Uh, Ngugu ... Beware of the stairs on a rainy day! !!Tragedy caused by a moment of carelessness (tears) | Child-rearing diary in the middle
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Tenosynovitis, tight back, exfoliation fracture, sciatica, sprain ...
Beware of the stairs on a rainy day! !!Uh, Ngugu ... The tragedy (tears) caused by a moment of carelessness Every year, I feel that the healing power is declining ... → Continue reading
"Mama Square" is filled with daily thoughts such as troubles, worries, fun, relaxed feelings, and things that we solved in this way.
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Wikipedia related words
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Fractures can occur in all bones.Bones originally have some flexibility, elasticity, and plasticity, and healthy bones are hard to fracture, but strong beyond their limits.External forceAnd repeated external force, on the bonetumorIf there is a lesion such as, it will be destroyed even with a slight external force.Also,clavicleAnd handsScaphoidThere are also bones that are structurally easy to concentrate external forces and break easily.Of human fracturesEveryday lifeAs a bone that is prone to fracture inclavicle,肋骨,Phalanx,nasal bone,Coccyx,Radius,Ulna,tibia,fibulaEtc.
After the fracture is completely healed, the length of the left and right arms and legs may differ depending on the individual and the treatment method.However, during the growing seasonNatural healing powerOften corrected to the same length.It may be corrected by surgery.
Since the treatment method for fractures varies greatly depending on the condition, various classifications are made.
Classification by cause
- Traumatic fracture
- A fracture caused by the application of external force to a healthy bone.Fractures due to accidents are classified into this category.Even if the direct cause of the fracture is an external force, if there is a pathological cause, it is classified as a pathological fracture.
- Fatigue fracture
- Due to repeated external force applied to healthy bonesfatigueRefers to a fracture that occurs whenIn addition, since the external force applied at one time is less than the durability of the bone but is caused by fatigue, it is likely to cause an incomplete fracture (crack fracture).
- Pathological fracture
- A fracture caused by the loss of bone health due to some illness.The fracture is caused directly by some external force, but the fracture occurred because the durability of the bone had decreased due to the disease before that.Diseases that lead to pathological fracturesOsteosarcoma,Multiple myeloma, Metastatic bone tumors are typical examples.
Classification by site (assuming long trunk bones of limbs)
- Fracture of the bone trunk
- Refers to a fracture near the center of the bone.
- Epiphyseal fracture
- Refers to a fracture at the end of a bone. There are two ends per bone, soDistal end fractureas well as the Proximal end fractureDistinguished as.In the upper and lower limbs (limbs), the epiphysis closer to the trunk is the proximal end, and the epiphysis farther from the trunk is the distal end.
Classification by integrity
- Complete fracture
- A complete fracture is a condition in which the bone is completely discontinuous.A general fracture means this complete fracture.
- Insufficient fracture
- Incomplete fractures are fractures in which the bone does not completely lose continuity for some reason.The so-called bone is cracked.Rhagades fractureIn addition, there is no damage to the periosteum even though the part below the dense layer is transected, so there is no change in the external shape.Subperiosteal fractureIs a typical example of this incomplete fracture.
Classification by openness
- Closed fracture (simple fracture)
- A closed fracture is a fracture in which the fractured part is not open to the outside of the body.It is also called a simple fracture as opposed to a complex fracture.In this case, since the risk of bacterial infection in the fractured part is low, only musculoskeletal treatment is required.
- Open fracture (complex fracture)
- An open fracture is a fracture in which the fractured part is open to the outside of the body.Depending on the site and degree, if emergency surgery is not performed, heavy bleeding and infection may result in death.Extracorporeal exposure can lead to bacterial infections and complicate treatmentComplex fractureAlthough it is sometimes called, the term open fracture is often used because it is often misunderstood that the fracture is complicated (multiple fractures are seen).In this case, not only the treatment of the musculoskeletal system but also the treatment for infection is performed.
Classification by the number of fracture lines
- Singular fracture
- A singular fracture is a fracture in which one bone is transected in only one place (there is only one fracture line).Even if a plurality of bones are fractured, if only one bone is transected, it is a single fracture.
- Multiple fractures (double fractures)
- Multiple fractures refer to fractures in which one bone is transected at multiple points (a state in which there are multiple fracture lines).It is generally confused with a complex fracture, but as mentioned above, a complex fracture means an open fracture.Double fractureIt is also called, especially when it is cut into small pieces.Crushed fractureSometimes called.
Classification by fracture direction
- Lateral fracture
- A fracture whose fracture line is approximately perpendicular to the long axis of the bone.
- Vertical fracture
- A fracture whose fracture line is approximately parallel to the long axis of the bone.
- Oblique fracture
- Fractures whose fracture line is at an angle to the long axis of the bone (neither approximately right angles nor parallel).
- Spiral fracture
- A fracture whose fracture line is spiral with respect to the long axis of the bone.
Classification by how external force is applied
- Shear fracture
- A force was exerted to slide it perpendicular to the long axis of the bone (Shear) Refers to the fracture caused by this.In this case, lateral fractures are likely to occur.
- Compression fracture
- Refers to a fracture caused by excessive compression of a bone.
- Twist fracture
- A fracture caused by a twisting force on a bone.In this case, spiral fractures are likely to occur.
- Flexion fracture
- A fracture caused by a bending force on a bone.In this case, compound fractures are likely to occur.
- Exfoliation fracture
- It refers to a fracture that occurs when the bone at the attachment site is torn by the traction force of muscles, tendons, ligaments, etc., without external force acting directly on the bone.In severe cases, surgery is required.
Symptoms and complications
Symptoms seen during fractures include fracture-specific symptoms and general traumatic symptoms (non-fracture-specific symptoms).Listed below, but note that not all of these are observed.
Symptoms specific to fractures
- Abnormal movement
- The parts that do not move under normal conditions move like joints.It is prominent in complete long bone fractures, but less common in incomplete and compression fractures.
- Rubbing sound
- When abnormal movement occurs, the fracture ends touch each other and make a sound.However, it is not audible but palpable by the therapist.
- Dislocation, deformation
- Fractured bones shift or bend (dislocation).As a result, the appearance of the fractured site changes.
General trauma symptoms
- On the bone itselfNerveBecause there is no, it breaks, etc.damageIt doesn't hurt, but when you have a fracture, the nerves on the surface of the bone are concentrated.PeriosteumIs destroyed and in most cases severe spontaneous painTendernessProduces.Tenderness at the time of fracture is characterized by being strong only in the fractured part.Marguegne Fracture PainCalled.
- Bleeding of bones and surrounding tissues makes it impossible to support the fractured area, pain restricts movement, etc.
In fractures of the spine, bone fragments can damage the spinal cord, paralyzing its area of control and, in the case of the cervical spine, death.Similarly, in limb fractures, bone fragments can damage nerves and blood vessels.Rib fractureIn this case, there is a risk of lung injury or heart injury.Bone marrowWhen a spongy bone such as a long canal bone or pelvis or a femur is fractured, a hemorrhagic shock due to a large amount of internal bleeding or a bone marrow embolism / pulmonary fat embolism due to bone marrow or lipid droplets from the bone marrow cavityFat embolism), Etc. may lead to death.In addition, elderly people tend to be bedridden due to fractures, which accompanies it.dementia,pneumoniaIt is easy to cause such things.
Fracture reduction should be done as soon as possible.You should not wait until the swelling has healed.It is said that open wounds can be sutured as safely as possible while keeping the risk of infection low within 6 to 8 hours (golden time) after injury.This time varies depending on the body part, and is 24 hours in the case of facial trauma.After this timeBacteriaAlthough the possibility of wound infection due to the proliferation of the disease increases dramatically, it is not always the case that wounds that have passed the golden time cannot be temporarily closed, and should be regarded as a measure of infection risk.The feeling around here is the same as the treatment of raw things.
If there is no bone dislocation in a simple fracture, it is fixed as it is, and if there is bone dislocation, it is restored to normal alignment by non-invasive reduction such as manual reduction or traction or open reduction by surgery, and for a certain period of time. Fix and keep rest.Non-invasive repositioning is whether the junction is normal,RoentgenUse such as to increase the accuracy.On the other hand, in complex fractures, the bones pop out of the epidermis and communicate with the outside world where various bacteria are present, so prevention of infectious diseases is the most important issue.Careful cleaning and disinfection of the wound and excision of contaminated and crushed tissue (debridement) should be performed immediately after the injury.AntibioticsIs also actively administered.The time required for bone fusion depends on the site of injury and age, but all fractures are repaired using the same process.However, there are cases in which bone union is prolonged or does not heal due to infection or inappropriate treatment.
The goal of treating upper limb fractures is to preserve hand function.Some deformation or shortening is okay.On the other hand, the goal of treating fractures of the lower limbs is to be able to carry a painless and stable load.Avoid deformation as much as possible so as not to shorten it.It is said that exercise of other limbs should be started immediately after hospitalization and treatment of fractures.
Sprains are fixed in one joint, while fractures are fixed in two joints.If one joint is fixed due to a fracture, supination and supination movements are possible and reduction is not possible.
- Internal fixation
- A method of joining bones with fixtures such as metal plates, wires, and pins by surgery.
- External fixation
- Plaster castA method of fixing the fractured part from the outside of the body so that it does not move.
- Upper limb fracture
- For fixing fractures of the upper limbsSplintOn top of theTriangle clothJust do.There is also a method of wearing a bust band from the top of the sling, including the trunk.
- Long tube fracture
- When placing an unstable long tube fracture on a splint, pull the fractured part up and down.Basically, in the case of a fracture, pulling does not damage the soft tissue.However,肘,kneeIn the case of surroundings, traction may cause soft tissue damage.Also, in the case of an open fracture, bone fragments that have come out of the body enter the body and cause infection, so in principle they should not be towed.
- External fixation
- A method in which a pin is skewered into the bone around the fractured part by surgery, and the part outside the body is supported by a metal rod or resin (resin).It is useful for open fractures, when there is a risk of increased risk of infection due to surgical operations on the injured part, or for crushed fractures.
- Percutaneous steel wire fixing
- The bone is skewered from the outside of the skin under fluoroscopy using a Kirschner wire or the like and fixed (see the image on the upper right).
In Gult's healing days,Healing TheMetacarpal bone2 weeks肋骨3 weeksclavicle4 weeksHumerus5 weeksHumerus6 weeks in the bodytibia7 weeks, bothLower leg bone8 weeksThigh boneIt takes 8 weeks for the femoral neck and 12 weeks for the femoral neck.
Plaster castIf it swells after being rolled up in a hospital and it hurts severely, it is considered that there is a circulatory disorder.You should see a hospital immediately and cut the cast and lower roll.Fractures are basically painful during physical activity, but persistent severe pain at rest may be due to angiopathy.
Traction therapy (to reduce fractures)English: traction treatment) May be performed.
Frequent observation is required when performing direct traction.Fractures of the femur are prone to common peroneal nerve palsy.For fractures of the lower limbs, it is necessary to examine whether the toes are deflected.
Fractures in certain age groups
Fractures common in children and before puberty
- : In a flexible young person, the bones may not be completely broken, but the branches of a young tree may be bent.
- : A part of the bone is crushed by applying pressure in the long axis direction, and a ring-shaped ridge like a bamboo knot is formed in the middle.
- Epiphyseal injury: Misalignment at the epiphyseal region during growth.When dislocation is observed, it is also called epiphyseal dislocation.
- Supracondylar humerus fracture
Fractures common in old people
Old manIn the case of, bone weakening due to a potential decrease in bone mineral content (osteoporosis) And walking instability due to muscle weakness, the following fractures are likely to occur due to falls.
- Thigh boneNeck fracture
- vertebralCompression fracture
- HumerusSurgical neck fracture
- RadiusDistal end fracture
Fractures of the head, spine, and trunk
- Fracture of the head
- Fracture of the thorax
- Fracture of the spine
- Cervical dislocation fracture
- Compression fractures (thoracic and lumbar spine)
- Crushed or ruptured fractures (thoracic and lumbar spine,Chance fracture)
- Pelvic fracture
Fracture of the upper limb
- Fracture of the shoulder
- Fracture of the upper arm
- Fracture of the elbow
- Supracondylar humerus fracture
- (Proximal ulnar fracture)
- Fracture of the forearm
- Fracture of wrist
- Broken hand
Fracture of lower limb
- Hip fracture
- (Fracture below the femoral head)
- Fracture of the thigh
- Fracture of the knee
- Fracture of the lower leg
- Fracture of ankle
- Fracture of the leg
- Spinal cord injury
- Plaster cast
- Plastic surgery
- Oral Surgery
- Judo reduction
- Kenneth J Koval, MD Joseph D. Zuckerman, MD (2001) Jestes zjebany (2nd ed.). ISBN-0 7817-3141-0
- "Standard Orthopedic Surgery" Igaku-Shoin, 2008 ISBN 978-4-260-00453-4
- "Fracture / Dislocation" Nanzando, 2005 ISBN 978-4-525-32002-7
- "Handbook of Fractures Learned from Rockwood" Medical Science International, 2004 ISBN 978-4-89592-370-5
- "Illustrated How to Proceed with Fracture Treatment" Igaku-Shoin, 2008 ISBN 978-4-260-00025-3
For humansLumbar sacral plexusStarting fromCommon peroneal nerveとTibial nerveIt ends in two parts.Of the peripheral nerves that make up the lumbosacral plexus, the ones that make up the sciatic nerve are the 4th, 5th, and 1st to 3rd (L4 to S3).
The sciatic nerve runs after leaving the lumbosacral plexusPiriformisPassing in front ofInferior gluteal nerveTogether with (), go out of the pelvis and the posterior surface of the thigh (Gluteus maximusとBiceps femorisGo down (in front of) and (Biceps femoris,Semitendinosus,Semimembranosus)WhenGreater adductor muscleへMuscle branchBranch and the back of the knee (Popliteal fossa2 terminal branches () aboveCommon peroneal nerveとTibial nerve).
As a symptomSciaticaThere is.
To be precise, only the adductor muscle is innervated by the sciatic nerve, and the semitendinosus and semimembranosus muscles are innervated by the tibial nerve, which is a branch of the sciatic nerve.The biceps femoris is the dual innervation of the tibial nerve and common peroneal nerve, which are branches of the sciatic nerve.