Treatment of bone fractures begins with first aid to the victim and ends with a course of rehabilitation. A bone fracture is one of the most common types of injury. It can occur due to a severe blow or a disease that affects the strength of bone tissue.
A fracture occurs as a result of any traumatic action or due to increased fragility of bones and represents a complete or partial violation of the anatomical integrity of the bone.
At the moment, there are several classifications based on certain characteristics. Such detailed characterization is required to determine the most effective treatment strategy.
The most common cause of a fracture is some kind of trauma that breaks the integrity of the bone under the influence of an external force. Multiple fractures or combined with other injuries are especially dangerous.
There are also fractures that occur due to tissue damage by diseases such as osteomyelitis or osteoporosis. As a rule, the victim feels pain in the area of the fracture even before it occurs. And the occurrence of a pathological bone fracture occurs when an injury of inadequate strength is received, for example, from a fall from a small height or from a blow with a light object.
Osteoporosis is a disease that affects bone tissue, causing it to become brittle and porous. Fractures are considered the most obvious symptom of osteoporosis, and specifically a hip fracture is the most dangerous. Until a fracture occurs, the patient often does not realize that he is developing osteoporosis. For this reason, if a patient believes that he received a fracture from a minor injury, he should undergo an osteoporosis diagnosis - densitometry. If the device shows that bone density is reduced, the patient will have to reconsider his lifestyle in order to avoid repeated fractures: include more calcium in the diet and start taking special medications - osteoprotectors.
Diagnosis of bone fractures is carried out by x-ray examination. X-ray films the area of the suspected fracture from several angles and in different projections. Based on the image, a traumatologist can most accurately classify a fracture, looking at its fragments, the direction of displacement and other signs. After treatment has begun—either conservative or surgical fixation—the patient is again x-rayed. And the next examination is carried out no earlier than two weeks later to monitor the fusion.
Help for the victim must be provided in the very first minutes of injury. First, you need to relieve the pain shock, especially for children. If it is an open fracture, it is necessary to stop the bleeding and prevent infection. The next stage is immobilization, that is, creating conditions in which the broken limb will be absolutely immobile. Never try to set bone fragments yourself, as this may result in internal bleeding or bone displacement.
Within the walls of a medical institution, the patient is immediately diagnosed, then the debris is compared (displaced) and securely fixed. The artificial displacement of parts of the bone is called reposition and can be open or closed. With closed reduction, bone fragments are compared manually or using special devices; if necessary, a skeletal traction system is used. Such methods are most often used in the treatment of closed fractures. Open reduction involves surgery and then connecting the pieces of bone using fixation devices.
Fractures are restored in different ways, it depends on the complexity and location, the time frame varies from several weeks to several months. The rehabilitation course is prescribed by a doctor a few days after receiving a fracture and is based on three components - physical therapy, magnetic therapy and physiotherapy.
Therapeutic exercise includes a set of special exercises, the implementation of which will prevent the process of tissue degeneration of the damaged limb and muscle atrophy from beginning.
Magnetic therapy is used to restore muscle strength and coordination of movements. Complex fractures cannot be treated without this method.
Physiotherapy is a complex of different procedures that are used for different periods. At the beginning of treatment, ultrasound and UHF heating are used to relieve swelling and pain. Then electrophoresis and laser therapy, when the plaster is already removed. Passive exercise therapy is a medical massage, which also acts on the central nervous system, relaxing it or, conversely, activating the activity of all ongoing processes.
Proper physical activity. Before sports training, be sure to warm up and agree on an individual set of exercises with the instructor.
Getting rid of bad habits. When talking about the dangers of smoking and alcohol, people most often think of the lungs, liver and kidneys, but toxins cause just as much damage to the bones.
Nutrition. If the body does not receive the required amount of calcium, it makes up for the deficiency at the expense of bone tissue, reducing its density. Another microelement necessary for bones is vitamin D, which is formed in the skin due to sunlight. This substance is most needed in childhood and old age, since during these periods it is most poorly absorbed.
Prevention of falls. Quite a large percentage of household fractures. Therefore, the floor must be non-slippery, especially in the bathroom; wires must be removed from the floor so that they cannot get tangled in them. When outdoors, you should cross the road correctly and wear shoes appropriate for the weather.
For an effective treatment method, the doctor must identify the arthritic form.
Diagnosis comes down to determining the degree of damage to the shoulder joints. There are three forms of arthritis.
The main cause of osteoarthritis or arthritis is aging and wear and tear of tissue. The result of these degenerative processes is the destruction of the outer, smooth surface of the bone (articular cartilage). Most often, people who have crossed the age of 50 are susceptible to osteoarthritis.
People of any age are susceptible to the appearance of a systemic inflammatory process of the synovial membrane, called rheumatoid arthritis. This type of arthritis is characterized by damage to symmetrically located joints.
Post-traumatic arthritis (a form of osteoarthritis) is caused by trauma. This may be an inflammatory process after a crack, joint displacement, or rupture of the rotator cuff muscle.
Pain in the joint is the first symptom of arthritis. At first it bothers you during physical activity of the joints, then the pain begins to bother you more often, even at rest.
Clinical signs manifest themselves in different ways. The inflammatory process in the scapulothoracic shoulder joint is manifested by pain in the posterior region of the shoulder. It may intensify depending on the weather.
When the acromioclavicular joint is injured, pain is felt in the front of the shoulder. If arthritis simultaneously affects the scapulothoracic and acromioclavicular joints, pain worries the patient in both the anterior and posterior regions of the shoulder.
The progression of the disease affects joint mobility. The process of combing hair becomes difficult, the arm has difficulty lifting up, the joint “crunches,” and crepitus—crushing of the bone—is felt. Every movement is accompanied by pain not only during the day, but also at night, which disrupts sleep.
An accurate diagnosis of arthritis and its degree can be made after a medical examination based on test results, including an x-ray of the joint.
The patient is 31 years old. The joint gap is sharply narrowed.
Diagnosis: rheumatoid arthritis
An x-ray reveals a narrowed joint space, degenerative and destructive changes in the articular cartilage, followed by reactive bone growths (osteophytes), leading to dysfunction of the joint. To relieve pain, an injection of an anesthetic injected into the joint is used. If after the injection the pain subsides, then the diagnosis was made correctly.
The same patient 9 months later.
Negative dynamics of radiological changes.
Any form of arthritis of the shoulder joints is subject to complex therapy. In order to treat inflammatory processes, medications and physiotherapeutic procedures are prescribed to get rid of not only the clinical signs of the disease, but also the source of infection that caused the inflammatory process.
The patient is advised to change the rhythm and lifestyle, avoid movements and physical activity that cause pain. A positive effect is observed from the use of warm compresses and the use of nutritional supplements (chondroitin, aminoglucose, etc.).
Chondroprotectors help slow down destructive processes and even restore joint functionality with the help of biologically active substances included in their composition. Since the primary symptoms of arthritis are pain, swelling, and stiffness of the joint, at the very beginning treatment is aimed at stopping the inflammatory processes. For this purpose, therapeutic and surgical methods are often used.
To treat shoulder arthritis, the use of physical therapy is mandatory. It helps stretch and strengthen muscles and prevent atrophic changes.
After diagnosis, the doctor first prescribes medication and physiotherapeutic treatment, the results of which often help to avoid surgical intervention. And only in the absence of positive results from non-invasive treatment methods, if it is obvious that the disease is progressing, is surgery prescribed.
Depending on the extent of the damage, the shoulder joint is completely replaced with a prosthesis (arthroplasty) or only the upper part of the shoulder bone is replaced with a prosthesis (hemiarthroplasty). During acromioclavicular joint replacement surgery, a small, inflamed portion of the collarbone is usually removed. In place of the resulting void, dense connective tissue forms over time. As a result of this resection, the functions of the joint are preserved.
Despite the achievements of modern medicine, any operation is associated with certain risks and complications. An orthopedic doctor tries to foresee and minimize the negative consequences of any surgical intervention.
In addition to all kinds of lotions, ointments, compresses, complex therapy for arthritis of the shoulder joints includes decoctions and infusions of herbs, which since ancient times have been used by traditional healers to relieve pain and combat inflammatory processes.
Many patients report positive results after taking a decoction of lingonberry leaves. For its daily preparation, two teaspoons of leaves are enough. They are filled with water (1 glass) and boiled for 15 minutes over low heat. The cooled decoction is filtered and taken throughout the day.
To prepare it, you need to put 20 grams of leaves in a glass and completely fill the container with boiling water. After 20 minutes, the infusion is ready for use. Take 1 tablespoon three times a day.
For the decoction, 3-4 grams of dry blackcurrant leaves poured with boiling water is enough. After 15 minutes of infusion, the decoction is drunk completely. It should be prepared and taken three times a day.
Creeping thyme is also used in folk medicine as an anti-inflammatory agent. 15 grams of dry crushed herbs are poured into a glass and infused for 15 minutes. The infusion is drunk during the day in equal portions in 3-4 doses or used for compresses.
Corn silk (1 teaspoon), poured with boiling water (1 cup) and boiled for 10 minutes, can be used instead of tea. Honey added to the decoction enhances its healing properties. Traditional healers recommend treatment for at least two weeks.
The elbow joint is a complex mechanism of three simple joints (humeroradialis, humeroulna and radioulna) that provides movement to the three bones of the arm: the ulna, radius and humerus. That is why, when at least one elbow joint is affected by arthritis (inflammation), it becomes difficult or even impossible to move the arm. Read this article about how to suspect this common disease in time, what are its causes and how to treat arthritis of the elbow joint.
Like other types of arthritis, arthritis of the elbow creeps up unnoticed: at first it is barely noticeable discomfort in the morning and aching pain “due to the weather,” especially often arthritis comes with cold weather. The pain goes away quite quickly, and only a few people consult a doctor in the first stages of the disease. And only when arthritis of the elbow joint worsens or becomes chronic, a person usually seeks medical help and undergoes quite a long treatment. Most often, these are elderly people over 65 years of age: every sixth person at this age suffers from complications of elbow arthritis, and sometimes even becomes disabled.
Elbow pain in only 10% of cases is a symptom of arthritis. But it’s not worth hoping that you’re not sick, and it’s not worth taking risks without getting diagnosed. It is better to exclude the disease than to allow it to develop, because inflammation can spread from the elbow to other joints.
Arthritis of the joints can be recognized by pain, which differs depending on the cause of inflammation (dull and aching - with gouty arthritis, sharp and restricting movement - with rheumatic arthritis). Local symptoms also include swelling and redness of the skin, a local increase in temperature in the elbow area, and deterioration in mobility. All these signs indicate damage to the articular cartilage and excess fluid around it.
General symptoms of elbow arthritis do not appear immediately and intensify as the problem worsens. First of all, it is fatigue, heat and fever, headache, nausea.
Arthritis of the elbow joint in acute and chronic form can have serious complications. Without treatment, the tissue around the inflamed joints can tighten, causing the arm to become locked in one position and no longer extend (joint stiffness). The defect can be corrected by plaster, and in particularly difficult cases, surgery. Also, the consequences of untimely prevention and treatment of arthritis are phlegmon - purulent inflammation of the deep or superficial tissues of the hand, bursitis - inflammation of the periarticular bursa, ankylosis - fusion of joints and complete loss of motor ability of the hand.
An accurate diagnosis of elbow arthritis is made by a rheumatologist, orthopedist or arthrologist. But palpation and other clinical methods of examining the patient alone are not enough. For a complete clinical picture, you will need a direct and lateral x-ray of the elbow and, what is important for identifying all inflammatory diseases, a general blood test. If the localization of the inflammatory process cannot be determined, ultrasound examination (ultrasound), MRI, atromography or diagnostics using a thermal imager come to the rescue. But sometimes this is not enough to find out the true cause of arthritis of the elbow joint. In such cases, an analysis of the synovial fluid (SF) of the elbow joint may also be necessary - it is removed using a medical needle (puncture). Data on the contents of the periarticular fluid obtained during the analysis of the SF allows the doctor to accurately determine the presence of arthritis and its type (inflammatory or non-inflammatory), since inflammation can also be caused by bacteria.
Interestingly, only women are at risk of inheriting arthritis of the elbow joint. In their case, the HLA-B27 gene may be the trigger for arthritis. This explains why elbow arthritis is more common in females.
A common etiological factor for men and women is rheumatic diseases (collagenoses), occurring predominantly with systemic or local damage to the connective tissue (rheumatism and complications of other diseases, systemic vasculitis, diffuse tissue diseases).
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Microcrystalline arthritis is a group of joint diseases caused by the deposition of crystals; the most common are urates (cause gout) and calcium pyrophosphates (cause of pyrophosphate arthropathy).
Psoriatic arthritis is a concomitant inflammation of the joints, which in 10% of cases appears with a chronic disease of the skin and nails - psoriasis - and this does not always happen at the same time. Sometimes psoriatic arthropathy appears after 10 years or, on the contrary, precedes the symptoms of psoriasis.
Reactive arthritis - inflammation of the joints after an infection, incl. STDs (chlamydia, gonorrhea, syphilis) or intestinal disorders (yersiniosis).
Osteoarthrosis is a group of diseases that affect the cartilaginous tissue of the articular surface (articular cartilage, subchondral bone, ligaments, bursa, capsule and muscles).
Bechterew's disease is a chronic progressive inflammation of the intervertebral joints, which leads to their fusion.
Hemorrhalgic vasculitis is a disease primarily affecting the capillaries of the skin, joints, gastrointestinal tract and kidneys. Joint damage is observed in most patients with this type of vasculitis, although large joints are most often affected.
Buerger's disease (thrombagiitis obliterans) is a pathological process of blood flow disturbance, which is characterized by inflammation of small vessels of the extremities and spreads to large vessels.
Periarteritis nodosa is an arterial disease that causes damage to the arteries of internal organs.
Systemic lupus erythematosus is an autoimmune disease in which the immune system begins to kill healthy cells, in the process producing substances that damage the skin, internal organs and joints.
Dermatomyositis is a systemic disease of connective tissue and muscles accompanied by impaired motor function. Joint syndrome is manifested by pain and impaired mobility.
Systemic scleroderma is hardening of connective tissue with subsequent damage to internal organs. Joint damage manifests itself as pain and stiffness.
Mixed connective disease (Sharpe's syndrome) is an autoimmune connective tissue disease that causes symptoms of lupus erythematosus, systemic scleroderma, myositis and rheumatoid arthritis.
Treatment for elbow arthritis will directly depend on the causes of its occurrence. Primary arthritis is not associated with other diseases, while secondary arthritis accompanies other diseases that need to be treated first. Infectious arthritis can also be primary (infection enters directly into the elbow joint through wounds) and secondary (viruses and bacteria enter through adjacent tissue).
Surgical treatment is a last resort, which is used only in very difficult cases. Most often, conservative treatment, which consists of drug therapy, physiotherapy, massage and therapeutic exercises, is sufficient.
Usually a person consults a doctor when pain in the elbow joints begins to bother him, but the doctor’s main task is not only to relieve pain, but also to stop the inflammatory process in the joints. This is the logic of treating elbow arthritis: painkillers and non-steroidal anti-inflammatory drugs are prescribed. After the attending physician is convinced of the accuracy of the diagnosis, assesses the cause of arthritis and its location, he may prescribe the following medications.
Other medications for the treatment of elbow arthritis : If the arthritis is due to an infectious disease, antibiotics are indispensable. Since drug treatment does not always act sparingly, no matter how much one would like it, immunostimulants and antitoxic drugs, as well as diet and proper nutrition for arthritis, which we have already written about, help the body survive stress.
Treatment of arthritis of the elbow joint includes not only tablets, injections, but also local effects on the affected joint: creams and ointments, gels and lotion solutions. They help relieve swelling, reduce pain and improve motor ability of the hands.
During a flare-up of elbow arthritis, it is often recommended to wear elbow pads, braces, or regular bandages.
If the inflammation is accompanied by the release of pus, it must be immediately removed and the affected area treated with a strong anti-inflammatory agent (butadione, neurodiclovit, etc.).
To avoid fusion of joints and muscle atrophy, the doctor may prescribe additional physiotherapeutic procedures using magnetic or ultrasonic waves, laser, electropheresis, etc. However, such manipulations are only possible if the pain has passed and a period of remission has begun.
Therapeutic exercise, massage, healing mud are a good additional means of preventing arthritis of the elbow joint and treating it.
Arthroscopy for arthritis of the elbow joint is surgery on the elbow joint under conduction anesthesia or general anesthesia through small punctures and incisions, which is the main advantage. Firstly, with arthroscopy, the joint is practically not injured during the access process, and secondly, significant scars can be avoided after surgery. This operation can identify and remove even small defects in the affected joint and minimize complications.
Endoprosthetics of the elbow joint - just an hour at the operating table is enough for modern surgeons to replace damaged parts of the elbow joint with implants. And the very next day after the operation, the patient will undergo therapeutic exercises under the guidance of a specialist. At first these are simple exercises, then they become more active, within a week after endoprosthetics, electrical myostimulation is prescribed, and in most cases the patient is safely sent for treatment at home.
Artodesis for arthritis of the elbow joint is the removal of articular cartilage on the articular surfaces of the radius, ulna and humerus, instead of which a piece of bone removed from the olecranon is placed into the cavity in the area of the olecranon fossa and fixed. The patient is advised to avoid putting weight on the joint for eight weeks, and after six months the implant is removed. Doctors do not often resort to such an operation, since the arm may subsequently become shortened.
Arthrolysis of the elbow joint is an external surgical intervention under conduction or general anesthesia, after which the range of motion in the loose joint is reduced due to the creation of additional ligaments and bone restraints. This operation is prescribed in cases where a person loses the ability to bend and straighten the arm at the elbow.
Synovectomy for arthritis of the elbow joint - removal of part of the periarticular membrane under conduction anesthesia or general anesthesia. The operation is quite gentle and is necessary in cases of rheumatoid arthritis. After surgery, it is possible to maintain the motor function of the joint and completely stop the inflammatory processes in other parts of the elbow joint.
Elbow osteotomy is the removal of the olecranon or part of the bone to relieve pressure on the joint. Often in surgery, longitudinal osteotomy is used, which reduces the time of refixation of the removed fragment of the olecranon, while the fastening can be positioned so that the patient does not feel discomfort in the postoperative period. Also, the fixators are removed through small incisions, which improves the cosmetic effect after surgery.
Resection for arthritis of the elbow joint - partial or complete removal of the joint. Most often, it is enough to resect only a small part of it to completely restore the function of the elbow. In some cases, the head of the radius is removed, especially in older people who have developed traumatic arthritis. In young people, the radius bone is not removed because this may cause deformation of the joint. Complete removal of the joint is performed for purulent arthritis. During the operation, catheters are inserted into the wound to continuously administer antibiotics.
Elbow arthroplasty is the replacement of damaged areas of the joint using an artificial implant or biological graft. The operation is carried out using a camera and a modern micro-instrument - an arthroscope. Sometimes the entire elbow joint or one of its three components is transplanted. Arthroplasty is designed to maintain joint mobility and gives good results, especially in young patients. This is a closed type of operation, and the patient will be able to go home after an hour or two, having received a list of painkillers and anti-inflammatory medications.
The foot is a complex anatomical structure, which is one of the important components of the musculoskeletal system and can withstand disproportionately large dynamic and static loads. This part of the body performs several functions, the main one of which is the spring. It lies in the ability of the foot to absorb loads and walking. The human foot is divided into three sections and includes 26 bones and 4 osteoarticular joints. An inflammatory process that affects one or several joints at the same time is called arthritis of the foot.
The development of foot arthritis occurs when there are changes in the synovial fluid (the elastic mass that fills the joint cavity and protects the joint from damage), as well as when inflammation develops in it.
If inflammation occurs in one of the joints of the foot (subtalar, talocaleonavicular, calcaneal-cuboid or sphenavicular), the volume of synovial fluid in the articular joint increases significantly. It begins to compress the synovial membrane, and that, in turn, due to the presence of a large number of nerve endings, begins to respond almost instantly with an inflammatory reaction.
In clinical practice, all foot arthritis, which includes about 100 different pathologies, is usually divided into 2 large groups:
The main reasons provoking the development of the pathological process include:
It should be noted that the provoking factors for the development of inflammation are most often hypothermia and heavy physical stress on the joint.
Despite the fact that there are many reasons that provoke the development of inflammation, the clinical picture for all arthritis is quite similar. All symptoms are divided into specific (characteristic only for this pathology) and nonspecific (occurring in arthritis of any origin).
As a rule, when inflammation develops in one (or several) joints of the foot, making a diagnosis does not present significant difficulties.
First of all, a diagnostic examination and collection of the patient's medical history is performed, which allows establishing a connection between damage to the joints of the foot and the presence of an infectious disease, injury, allergy, focal infection or other pathological process.
Next, the patient is recommended to undergo all the necessary laboratory tests (general blood and urine tests, blood for C-reactive protein, rheumatic complex, etc.) and undergo an X-ray examination in two standard projections. Electroradiography of the foot joints has also proven itself to be effective.
A sufficiently informative study to clarify the nature of the inflammatory process is joint puncture and subsequent morphological examination of the synovial fluid.
If it is necessary to conduct a specific study, patients are prescribed an analysis for LE cells (if the development of systemic lupus erythematosus is suspected), a blood test for uric acid (for gout), and also to detect the presence of antibodies to cyclic citrullinated peptide (for rheumatoid arthritis).
Therapy for foot arthritis in each specific case is prescribed purely individually after determining the cause of inflammation and is performed in a complex manner. The treatment algorithm includes etiotropic and pathogenetic drug therapy, as well as non-drug correction of the disease.
To relieve pain and relieve inflammation, patients are prescribed non-steroidal anti-inflammatory drugs of systemic and local action. When treating rheumatoid arthritis, the drug complex necessarily includes basic immunosuppressive drugs, as well as hormonal agents.
Antibacterial or antiviral drugs, chondroprotectors and immunomodulators can be used as a specific treatment prescribed according to medical indications.
Physiotherapeutic treatment of foot arthritis is recommended only when the disease is not exacerbating. Cryotherapy, massage and laser treatment have proven themselves well.
At the same time, patients are recommended to regularly perform therapeutic exercises, reduce the load on the joints of the foot, make nutritional corrections, and, with the permission of the attending physician, use certain methods of traditional medicine.