Open arm fracture

The most severe damage to the bone tissue of the upper limbs, in which fragments of broken bones were injured other structures: there was a rupture of the muscular, connective tissue, skin, leaving out the fragments of the affected bone is an open fracture of the arm.

[1]

Epidemiology

An open arm fracture is the most common injury. As statistics show, most cases of this type of fracture are fixed in men. More than half of cases of open fracture concern patients of the age category from 21 to 50 years.

The most frequent injuries are received in domestic or industrial conditions, as a result of a traffic accident or a fall from a height.

[2], [3], [4],

Causes of the open fracture of the hand

To fracture of the upper extremities include injury to the bones of the forearm, shoulder, elbow joints, radius bone, wrist, metacarpal bones, phalanges of fingers. In most cases, such a trauma is subjected to large tubular bones.

The most common causes of open fracture are:

1. Falling on the arm.
2. Consequence of a strong blow.
3. Great physical exertion on the arm.
4. Age changes in the human body.
5. Disease:
   • Osteoporosis.
   • The bony cyst.
   • Hyperparathyroid osteodystrophy.
   • Neoplasms of bone tissue (benign or malignant).
   • Osteomyelitis.
   • Metastases in bone tissues.

[5], [6], [7]

Pathogenesis

With an open fracture, the pathogenesis of the disease is caused by a violation of the integrity of the bones of one of the sections of the skeleton of the upper limbs. After fracture, acute fragments perforate the muscle tissues of the hand, damage the skin. Often, bone fragments can be observed visually, without using special medical equipment. Open wounds due to a fracture can mintinfitsirovatsya with the subsequent development of suppuration.

Traumatologists such traumas are divided into fractures of pathological and traumatic etiology. In case of a trauma, the bone undergoes a sudden strong mechanical pinpointing, whereas a pathological fracture is the result of changes in bone tissues resulting from the course of pathological processes caused by the disease or age-related changes.

[8], [9]

Symptoms of the open fracture of the hand

Recognize the trauma is easy, because the symptoms of an open fracture of the hand do not allow you to doubt the diagnosis:

1. Sharp and sharp pain. Painful syndrome persists even when the upper limb is at rest. At movement the pain amplifies, the chamber is felt. Possible and painful shock.
2. Uncharacteristic, unnatural position of the site of the upper limb.
3. In the place of fracture, the mobility of tissues can be observed, which should not occur under normal conditions.
4. When palpation, you can hear a crackling characteristic (fracture) characteristic of a fracture. In some cases, this sound is heard with a phonendoscope, and sometimes without a device.
5. Often, it is possible to observe outward fragments of bone.
6. Damaged tissues that form the wound bleed heavily.
7. Perhaps the appearance of a cold snap in the damaged arm. It indicates a violation of hemodynamics, which occurred due to scarification of a large main artery, or their clogging with a thrombus. More often such a clinical picture is observed in elderly patients.
8. The site of damage begins to swell "in front of".
9. Hematomas. In the place of their formation, pulsation is possible. This fact indicates the presence of subcutaneous hemorrhage.
10. If nerve endings are damaged, paralysis of the upper limb.
11. Decreased tactile sensitivity.

First signs

When you get an open fracture of the hand, the first signs that the victim feels are sharp, painful to the shoulder area. A traumatic shock is possible. Subsequently, a bleeding wound with outbreaks of bone fragments is visible on the arm.

Despite the small size of the phalanx, an open fracture of the finger is a serious pathology. Medical statistics "speak" about 5% of such diagnoses from all fracture cases.

[10], [11]

Complications and consequences

Even in the case of timely and qualified first aid, the patient may have consequences and complications after the treatment of an open fracture of the hand:

1. Development of osteomyelitis.
2. Incorrect fusion of bone tissue, bone deformation.
3. Partial or complete loss of functionality of the injured hand.
4. In the future, the actual site of the disorder can directly hurt, as well as the nearby muscle tissues and joints.
5. Fat embolism - disemulsified particles of free fat enter the bloodstream.
6. With improperly fused bone, surgery may be required.
7. Infection of the open wound with its subsequent suppuration.
8. There is a high probability of muscle contracture development (shortening of the size and reduction of muscle stretch).
9. Limited mobility of the joint.
10. Disturbance of blood circulation.
11. Atrophy of muscle tissue.
12. The probability of thrombosis is great.
13. Stagnant phenomena in the lungs that cause pneumonia.
14. Formation of the bone callus.
15. Development of a false joint.
16. Deterioration of tactile sensitivity.
17. Partial or complete paralysis of the hand.
18. Possible respiratory and cerebral insufficiency.

[12]

Diagnostics of the open fracture of the hand

With such a trauma, the diagnosis of an open fracture of the hand is not very difficult, since even a visual examination of a person who does not have medical education allows you to determine the diagnosis.

Carrying out the radiography allows you to get the most accurate picture of the fracture, the presence of fragments, their location. It is rare, but there may be a need for a CT scan.

[13], [14]

Treatment of the open fracture of the hand

When patients are injured, treatment begins with the provision of first aid. The broken section of the hand should be properly fixed to immobilize the fracture site. This will not allow the bone fragments to shift even further at the moment when the victim is transported to the hospital. 

An open fracture of the hand is accompanied by a bleeding wound. Therefore, it is necessary first of all to stop the bleeding.

This is done by applying a compression harness.

It is necessary to prevent infectious infection, the wound is treated with an antiseptic: chlorhexidine, iodine, degimicide, ethyl alcohol, dekamine, hydrogen peroxide solution, ethonium, cerigel, potassium permanganate, rockal, hydroperite.

Upon the arrival of the victim in a specialized trauma department, the first thing the trauma doctor does is inject an anesthetic drug into the soft tissues of the damaged area. Mainly used drugs: nurofen, ketoral, bulivacaine, nimesulide, novocaine, lidocaine, narupin,

Novocaine is administered 0.25%, 0.5% and 2% solution in the form of injection in a volume of 5 - 10 ml.

Contraindication to the use of this drug is only increased sensitivity to para-aminobenzoic acid and other components of the pain medication.

There are two ways to treat an open fracture of the hand: conservative and surgical.

Conservative treatment is allowed only if the X-ray image does not have numerous bone chips. The trauma doctor starts to put the bones in a natural position, if there are splinter fragments, they are returned to their place. Then a plaster bandage is applied to the hand. Usually, in order to assess the quality of the joining of the elements of the broken bone, the specialists prescribe a repeated X-ray. This will significantly reduce the likelihood of improper bone fusion.

If the situation is more severe, the specialist goes for surgery. The patient under the local, in rare cases under general anesthesia, undergo an operation to restore the bone.

First aid with open fracture of arm

In many respects, the result of treatment depends on the quality of providing the injured person with an open fracture of the hands with timely and high-quality first aid.

The first thing to do is decontaminate the wound and stop the bleeding. This can be done using any antiseptic agent (for example, hydrogen peroxide or ordinary vodka), as well as a tight bandage that will block the injured blood vessel. If the bleeding is severe, then a compression harness should be used. In its quality, you can use a rope, belt, bandage, leather belt or loose fabric.

But before applying the tourniquet, it is necessary to understand what type of blood loss the victim has. If the bleeding blood has a dark tinge, bleeding is a major bleeding. The tourniquet is applied below the lesion site. In this case every 30 minutes, the tension of the tow should be relaxed.

If the blood is bright, scarlet, pulsating - this is a dangerous arterial bleeding. At an arterial bleeding the probability of a lethal outcome is great. It should be stopped as soon as possible. In this situation, the tourniquet is superimposed above the lesion site. It is necessary to call an ambulance. If, after one and a half hours of assistance has not arrived, for three to four minutes, the harness should be harnessed, then clamped again. This is necessary to prevent tissue necrosis of the affected limb.

In order not to worsen the condition of the victim, the hand should be immobilized. You can fix it with a tire, two wooden slats superimposed on either side of the injured limb. So that the tire or bars do not move, they are wound on top of them with a bandage or with any other fabric.

If an open fracture affects the scapula, humerus or collarbone, it is desirable to place a small cushion between the upper limb and the armpit, and tie the arm to the trunk.

Such a trauma causes severe pain to the victim, so you should give him any analgesic: analgin, spasmalgol, spasmalnin, optalgin.

The patient should be provided with a comfortable position and urgently delivered to the admission department of traumatology.

[15]

Operative treatment

In severe pathology, a traumatologist is forced to resort to an operative treatment for such a patient. The operation is performed under the influence of anesthesia (local or general). If the wound is infected at the time of hospitalization, the surgeon excises the affected tissue, sanitizes the wound cavity.

Bone "going" to the smallest breakaway pieces. For better retention in the required position, such a patient can be inserted special plates or spokes made of an inert medical alloy.

If the tendons and muscle tissues are damaged, the surgeon, using the catgut for the internal seams, differentiates them.

The wound is stitched and a sterile bandage, the hand is fixed by the tire.

Prevention

To reduce the risk of getting an open fracture of the hand, and any other fracture, you should adhere to a number of rules. Prevention of injury includes:

1. Introduction to the diet of foods rich in calcium.
2. Use of appropriate protective equipment when carrying out hazardous work or playing sports.
3. Minimize the situations that can provoke a fall: work at height without insurance, ice.
4. It is necessary to monitor your health, not allowing the development of osteoporosis.
5. Timely and complete cure of other diseases, the progression of which can be detrimental to the condition and strength of bone tissue.
6. Differentiated and cautious approach to the loads that are given to the hands.
7. Admission courses of drugs that eliminate calcium deficiency in the body.

[16], [17]

Forecast

In most cases, an open fracture of the arm is treated qualitatively and a prognosis for the future in such patients is favorable.

But if the patient was not promptly and correctly provided with the first medical aid, then this could be fraught with disability and disability of the injured hand, and in rare cases even with a fatal outcome.

The duration of healing after an open fracture of the hand depends on the condition of the organism of the victim (history, complexity of the fracture and the presence of complications) and his age. In children and young people, due to the high level of tissue regeneration, this process is much faster than in older people.

[18], [19], [20], [21]