Fractures of the limbs and clavicle, the first emergency pre-medical and medical care for fractures.

A bone fracture is a violation of its integrity. Bone fractures are divided into full and incomplete, open and closed. In addition, fractures can be without displacement of bone fragments relative to each other or with displacement. 

Fractures of the limbs and clavicle, the first emergency pre-medical and medical care for fractures.

Bone fractures are traumatic or pathological. The former occur during falls, road and industrial accidents, etc. The latter are associated with metabolic disturbances in the body and occur when physical activity is small for a healthy person or under the influence of a traumatic factor of small strength.

, acute blood loss, there is a high probability of infection with the development of sepsis.

First aid for bone fractures.

To stop bleeding with open bone fractures, the tourniquet is rarely used – it is enough to apply a tight pressure bandage. A sterile dressing should be applied to the area of ​​any wound in the area of ​​bone fracture. Before applying a bandage, it is better to lay a limb on a special transport bus or on a tire from improvised means a stick or an iron rod so that the limb can be bandaged to it. Injured limbs give an elevated position. It is strictly forbidden to independently push bone fragments into the wound, to compare them!

For pain relief, intramuscularly use solutions of metamizole sodium or tramadol (1-2 ml each). You can take the drugs inside (1-2 tablets of metamizole sodium 0.5 g each, 1-2 capsules of tramadol 0.05 g each). Paramedics administer narcotic analgesics for severe bone fractures (1% solution of promedol). If the victim develops a pain shock, then they begin antishock therapy. The patient must be urgently taken to the intensive care, surgical or trauma unit on a stretcher in a supine position.

Clavicle Fractures.

A collarbone fracture is a pathological condition of a given bone in which its anatomical integrity is impaired. In most cases, this type of fracture occurs in the middle third of the clavicle – where the bone is most thinned and curved. In fact, the clavicle is an S-shaped tubular bone, curved along its axis. Its horizontal part is located in front and on top of the chest, being the border of the neck. One articular end of the clavicle connects to the sternum, and the other to the scapula. The collarbone is easily palpated under the skin throughout..

There are three main causes of a clavicle fracture..

1) Drop on a straightened upper limb or elbow joint.
2) A powerful blow with the shoulder (including when falling).
3) Direct impact to the clavicle.

As with most fractures, complete and incomplete displacement of bone fragments is possible. Displacements of bone fragments and deformation of the damaged part of the body with incomplete fractures are minimal, even the function of the arm is preserved. A certain difficulty in the form of pain is represented only by movements in the region of the shoulder girdle when moving the arm to the side. In general, complaints of pain without palpation of the clavicle are minor. Often, the first complaints of the victim appear 1.5–2 weeks after the injury, when bone marrow (thickening on the clavicle) forms on the fragments.

With complete fractures, displacement of clavicle fragments occurs under the action of the sternum of the clavicular mastoid muscle; while a fragment of the clavicle connected to the sternum moves up and back, and the peripheral one moves down and inside. The main complaints of the patient with a complete fracture are pain in the area of ​​damage and when moving the upper limb. Also, in most cases, there is a limitation of mobility in the shoulder joint. In the area of ​​the collarbone fracture, swelling, deformity, local hemorrhage, as well as shortening of the shoulder girdle are formed.

The victim’s shoulder is slightly lowered and shifted forward. If the ends of the bone fragments rub against each other, this gives additional pain to the patient. It is extremely rare for closed fractures of the clavicle to damage the vascular nerve bundle and the dome of the pleura. The patient is forced to hold the forearm and elbow of the injured limb with his healthy hand, pressing them to the body as much as possible, and the movements in the shoulder joint are significantly limited due to pain.

In the course of a palpation study of the place of a possible fracture, pathological mobility in the clavicle area (due to the movement of bone fragments), as well as crepitus (crunching) are often determined. The final diagnosis is possible after an X-ray examination, which finally confirms the collarbone fracture.

First aid for collarbone fracture.

The first aid for a collarbone fracture is the application of cold in the fracture area, since a further increase in swelling can complicate the provision of qualified medical care. If possible, the patient should be given an anesthetic (topically or internally) – 2 ml of a 50% solution of metamizole sodium, 1-2 ml of tramadol, 1-2 ml of ketorolac.

Effective for fracture of the clavicle is an eight-shaped bandage. When it is applied to the area of ​​the shoulder joint, pieces of cotton are laid so that they go into the axillary region. The required bandage width is 13–15 cm, and the bandage itself should not be too tight to avoid pressure vessels. The upper limb from the damaged side of the body is placed on a hanging bandage – a scarf. To avoid muscle atrophy, with this injury, active gymnastic exercises are prescribed for the fingers and elbow joint.

The eight-shaped bandage and tires are removed after 2 weeks when the fracture site is fused (under the control of radiography). The disability of victims usually recovers 3–6 weeks after the injury. Correction should be made for the age and condition of the injured bones, elderly patients, patients with osteoporosis need longer treatment.

It should be noted that incomplete (subperiosteal) fractures of the clavicle, most often observed in children, do not require fixation. An X-ray examination should always be carried out, since an abnormally complete complete fracture of the clavicle can lead to a long-term, until surgical removal, disruption of movements in the upper limb up to disability.

Based on Quick Help in Emergencies.
Kashin S.P..

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