What Is a Closed Fracture?

Soft tissue injuries are less severe in closed fractures, and fractures heal faster. First aid for fractures:

Closed fracture

Soft tissue injuries are less severe in closed fractures, and fractures heal faster. Closed fractures are interruptions of bone integrity and continuity. Closed fractures can be caused by trauma and skeletal diseases, such as osteomyelitis, bone destruction caused by bone tumors, fractures that occur under slight external force, and become pathological fractures. Closed fractures can be caused by trauma and skeletal diseases, such as osteomyelitis, bone destruction caused by bone tumors, fractures that occur under slight external forces, and become pathological fractures, with traumatic fractures accounting for the majority.

First aid for closed fractures

Soft tissue injuries are less severe in closed fractures, and fractures heal faster. First aid for fractures:

(1) General treatment: All patients with suspicious fractures should be treated as fractures. Save lives first. When a closed fracture has the risk of penetrating the skin and damaging blood vessels and nerves, significant displacement should be eliminated as much as possible, and then fixed with a splint.

(2) Wound dressing: If the wound end has been punctured and contaminated, but it is not compressed, it should not be immediately reset to avoid bringing dirt deep into the wound. If the fracture end has slipped back into the wound by itself when bandaging the wound, it must be explained to the physician in charge to draw their attention.

(3) Proper fixation: the most important item in fracture emergency treatment. The purpose of the first aid fixation is threefold: 1) to prevent the fractured end from moving and damage the soft tissues, blood vessels, nerves or internal organs during transportation; 2) to relieve pain after the fracture is fixed, which is helpful to prevent shock;

(4) Rapid transportation: principles for treating fractures: reduction, fixation and functional exercise.

Signs and symptoms

Shock, soft tissue injury, bleeding, fracture.

Closed fracture diagnosis

Specific signs of closed fractures include

a. Malformation and displacement of the closed fracture segment can change the shape of the affected limb, which is mainly shortened, angled or rotated.

b. Abnormal activity: In normal situations, the limbs cannot move, and abnormal activities occur after closed fractures.

c. Bone fricative or abrasive sensation: After a closed fracture, when two closed fracture ends rub against each other, bone fricative or abrasive sensation can occur. Those with one of the above three unique signs of closed fracture can be diagnosed as closed fracture. However, the abnormal activity of closed fractures and bone fricative induction should be paid attention during the initial examination of patients. Do not deliberately repeat multiple examinations to avoid aggravating the damage of surrounding tissues, especially important blood vessels and nerves. It is worth noting that some closed fractures Such as fracture closed fractures and embedded closed fractures, the above three typical signs of closed fractures may not appear, and X-ray films should be routinely performed to confirm the diagnosis.

X-ray examination of closed fracture X-ray examination is of great value in the diagnosis and treatment of closed fracture. Anyone who suspects a closed fracture should undergo routine X-ray film examination, which can show incomplete closed fractures that are difficult to find clinically, deep closed fractures, intra-articular closed fractures, and small avulsion closed fractures. . Even those who have clinically showed obvious closed fractures, X-ray film examination is necessary to help understand the types of closed fractures and the condition of closed fracture end displacement, which has important guiding significance for the treatment of closed fractures.

X-ray examinations of closed fractures should generally include orthophotos, including near a joint, and X-rays of special locations, such as metacarpal and metatarsal orthotopic and oblique radiographs, if necessary Position and axial position, wrist scaphoid bones in the normal and sacral positions, and sometimes when the damage is not determined, still need to take X-rays of the corresponding parts of the contralateral limbs for comparison, it is worth noting that there are some slight Fracture closed fracture, emergency dispatch

fracture If there is no obvious closed fracture line, if the clinical symptoms are more obvious, the film should be reviewed 2 weeks after the injury. At this time, the closed fracture line can often have a closed fracture line, such as a carpal scaphoid closed fracture.

Closed fracture asking about injury

Including the cause, time, place of injury, body position at the time of the injury, and where to land first. If there is a wound or bleeding, you should also ask whether the wound has been treated, whether the tourniquet has been used, and the tourniquet time.

Comprehensive examination of closed fractures

Pay attention to shock, soft tissue injury, bleeding, check wound size, shape, depth and contamination. Extremities exposed, with or without nerve, blood vessel, craniocerebral, visceral injury, and fractures in other areas. Serious injuries must be carried out quickly.

X X-ray examination of closed fracture

In addition to normal and lateral X-rays, special postures should be taken according to the injury, such as the open position (upper cervical spine injury), dynamic lateral position (cervical spine), axial position (scaphoid, calcaneus, etc.) and Tangent position (patella). For complex pelvic fractures or suspected intravertebral fractures, tomography or CT should be performed as appropriate.

Closed fracture treatment plan

Manual reduction of closed fractures

1) Most fresh and stable fractures of the extremities can be manually reduced and externally fixed.

2) Local anesthesia, nerve block anesthesia or general anesthesia can be used as appropriate.

3) Follow the reset and fix principles described above.

Closed fracture continuous traction

1) Femoral fractures, unstable tibiofibular fractures, humeral supracondylar fractures that are difficult to reduce by hand or severe swelling, etc., should be treated with continuous traction reduction.

2) Pediatric traction can be used for fractures in children. The fracture of the femoral shaft in children under 4 years of age can be traction with Bryant suspension; children over 12 years of age can be traction with bone, but care should be taken not to damage the callus.

3) While continuous traction, it can be fixed with plaster support or small splint to correct lateral displacement and angular deformity of the fracture end.

4) After continuous traction until the fibrous healing of the fracture end is stable and stable (usually 3 to 4 weeks), it can be fixed with gypsum cast, gypsum tray or small splint, and the traction can be continued until clinical healing of the fracture.

Surgical reduction and internal fixation of closed fractures , external fixation with Menzi

Traditional Chinese medicine orthopedic manipulation closed reduction, Meng's external fixator for treatment of fractures, does not damage normal tissues, no incision bleeding, minor trauma, fast fracture healing, good function recovery, no need for secondary surgery after fracture healing, etc. For example, we applied 36 patients with tri-ankle fractures and dislocations who failed to undergo manual reduction splint and plaster fixation. Results The overall excellent and good rate was 91.7%; no pinhole infection, no fracture nonunion and malunion healing. Compared with the literature, the excellent and good rate of manual splint and plaster fixation was 73.1%; the excellent and good rate of conservative treatment was 83.3%. The ankle fixed reduction device has obvious advantages in treating tri-ankle fractures.

The clinical study of the traditional Chinese medicine orthopedic multidimensional external fixator for the treatment of unstable fractures of the distal radius has been listed as the dominant disease project by the Chinese Academy of Chinese Medical Sciences.

Closed fracture indication

1. Complex fracture, open fracture, comminuted fracture.

2. Local soft tissue contamination and fracture after burns.

3. Post-fracture deformity orthopedics.

4, non-union fractures are prone to internal fixation.

5. Patients with fractures who refuse internal fixation.

6, such as: tibia and fibula fractures, unstable distal radius fractures, pilon fractures, humeral shaft fractures, ankle fractures

Closed fracture , Horseshoe instep and so on.

Code of operation for closed fractures

01. Anesthesia: nerve block, spinal anesthesia, epidural anesthesia.

02. Aseptic operation: Pay attention to strict disinfection.

03. Manipulative reset: pull-out traction, rotation flexion and extension, swing touch; touch, connect, end, lift, press, rub, push, hold, fold the top, bend and stretch and so on.

04. Golden needle dial bone: According to the fracture x-ray film, intra-articular fracture, pry with a round needle to reset. Patients with old fracture deformities healed and then fixed after surgical osteotomy.

05. Closed puncture: Avoid important nerve blood vessels, puncture laterally according to different fractures, and prepare for installing the external fixator left.

06. Installation of external fixator: to achieve a stable fixation of the fracture.

07. External fixator adjustment: according to the fracture reduction and healing process.

08. Postoperative care: Needleway care.

09. Removal of external fixator: according to fracture healing.

10. Functional training: according to the period of fracture healing.

Closed fracture indication

(1) Fractures that cannot be reduced by manipulation, such as the insertion of soft tissue at the fracture end and some intra-articular fractures.

(2) Those who cannot be aligned by manual reduction and fixation, such as displaced metatarsal fractures and ulna olecranon fractures.

(3) Combined nerve and blood vessel injuries require surgical exploration.

(4) Those who have obvious superiority in the internal fixation of fractures in some parts, such as the mid, middle and upper and lower 1/3 transverse fractures of the femoral shaft, femoral neck fractures, etc. .

(5) Those with fracture deformity affecting function.

(6) Multiple fractures of the same limb.

(7) Be cautious about surgical reduction and internal fixation of pediatric fractures, and do not damage the epiphysis.

Preparing for closed fractures

(1) According to the routine treatment before general surgery.

(2) Select internal fixation equipment, such as steel plates, screws and intramedullary nails of appropriate specifications and sizes. Only the same metal internal fixation equipment can be used in the same wound to avoid electrolysis and affect fracture healing.

Closed fracture

(1) Strictly aseptic operation, try to peel off the periosteum as little as possible.

(2) Select internal fixation that is suitable for the type and location of the fracture, such as intramedullary nails, Ender nails, steel plates, steel wires, screws, bolts, Kirschner wires, and sutures.

(3) During the operation, observe again whether the internal fixation is compatible with the anatomical characteristics of the fracture end, such as whether the diameter of the intramedullary nail and the medullary cavity are consistent.

(4) If the internal fixation is not firm, postoperative external fixation should be supplemented until clinical healing. Those with solid internal fixation can decide whether to protect with plaster support after surgery. After hip internal fixation, it can be supplemented with skin traction or wearing wooden shoes to prevent external rotation of the affected limb.

Postoperative management of closed fractures

(1) Treat as usual after general surgery.

(2) Regular X-rays were performed to observe the position of internal fixation and fracture healing. Those who have slipped or dislodged the internal fixation should try to correct it, and those with delayed healing should be fixed externally.

Closed fracture diet conditioning

1. Eating more vegetables, protein, and a vitamin-rich diet can prevent the occurrence and development of osteoporosis.

2. The diet at the early stage of the fracture should be light to facilitate the removal of blood stasis and swelling. At the later stage, the taste should be heavy. Choosing a suitable diet to replenish the liver and kidneys is conducive to fracture healing and functional recovery.

Closed fracture tissue repair

fracture

Closed fracture Fixation: After debridement, the fracture should be reduced under direct vision. According to the type of fracture, the appropriate internal fixation method is selected to fix the fracture. The fixation method should be the simplest and quickest. It may be appropriate and external fixation if necessary after surgery. If the fracture is stable, it is not easy to be displaced after reduction, or internal fixation may be used, and external fixation is simply used. The third open fracture and the second open fracture have a debridement time longer than 6-8 hours after the injury. It is not suitable to use internal fixation. External fixators can be used, because more than 6-8 hours, the bacteria contaminated at the wound site have been After the incubation period, it enters a period of logarithmic proliferation. As an inanimate foreign body, the internal fixation is low, and the antibacterial agent is difficult to function. It is easy to cause infection. Once the infection occurs, the internal fixation does not have to be removed, otherwise The infection does not stop and the wound does not heal.

Important soft tissue repair: Tendons, nerves, blood vessels and other important tissue injuries should be repaired with a suitable Buddha during debridement in order to restore limb function as soon as possible.

Wound drainage: use a silicone tube, place it in the deepest part of the wound, pierce the body from the normal skin, and connect a negative pressure drainage bottle, remove it at 24-48 hours. If necessary, antibiotics or slow-release antibiotics can be placed in the wound before the wound is closed.

Closed fracture

Completely closing the wound and striving for primary healing is the key to transforming open fractures into closed fractures. It is also the main goal of debridement. For first- and second-degree open fractures, most of the wounds can be closed in one stage after debridement, and in third-degree open fractures, various methods should be used to close the first stage as much as possible after debridement. The development of wounds and microsurgery has provided better methods and more opportunities for the treatment of such injuries. a. Direct suture: If there is no obvious defect in the skin, it can be sutured directly, and it can directly cross the wound of the joint. Although there is no skin defect, it should not be sutured directly to avoid scar contracture of the wound and affect the joint movement. .

b. Reduced suture and skin grafting: skin defects, large wound tension, can not be directly sutured, such as the surrounding skin and

fracture Soft tissue damage is minor, and a reduction incision can be made on one or both sides of the wound parallel to the wound. After the wound is sutured, if the incision can be sutured, the suture is directly sutured, otherwise the skin is implanted at the incision gap, such as a skin defect at the wound, and the local soft tissue bed is good without bone, nerves, blood vessels and other important tissue exposed. Direct skin grafting.

c. Delayed closure: The third degree of open fracture, serious soft tissue damage, the tissue necrosis can not be determined culturally, and the chance of infection is large. After debridement, the surrounding soft tissue can be used to cover the fracture, open the wound, and wet with sterile dressing Apply and observe for 3-5 days, and debride again, completely remove the inactivated tissue, and perform free skin grafting. If skin grafting is difficult, it can be covered with a flap graft.

d. Flap transplantation: a third-degree open fracture with extensive soft tissue damage. The fracture is exposed. The lack of soft tissue coverage can easily lead to infection. You should try to cover the window with various flaps, such as locally transferred skin. Petal, vascular pedicle island flap and anastomotic free flap transplantation.