Technique for applying a splint for an open hip fracture. Fracture of the femur: classification and types. Applying a tourniquet or twist

Immobilization for fractures is the main first aid measure to ensure bone immobility. The fact is that the movements, whether voluntary or not, that the victim makes during delivery to the doctor cause him serious harm. Immobilization minimizes additional trauma to soft tissues and blood vessels from sharp bone fragments at the fracture site, and reduces the possibility of shock, significant bleeding, or development of infectious complication. The timing of immobilization depends on the distance to medical institution and range from several hours to 2-3 days.

Types of fractures and the need for first aid

It is customary to distinguish between pathological fractures that occur when various diseases bones, and traumatic, occurring as a result of exposure to a large dynamic load on the bone during injury. Chronic fractures occur somewhat less frequently when the load on the bone was, although not excessive, prolonged.

Traumatic fractures are usually divided into:

• closed;
• open, when in addition to a broken bone there is also a wound;
• intra-articular, in which blood accumulates in the joint capsule.

Each of the types, in turn, can be with or without displacement of bone fragments.

Exist pronounced signs, which can be used to determine whether the victim has a fracture:

• severe pain at the site of injury;
• in case of a limb injury - a change in shape and size compared to the uninjured one;
• bone mobility at the site of injury, which was not observed in the normal state;
• inability to move the injured limb.

Open fractures also pose a danger because pathogens can enter the wound and become infected. Damage to tissue from bone fragments causes bleeding, often significant. If the fracture is open, there is external bleeding, and if it is closed, internal bleeding develops, which is no less dangerous. If there are several fractures, or they are open and severe, traumatic shock often develops, requiring emergency treatment. medical measures. One of important points in the treatment of fractures is qualified first aid, the main activities of which are:

• anesthesia;
• stopping bleeding if the fracture is open:
• prevention of shock or measures to combat it;
• ensuring immobility of the injury site by immobilization, reducing pain and preventing shock;
• urgent delivery of the victim to a medical facility.

Using splints for fractures

Types of splints for fractures

Standard ready-to-use tires vary in size and design features. They are often intended for immobilization of the upper or lower extremities, and in some cases for their traction.

Standard tires are made from various materials:

• made of steel mesh or wire, such as flexible ladder-type Kramer tires;
• wood: from slatted wooden structures, such as Dieterichs tires;
• plastics;
• thick cardboard.

In the event that transport immobilization is required for a relatively long term, use plaster bandages or splints. The peculiarity of such tires is that they are made individually for each victim. They fix bone fragments well and fit snugly to the body. A relative disadvantage of this immobilization option is the difficulty of transporting a victim in frosty weather, while the tire is still wet.

It often happens that ready-made standard tires are not at hand. In this case, it makes sense to use scrap materials located nearby. Usually boards or thick rods are used; thin rods can be tied in the form of a bundle for convenience.

It must be borne in mind that if rescuers or a medical team are already on their way to help the victim, there is no need to construct an improvised splint from scrap material; it is more advisable to wait for professional help.

Rules for applying a splint for immobilization

Algorithm for applying an immobilization splint to the upper limbs

• the injured arm is bent at an angle of 90 degrees;
• under your arm, in the axillary fold, you need to place a roll of clothing or soft material, about 10 cm in size;
• if a bone in the shoulder is broken, it is most convenient to use a flexible standard Kramer splint; in its absence, available hard materials are used;
• fix the shoulder and elbow joint, and the second - elbow and wrist;
• the bent arm needs to be suspended on a scarf.

When the bones of the forearm are fractured, the elbow and wrist joints are fixed with a splint, a roller measuring 8-10 cm is placed in the armpit. The arm is bent at an angle of 90 degrees and suspended on a scarf. Sometimes it happens that a solid object for making an improvised tire cannot be found. In this case, the broken forearm bone can be fixed by bandaging it to the body.

Fractured fingertips upper limbs It’s better not to bandage, it’s more convenient to control blood circulation.

Immobilization for other types of fractures

For a fracture of the femur, one splint is applied with inside injured limb, fixing the knee and ankle joint. Such a splint should reach the groin, where a soft cushion with a diameter of about 10 cm must be placed. On the outside of the leg, the splint is placed so as to fix all three joints: the hip, knee and ankle. Joints should be grasped to prevent movement in them; otherwise it will be transmitted to the area of ​​the broken bone. In addition, such fixation prevents dislocation of the head of the damaged bone.

This is how a splint is applied for a hip fracture

In case of a tibia fracture, splints are also applied along the inner and outer surfaces of the damaged limb, fixing the knee and ankle joint. If it is not possible to find material at hand to construct an immobilization splint, the injured leg can be fixed by bandaging it to the uninjured leg. However, such a measure is considered not reliable enough and is used in extreme cases.

It is unacceptable to transport victims with fractures, even over short distances, without immobilization.

If the clavicle is fractured, you need to hang the victim’s arm in a scarf. If you get far enough to a medical facility, you need to apply a figure-of-eight bandage to pull the shoulder girdle back and fix it in this position.

If immobilization is required for rib fractures, chest apply a tight fixing bandage, after anesthetizing the victim. The chest is bandaged as you exhale, while the contracted ribs make only minimal movements during breathing. This reduces pain and eliminates the risk of additional soft tissue injury from debris. Uncomplicated rib fractures heal quickly, but complications from injury pose a serious danger internal organs broken ribs.

When the foot is broken, a flexible Kramer splint is applied until upper thirds shin, modeling it along the contour back surface.

First aid for severe fractures

Fractures of the pelvic bones - severe, life-threatening victim, damage characterized sharp pain, inability to walk, stand, or raise a leg. To provide first aid, the victim is placed on a rigid stretcher with his back down, while his legs are left in a bent state. Soft cushions should be placed under the knees.

The most severe injury is considered to be a spinal fracture, which can occur when strong impact in the back or during a fall from a height. The victim experiences sharp pain, swelling and protrusion of the damaged vertebrae occurs.

When providing assistance, you need to be extremely careful, since displacement of the vertebrae often leads to damage spinal cord and its rupture.

The victim is placed on a hard surface, doing this on command, and without allowing kinks in the spine. Then they are secured with wide straps. In case of fracture upper sections spine, it is necessary to place soft cushions in the neck area.

Anyone can find themselves in an emergency situation. And in this case, knowledge of the rules for providing first medical care can save lives. The main thing is to maintain clarity of thinking and not try to perform manipulations that require special training.

Rules for the provision of primary care

The task of the person who provides first aid is not to make the victim worse than he already is. It should relieve pain and provide rest to the damaged area. This is the main task (PMP) for fractures.

First of all, it is necessary to assess the severity of the victim’s condition and locate the location of the injury. Then, if necessary, stop the bleeding. It is not recommended to move a person until qualified help arrives, especially if he has a spinal fracture or damage to internal organs. In some emergency situations Evacuation from the scene is vital. In this case, rigid stretchers or shields are used.

An isolated injury requires a slightly different approach. It is necessary to immobilize the injured limb with a splint, giving it the most physiological position. It is imperative to fix the joint before and after the fracture. If there are no other complaints, the victim is transported to a medical facility.

Open or closed fracture?

PMP for fractures depends on the shape, type and severity of the injury. During the examination of the victim, it is necessary to determine the type of fracture, since depending on this, first aid will be slightly different. Any diagnosis is based on certain criteria. In the case of a fracture, there are relative and absolute signs indicating the presence of injury.

Relative signs:

1. Pain. When tapping or trying to change the position of the injured limb, discomfort occurs.
2. Edema. It hides the picture of the fracture, is part of the inflammatory response to damage, compresses soft tissue and can move bone fragments.
3. Hematoma. Indicates that the integrity of the vascular network at the site of injury has been compromised.
4. Impaired function. Manifests itself in limited mobility or inability to withstand the usual load.

Absolute signs:

1. Strange, unnatural position of the bone, its deformation.
2. The presence of mobility where it never existed.
3. Presence of crepitus (air bubbles) under the skin.
4. With an open fracture, skin damage and bone fragments are visible to the naked eye.

This is how you can determine the presence and type of fracture without the use of complex technology.

Fracture of the bones of the upper limb

PMP involves giving the limb the correct position and fixing it to the body. To do this, you need to bend your arm at the elbow so that you get a right angle and press your palm to the victim’s chest. To apply a splint, choose a material that is longer than the forearm and hand. It is secured to the limb in the presented position, then the arm is suspended on a bandage, which is a piece of fabric tied with a ring and thrown over the neck to eliminate possible stress.

A shoulder fracture requires slightly different tactics. The position of the limb is also given at an angle of ninety degrees, but two splints are applied:

• outside the shoulder so that it falls below the elbow;
• along the inner surface of the hand from armpit to the elbow bend.

The splints are first bandaged individually and then secured together. The hand also needs to be suspended on a belt, scarf or any piece of material that is at hand. The victim should only be transported to the hospital while sitting.

Fracture of lower limb bones

In order to provide emergency medical treatment, you need to stock up on a large number of long and wide tires (boards, pickets, etc.). When immobilizing a limb in case of a hip fracture, the first splint should go from the outside, with the upper end resting against the armpit cavity, and the other reaching the foot. The second splint runs from the perineum to the foot, protruding slightly beyond it. Each of them is bandaged separately and then together.

If materials for a splint are not available, the injured limb can be bandaged to the uninjured leg.

A fracture of the tibia requires the same fixation as a fracture of the femur. The victim is taken to the hospital only lying down.

Fractures of ribs and jaw

Since when the ribs are fractured there is nothing to fix them, a tight bandage is applied to the chest. The victim is recommended to breathe exclusively using the abdominal muscles, without loading the chest. If there are not enough bandages, you can use pieces of fabric or scarves. It is important that a person does not lie down under any circumstances, since sharp fragments of ribs can damage the lungs, heart, and pierce the diaphragm.

Most often the result of a fight or a fall. Therefore, it is quite reasonable to assume that the victim also has a concussion. First aid in in this case consists of covering a person's mouth, giving him analgesics and securing his jaw with a bandage, tying its ends on the top of his head. The main thing is to monitor the position of the tongue so that it does not overlap Airways. If the victim is unconscious, then it is necessary to lay him on his side or face down. Transport immobilization for head fractures should be in a horizontal state. This will help avoid stress on damaged bones and prevent asphyxia.

First aid for an open fracture

PMP for an open fracture should be provided as quickly as possible. In such a situation, the risk of complications such as collapse and massive bleeding increases significantly.

Therefore, the algorithm of actions is as follows:

1. Examine the victim and assess his condition.
2. Give him painkillers to prevent traumatic shock.
3. Treat the skin around the wound with peroxide solution, iodine or any other antiseptic.
4. Use a sterile gauze pad to gently dry the bottom and edges of the wound.
5. Folded several times, apply to the wound, but do not press.
6. Perform immobilization using improvised means.
7. Do not set the fragments under any circumstances!
8. Call an ambulance.

PMP for a closed fracture will have similar stages, with the exception of those points that talk about wound treatment.

Immobilization

Immobilization is the immobilization of an injured part of the body. It is necessarily performed in case of fractures of bones and joints, rupture of nerve and muscle fibers, and burns. Due to pain, the patient may make sudden movements, which can aggravate his injuries.

Transport immobilization involves keeping the victim immobile while he is transported to a medical facility. Since some shaking is inevitable during movement, good fixation of the patient avoids aggravating the situation.

There are rules that, if followed, will make splinting the least painful for the victim.

1. The splint must be large enough to support the joint above and below the fracture site. And if the hip is damaged, the entire leg is immobilized.
2. A splint is formed either on the victim’s healthy limb or on oneself, so as not to cause additional inconvenience to the patient.
3. The splint is applied over clothing to avoid infection of the wound.
4. To avoid bedsores in areas where the bone is close to the skin, soft material is placed under the splint.
5. The splint is not fixed on the side where the broken bone protrudes, because it is strictly prohibited to set it before arriving at the hospital.

Types of medical splints

A medical splint can come in several modifications, depending on the purpose of its use. There are prosthetic splints that both hold the affected area in one position and replace the missing section of bone.

The following types of immobilization splints are distinguished:

• A Kramer splint is a lattice made of thin wire, which is covered on top with several layers of bandage or soft fabric. The frame can be given any shape that is necessary in a particular case, this makes it universal.
• Dieterichs tire - consists of two wooden boards with holes drilled in them through which belts or fabric are pulled. The kit also includes a small flat bushing that is inserted into the hole, fixing the tire at the desired level.
• medical is a sealed chamber into which the injured limb is placed. Then air is pumped between its walls, and the body part is securely fixed.
• The Shants splint is a collar-fixator used for diseases of the spine, as well as for the prevention of displacement of the cervical vertebrae during back injuries.

PMP for bleeding

Bleeding is a consequence of a violation of the integrity of the vessel wall. It can be external or internal, arterial, venous or capillary. The ability to stop bleeding is essential for human survival.

PMP for bleeding requires compliance with certain rules.

1. It is necessary to wash a bleeding wound only if caustic or toxic substances have entered it. In case of other contaminants (sand, metal, earth), the damaged area cannot be washed with water.
2. Do not lubricate the wound under any circumstances. This prevents healing.
3. The skin around the wound is mechanically cleaned and treated with an antiseptic solution.
4. Do not touch an open wound with your hands or remove blood clots, as these clots will inhibit bleeding.
5. Remove from wound foreign bodies Only a doctor can!
6. After applying a tourniquet, you must immediately call an ambulance.

Applying a bandage

The bandage is applied directly to the wound. To do this, use a sterile bandage or clean cloth. If you doubt the sterility of the material, it is better to drip iodine onto it so that the stain becomes larger than the wound. A roll of bandage or cotton wool is placed on top of the fabric and bandaged tightly. When the bandage is applied correctly, the bleeding stops and the bandage does not get wet.

• Attention: in case of an open fracture and a protruding bone, it is prohibited to tightly bandage and set the bone! Just apply a bandage!

Applying a tourniquet or twist

A hemostatic tourniquet can both help in the fight against bleeding and aggravate the severity of the victim’s condition. This manipulation is resorted to only in cases of very heavy bleeding, which cannot be stopped by other methods.

If you don’t have a medical device at hand, a regular thin hose will do. In order not to pinch the skin, you can put a twist on your clothing (sleeve or pant leg) or place a piece of any dense fabric. The limb is wrapped with a tourniquet several times, so that the turns do not overlap each other, but there are also no gaps between them. The first one is the weakest, and with each subsequent one it is necessary to tighten it more strongly. The hemostatic tourniquet can be tied when the bleeding stops. Be sure to record the time the tourniquet was applied and secure it in a visible place. In the warm season, you can keep it for up to two hours, and in the cold - only an hour.

Hip injuries are a phenomenon that can be encountered even in Everyday life. Not only athletes or stuntmen find themselves in situations where hip bones break, but also people who are far from sports.

There are three types of damage:

• Traumatic – under heavy dynamic loads. They are open, closed, intra-articular.
• Pathological - due to bone tissue dysfunction.
• Chronic – due to long-term physical pressure(in people involved in active look sports).

Any damage can be aggravated by the displacement of fragments. If open, there is a risk of bacteria entering the blood, and if severe, there is a risk of shock.

Joints that can be damaged by a hip fracture

The cause of the violation of the integrity of the proximal part (neck and trochanteric region) of the femur is a fall to the side.

Signs of injury:

• distorted appearance of the joint;
• pain in the hip area;
• difficulty when trying to quickly change the position of the leg;
• reduction in the length of the injured limb.

Transport immobilization for hip fracture

Immobilization is the name given to the fixed immobilization of a broken limb.

To move the victim, the joints adjacent to the injured leg must be secured:

• knee;
• ankle;
• hip.

Tires required:

• external;
• back;
• internal.

All fixators must fit closely to the limb.

After taking the above measures, it is necessary to take the victim to the emergency room.

If the femoral neck is damaged

Immobilization for a femoral neck fracture is carried out according to the following rules:

• put the victim on his back;
• if there is pronounced pain, give analgesics;
• carry out the necessary fixation actions;
• It is forbidden to disturb the diseased part of the body again, so as not to cause damage;
• clothes should be cut, and if on the street low temperature– insulate a broken limb;
• movement should be carried out in a lying position on a rigid device (carrying).

Dieterichs splint for hip fracture

Application is carried out by adjusting the splint to the height of:

1. Give the outer branch the size from heel to armpit, and the inner branch from the groin to the heel.
2. The tires must be moved so that they extend beyond the foot at a distance of 8-12 cm.

Fixation of the jaw around the limb is achieved using pegs, so the slots should be opposite each other. To eliminate the possibility of displacement, the splints are secured with a bandage or bandage.

To prevent injuries at the points of support of the devices, place something soft under them and under the foot. If the heel is not sufficiently secured, immobilization will not be beneficial.

For reliability, it is necessary to apply several layers of cotton wool at the points of contact of the jaw with:

• ankle;
• the area around the greater trochanter;
• knee.

Both branches are attached to wire devices by planks under the sole and tied to the body with straps.

The leg should be extended to the level of correction, ensuring that the bars are in close contact with the groin and armpit. The heel is then attached with a twist to the bottom cross board.

Finally, the jaws are fixed to the body with bandages throughout the body, paying attention Special attention areas of the chest, lower leg and thigh.

If movement is necessary, rings made of medical bandage in 8 layers are used.

Additionally, Cramer splints are used to increase the strength of the structure and make it easier to change positions and move the patient. They are attached to each other, and the resulting part is applied from the shoulder blades to the lower third of the lower leg. Improper application of the splint can result in joint dislocation.

Technique for using ladder tires

Applying a splint to the hip begins with preparing the material. Procedure:

1. Fasten 2 tires along the length, bending the lower end of one at a level of 20 cm from the end. This part is designed for the outer surface of the leg and the side of the body up to the armpit.
2. The first splint is adjusted to the inner thigh.
3. The second part of the structure is formed with a recess for the foot and the knee joint.

Fixation of the leg with ladder splints is carried out according to the Dieterichs method.

Splinting with improvised material

In emergency situations, specialized devices for the immobilized limb may not be available. In this case, hard means can be used: boards, sticks. Their size depends on the size of the victim. In the absence of medical bandages, flexible soft materials can also be applied.

Immobilization as a treatment method for fractures

Proper fixation of the leg is an integral part of recovery.

In the absence of knowledge of a clear sequence of actions for providing first aid, it is necessary to give the victim analgesic drugs and calm him down until qualified specialists arrive. Any movement of the patient is prohibited.

Treatment of a hip fracture by immobilization is carried out in accordance with the following rules:

1. The affected area is treated with painkillers to local application. Novocaine or Lidocaine is most often used.
2. Bone tension lasts no more than 10 days.
3. Freeing the limb from restraints.
4. Movement of the patient from one side to the other.
5. Providing a sitting position.
6. Get up with crutches after 20 days.
7. Discharge (if there is no need for further doctor action).

Hip abduction orthosis

If pain persists after a hip fracture, a course of anti-inflammatory and painkillers is prescribed.

Wearing a fixing bandage helps reduce the load on the hip and speed up recovery. Basic properties of the orthosis:

1. Firmly fixes the hip.
2. Reduces pressure on the bone.
3. Possibility of fixing hip joint in a state of abduction.
4. Helps reduce swelling and pain.
5. Adjustable depending on body parameters.
6. The plastic parts of the orthosis are easy to use.

Immobilization for a hip fracture minimizes injury to adjacent tissues from bone fragments. Thanks to correctly provided first aid to the victim, the likelihood of complications is reduced. In the absence of knowledge and skills, it is necessary to urgently call specialists.

The hip joint is a large and important anatomical formation of the human body. Due to the significant functions that it has to perform in the process of life, it very often undergoes pathological changes even in childhood. Perthes disease is one such disease. This will be discussed in this article.

What kind of pathology is this

Perthes disease is a specific lesion of the anatomical structures that make up the hip joint. First of all, the head of the femur is susceptible to pathological transformation. Subsequently, destructive changes spread to the acetabulum and periarticular tissues. The sad result of such rearrangements is the destruction of the femoral head, deformation and dysfunction of the entire lower limb with its shortening compared to a healthy limb.

Perthes disease has the characteristic feature of primary onset in childhood. The disease can either stop its progression or cause severe consequences that will have to be dealt with throughout life. The incidence of osteochondropathy of the femoral head is low. The disease is registered mainly among boys in the age range from 3-4 to 13-15 years. Right-sided localization predominates, but it can be left-sided or even bilateral.

Important to remember! Perthes disease is called aseptic necrosis or osteochondropathy of the femoral head. This is due to the mechanisms of triggering and progression of the disease exclusively in childhood!

What is the basis of the disease

The pathogenetic basis of Perthes disease is considered to be circulatory disorders. All subsequent deviations are based on this link in pathogenesis. Therefore, the disease is called aseptic necrosis of the femoral head. This means that against the background of microcirculatory disorders of the hip area and everyday loads on the joint, a gradual destruction of the cartilaginous covering occurs, and then the bone base of the femur in the head area. It is this part of it that is most sensitive to ischemia (circulatory failure). Subsequently, osteoporosis occurs with osteomalacia and osteolysis (the bone softens and breaks down). Under the influence of weight, the length of the head and neck of the femur decreases according to the type of depressed fracture. Gradually, the limb shortens, and the hip joint becomes closed, as it becomes overgrown with dense scar tissue.

Causes

There is no single cause for the development of Perthes disease. All possible factors for its triggering are given in the table.

Important to remember! Children with to varying degrees The severity of circulatory disorders in the femoral head has different chances of triggering destructive changes. They always correlate with physical activity lower limbs of the child. The earlier and more intense the load on the sensitive hip joint, the faster the disease progresses!

Clinical picture

Perthes disease is characterized by the following symptoms:

1. Pain. The child begins to complain of pain in the limb. They are more pronounced when walking, but in advanced stages they manifest as pain at rest. How older child, the more clearly he points out the pain points.
2. Lameness. Children with Perthes disease eventually begin to limp on the affected leg when walking. Initially, lameness is moderate and is due to pain syndrome, but gradually becomes more noticeable due to structural changes in the hip joint and surrounding tissues.
3. Swelling and palpation pain in the hip area caused by a secondary inflammatory process.
4. Hypotrophy (decrease in mass and volume) of muscle groups that carry out movements in the affected hip joint. Such manifestations are associated with a reflex decrease in motor activity of the limb;
5. Restriction of mobility of the hip joint affected by Perthes disease, up to their complete absence with the inability to walk. More typical for older children and adults, as it is caused by the destruction of articular structures with their replacement by abnormal scar tissue;
6. Shortening of one of the limbs compared to a healthy one.

Diagnostics

Perthes disease is easily diagnosed using plain x-rays of the hip joint. The study does not have to be performed in two projections; only a direct one is sufficient. The disease may not be noticed at the first stage due to the lack of reliable radiological signs and criteria. Any subsequent stage can be easily diagnosed. Therefore, if after absence pathological changes An x-ray shows that the child continues to have pain in the hip joint; a repeat x-ray is indicated. Monitoring the condition of the joint can be carried out using ultrasound examination. It is rare to resort to such expensive diagnostic methods as computed tomography or magnetic resonance imaging.

How can you help?

Unfortunately, treatment of Perthes disease in children and its consequences in adults is not as easy as diagnosis. The possibilities for restoring lost blood flow in the area of ​​the affected joint are modest, despite the abundance medications and instrumental methods.

You can help stop the destruction of the head of the hip joint by improving metabolic processes in the body and unloading the affected limb. The ways to achieve treatment goals are:

1. Administration of drugs that improve microcirculation: pentoxifylline and its analogues;
2. Metabolic agents: solocoseryl, mildronate, mumiyo;
3. Vitamin therapy. B vitamins are especially valuable in the form complex drugs(Milgama, Neuobex, Neuromax);
4. Calcium preparations: calcium D3-Nycomed, calcemin;
5. Chondroprotectors: alflutop, teraflex, artron complex, movex. Used in older children and adults;
6. Limitation or complete elimination of loads on the affected limb. In young children it is achieved by applying a variety of plaster splints, traction and splints for a long period. Children of elders age groups can move only with the help of additional devices (crutches). Any load on the hip joint is strictly prohibited. The joint can be fixed using a custom-made orthosis. The duration of immobilization is determined by the attending physician individually in each specific case.
7. Physiotherapeutic procedures and exercise therapy. Electrophoresis, paraffin baths, UHF, magnetic therapy and exercises to strengthen the muscles of the thigh and gluteal region are mandatory;
8. Spa treatment. It is advisable that it be carried out in specialized sanatoriums for children with similar problems. A lot depends on the correctness of its implementation. Mud therapy methods are used, water procedures, herbal medicine, massage and gymnastics.
9. Surgery. In childhood, it is indicated in rare cases and is aimed at temporary restoration of the axis and length of the limb. Those cases of Perthes disease when, despite conservative measures taken, it was not possible to stop the destruction of the hip joint, are subject to surgical treatment. Its essence is the replacement of destroyed structures with an artificial prosthesis (endoprosthetics).

Important to remember! The more early age Perthes disease begins, the greater the child’s chances of a full recovery with minimal destructive changes to the hip joint!

Perthes disease is an ambiguous pathology, the outcomes of which largely depend on the cause of microcirculatory disorders in the hip joint. The more pronounced they are, the less opportunities there are to stop the progression of the disease, even with complex treatment.

If a hip fracture occurs, the patient must be taken to a medical facility as soon as possible, since complications may occur if first aid is provided incorrectly. An ambulance should be called to transport the victim; the injured limb must be properly immobilized. Before doctors arrive, pain can be relieved with analgesics.

For immobilization, a medical splint or improvised materials are used to assemble the fixing structure. 3 joints are fixed - ankle, knee and hip - with three products of different lengths. The first splint runs along the body, the second is attached to the back of the thigh, the third fixes the area from the groin to the foot. The following types of tires can be used: ladder, pneumatic, Boller design, Dieterichs tire. The product should not touch the skin. It is better to apply the structure over clothing.

Competent first aid for damage to the femur is the key to the success of further treatment. Regardless of the person’s condition, the first step is to call an emergency medical team. To prevent painful traumatic shock, narcotic analgesics are used. The victim is then prepared for transport.

Immobilization plays an important role during transportation. It helps prevent the fragments from moving. For this purpose, a special medical splint is applied, or lower limbs can be fixed using available materials (bandages, towels, items of clothing, boards, branches). Modern medical cars are equipped with special damper stretchers - such a device dampens vibrations when the car moves, reduces shocks and shocks.

Immobilization

If any part of the femur is damaged, three adjacent joints must be fixed simultaneously during transportation - the hip, knee and ankle. Such fixation in case of a fracture is achieved by applying three splints of different lengths: the first, the longest, is fixed to the body. It runs from the armpit along the torso and leg, protruding slightly beyond the foot. The second runs along the back of the thigh from the buttock to the foot. The third is from the groin to the foot. The splints must be fixed at three points - at the level of the joints.

For an open fracture, the technique for applying immobilization agents is similar. Additionally, you will need to use a tourniquet to stop bleeding; a splint is applied with fixation above and below the fracture area.

Types of tires

Special medical supplies immobilizations differ not only in design features, but also in materials (metal wire, wooden slats, plastic, cardboard), sizes, and operating principles (there are fixing splints and those with a traction function). In the warm season, a gypsum splint is used. Let's take a closer look at some types:

• Staircase - for yours appearance resembles a rope ladder made of wire. The undoubted advantage is flexibility, thanks to physical properties material, such a splint can be modeled according to the shape of the affected limb. At the same time, this design has low strength, and since in case of a hip fracture it is necessary to use a long-length clamp (to fix three joints, including a very mobile one - the knee), such a splint is easy to break.
• Dieterichs splint - consists of wooden planks, has high rigidity and reliable fixation, mainly used for hip fractures. Disadvantage: during long-term transportation, due to its high rigidity, it provokes the formation of bedsores.
• Pneumatic tires - easy to apply, the fixing effect is achieved due to the air pressure inside the tire. They are compact, mobile, and thanks to their design features, they completely replicate the relief of the limb being fixed.
• Boller, Pankov splints are extension splints, the limb is half-bent and slightly abducted, but at the same time it is fixed to the body and healthy leg. Such designs allow you to change the position of the limb, which subsequently makes it possible to carry out therapeutic exercises. Thanks to the design features, the size can be easily adjusted and is used for both adult and pediatric patients.

Overlay methods

The main rule of splinting for a femur fracture is that the injured limb must be fixed on both sides simultaneously.

The internal splint immobilizes two joints - the knee and ankle, while the external splint immobilizes three - the ankle, knee and hip. The main task of such immobilization is to prevent dislocation of the head of the hip joint. On the groin side to prevent injury and minimize discomfort place a small soft cushion.

Splinting is performed in the supine position after using painkillers. If the victim has open wounds, perform appropriate aseptic and antiseptic treatment, apply a sterile bandage. The immobilizing agent should not be allowed to come into direct contact with skin– you can put a gauze bandage or any of the available means. The splint is fixed firmly over clothing and shoes, but maintaining the normal intensity of blood circulation. If there is visible deformation, the remedy is applied on the side opposite to it; it is strictly forbidden to correct the damage on your own. Some splints (Diterikhs, for example) must be adjusted to the patient’s height before use, or parts of the splints must be used when helping children.