Complete separation of the articular ends of the bones

It can be carried out in different ways. The most common form of immobilization is a plaster cast, but in some cases other methods are possible: soft Desaut bandage for shoulder injuries, skeletal traction for hip injuries (see). The duration of immobilization after a shoulder injury is approximately 3 weeks, and for a hip injury it is up to 4 weeks. Injuries to the collarbone, lower leg and foot require prolonged immobilization (1-1.5 months).

Injury to the collarbone/shoulder joint

This condition is treated by a neurologist.

One of the most insidious injuries that cannot always be detected and treated in a timely manner is a clavicle injury. It occurs primarily in athletes and people of working age and requires urgent trauma care as well as consistent treatment and rehabilitation measures.

Opinion from a CMRT specialist

Date Published: June 24, 2021 Date Reviewed: January 13, 2023 All facts have been verified by a doctor.

Symptoms of ACS injury

When the acromion is dislocated, the most characteristic symptom is pain and limited mobility. Swelling quickly appears in the area of the injury and the dislocated segment lifts slightly backwards. There is almost always a specific 'key' symptom: when the protruding edge is pressed in and swings back when released. Incorrect extension of the arm is noted in the first hours after injury.

In contrast to a partial injury, a complete rupture of the ligaments at the acromioclavicular joint is associated with pronounced instability of the joint. A massive bruise occurs on the left or right side in the collarbone area. Unbearable pain leads to almost complete immobilization of the upper extremity, which must be supported by a healthy arm.

Causes of osteoporosis

Many people believe that high calcium consumption prevents osteoporosis in the bones. This is not entirely true. On the one hand, excessive calcium intake is associated with kidney stones and impaired calcium metabolism. On the other hand, osteoporosis can also occur if there is sufficient calcium intake in the body as a result of malabsorption, e.g. B. due to vitamin D deficiency.

The harmonious functioning of all systems in our body is like an orchestra in which each musician contributes his or her own unique composition. For example, in bone tissue, special cells called osteoclasts are responsible for breaking down calcium from the bones, while the 'building' cells called osteoblasts are responsible for the formation of new bone tissue. As a result of various factors, an imbalance in the work of this 'team' can occur when the osteoclasts begin to break down bone tissue and the osteoblasts do not have time to replenish it. The result is osteoporosis of the bones.

The main causes of osteoporosis are:

• Changes in the body that occur with age Age-related changes in the body (from the age of 35, bone density begins to gradually decrease);
• Falling hormone levels in women (Hormonally-related osteoporosis occurs during menopause: due to the decline in estrogen, the bone tissue in many women begins to lose density, and in the following five years after menopause, a woman can lose up to a fifth of her total bone mass)
• reduced testosterone levels in men;
• long-term use of certain medications: corticosteroids (Steroid osteoporosis), antidepressants, anticonvulsants;
• Vitamin D deficiencywhich promotes calcium absorption;
• Thyroid diseases, diabetes mellitus, chronic kidney or liver failure, rheumatic diseases, gastrointestinal diseases;

Types of osteoporosis

Depending on the causes of osteoporosis, the following types are distinguished Primary osteoporosis i secondary osteoporosis.

Types of primary osteoporosis:

• Idiopathic osteoporosis in adults (cause unknown)
• Postmenopausal osteoporosis (type 1);
• Ideopathic juvenile osteoporosis;
• Senile osteoporosis (type 2, in older people).

Secondary osteoporosis (secondary osteoporosis) is caused by various causes, e.g. B. due to endocrine disorders, inflammatory joint diseases, blood diseases, etc.

Osteoporosis can be limited to one bone (local osteoporosis, focal osteoporosis), affect multiple surrounding bones (regional osteoporosis), or the entire skeletal system (systemic osteoporosis or diffuse osteoporosis). Certain forms of osteoporosis are also known as macular osteoporosis.

Caused

A fracture with displacement can be caused by a sports, household or work accident, a fall from a height, a car accident, a criminal accident or a natural disaster.

Displacement is one of the main symptoms of most fractures. The severity of the sprain can vary greatly, ranging from a mild sprain that does not affect the form and function of the limb to a severe sprain with severe curvature and segmental shortening. The dislocation can have primary or secondary causes. A primary cause is the impact that caused the fracture. Secondary causes include reflex muscle contraction and elastic retraction, as well as changes in fracture position caused by improper lifting, transporting, or repositioning of the injured party.

There are different types of displacement. During angular displacement, an angle is created at the fracture site. This type of displacement occurs in all diaphyseal fractures and can be caused directly by trauma, but in most cases is a result of muscle tension. Lateral displacement is characterized by the spread of bone fragments to different sides and is more common in transverse fractures.

Longitudinal displacement is the most common and is accompanied by a displacement of one bone fragment relative to another in the direction of the bone axis. It is caused by muscle contraction and is accompanied by a significant shortening of the limb. Peripheral displacement is less common and is caused by the rotation of one of the fragments around its axis. A periprosthetic fracture is more likely to be 'rotated'. It is not uncommon for multiple types of displacement to combine to form complex combinations.

classification

We can classify fractures with displacement based on the mechanism of injury:

• Compression or entrapment fractures. They occur when the bone is subjected to a transverse or longitudinal impact. Long bones are more commonly injured by transverse compression, with the fracture line typically running between the diaphysis and metaphysis, with the narrower diaphysis embedded in the metaphysis and the metaphysis and epiphysis flattened. In some cases, no significant displacement occurs in these fractures, but significant displacement of the fragments, including fragmentation and complete loss of congruence of the articular surfaces, may occur.
• Flexion fractures. They can arise from indirect or direct impacts. Multiple fractures occur on the convex side of the bone when attempting to bend it in different directions. When the bone's elastic limit is exceeded, the bone fractures, often in the form of a wedge fracture located between two large bone fragments.
• Torsion fractures. (Torsion fractures.) They occur when one end of the bone is blocked and at the same time the other end is rotated axially. They occur more often in large long bones (shinbone, humerus, femur). These fractures can occur due to a violent twisting of the hand (diaphysis humeralis copula), due to skiing during a fall (spiral fracture of the tibia), etc.
• Burst fractures. Occasionally occur when ligaments are torn. Small pieces of bone to which ligaments and tendons are attached become detached. The fracture usually extends over a considerable distance and self-healing is no longer possible.

In traumatology and orthopedics, fractures are differentiated according to the direction of the fracture line in relation to the bone axis:

• Transversal – The plane of the fracture is transverse. These fractures are usually the result of direct trauma and are characterized by a jagged, ragged fracture line. A combination of transverse and longitudinal fracture (Y or T fracture) can occur and usually affects the lower tibial, femoral and humeral epiphyses.
• Longitudinal fracture – The fracture plane coincides with the axis of the bone. They are rare and sometimes part of periarticular or intraarticular T-shaped injuries.
• Spiral or helical – The fracture plane is spiral-shaped; one fracture has a sharp edge and the other has a similarly shaped depression. Occurs as a result of twisting of the bone around its axis, e.g. B. when a limb is twisted.
• Aslant – The plane of the fracture is at an angle to the bone axis. The end of the fracture is usually smooth, without large jagged edges. The bone fragments are at an acute angle and one protrudes beyond the other. The x-ray shows normal alignment of the fragments in one projection and significant displacement of the bone fragments in the other projection.

diagnosis

Diagnostic steps include a physical examination by palpating the injury site. The next step is a hardware inspection. At this stage, x-rays are taken and the doctor determines the extent and location of the injury.

In the event of an incident resulting in a traumatic dislocation, first aid measures should be taken before consulting a trauma surgeon:

• Immobilizing the injured area by applying a splint;
• applying a cold compress to reduce swelling;
• Taking a painkiller to relieve the pain.

Under no circumstances should you undertake further self-treatment. This can lead to irreversible health damage.

It is the doctor's job to readjust the flexible limbs. Before this procedure, the patient receives an injection of a general or local anesthetic. The choice of anesthetic depends on whether the patient is allergic to certain medications.

For congenital sprains, it is important to start treatment as early as possible (up to 2 years of age). Otherwise, patients may need to be splinted, fitted with orthopedic shoes or operated on.

prevention

Preventive measures should be taken in the months following treatment. This helps the affected person stabilize more quickly and reduces the risk of a recurrence. Possible measures are:

• exercise courses in a physiotherapy clinic;
• massages;
• physiological treatments;
• visits to the swimming pool;
• walks in the fresh air;
• Avoiding strenuous exercise.

Current diagnostic methods for ankylosis

If you have multiple signs or symptoms of ankylosis, you should seek medical attention immediately.

Before diagnosing and treating this condition, it is important to know which doctor you should see. Of course, it is advisable to see a general practitioner who will take a medical history and diagnose the existing illness. After an initial superficial diagnosis, the patient with ankylosis is referred to a traumatologist, orthopedist or surgeon.

The first step in the diagnosis by the specialist is a visual examination. Swelling and redness of the surrounding tissue as well as changes in the shape of the joint and the degree of restriction of movement provide information about the patient's condition and say a lot about the course, severity and of course the prospects of recovery of the disease.

To make an accurate diagnosis and determine the type of disease, the patient is referred to instrumental diagnostic methods - these include, among others, X-rays, MRI and CT scans.

Treatment of ankylosis

As with any other musculoskeletal disorder, treatment of ankylosis relies on a combination of available methods. It is worth noting that due to a number of features of the pathogenesis of the disease, pharmacotherapy is used primarily to eliminate the etiological factor, as well as to relieve the pain syndrome. Despite the variety of therapeutic approaches, surgery remains the only preferred and most effective solution.

Conservative treatment of ankylosis

Ankylosis of the fibula is treated conservatively. Physiotherapy treatments used to relieve pain include:

• mud baths;
• electrophoresis with analgesics;
• Therapeutic exercises and massages;
• Spa treatment.

Surgery for ankylosis

If conservative therapy is unsuccessful or the attempts make no sense, the time has come for a more radical solution - preparation for surgery.

To remove bony stiffness, one of the following operations can be performed

• Redression – the forced stretching of the tissue with subsequent restoration of the anatomical position;
• Osteotomy – the targeted fracture of a bone to restore a natural joint end connection;
• Arthroplasty – removal of excess bone formation that has grown together during the progression of the pathology, using a strut made of artificial material to allow free movement of the joint components;
• Endoprosthesis.

There is a list of contraindications to surgery, including active inflammatory processes in the periarticular tissue.

Traumatic dislocations

Traumatic dislocations are the most common, accounting for between 1.5 and 3 % of all injuries. Their frequency in different joints varies and depends on the functionality of the joints and their anatomical and physiological characteristics. The most common (more than 50 % of all V.) are V. in the shoulder joint, where there is a pronounced discrepancy between the size and shape of the humeral head and the articular surface of the scapula, which is one of the predisposing factors; the hip joint has a deep socket as well as a strong capsule and ligaments, which largely explains the relative rarity of V. in the hip joint.

The occurrence of a traumatic vein is usually associated with indirect trauma and forced movement to the joint. This creates a fulcrum for the bipedal lever, with the long arm being the dislocated portion of the limb and the short arm being the intra-articular portion. The more distal the force is and the greater the discrepancy between the short and long arms, the easier it is for a dislocation to occur.

A traumatic dislocation is usually accompanied by a large-scale tear of the joint capsule, but in the temporomandibular and sternoclavicular joints, tearing of the capsule in V is rare. Ligament injuries in the form of partial tears, sprains and other minor injuries almost always accompany V. along with; A complete ligament tear is most common in lateral veins in lock joints. Damage to the joint capsule and surrounding soft tissues can lead to intra-articular hemorrhages with congestion of the synovial membrane, accompanied by pain, and later deforming arthritis may develop (see). In some cases, the V. is accompanied by damage to large blood vessels and nerves, e.g. B. the popliteal artery in the posterior tibial vein, the axillary nerve in the brachial vein.

Depending on how much time has passed since the injury, the lesions are divided into fresh (up to 3 days), red (up to 3 - 4 weeks) and overdue (more than a month), and depending on the condition of the skin - into closed and open divided. This classification of wounds is of great practical importance, both in choosing treatment and in determining the outcome of the injury.

Habitual dislocation

Habitual dislocation Most often occurs in the shoulder joint and is the result of inadequate treatment - traumatic dislocation, imperfect or inadequate immobilization. In a habitual dislocation, the joint bones move without any apparent external force, even during normal movements, due to a weakening of the joint capsule at the site of the previous tear.

Fig. 9: Repaired habitual dislocation of the humerus. The typical thickening of the posterior surface of the humeral head is marked with an arrow.

The so-called habitual dislocation of the humerus is due to anatomical factors that are obviously of genetic origin, since the head of the humerus is abnormally flattened on the x-ray (Fig. 9) and sometimes even flattens towards the anterior edge of the scapula socket.

TreatmentTreatment is usually surgical – capsulorrhaphy (sewing the capsule), tenotomy, osteoplasty (see Figure 9). Bone transplants, plastic surgery (on muscles, tendons, fascia), etc.

Hand and foot

Figure 4: Shoulder joint (ball-and-socket joint): scapula, humerus

The biggest differences can be observed in the structure of the hand and foot. Among the joints of the hand there are many movable joints that make it possible to perform various subtle movements. Of particular importance are the joints of the thumb, which allow the thumb to oppose all other fingers, making it easier to grasp objects. Only humans can achieve such wrist development! The foot supports the entire weight of the human body. Thanks to its curved structure, it has elastic and supportive properties. Thickening of the arch of the foot (flat foot) leads to rapid fatigue when walking.

Joint mobility increases with training - just think of the incredible mobility of athletes and circus acrobats. But normal people also need to move more to maintain good mobility in their joints. Children generally have greater mobility in their joints than adults, especially older people. This is due to loss of flexibility of the ligamentous apparatus with age, erosion of articular cartilage and other causes.

Exercise is the best healer

Restricted mobility and pain when moving joints may be related to the gradual destruction of articular cartilage and impaired production of synovial fluid. As a result, the cartilage in the joints gradually thins and crumbles and there is no longer enough lubricant, resulting in reduced joint mobility. To avoid this, it is important to lead a healthy and active lifestyle, eat right and, if necessary, follow the doctor's advice - after all, life consists of exercise, and exercise is not possible without a well-functioning musculoskeletal system.

Author: Olga Gurova, PhD, senior scientist, associate professor, Department of Human Anatomy, PFUR

Symptoms of stiffness

• 3 weeks for healing of ribs, finger bones and metacarpals;
• 4 weeks for clavicle healing;
• 2.5 months for tarsal, metatarsal, wrist and forearm consolidation;
• 3 to 4 months for hip, shoulder and lower leg healing;
• 6 months for consolidation of a femoral neck fracture.

The doctor detects the signs of bone fusion using x-rays or other imaging tests. It is difficult for the patient to recognize a consolidated fracture based solely on his own feeling. To avoid aggravating the situation by trying to determine whether the bones have fused together, do not put any weight on the injured area until the cast is removed and check-ups are performed.

Only the attending physician can objectively assess the condition of the hard and soft tissues and then give recommendations for further rehabilitation. It is advisable to have check-ups before the procedure to ensure that there is no abnormal or incomplete healing. This is not necessary unless absolutely necessary:

All procedures must be discussed with your doctor. He will also tell you when the cast will be removed and when the traction will be removed. Any new symptoms must be reported to him.

Causes of abnormal stiffening

Unfortunately, not all patients recover within the usual time frame. Delayed recovery can be caused by:

• Ca deficiency;
• metabolic disorders;
• inadequate nutrition;
• Infectious processes in the area of fractures;
• Osteoporosis;
• hormonal imbalances.

A consolidation fracture is often problematic in old age. The femoral neck injury is particularly dangerous in this category. Unfortunately, there are many cases where patients with this serious injury remain bedridden until death. The mortality rate is accelerated in such cases.

For a successful merger, three essential factors must be met. These are:

While the first two conditions depend mainly on the doctors, the last factor lies largely on the shoulders of the patient. The special exercises prescribed by the doctor must be performed regularly. Then the blood and lymph are completely supplied with blood. The general conditions gently stimulate this process:

• Troubleshooting disruptions caused by injuries and chronic problems;
• Enrichment of the diet with vitamins and trace elements;
• Maintaining optimal homeostasis.

Which doctor can recognize a consolidated fracture?

During the entire period when the patient is in extension, walking in a cast or performing post-rehabilitation, he must be monitored by a specialist. The necessary care is ensured:

Rehabilitation after an osteotomy

Let's consider the recovery period after surgery using the example of corrective osteotomy.

The patient remains in the hospital under medical supervision for 3 to 7 days. During this time, the surgical wound is regularly bandaged and painkillers, antibiotics and anticoagulants are administered. It is important to get up as early as possible and not lie down.

After discharge, the patient must continue taking the prescribed medication at home. On days 10-14 the stitches are removed. Further rehabilitation is indicated - use of crutches for up to 6-12 weeks, regular check-ups with the doctor. Heavy physical exertion is only allowed 6-8 months after the operation. Sometimes the attached metal structures are removed after 1-2 years.

Possible complications

Some complications occur during osteotomy, others during the rehabilitation period.

• Abnormal bone fusion. Occurs as a result of incorrect fixation of bone fragments during surgery. This complication requires a second procedure.
• Failure of the bone anastomosis. May occur due to serious comorbidities, smoking, poor blood circulation in the operated area and osteoporosis. The operation is repeated and special rehabilitation is recommended for treatment.
• Compartment syndrome. Occurs when the tourniquet is overtightened during surgical manipulation. Special medications are prescribed for treatment; in severe cases, a fasciotomy is performed.
• Abnormal function of the joints near the surgical field. This complication is characteristic of the absence or violation of rehabilitation. The use of LFC is recommended.
• Infections. You can become infected during surgery or if wound care is inadequate. Antibiotic therapy is prescribed, and in severe cases, revision surgery is required.
• Nerve damage - surgeon's errors or peculiarities in the position of the nerve endings in the patient. The function of the damaged nerve cannot be restored.
• Thromboembolic disease. Occurs when anticoagulants are prescribed incorrectly, when the patient gets up too late, when wearing a compression stocking is not possible. To reverse this complication, high doses of anticoagulants and anticoagulants are required.

• tibia and fibula.
• Bones of the tarsal bone of the hand.
• The bones of the human heel.
• Complete leg orthosis.
• Displacement fracture of the heel bone.
• Bones of the human ankle.
• Fracture of the lateral condyle.
• bones of the foot.