.
• 4. Depending on the nature of the damage, fractures can be incomplete or complete.

Incomplete fractures are characterized by partial disruption of the integrity of the bone. These include:

Cracks (Fissurae), in which the main substance of the bone is split, and the periosteum retains its integrity. Cracks can be through - through the entire thickness of the bone and superficial (determined by X-ray).

Fractures (Infactiones) - represent a violation of the integrity of the cortical layer and periosteum up to half the diameter of the bone. They occur when the bones are strongly bent (on the convex side of the ribs).

Fractures are marginal defects of bones; most often occur on flat bones (fractures of the scapula, tubercles of the pelvic bones, spinous or transverse costal processes of the vertebrae).

Subperiosteal fractures are a violation of the integrity of the bone without compromising the integrity of the periosteum.

Perforated fractures or holes - occur mainly as a result of gunshot or puncture wounds.

Complete fractures are characterized by complete separation of the bone along its entire length or width.

• 5. If a violation of the integrity of the bone occurs in one place, then such a fracture is called a single fracture, in two places it is called a double fracture. There may also be multiple fractures.
• 6. Depending on the position of the fracture line to the longitudinal axis of the bone, the following types of fractures are distinguished:

transverse - the fracture line runs across the bone;

oblique - the fracture line runs at an angle; the surfaces of bone fragments are often sharp; by shifting and injuring tissue, they can cause an open fracture;

longitudinal - the fracture line runs along the long axis; such fractures are rare;

spiral - the fracture line is a spiral; it is the result of twisting of the bone;

jagged - fragments have irregularly pointed, jagged edges;

impacted - observed due to compression of the bone in the longitudinal direction; most often such fractures are epi- or metaphyseal, when the diaphysis of the bone is pressed into the epiphysis;

comminuted fracture - characterized by the formation of one to three fragments;

comminuted fracture - characterized by the formation of a large number of fragments; occur with severe injuries or gunshot wounds of long tubular bones;

a crush fracture is, in fact, a combination of a crush fracture with crushing of soft tissues, when bone fragments are mixed with soft tissues; this type of fracture is the most unfavorable, since it is almost impossible to restore the anatomical integrity of the bone;

avulsion - a fracture characterized by the separation of the end or tubercle of a bone as a result of strong muscle contractions; Most often, avulsions of the calcaneal and ulnar tuberosities and the coronoid process of the hoof bone are observed.

When fractures occur, the ends of the bone may move relative to each other. This occurs under the influence of a traumatic factor, as well as muscle contraction. The ends of bone fragments can shift at an angle, to the side, as well as with shortening or divergence in length.

61434 0

The Universal Classification of Fractures (UCF) was developed by a group of authors led by Maurice Muller. The principle of the UKP is to determine the type, group and subgroup of fracture of each bone segment with details of the damage.

In Fig. Figure 1 shows a hierarchical division of fractures characteristic of any distal segment of a long bone into three type and 27 subgroups

Rice. 1.

The three types of fractures of any bone segment are designated by the capital letters A, B, and C.

Each type is divided into three groups, designated by letters with Arabic numerals (A1, A2, A3, B1, B2, B3, C1, C2, C3). Group A1 injuries are the simplest with the best prognosis, and C3 are the most severe fractures with a poor prognosis.

After accurately determining the type and group of fracture, it is necessary to begin determining the subgroup and detailing.

Anatomical location

Anatomical localization is indicated by two numbers (the first for the bone, the second for its segment).

Each bone or group of bones is designated by a number from 1 to 8 (Fig. 2): 1 - humerus; 2 - radius and ulna; 3 - femur; 4 - tibia and fibula; 5 - spinal column; 6 - pelvic bones; 7 - hand bones; 8 - bones of the foot.

Rice. 2.

All other bones are classified under the number 9: 91.1 - patella; 91.2 - collarbone; 91.3 - shoulder blade; 92 - lower jaw; 93 - bones of the face and skull.

(Fig. 3). Each long bone has three segments: proximal, diaphyseal and distal. The ankles are an exception and are classified as the 4th segment of the tibia or fibula (44).

Rice. 3.

Rule of "squares". The proximal and distal segments of the long bone are limited by a square, the side of which is equal to the diameter of the widest part of its epiphysis.

Exceptions: 31 - proximal segment of the femur, limited by a line running transversely along the lower edge of the lesser trochanter; 44 - ankle fractures are not included in segment 43-, they are separated into a separate segment.

Distribution of fractures by segment. Before assigning a fracture to a particular segment, it is necessary to determine it center. Determining the center of a simple fracture is not difficult. The center of the wedge-shaped fracture is located at the level of the wide edge of the wedge-shaped fragment. The center of a complex fracture can only be determined after reduction.

Any fracture in which there is displacement of a fragment of the articular surface is intra-articular. If a non-displaced fracture is represented by a crack reaching the articular surface, then it is classified as metaphyseal or diaphyseal, depending on the location of the center.

Three types of long bone fractures. The types of fractures of the diaphyseal segments of long bones are identical. These are either simple fractures (type A), or splintered. Comminuted fractures can be either wedge-shaped (type B), or complex (type C), depending on the contact between the fragments after reposition (Fig. 4).

Rice. 4.

Three types of fractures of the distal segments (13-, 23-, 33-, 43-) and two of the four proximal segments (21-, 41-) are identical. These are either periarticular fractures (type A), or intra-articular fractures, which may be either incomplete (type B), or complete (type C).

The three exceptions are the proximal shoulder, proximal hip and ankle: 11 - proximal shoulder: type A- periarticular unifocal fracture; type B - periarticular bifocal fracture; type C- intra-articular fracture. 31 - proximal segment of the femur: type A - trochanteric zone fracture; type B - neck fracture; type C - head fracture. 44 - ankles: type A - damage to the subsyndesmotic zone; type B - transsyndesmotic fracture of the fibula; type C - damage to the suprasyndesmotic zone.

Diagnosis coding

An alphanumeric coding system was chosen to designate the diagnosis, ensure it was entered into the computer, and received back. Two numbers are used to indicate the location of fractures of the long bones and pelvis. They are followed by a letter and two more numbers to express the morphological characteristics of the fracture.

Alphanumeric coding for the diagnosis of long bone fractures is presented in Fig. 5.

Rice. 5.

An example of coding a distal segment fracture (Fig. 6):

2 - radius and ulna;

3 - distal segment;

C - complete intra-articular fracture;

3 - articular comminuted fracture;

2 - metaphyseal comminuted fracture.

Rice. 6.

The diagnosis can be supplemented by detailing, selected from the following options:

1) dislocation in the radioulnar joint (fracture of the styloid process);

2) simple fracture of the neck of the ulna;

3) comminuted fracture of the neck of the ulna;

4) fracture of the head of the ulna;

5) fracture of the head and neck of the ulna;

6) fracture of the ulna proximal to the neck.

Let's assume we have chosen a detail - a dislocation in the radioulnar joint, a fracture of the styloid process. Then the full diagnosis code is 23—C3.2(1)— radius and ulna, distal segment, complete intra-articular fracture, articular comminuted, metaphyseal comminuted, dislocation of the radioulnar joint, fracture of the styloid process.

Sometimes an extremely high level of precision is required to identify a subgroup. Under the new system, the surgeon simply finds the appropriate detail numbered from 1 to 9 and places it in parentheses immediately after the number indicating the subgroup.

Detail numbers 1 to 6 provide additional information about the location and extent of the fracture, while the second numbers (7-9) add descriptive information. These three common additional parts are:

7 - bone defect;

8 - incomplete separation;

9 - complete separation.

Detailing is more often used when describing subgroups in order to make the diagnosis more detailed. However, it can be used for groups and even types of fractures. When granularity is used to describe groups of fractures, it classifies all subgroups within that group.

Similarly, detail is used to describe types of fractures: it classifies all groups and subgroups of a given type. For example, for fractures of the distal segment of the radius/ulna to indicate all incomplete intra-articular (type B) and complete intra-articular (type C) fractures, it is important to indicate whether there is a concomitant injury to the radioulnar joint (see above).

In types B and C vertebral fractures (5-), it is necessary to determine the combination of anterior and posterior injuries. Thus, anterior injuries to the vertebral bodies and discs are indicated by a lowercase letter a(a1, a2, etc.), and all posterior injuries of the intervertebral ligaments of the spinous processes and apophyses of the joints - lowercase b(b1, b2, etc.).

For pelvic fractures (61-) letter A details the main damage to the rear half-ring, while the letter b defines the concomitant contralateral injury, and the letter With- associated damage to the anterior semi-ring.

Acetabular fractures are a more complex problem, therefore, instead of two or three additional data in an already known subgroup, we have seven definition options:

a - indicates the main damage;

b - provides additional detail of the main damage.

To describe in detail the associated joint injury found during surgery:

c — determines damage to articular cartilage;

d - determines the number of fragments of the articular surface, including the walls;

e — determines the displacement of fragments of the acetabulum;

f—determines a fracture of the femoral head;

g - describes intra-articular fragments that require surgical removal.

Methodology for using classification

To determine the location of a fracture, you first need to identify a bone or group of bones, and then a segment of the bone. In our example, segment 23—radius and ulna bones, distal segment.

After determining the segment, you can begin to determine the type and group of fracture by answering 2-4 questions.

Question 1a for segment 23-: “Is the fracture periarticular or intraarticular?” If the fracture is periarticular, then you can immediately proceed directly to determining its group. If the fracture is intra-articular, as in our case, then it is necessary to answer question 1b: “Is the fracture incomplete intra-articular?” (type B) or complete intra-articular (type C)?

The type C fracture group is determined almost similarly.

The second question: “Is the fracture simple or comminuted intra-articular?” The fracture shown in Fig. 6 and chosen as an example, is a complete intra-articular comminuted (CI). This is the most severe type C fracture.

When defining a subgroup, a choice must be made from three options. According to the rule of squares, which locates the fracture in the distal segment of the radius or ulna, the correct answer is “comminuted metaphyseal fracture.”

To indicate concomitant damage to the distal radioulnar joint, we must refer to detailing. The radiograph shows a rupture of the radioulnar syndesmosis and a fracture of the styloid process of the ulna.

Full diagnosis code 23—C3.2(1).

23 - radius and ulna, distal segment;

C3 - complete intra-articular fracture of the radius, articular comminuted;

2 - metaphyseal comminuted fracture;

(1) - rupture of the radioulnar syndesmosis with a fracture of the styloid process.

Traumatology and orthopedics. N.V. Kornilov

A bone fracture is a violation of its integrity caused by violence or a pathological process (tumor, inflammation). Bone fractures are often accompanied by damage to soft tissue, nerve trunks, large blood vessels, brain, lungs, liver and other organs.

Classification of fractures

Bone fractures can be congenital or acquired.

Congenital fractures occur in utero, due to the inferiority of the fetal bone skeleton, and as a result of the use of force when removing the fetus during childbirth.

Acquired fractures are divided into traumatic and pathological.

Traumatic fractures occur under the influence of mechanical factors.

Pathological fractures occur in pathologically altered bone (osteomyelitis, tuberculosis, syphilis, echinococcosis of bones, malignant tumors). They occur with minor trauma, and sometimes without trauma.

Based on the integrity or damage to the skin, fractures are divided into closed and open.

Depending on the location, fractures are divided into epiphyseal, metaphyseal and diaphyseal.

Epiphyseal fractures are the most severe; they often lead to displacement of the articular surfaces and dislocations. If the bone is damaged within the joint capsule, then such fractures are called intra-articular. With these fractures, severe pain appears and the function of the joint is impaired.

Metaphyseal fractures (periarticular) are fixed by the mutual adhesion of one fragment to another, or impacted fractures. With such fractures, the periosteum is most often not damaged.

Depending on the mechanism, fractures can be caused by compression, compression, torsion, or avulsion.

The mechanism of bone loss takes into account elasticity (firmness) and fragility. In childhood, bones are more elastic than in adults.

Fractures from compression and compression can occur in the longitudinal and transverse directions to the axis of the bone.

Long tubular bones are more easily damaged by compression in the transverse direction than in the longitudinal direction. With compression in the longitudinal direction, impacted fractures are more often observed.

A typical compression fracture is the flattening of bones when they are damaged (compression fracture), often found in flat bones. With a large mechanical force compressing the bone, complete bone fragmentation can occur.

Fractures from bone flexion occur as a result of direct and indirect violence. The brush bends beyond its elastic limits. On the convex side, a rupture of the cyst tissue occurs, a number of cracks form and the bone breaks.

Fractures caused by twisting along the longitudinal axis are called spiral or helical. These fractures are more common in large tubular bones (femur, humerus, tibia). In this case, one end of the bone is fixed, and the other is aimed at twisting, that is, rotation around its axis.

Avulsion fractures occur due to strong muscle contractions that occur suddenly; bone areas to which tendons, ligaments, and muscles are attached are torn off (fracture of the ankles, heel bone, patella, etc.)

Depending on the degree of damage, fractures can be complete - through the entire thickness of the bone - and incomplete, when there is only a partial violation of the integrity of the bone.

A crack (fissura) is an incomplete fracture of the bone, in which the fracture plane does not gape.

Depending on the direction of the fracture plane to the long axis of the bone, fractures are transverse, almost at a right angle to the axis of the bone diaphysis. The fracture surface is jagged. Sometimes transverse fractures are combined with a longitudinal crack, the so-called. T-shaped or Y-shaped fractures.

Longitudinal fractures form when the plane of the fracture coincides with the long axis of the tubular bone. They are rare.

Helical, or spiral, fractures occur when the bone twists around its axis. The fracture plane has the appearance of a spiral.

Depending on the number of fractures, they can be single, if the fracture is in one bone, or multiple, when there are many fractures in one bone or in several bones.

Bone fractures can be uncomplicated or complicated. Complicated fractures include fractures of the skull with damage to the brain, fractures of the pelvis with damage to intrapelvic organs, fractures of bones with rupture of large vessels.

Combined fractures include those that are combined with damage to other organs located far from the fracture site, for example, a skull fracture and liver rupture.

Types of displacement of bone fragments:

1. displacement at an angle, when the axes of the fragments form an angle at the fracture site;

2. lateral displacement is observed when bone fragments diverge in the direction of the diameter of the bone; it usually occurs with transverse fractures;

3. displacement along the length, longitudinal displacement, is the most common type of displacement in fractures of long tubular bones, this symptom is caused by the traction of the contracted muscles;

4. displacement along the periphery occurs due to the rotation of one of the bone fragments, usually peripheral, around the long axis.

The mobility of fragments along the bone is a very sure sign of a bone fracture, especially with diaphyseal fractures and is almost not expressed with a rib fracture.

Crepitus and abnormal mobility of fragments relative to each other give the appearance of bone crunching. If there are other reliable signs of a bone fracture, this symptom is not caused, since it is accompanied by very severe pain, increasing shock.

Fractures are a pathological condition in which bone deformation occurs under the influence of a damaging factor that exceeds the strength of bone tissue. Injuries are more common in childhood and old age, which is associated with the anatomical and physiological characteristics of the body.

A child's bones are more elastic and less durable than those of adults. This causes the skeleton to be vulnerable to traumatic factors. The high risk of fractures in children is associated with the child’s mobility and poor development of self-preservation skills. In older people, due to age-related changes, calcium salts are washed out of the bones, which leads to osteoporosis and a decrease in skeletal strength. Poor cerebral circulation, leading to poor balance and dizziness, causes unsteady gait and frequent falls.

In young people, the risk of bone deformation is associated with seasonality (ice), professional activity (intense physical activity), and sports (professional athletes). In the modern international classification of diseases (abbreviated as ICD 10), fractures are assigned class 19 - injuries, poisoning and other consequences when exposed to external factors.

Classification

The classification of fractures was created to simplify diagnosis, determine treatment tactics and prognosis of the disease. Injuries are distinguished by etiology (reason of origin), form of bone defect, displacement of bone fragments, formation of bone fragments and other factors. We will look at what types of fractures there are below and present different classifications of skeletal injuries.

From left to right there is a fracture inside the joint, open and closed injury

Fractures are classified based on the reason they occur:

• traumatic – occur when healthy bones with a sufficient degree of strength are exposed to an intense traumatic factor;
• pathological - occur when a traumatic factor of insignificant damaging force is exposed to pathologically altered bones with low strength potential.

Traumatic bone defects appear due to a direct blow, a fall from a height, violent actions, awkward movements, or gunshot wounds. Such fractures are called straight. Sometimes the place where the force is applied and the area where the injury occurs may be located at some distance. These are indirect fractures. Pathological bone defects occur against the background of diseases that lead to weakening of bone tissue and reduce its strength. A high risk of skeletal injuries is caused by bone cysts, tumors or metastases, osteomyelitis, osteoporosis, impaired osteogenesis during embryonic development, and chronic wasting diseases.

Based on the communication between bone fragments and the environment, fractures are distinguished:

• open – accompanied by damage to the external integument;
• closed - occur without the formation of a wound.

Open bone defects can be primary or secondary. Primary ones are characterized by the formation of a wound when exposed to a traumatic factor. Secondary ones appear after the moment of injury as a result of the cutting of the skin by the sharp edges of the bones due to improper transportation of the patient to the emergency room or unsuccessful repositioning of the bone during treatment.

Bone fractures differ in the direction of the bone defect line

Closed fractures are:

• incomplete – formed like a crack without displacement of bone fragments;
• complete - characterized by complete separation of the ends of the bone and displacement in different directions;
• single – injury to one bone;
• multiple – injury to several bones;
• combined – the occurrence of a bone defect as a result of the influence of various negative factors (mechanical, radiation, chemical);
• combined – skeletal injuries are combined with damage to visceral organs.

Incomplete fractures occur due to exposure to minor traumatic forces. More often, such defects occur in children whose bones are covered with a thick and elastic periosteum. The child is characterized by injuries of the “green stick” type – bone cracks without displacement of fragments. Incomplete defects include marginal and perforated fractures, fractures and cracks. Complete separation of bone fragments develops when a significant impact force is applied or a defect is formed in areas of bones with well-developed muscles. Muscle contraction leads to displacement of bone fragments in different directions along the trajectory of muscle fiber traction.

A displaced fracture is considered a serious injury that requires long-term treatment and a recovery period. Open injuries are also included in this group. In addition, they are accompanied by primary infection of the wound, which can lead to osteomyelitis and sepsis. Displacement of fragments of damaged bones causes the development of complications associated with damage to muscle tissue, nerves and blood vessels.

Fracture inside a joint

As a result, open and closed bleeding, impaired innervation of the limbs, paralysis and decreased sensitivity occur. Damage to soft tissue and large blood vessels leads to painful and hemorrhagic shock, which complicates the treatment of the injury and can cause death. A non-displaced fracture usually does not lead to undesirable consequences and in most cases has a favorable outcome.

Based on the location of the bone defect, the following types of fractures are distinguished:

• formation in the lower, middle or upper third of the bone (in case of injuries to tubular bones);
• impacted or impression (in case of injuries to spongy bones, for example, vertebrae);
• diaphyseal (located between the ends of the tubular bones);
• metaphyseal (located near the joints);
• epiphyseal (located in the joint cavity);
• epiphysiolysis (in the bone growth zone in childhood).

Epiphare injuries can occur as fracture-dislocations, which complicates the treatment of the disease and lengthens the rehabilitation period. Epiphysiolysis with inadequate therapy contributes to the premature closure of skeletal growth zones and causes shortening of the damaged limb.

Depending on the shape of the bone defect line, the following types of fractures are distinguished:

• oblique,
• transverse,
• longitudinal,
• screw,
• splintered.

A comminuted fracture is accompanied by the formation of one or more bone fragments, which are completely separated from the bone and are located in the soft tissues. Such injuries require surgical treatment and a long period of rehabilitation. A comminuted fracture with the formation of multiple fragments is usually called comminuted. It causes a significant defect in the damaged bone. Comminuted fractures can be finely or coarsely comminuted.

Defects with a transverse fracture line are classified as stable injuries with rare displacement of bone fragments. Other types of fractures lead to displacement of fragments due to muscle traction after injury and are included in the group of unstable fractures. Proper transportation of the patient to the emergency room and adequate treatment methods prevent the development of complications due to displacement of bone fragments.

Classification of bone fractures helps to choose the right treatment tactics, prevent the development of undesirable consequences, and predict the duration of therapy and the rehabilitation period. Establishing an accurate diagnosis, according to the modern classification, improves the prognosis of injury and reduces the risk of developing severe complications.

Consequences

After a fracture occurs, you must immediately seek medical help. In case of severe injuries, which are accompanied by the formation of a wound or displacement of damaged bones, bleeding, multiple bone lesions, deterioration of the general condition of the victim due to hemorrhagic and painful shock, an ambulance should be called. If it is impossible to call doctors, the patient is transported independently to the trauma department after first aid and the application of transport splints.

With methods for using immobilization splints, rules for providing first aid and methods for treating fractures.

Internal blood loss leads to hematoma formation

Undesirable consequences of a fracture occur when the victim is transported incorrectly to the hospital, late seeking medical help, inadequate choice of therapy and violation of the treatment regimen. If you suspect an injury, you must consult a doctor, undergo X-ray diagnostics and promptly begin treatment if a bone defect is confirmed.

Outcomes of fracture healing:

• complete restoration of the anatomical structure and function of the injured leg or body part;
• complete restoration of the anatomical structure with limited functionality;
• improper fusion of bones with dysfunction of a limb or part of the body (deformity, shortening of the limb);
• Non-union of bone fragments with the formation of a false joint.

Complications that arise after healing of the injury depend on the correct reposition (comparison) of fragments and sufficient fixation of the bone, concomitant soft tissue damage, rehabilitation measures and the duration of the period of limitation of motor activity. The types of bone fractures affect the healing time of the injury. Longer therapeutic immobilization is necessary for open injuries, closed injuries with bone displacement and the formation of bone fragments, as well as in the case of intra-articular disorders and the formation of fracture-dislocations.

Useful information on how to recognize fracture formation, clinical signs of injury and diagnosis of the disease.

Complications of fractures can be divided into 3 main groups:

1. Static disorders of bone tissue (absence or improper healing, deformation or shortening of the leg, formation of a false joint).
2. Soft tissue disorders (deterioration of blood flow and innervation, muscle atrophy, bleeding).
3. Local infection at the site of injury (wound, bones) or spread of infection throughout the body (sepsis).

Limb deformity due to improper bone fusion

Unhealed bone fractures are formed when the fragments are incorrectly juxtaposed, as a result of which the formation of callus is disrupted. When soft tissue gets between the ends of a damaged bone, a false joint may occur, which leads to pathological mobility at the site of injury and disruption of the normal function of the limb. Due to the pathology of bone consolidation, shortening or deformation of the limbs develops, which leads to disability.

Bleeding from large vessels when their integrity is violated by sharp edges of bones causes the development of bleeding. With a closed injury of the hip, the blood loss is 1-2 liters, the bones of the leg - 600-800 ml, the bones of the shoulder - 300-500 ml and the forearm - 100-250 ml. With open injuries in the area of ​​large blood vessels (carotid, inguinal, femoral arteries and aorta), bleeding can cause significant blood loss (more than 2 liters) and lead to death.

A bone fracture with damage to the nerve trunks causes impairment of motor function and sensory function. After the defect heals, a large callus may form, which puts pressure on blood vessels and nerves. As a result, paralysis and paresis develop, congestion in the tissues leads to disability.

Prolonged immobilization of the limb contributes to muscle atrophy and the formation of joint immobility (ankylosis). After removing the plaster, traction or external fixation device, a disturbance in the outflow of blood and lymph from the damaged area of ​​the limb is observed, which causes swelling, bluishness of the skin and stiffness of the joints. To prevent the formation of undesirable consequences of a fracture of the limbs, adequate therapy is carried out and rehabilitation measures are used at different stages of injury healing.

Pseudarthrosis formation

Infectious complications are typical for open bone injuries. As a result of injury, pathogenic microorganisms enter the wound, which cause suppuration of soft tissues, bones (osteomyelitis) or generalization of infection (sepsis). Less commonly, ulcers form in the area of ​​internal or external osteosynthesis (comparison of bones using knitting needles, plates, screws). To prevent infection, the wound is treated aseptically, the skin defect is sutured, and a course of antibiotics is prescribed.

Improper or prolonged healing of fractures causes scarring that puts pressure on blood vessels and nerves. This leads to chronic pain after consolidation of bone fragments and return to normal physical activity. Painful sensations intensify after long walking, carrying heavy objects, changing weather conditions, and can cause insomnia and mental exhaustion of the body. A significant decrease in working capacity due to constant pain leads to disability.

Bone fractures differ in various ways. To make an accurate diagnosis and select the correct treatment method, a classification was created that reflects the specific features of a particular injury. The consequences of fractures depend on the severity of the injury, timely provision of first aid, and correctly selected treatment and rehabilitation tactics. If you follow the doctor's recommendations, in most clinical cases it is possible to completely restore the anatomical integrity of the damaged bone and the functional activity of a limb or part of the body.

There are classifications of fractures, such as the Kaplan classification (1968), the C.S. classification. Neer (1970).

Currently, many countries around the world have adopted the classification proposed by M. Muller (AO/ASIF 1993), since it divides fractures depending on the morphological characteristics of each segment into types, groups and subgroups, and this classification is also universal (since it is used by traumatologists in all over the world, both for diagnosis and for printed works in various international publications), it directly shows the type of fracture and the tactics of further treatment (Müller M.E.M. Algover, R. Schneider, H. Willinger).

The fundamental principle of the universal classification of fractures AO/ASIF is the division of fractures of all bone segments into three types and their further division into three groups and their subgroups, as well as their distribution along an increasing line of severity in accordance with the morphology of the fracture, the complexity of treatment and prognosis. What type?.. Which group?... Which subgroup?.. These three questions and three possible answers to each question are the key to classification. These three types are called: A, B, C. Each type is divided into three groups: A1, A2, A3; B1, B2, VZ; C1, C2, NW. Thus there are 9 groups. Because each group is then divided into 3 subgroups, indicated by numbers. 1, .2, .3, there are 27 subgroups for each segment. These subgroups represent the three characteristic types of fracture for each group. The colors green, orange, and red, as well as the darker color of the arrows, indicate increasing severity: A1 represents the simplest fracture with the best prognosis, and S3 represents the most complex fracture with a poor prognosis.

Anatomical localization.

It is identified by two numbers, one for the bone and one for its segment.

The long bones, the ulna and radius, as well as the tibia and fibula, are taken as one bone. Therefore we have 4 long bones:

1 = shoulder

3 = femoral

4 == tibial/peroneal.

Bone segments.

Each long bone is divided into three segments: proximal, diaphyseal and distal segment. The ankle segment is an exception and is classified as the fourth segment of the tibia/fibula. The segments are designated by numbers: 1 = proximal, 2 = central, 3 = distal segment. The size of the proximal and distal segments of long bones is determined by a square, each side of which corresponds to the wide part of the epiphysis of the bone. Before a fracture is assigned to a particular segment, it is first necessary to determine its center. In the case of a simple fracture, the localization of its center is obvious. In a wedge-shaped fracture, its center is located at the level of the widest part of the wedge. For a complex fracture

its center can be determined only after reposition. Any fracture accompanied by displacement of a portion of the articular surface is classified as an intra-articular fracture. If a non-displaced fracture is represented by a gap that reaches the articular surface, it is classified as metaphyseal or diaphyseal, depending on the location of its center.

According to the AO/ASIF classification, all diaphyseal fractures are divided into

into 3 types based on the presence of contact between two fragments

after reposition: A (simple fracture) - contact > 90%, B (wedge-shaped

fracture) - there is some contact, C (compound fracture)

No contact.

Simple fracture (type A) - single circular fracture line

diaphysis with small cortical fragments amounting to less than

10% of the bone circumference, which can be neglected since they

do not affect treatment and prognosis. A1 - spiral fracture, A2 - oblique

fracture, A3 - transverse fracture.

Wedge-shaped fracture (type B) - comminuted fracture of the diaphysis with

one or more intermediate fragments, in which after

reposition there is some contact between the fragments, B1 - wedge-shaped spiral fracture, B2 - wedge-shaped flexion

fracture, VZ - wedge-shaped fragmented fracture.

Compound fracture (type C) - comminuted fracture of the diaphysis with one

and more intermediate fragments, in which after reposition

there is no contact between proximal and distal

fragments, C1 - complex spiral fracture, C2 - complex segmental

fracture, SZ - complex irregular fracture.

Type A fractures are the simplest injuries with

best prognosis for full functional recovery

limbs. Type C fractures are the most complex injuries

with a poor prognosis. These fractures give the greatest number

nonunions, false joints and persistent post-traumatic contractures

large joints.

Proximal and distal segments

Fractures of the proximal and distal segments are either “extra-articular” (type A) or “intra-articular”. Intra-articular fractures are either “incomplete articular” (type B) or “complete articular” (type C).

Given the many different options that must be considered when creating a classification of open or closed fractures, we have combined the widely accepted AO classification for long bones (Maurice E. Miiller et al. 1987) with the classification of soft tissue injuries: I = INTEGUMENT = skin, Closed Integument = closed skin, Open Integument = open skin; MT=Muscles, Tendon=damage to underlying muscles and tendons.

2.2 AO classification of soft tissue damage during fractures:

To describe skin damage, the letter "I" was chosen for the outer integument (INTEGUMENT). This word translates well into most languages. The letters "C" indicate closed (Closed) and "O" - open (Open) fractures. Thus, for closed fractures:
IC1 = no skin lesions.
IC2 = skin not torn but bruised.
IC3 = limited skin detachment.
IC4 = widespread, closed skin detachment.
1C 5 = necrosis from contusion.

Skin lesions O (open fractures)

IO1 = skin tear from inside to outside,

IO2 = skin laceration less than 5 cm long, bruised edges.

IO3 = skin injury more than 5 cm long, more common bruise, non-vital

capable edges

IO4 = significant full-thickness contusion, abrasion, skin defect

IO5 = widespread open skin detachment