The first aid at an open fracture site is as follows:
- it is necessary to stop bleeding: with severe arterial bleeding, by applying a tourniquet above the fracture site and wound (indicating the time of its application), with minor bleeding, of a pressure bandage on the wound area;
- The wound over the fracture should be closed with a sterile bandage, while nothing can be touched at the wound itself;
- give the victim any painkiller.
First aid for an open fracture is carried out until the brigade of the ambulance service arrived. During this time, the victim with an open fracture of the hip, pelvis or skull move or move to another place is not recommended that bone fragments do not damage the larger areas of soft tissue.
To prevent displacement of bone fragments, correct transport immobilization is necessary with open fractures. For example, when the ray bone is broken, a tire is applied, which keeps not only the bones of the forearm in the stationary state, but also the joints - the elbow and the wrist. And with a shin fracture with the help of a tire from improvised materials, it is necessary to fix the knee and ankle joints.
If the victim has an open fracture of the pelvic bones, then it must be placed so that part of the body above the waist is slightly raised, and under the knees (to make them semi-bent), a slight elevation is necessary, which can be made from a rolled-up garment.
When the fracture of the lower jaw is open, transport immobilization is provided by tying the jaw over the head, and the injured person is taken lying down.
Considering the complexity of the trauma, treatment of open fractures is performed in a complex manner.
Treatment of the wound is necessary - see more details - Treatment of open wounds, anesthesia, anti-inflammatory therapy, reposition - anatomically accurate combining of bone fragments - and fixing them in the most appropriate way for each case.
It can be plaster or plastic longa - when an open fracture of the limbs without displacement. But in the presence of bias and bone fragments (in particular, with an open fracture of the thigh or lower leg), skeletal traction under traction is used, which ensures their stable position and thereby contributes to the normal fusion of the fracture.
In most cases, surgical treatment is necessary - in order to properly treat the wound, as well as to make the best possible alignment of the broken bones. After anatomical reposition, fixation is required, for which in the arsenal of surgeons-traumatologists there are special spokes, pins, staples, plates. The most famous apparatus with which external fixation of bone fragments is made is the apparatus of surgeon Ilizarov. Although the BDW pioneer is compression-distraction osteosynthesis (that is, the surgical repositioning of fragments with fixation constructs) - is the Belgian surgeon Albin Lambotte, who worked in the Netherlands, who used the first metal compression-distraction apparatus developed by him in the early 20th century - a simple unilateral external fixator of broken bone.
After the adhesion of the bone, the fixation structures are removed, and the soft tissues are sutured. Surgical treatment of open fractures also includes the removal of damage to the peripheral nerves, which can be carried out at a later date - within three months after the injury (after the detection of certain dysfunctions). These operations are performed by neurosurgeons.
Medicamentous treatment of open fractures
Medicamentous treatment of open fractures is carried out using antibacterial, analgesic, decongestants, immunostimulating, neuroprotective agents.
Applying antibiotics - Amoxiclav, Cefazolin, Ceftriaxone, Metronidazole (Flagil) and others - doctors prevent or significantly reduce inflammatory complications. Amoksiklav is injected into a vein of 1.2 g (children under 12 years of 0.03 g per kilogram of weight) at intervals of not more than 8 hours. A single dose of Cefazolin is 0.5-1 g (for adults), is administered similarly. The side effects of these drugs, common to all antibiotics, include nausea, diarrhea and enterocolitis; urticaria; changes in blood (anemia and leukopenia); increased levels of hepatic enzymes and nitrogen in the urine.
To stop pain injectively or orally, use drugs of the group of non-steroidal anti-inflammatory drugs (NSAIDs): Indomethacin, Ketoprofen, Ibuprofen, etc. Thus, Indomethacin can be administered intramuscularly for two weeks - once or twice a day (60 mg each), and then go to the reception of tablets - 25 mg twice a day, always after a meal. Among the side effects of NSAIDs are headache, gastrointestinal manifestations with pains in the stomach. Therefore, these funds are contraindicated in the presence of peptic ulcer diseases, as well as with bronchial asthma in the anamnesis.
Drugs that stabilize capillaries, for example, Methyl ethylpyridinol or L-lysine exciter, are used against edema. L-lysine is injected into the vein 5-10 ml once a day (with open TBT twice a day) for 3-7 days; The dose for children is calculated by body weight. This drug is not used for renal failure and concurrent with cephalosporin antibiotics; In rare cases, there may be side effects in the form of an allergic reaction.
In addition, with open fractures - the stimulation of tissue metabolism and the regeneration of damaged tissues - it is considered expedient to use the immunomodulating agent Timalin. Intramuscular injections of this drug (a one-time dose of 5 to 20 mg) are done once a day; the course of treatment lasts up to five days.
Calcium gluconate and calcium hydroxyapatite (Osteogenon) contribute to the restoration of bone tissue and fixation of calcium in it. Osteogenon after fractures is recommended to take twice a day (1-2 tablets) for 2.5-3 months. This remedy is contraindicated for problems with the kidneys and patients under 18 years of age.
The drug Gliatilin (Cereton) refers to neuroprotectors and is used to regenerate damaged peripheral nerves, especially with open fractures and other craniocerebral trauma: one capsule per day; In severe cases, the drug is administered parenterally (in droppers).
Rehabilitation after an open fracture
The length of the rehabilitation period, which begins after removal of the longi or compression-distraction apparatus, as well as the forecast of the further condition depends on the localization of the open fracture and the degree of its complexity.
A modern complex of rehabilitation measures that facilitate the return to the affected skeletal structures of their physiological functions includes various physiotherapy procedures, special therapeutic gymnastics, massage, as well as mechanotherapy or prolonged passive joint development - CPM therapy.
This method, the concept of which was created by the Canadian orthopedic surgeon Robert B. Salter (Robert B. Salter) in the 1970s, aims to develop joints after injuries with the help of special devices. CPM-machines cause the joints to bend to a predetermined degree without the involvement of the muscle strength of the patient. In this case, the degree of flexion of the joints increases as the rehabilitation proceeds after an open fracture, and the range of motion gradually expands.
Physicians-rehabilitologists advise you to eat right during the recovery period after an open fracture, using enough protein, vitamins A, C, D and Group B, as well as calcium-rich dairy products and products containing phosphorus (vegetable oils, beans, oats, almonds, nuts) .