Recovery period after fracture. Fracture of the spine: all the facts about the injury. What results do we strive to achieve

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Fractures of the spine are a serious orthopedic pathology. The most common symptom of such an injury is moderate or severe. pain syndromeincreasing with movement. Regardless of which part of the ridge the injury occurred, it has serious consequences, as the spinal cord passes through the center of the vertebrae. Violation of its integrity leads to neurological problems, paralysis or death.

Spinal Fracture: Classification

Various types of damage are known to medicine: compression, explosive, flexion-distraction, fracturing, and others. All of them in the ICD-10 are classified depending on the mechanism of the damaging effect, the area of \u200b\u200bdamage to the bone tissue, its nature.

Based on the direction of impact, they are divided into:

• Flexion and extensor - this type of injury can be obtained with a sudden sudden advancement of the body;
• Dissecting damage;
• Rotational injuries;
• Fractures of axial (or axial) impact.

Depending on the area of \u200b\u200bdamage and the mechanism of injury:

• Compression  (also called dispersion or depression) - this type of ridge damage is most common among people whose bones are very weak. Excessive compression or contraction of the vertebrae may break.
• Wedge-shaped  is a subtype of a depression fracture. With it, part of the vertebra, usually the anterior one, contracts under pressure and becomes wedge-shaped.
• Comminuted  spinal fractures.
• Damage mixed type.
• Fracture dislocation  - occurs with any form of the above damage to the back, but it is accompanied by a displacement of the vertebrae.
• Regional  - for this species, the separation of a thin lamellar fragment from a whole vertebra is characteristic.

The classification of violations, depending on the ability to preserve the natural anatomical relationships of its structural parts in all normal postures of the body, divides all such injuries into types:

• Stable - arise without bias, do not cause spinal deformity or the development of neurological problems. With a stable fracture, the patient can still carry and redistribute weight. This species refers to uncomplicated and closed injuries.
• Unstable  - they are characterized by difficult transfer and redistribution of human weight. They can provoke additional deformation of the spine and cause a worsening of the patient's condition. Most often, this type refers to pathological or complicated.
• Explosive  - this species is considered averaged between the two previous ones. It happens when the spine is subjected to sharp extreme loads. In contrast to compression damage, where a violation of the integrity of the ridge occurs in any one area, discontinuous ones are characterized by multiple fracture sites. The spine can be fragmented in several places. Since the vertebrae are completely destroyed, bone fragments can spread and injure the spinal cord.

But these are not all the types that occur with such injuries. Depending on the area of \u200b\u200bdamage to bone tissue, fractures differ in the names of these zones: cervical, thoracic, lumbar, sacral, and tailbone fracture. Due to the nature of the main load, the most common are injuries of the thoracic and lumbar, cervical and sacral injuries are much less common.

There are other classifications of the violations in question. They are divided according to the degree of central nervous system division into fractures with and without damage to the spinal cord. By area - single and multiple.

Causes of injury

The most common causes of vertebral fractures are car crashes. They account for about 45% of all injuries of this kind.. About 20% of all cases of vertebral integrity violation occur in falls, and about the same amount in violent acts (fights, beating, etc.). Sports injuries result in a ridge fracture in about 10% of all cases. The remaining causes of back injuries of this kind are associated with diseases of the musculoskeletal system, bone condition, tuberculosis and even metabolic disturbance.

It should be noted that the causes of spinal fractures in its different departments differ from each other. Injuries in the cervical spine occur due to a sharp mechanical impact on him. The cause of damage to the chest is a fall from a height on the legs or pelvis, strong and sharp blows to the sternum. In the lumbosacral region, such an injury can be triggered by pathological transformations in the structure of bone tissue, oncological metastatic tumors, and sports and domestic injuries.

Fracture symptoms

The main clinical signs of vertebral fractures usually include one or a combination of the following symptoms:

• The sudden appearance of pain in the back, its intensification during movement, a change in body position;
• Limitation of mobility of the vertebrae, patient movements;
• Violation of the functional connection between the torso and lower limbs;
• Visual spinal deformity;
• Decreased growth due to shortened spinal column caused by trauma;
• With damage to the spinal cord, numbness of the limbs, paralysis, disability, and death are noted.

Symptoms of a spinal fracture may vary depending on the type of injury. With compression of the vertebrae, the main symptom is the presence of back pain. It can occur both gradually with subsequent slow deterioration of the patient's condition, and suddenly. The intensification of pain in humans is noted when wearing and lifting heavy objects. During compression, the stoop caused by twisting of the spine is characteristic of the victim.

Signs of injury in children

In a child, similar injuries can also occur and usually occur in a mild form. Parents may not even be aware of the true causes of back pain in their baby, believing that this is just a bruise. Indeed, with compression fractures, the characteristic signs of injury include back pain in the area of \u200b\u200bthe impact, and their spread to nearby tissues and organs.

• Compression of the thoracic vertebrae in a child causes pain in the shoulder blades and spreads to the entire chest, depending on the degree of injury. Respiratory problems may occur.
• With damage to the lumbar spine, the pain spreads to the abdomen and partially affects the chest. At the same time, a limitation of body mobility is noted.
• For injuries cervical  spinal pain syndrome covers the muscles of the neck, which are in tension, their mobility is limited.

Otherwise, the signs of damage are similar to adults. Depending on the degree of violation of the integrity of the spinal cord, neurological problems can occur, expressed in numbness of the limbs, paralysis, disability, and even death.

First aid

Not only the severity of the consequences of the fracture, but also the life of the victim depends on the ability to correctly and correctly provide first aid for a fracture of the spine.

How serious is the injury and what is its nature can only show an x-ray or MRI. Therefore, up to the moment of diagnosis, even a spinal injury should be considered a fracture, and the victim should follow the procedure for providing first aid for damage to the ridge according to this algorithm.

The algorithm of the RFP actions for the problem under consideration is as follows:

1. If the person is in a safe place, then any movement should be excluded before the arrival of the ambulance.
2. It is necessary to provide the victim with complete rest, not trying to plant him or to change the position of the body. Prior to the arrival of doctors, he should remain lying on an even, rigid horizontal surface on his back. You can not turn a person to one side.
3. Leaving the patient alone is strictly prohibited.
4. You should call an ambulance and stay with the victim until her arrival.

Often, compression fractures can be taken as a normal bruise, since this type of injury does not have any distinctive symptoms. Attempts to massage the injured place to the victim can provoke unpredictable consequences for his health and even cause the death of the patient. The same thing can happen when the victim tries to get to his feet.

Human transportation

Transportation during fractures of the spine should be given special attention, because improper transportation of the patient from the scene to the hospital can harm him even more than the injury itself. It is important to know how the correct transport immobilization is carried out in case of such violations. In order to avoid the development of complications, it is performed in accordance with the following rules for the transfer of the victim:

1. At least 3 people should be involved, ideally 4-5.
2. It is necessary to transfer the patient on a rigid horizontal surface: a shield, rigid stretchers, boards, etc.
3. You can’t pull the stretcher, behave carelessly, as the harsh actions of people who endure the victim can hurt him and harm his condition.

Valentin Dikul: “The spine is the core of a person, the core of his health. Like a tree trunk. Without a trunk, a tree cannot exist. So is a man without a spine. ”

Treatment

The treatment of spinal fractures is a rather lengthy and complex process. For effective bone fusion, it is not enough to fix them and provide immobility. In some cases, fragments and fragments need to be combined into a single whole. Therapy depends on the location and type of fracture, as well as on the degree of neurological compression.

Painkillers

When injured, a person experiences acute pain. If this violates the integrity of the bones, then their fragments injure the surrounding tissue and nerve endings. This causes a strong and lasting painful sensation. In order to reduce them, anesthetics are used.

Pain relief for fractures should be prescribed only by a doctor. Moreover, he must evaluate such indicators of the general condition of the patient as pulse rate, the presence of cyanosis of the lips, cold sweat, consciousness, and shallow breathing. Anesthetics are given orally and intramuscularly. Fracture injections are more effective, since the pain medication immediately enters the bloodstream.

In case of a fracture, the following types of anesthetics can be prescribed to the victim:

• Non-narcotic analgesics. They are prescribed for moderate pain. The advantage of these drugs is that they are not addictive in the patient and practically do not affect the nervous system. In addition to the anesthetic effect, such drugs have anti-inflammatory effects. Of the adverse reactions, drowsiness, lethargy, and a decrease in concentration of attention should be noted.
• Narcotic anesthetics. These drugs are taken under the strict supervision of a physician and only for certain indications. This may include damage to internal organs due to trauma, tumor damage to bone tissue, the postoperative period. Take these funds for a long time is prohibited, as they are addictive in the patient. As soon as the pain in the victim takes a moderate character, he is transferred to non-narcotic painkillers.
• Preparations for general anesthesia ( anesthesia) are used extremely rarely, only in cases of severe combined fractures or for surgical treatment of the patient.

Vitamins and Nutrition

The process of bone fusion to the formation of bone marrow is called consolidation, and the fracture in this case is called consolidating. It is quite long and depends on many factors: the rest of the damaged area, its reliable fixation, proper nutrition of the patient, taking vitamins and much more.

In order to accelerate the time of restoration and fusion of bone tissue, the patient needs vitamin complexes and a full balanced diet. The role of vitamins in bone damage has been proven by specialists, because the body needs minerals and trace elements to build new bone structures. They accelerate metabolic processes, strengthen bones, make them more durable.

For the treatment of fractures, vitamin complexes are used, which include vitamins B, D, C, calcium, folic acid, retinol, magnesium, as well as mummy extract. These components improve the collagen structure of the bone, eliminate their fragility, and contribute to a speedy recovery. The use of mummies for fractures helps the body cope with inflammation faster and partially eliminate pain.

The diet should be varied and balanced. The patient needs to eat foods rich in calcium, phosphorus, magnesium. The menu should contain proteins and complex carbohydrates. Necessary meat, fish dishes, fresh vegetables and fruits, dairy products.

Using a corset for back injury

In fractures, special devices are often used that facilitate the healing of injuries, and problems with the spine are no exception. For these purposes, apply corsets or orthoses that support him in the right position.

Orthopedic corsets allow you to fix the spine in the correct position, while reducing the load on the damaged areas. Wearing such devices prevents the displacement of the vertebrae relative to each other, protects the ridge as a whole, is a means of preventing various complications and consequences of a fracture. Thanks to orthoses, bone fusion is faster, and the time allotted for rehabilitation after an injury is significantly reduced.

Corset selection after the occurrence of such problems is carried out individually for each patient. Use this device should be no earlier than two weeks after the injury, depending on its severity. There are enough varieties of corsets for spinal fractures so that you can choose the one that is most suitable.

Types of Corsets

All corsets for the spine are divided into supportive and corrective:

• The use of supportive devices is typical for wearing during fractures, severe injuries, as well as after surgical treatment. With their help, it is possible to reduce or completely eliminate the load on the spinal column, to correct the existing deforming formations. The process of fracture healing using orthoses is much faster and more efficient.
• Corrective corsets are used to correct spinal defects in the presence of deforming changes in its structure.

Depending on what material corsets are made of, they are divided into the following types:

• Gypsum plaster. Their manufacture is carried out individually individually according to the anatomical features of the human body. The advantages are dimensional accuracy, reasonable cost and speed of production. The disadvantages include the large weight of the corset, as it is too voluminous in size. This quality of it can negatively affect the condition of the spine, which will be contraindicated in the coming months.
• Metal-plastic. They are purchased ready-made, but it is permissible to receive a custom-made metal-plastic corset. The advantages of this type of orthosis are its lightness, elasticity, good fixation of the body in the right position. The disadvantage is the high cost of the device.

Depending on their purpose, corsets have different degrees of rigidity, so they are divided into two types:

• Medium hard  - designed to eliminate pain that arise due to vertebral deformities due to its incorrect position. In fractures, this type is not used, except at the end of the rehabilitation period, when the bones are fully healed.
• Tight corsets  used for fractures with the purpose of rigid fixation of the spine.

Patient care

Immediately after receiving an injury, the victim is hospitalized, where he lies on a rigid support. The damaged area must be securely fixed with a corset. Patient care depends on the severity of the condition.

A bed with such injuries should also have sufficient rigidity. To achieve this requirement, a wooden shield from the boards under the mattress is placed on it. It is possible to use special functional beds, in which the head and foot can be adjusted in height, raising and lowering the patient's legs and head.

To prevent pressure sores, it is necessary to turn special pillows under the body below the site of damage to the spinal cord. The use of rollers for back injuries is the prevention of congestion in the lungs. For the same purpose, the patient is recommended breathing exercises.

Surgical treatment

The operation for a fracture of the spine is aimed at reducing compression of the spinal cord, stabilizing the spinal axis and its reliable fixation, preventing possible deformations in the area of \u200b\u200bviolation of the integrity of bone tissue, which can cause complications.

Indications for surgery are the following cases:

• Instability of the resulting fracture;
• Complications of trauma associated with damage to the spinal cord;
• Inefficiency of conservative treatment methods.

Such operations are successfully done in Russia. Only in Moscow there are about a dozen clinics of the corresponding profile. Perhaps treatment in Israel, but the cost of the operation will be much higher, and transport immobilization of the victim may be too difficult.

Rehabilitation period

Rehabilitation after a spinal fracture is an integral part of the treatment plan after the bones have healed. Further life after such injuries frightens people, their legs may continue to hurt, and fear arises when moving. Rehabilitation allows patients to fully recover after treatment, reduce pain and minimize disability with the hope of a full return to their functional level before injury.

In order for people who have experienced such back problems to be able to restore the functionality of the body, they are sent to the hospital immediately after discharge from the hospital rehabilitation centers. The program includes massage, physiotherapy exercises, swimming. In the rehabilitation sanatoriums professionally equipped for such patients, a special menu of dishes is provided for them, including all the necessary trace elements and vitamins.

Exercise therapy

Exercise therapy or therapeutic exercises for fractures of the back is important for the treatment and rehabilitation of patients. The set of exercises is selected by the instructor for each individual patient individually. This is because different types of damage require different loads and time for the rehabilitation process. With uncomplicated stable fractures, the recovery period may stretch for a year. If you experience any complications after an injury, this time may increase.

Exercise therapy for such injuries includes active and passive exercises on various muscle groups in order to strengthen the muscle corset for further independent maintenance of the spine in the correct position.

To the attention of patients! The patient should remember that after such injuries on the ridge, one cannot make any sudden movements, perform forward bends, or sit for too long. It is necessary to learn while standing to correctly distribute the load on the spinal column, the transition to the vertical position of the body should be performed without intermediate sitting.

Gymnastics for bedridden patients with a back fracture requires a lot of willpower from the patient. It is aimed at stimulating the cardiac and respiratory functions of the body, preventing atrophy of muscle tissue, constipation and blood clots, tone the nervous system and all body functions. Thanks to the feasible physical exercises, the patient will be able to maintain motor skills and abilities, prevent stiffness and immobility of the joints.

Swimming and massage

Usually massage therapy should begin on the second day of hospitalization. And during recovery of an organism it is not necessary to refuse this type of physiotherapy. Massage for such damage plays an important role. It is a prevention of articular deformities, relaxes muscles, reduces reflex excitability. During the rehabilitation period, the value of massage does not decrease. Thanks to it, muscle tone is restored, excess tension in the muscles and the spine itself is removed after physical activity, improves the general condition of the patient.

Swimming after a fracture is aimed at mobilizing the spinal column and restoring its functions. Classes in the pool are held under the supervision of an instructor. Sometimes swimming is combined with the exercise in water. This practice is most common in the rehabilitation of children.

Consequences of injury

For any injuries to the back, the doctors and the patient himself have a clear question: can a person walk with such injuries, will he face a wheelchair, will he be taken into the army with such injuries, or can one hope for a favorable solution to the problem.

The consequences of a spinal fracture can be very different. If the spinal cord was affected, then the risk of disability after injury increases significantly. Depending on the degree of neurological compression, disturbances in the work of internal organs, various urological consequences may appear. In other cases, with the correct and responsible approach to the prescribed treatment and rehabilitation, the doctors' forecasts for a person who has suffered such an injury are favorable.

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The knee joint is one of the most fragile moving connective sites in the skeletal system of the human body. Not surprisingly, after all, he is directly involved in the daily commission of a number of actions. People walk, run, ride bicycles - all this involves flexion and extension of the knee.

In addition, the knee joint is the largest in the body, and includes three parts: the femoral, tibial and fibular. Lower bones knee joint  connects the meniscus, and the ligaments and tendons of the knee connect the femur with the lower parts of the bone site. Depreciation during walking and other body movements is provided by articular cartilage, covering the bone surface on the inside of the joint.

Causes of Fractures

According to statistics, leg fractures account for 70% of cases of fractures of the knee joint. Basically, such injuries occur during falls, and are explained by the fact that a falling person, subconsciously grouping, lands on a bent leg.

Shrapnel knee fractures are often inherent in athletes. Injuries result from strong blows falling on an extended limb. “Sports” fractures also include injuries that occur after excessive extension of the trained muscle, which can cause separation of the lower part of the patella. Often, this type of fracture is characteristic of athletes who are jumping in length or height.

Knee fractures can be open and closed. In the case of open fractures, not only the bone is injured, but also the muscles and skin.

Diagnosis

Open fractures can be diagnosed with the naked eye. They are accompanied by bleeding, as well as the possible bulging of bone fragments on the surface of the damaged area of \u200b\u200bthe body. In the case of closed fractures, only a specialist using the radiography technique can diagnose their presence. The following external factors are identified that can help the doctor identify the presence of a fracture in the patient:

• The impressive size of the tumor formed around the knee, or directly on it;
• Deformation of the patella, which can be seen with the naked eye;
• Bruising and bruising on the site of an injured knee.

Among other things, attempts to move the leg can cause severe pain in the patient.

Treatment

Depending on which fracture was diagnosed in a particular case, the appropriate treatment is prescribed by the trauma surgeon:

1. Surgery followed by the conclusion of the injured limb in plaster. It is used in the diagnosis of open fragmentation fractures. In this case, the operation is necessary in order to return to the place the fragments of fragmented bone tissue.
2. In the case of closed fractures, conservative treatment is prescribed, which involves casting for a period of 4 to 6 weeks. After the passage of time, it is necessary to conduct an additional x-ray of the damaged limb, which will help determine whether the knee bones are properly healed. With a positive outcome, gypsum can be removed.

Rehabilitation

The timing of rehabilitation after a knee fracture may vary, depending on the severity of the injury and compliance with all medical recommendations. So, at a young age, the knee bones grow together quite quickly, while the elderly cope with the injury hard.

In any case, rehabilitation after knee fracture  should start while the leg is in the cast. So, there are several stages of rehabilitation, in which patients must follow the instructions of the attending physician. Recovery from a fracture involves:

• Drug treatment;
• Physical exercise;
• Massages
• Physiotherapy.

Drug treatment

To avoid the development of possible pathologies and inflammatory processes in the patient’s body, specialists prescribe medication. Medicines should be taken only by prescription, in the indicated doses.

Among other things, drug treatment can eliminate the pain that occurs in an injured limb when performing gymnastics prescribed as part of rehabilitation. Basically, doctors prescribe the following medications to patients:

1. Analgesics
2. Medicines against edema;
3. Tonus-lowering drugs;
4. Vitamins
5. Medicines for resorption of adhesions in tissues.

Recovery Exercises

  The period of rehabilitation after a knee fracture directly depends on the active development of the injured area by performing simple exercises.