Symptoms of a fracture

2021-01-26 12:00 AM

The bones connect together through the joints, making solid support for the muscles to function. The two long bones are primitive and stick to the muscles when stimulated or commanded by nerves.

Define

A fracture is the disruption of the normal anatomical structure of a bone. 

Anatomical and physiological features of the skeletal system

The skeleton of the body has 3 main tasks:

Protective duties (skull, chest, spinal canal ...). So, when this framework is damaged, the protected organs are very vulnerable.

The task of supporting: The skeleton is the pillar of the body, around the bone, is built and arranged the soft parts and all other parts of the body, especially the blood vessels and nerves that go close to the bone when broken Vascular and nerve damage.

The task of movement: The bones connect together through the joints, making firm support for the muscles to operate. The two long bones are primitive and stick to the muscles when stimulated or commanded by the nerve, the muscles are shortened or stretched, meeting the movement needs of the body. The two long bones are spongy bones that are easy to break when injured. During a fracture, the patient loses the muscle function of the limbs.

In children: The two long bones have increased cartilage plates for the body to grow when damaged by this cartilage disc, the limbs develop incorrectly and imbalanced. 

Epidemiology

A fracture is an accident that occurs in any age group, any gender, anytime and anywhere.

Each age has 1 common type of fracture:

Children: Or fracture clavicle, on arm protrusion, femur ...

Adults (over 50 years old): often fractured femur neck, head below the rotator bones ... 

Each profession has a type of fracture that usually occurs:

The furnace had broken his spine due to the tunnel collapse; lathes, saws often injure hands ...

Age-related fractures are more active:

Fractures are most common in the working-age; the age of physical exercise (about 20-40 years old) and the proportion of men is higher than that of women.

Causes and mechanisms of fractures

Due to injury is mainly

Traffic accident: Account for over 50% of the total causes of fractures.

Labour accidents are increasing.

Accidents caused by sports: soccer, racing ...

Accident in daily life: Fighting, slashing each other, falling trees ...

School accident: Met at school age. 

Pathological fractures: This type is rare.

Fracture caused by osteomyelitis.

Fracture caused by the bone tumour.

Due to congenital disease: Congenital prosthetic joint.

Direct injury mechanism

Injury with a strong force, directly on the limb, causes a serious injury: a complex fracture, crushing software, rupture of blood vessels and nerves (a traffic accident).

During wartime, there was also open fracture due to fire. In addition to the direct trauma mechanism, the wound is also subject to the heavy impact of the bullet, and the bones and software are much damaged. This is the most severe type of open fracture. 

The mechanism of indirect trauma: Bones often fracture twisted twists, soft more damaged (fracture on arm convex in children due to falling on the arm ...).

Anatomy of a fracture

Simple fracture: Horizontal fracture, cross fracture, twisted fracture, fresh branch break in children.

Complex fracture: Fracture of many floors, many sections, many pieces.

Migration of the bones: There are 4 common types of deviation:

Husband deviation causes shortness of expenditure.

Move to the side causing swelling.

Angular deviation and rotation deflect the chi axis. 

Severe or mild soft tissue injuries depending on the trauma mechanism:

Skin: Wound peeling skin, loss of skin.

Scales, muscles: Crushing, cracking, even peeling muscles in a large area.

Blood vessels, nerves: crush, lateral wound, severed.

Clinical symptoms of a fracture

Mechanical symptoms

Pain: After the accident, the patient hurts a lot, but when the limb is immobilized well, the patient relieves the pain quickly.

Reduced muscle function of broken limbs: if the broken branches are fresh or there is little deviation.

Complete loss of muscle function: If the limb breaks apart.

Systemic symptoms

Small fractures do not affect the whole body. If the fracture is large or associated with multiple trauma it can cause shock. 

Physical symptoms

The examination has a sequence of seeing, touching and measuring.

Look:

Are there blisters on the skin? Lesions in the skin or not? Peeling skin or not?

Signs of late bruising (24 to 48 hours after the accident): highly suggestive of the diagnosis. For example fracture on a convex arm bone with a bruise in the elbow, fracture of the heel with a bruise in the soles of the foot ...

Touch:

Gently palpation can see a raised head under the skin.

Signs of unusual movement.

The sound of scratching bones.

These two signs are two sure signs of fracture, not being intentionally searched for, easily shock the patient and further damage.

In addition, there are other signs: Look for sharp pain, swelling of the limbs, joint effusion. 

Measure:

Use a measuring tape, a degree to measure the limb, limb circumference, limb length and movement amplitude of the joint.

Look for the typical signs of limb deformity: limb deviation, angular folding, limb shortening ... This is a sure sign of a fracture to look for.

Measure the range of the joint through "starting position" 

Examination of the dominant blood vessels and nerves of the limbs:

Catch a rotating circuit, a cylinder in the wrist.

Getting the anterior tibial plateau, a posterior tibial plateau at the instep and heel tube.

Examination of motor and limb sensation. 

Symptoms of x-ray fracture

Principles of bone and joint x-ray system

Size: Take out 2 joints above and below the fracture.

Moderate x-ray: Clearly visible bone wall (cortex).

The injury is in the middle of the film.

In addition, it is necessary to ensure that administrative procedures are to be photographed straight, tilted film, clearly stating the shooting location, full name, patient's age, date of shooting, marking on the right and left side of the film. 

Read the movie

The x-ray film is a negative film: when black slits disrupt the bone wall, the wall is discontinued: it's a picture of a fracture.

Read fracture type:

Simple fracture (horizontal fracture, twisted cross fracture…).

Complex fracture (broken many floors, many pieces ...).

Cartilage breakage continues in children.

Broken joints, subsidence fractures, fractures ...

Deviation reading: Take the centre tip to read the deviation of the broken segment:

Movie straight: Reading sideways.

Movie tilt: Read front and back deviation.

Some special skeletal system imaging methods

Computer tomography: CT scanner (to diagnose all kinds of bone tumours, femoral neck fracture ...)

MRI magnetic resonance imaging (in spinal trauma, femoral neck ...)

Complications of fractures 

Complications immediately (immediate)

Shock: Pain, blood loss.

Pale skin patient, the cold person, sweating.

Indifferent face to the outside.

Small quick circuit, difficult to catch - no catch.

Low blood pressure - Blood pressure not measured.

Vascular damage: Large blood vessels are crushed or compressed.

The patient has a sense of finger dilation, finger motor paralysis.

The peripheral circuit is weak or lost.

The extremities are cold, purple.

Doppler ultrasound measurement of pulses: decrease or interrupt the flow of the bloodstream downstream. 

Compartment (general) compression syndrome

Each limb has many isosceles, which divides muscle areas into cavities.

Normally these compartments are virtual, very narrow and pass by large bundles of vessels and nerves. Broken bones cause a hematoma, swollen muscles (due to crushing, undernutrition ...) increase pressure in the cavity-causing pressure on nerve blood vessels.

Common leg chamber compression syndrome, after high fracture 2 lower leg bones (calf strain syndrome):

Calf pain, strain.

Sensory disorder to the toes: numbness, ants.

Weakness or paralysis of toe movements.

Weak pulse, loss of pulse in the ankle.

Cold, purple head.

Cavity pressure increase: Normal chamber pressure: 10 mmHg, when the chamber pressure is over 30 mmHg, the weight must be incision.

If left late, compression of the cavity causes limb necrosis. 

Neurological damage: The long bones have dominant nerves

Upper limb: Broken 1/3 between the body of the arm bone or fracture on the protrusion of the bridge that easily causes rotational nerve paralysis (drooping hand, losing the shape of the thumb)

Spine: Injury to the high neck spine C1 - C5: quadriplegic paralysis; injury to the spine, lumbar D12 - L1: paralysis of the lower extremities. 

Open fracture

Meet the following clinical conditions.

Look at the broken bone head through the wound.

Seeing bone marrow fat flowing through the soft wound.

Infection open fracture wound, inflamed bone: If the patient is late.

Early complications: 24 - 48 hours after injury.

Infection: Common after open fracture

Body signs: fluctuating fever, a slumped face, and an infected appearance.

Spot: The wound is red, cloudy or pus. Especially dangerous for serious infections such as anaerobic infection.

Nutritional disorders

Toàn's limb broke a water-proof nodule, his head was swollen.

So, when the patient has a fracture, he should keep his limbs in a high position (hanging arms, feet).

Sequelae

Muscle atrophy, stiffness: the patient has lost limb function.

Slow to heal: After 4-5 months, the bone does not heal.

Osteoarthritis: After 6 months without bone healing, surgery to combine bone and bone graft is required.

Osteitis: Treatment is complicated, costly and easily disabled.