Rupture: causes, symptoms, diagnosis, treatment

Ruptura is a violation of the anatomical integrity of tissues, caused by a force exceeding their elastic capabilities. Gaps - mechanical damage to soft tissues and internal organs with a violation of their anatomical integrity. They arise when a force is applied that exceeds the extensibility of the tissue. Possible ruptures: subcutaneous tissue, nerves, vessels, muscles, tendons, ligaments of joints, hollow and parenchymal organs. The clinic is different in each case.

[1], [2], [3], [4], [5]

What causes the gap?

The cause and mechanism of injury are similar to those in tension: traction exceeding the physiological possibilities of tissue elasticity.

Symptoms of Gap

The victim complains of pain in the place of injury, restriction of functions, tries to protect the damaged place.

Gaps of subcutaneous fat are manifested by the development of bruising and subcutaneous hematoma.

Fractures of the fascia (usually the femur) are determined palpation in the form of a slit-like defect. When the muscles are strained, an elastic, painless formation (muscular hernia) is palpated through the defect of the fascia, which disappears when the musculature is relaxed.

Muscle ruptures are: complete or partial (tears); are located either in the area of the muscular abdomen, or, more often, in the place of the passage of the muscle into the tendon. The most commonly injured: biceps, calf muscles, less often - abdominal quadriceps femoris. The rupture of other muscles is extremely rare.

At the moment of rupture, there is a sharp pain, often a sensation of a click, after which the limb function develops with the loss of the action of the damaged muscle. The abdomen of the muscle contracts toward the intact tendon (with a rupture in the abdomen - in the leading and leading side of the tendons). In this palpation, a defect in the location of the muscle is determined, and its spasms are palpated in the form of elastic and painful ridges. The diagnosis of partial muscle rupture is made only on the basis of assumptions: the nature of the injury (at the time of muscle strain); pain that increases with palpation is the muscle; pain during palpation of the leading and leading tendons; The presence of edema and bruising, a violation of muscle function.

Tears of tendons - more often Achilles, heads of the quadriceps; muscles of the hip and biceps muscles of the shoulder - are accompanied by: loss of muscle functions, hyperfunction of the antagonist muscle, the vicious position of this, segment, mixing: the abdomen of the muscle towards the intact tendon. Treatment, as well as with muscle rupture, operative, should be carried out as early as possible because of cicatrical changes in the muscle itself and the breaking of the ends of the tendon, which can determine the inefficiency of surgical plasty.

Gaps of articulations (symphysis) - the most common are ruptures of the lobial and acromioclavicular joints.

The ruptures of the acromial-clavicular junction are also defined as a dislocation of the acromial end of the clavicle: complete and incomplete. Occurs when striking the acromial process of the scapula or when it falls on the above shoulder. When examining standing, the protrusion of the end of the clavicle is revealed, when pressing on top, the symptom of the "key" is determined - the collarbone springs at hand. The diagnosis is confirmed radiologically, but the pictures are made standing, since in the supine position the displacement can be eliminated.

Tears or tearing of the pubic joint are rare, and are more often a complication of labor by a large fetus in a clinically narrow pelvis, very rare in pelvic fractures. Pain in the area of the lone articulation, the inability to raise the straightened legs (a symptom of the "stitched heel"), the inability to turn on its side. Palpation reveals soreness in the region of the pubic joint, divergence of the pubic bones by more than 1 cm, their mobility. Confirm the diagnosis radiographically.

Nerve breaks - usually accompanied by fractures of bones. In this case, the function of the innervated area and sensitivity decrease. Together with a traumatologist, a neurosurgeon is urgently called. To clarify the diagnosis, you can additionally produce electromyography.

Discontinuities of large vessels - often accompany bone fractures, but can also form with contusion injury, manifested by the formation of a strained hematoma, the absence of pulsation in the peripheral arteries, and sometimes can be determined by pulsation and systolic murmur over the hematoma. Given the development of anemia and gangrene of the limb, the patient immediately rushed to the traumatology, even in dubious cases where it is impossible to conduct angiography.

Tears of the internal organs have a fairly bright clinic, ruptures of the liver, gallbladder, pancreas, bladder, stomach and intestine give a picture of peritonitis, the rupture of the spleen gives a picture of hemoperitoneum; ruptures of the lung and bronchi are manifested by hemopneumothorax; when the diaphragm ruptures, along with hemoperitoneum, a diaphragmatic hernia is formed; with the rupture of the kidney and ureter develops paranephritis.

Diagnosis of the rupture

In the anamnesis - a trauma, by the mechanism similar to a trauma at a stretching.

[6], [7], [8], [9], [10], [11], [12],

Examination and physical examination

In addition to the signs characteristic of stretching, with breaks there are symptoms specific to this trauma:

• extensive hemorrhage into soft tissue, far beyond the damage zone;
• pathological increase in the volume of movements in the joint;
• a sharp violation of limb functions, for example, loss of ability to resist (stability) in the knee joint.

If the muscle is ruptured, when it is contracted, the bulging of the abdomen of the muscle stump is determined.

[13], [14], [15], [16],

Laboratory and instrumental research

With the help of radiography, pathologies of the bones are not detected.

Differential diagnosis

The rupture must be radiological differentiated from the fracture.

[17], [18], [19], [20], [21], [22]

Treatment of rupture

Treatment of a gap can be conservative and operative.

Conservative treatment

Conservative treatment is used more often with incomplete ruptures of ligaments and muscles (less often - tendons) and in the early periods - no later than 3-5 days from the time of injury. Apply circular gypsum immobilization with fixation of one or two adjacent joints in the position of maximum relaxation of injured ligaments and tendons for a period of 3-6 weeks. For this purpose, the extremities give the state of hypercorrection - the maximum deviation towards the damaged tissues. For example, with the extension of the inner lateral ligament of the knee joint, the shin is set in the position of reduction (cms varus), if the Achilles tendon is damaged, the limb is bent at the knee and ankle joint to 150 ° (pes equinus) in order to maximize relaxation of the triceps muscle of the tibia. The injured limb is given an elevated position on the pillow. From the 3rd-4th day, UHF (6-8 procedures) is prescribed through a plaster bandage. At the end of the immobilization, massage, exercise therapy, warm coniferous baths, rhythmic galvanization of the affected muscles, electrophonophoresis of procaine and multivitamins to the damage zone are shown.

[23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35],

Surgery

The most reliable method of repairing gaps is recognized as surgical. In the early stages, it is necessary to sew ruptured formations, in later terms resort to various types of plastic interventions.