В гипсе на сломанных конечностях нет ничего забавного. Это доставляет массу неудобств, начиная от перемещения в пространстве, заканчивая мытьём и невозможностью почесать загипсованное место. Но всё же эти ежата, котята, щенята и даже хомячки с покрытыми гипсом лапками неизменно вызывают у нас не столько жалось, сколько умиление:
Перелом ноги представляет собой травму одной или нескольких костей нижних конечностей, с последующим нарушением их целостности. Такие повреждения довольно таки распространены и могут очень сильно влиять на привычный образ жизни человека. Если у пострадавшего повреждена одна нижняя конечность, то он не сможет свободно ходить и заниматься своей обычной работой, делами.
В первую очередь, травма возникает в результате неосторожного хождения по улице или по дому.
На втором месте по распространенности фактора повреждения ног – это ДТП и падения с высоты.
Третье место отводится производственным несчастным случаям и криминальным разборкам.
Причиной, приведшей к таким травмам, могут быть заболевания, имеющиеся у пострадавшего, и кость в этом случае ломается даже в результате небольшой нагрузки на конечность. Чаще всего травмирование возрастает у людей, страдающих остеопорозом.
В группу риска получения травмы входят — спортсмены, переломы могут происходить у малышей или детей постарше, связано это с их повышенной подвижностью и неосторожностью, у пожилых людей, из-за возрастных патологий, происходящих в структуре костей.
Классификация травмы
Единой классификации для данной травмы не существует, так как имеются определенные показатели, от которых зависит тот или иной тип перелома.
В зависимости от степени тяжести, выделяют следующие повреждения конечностей:
- Полные – такие травмы бывают как без смещения, так и со смещением, но чаще встречается перелом ноги со смещением.
- Открытый перелом ноги. При этой травме присутствуют телесные повреждения, с выходом кости наружу.
- Закрытый перелом ноги. Он располагается внутри мягких тканей.
- Травма с осложнениями в виде жировой эмболии, инфицирования, травматического шока или повреждений других органов.
- Неосложненные сломы. Они протекают значительно легче.
От места локализации травмы, выделяют следующие виды:
- Повреждения бедренной кости. К этим травмам можно отнести перелом проксимального конца, диафизарный и перелом мыщелков бедра или, как его еще называют — дистального конца кости.
- Повреждения голени — травмы дистального характера, с разломом голеностопа и мыщелков кости большеберцовой.
- Повреждения стопы, при этом травмируются предплюсна, плюсневые кости и фаланги пальцев.
От того, какие особенности имеет линия слома, выделяют следующие виды:
- Поперечный – линия разлома располагается поперек оси.
- Косой – линия перелома располагается под углом к кости.
- Продольные повреждения – проходят вдоль кости.
- Винтообразный перелом излом по спирали повреждает кость.
Если повреждение осложнено наличием костного отломка, то переломы можно классифицировать следующим образом:
- Отрывная травма — от кости отходит небольшой фрагмент.
- Полифокальная травма – от костей оторвалось два и более крупных фрагмента.
- Вколоченная травма – один осколок входит в другой.
- Оскольчатая травма — имеются осколки.
- Раздробленная травма – множество мелких осколков.
- Компрессионная травма провоцируется сжатием конечности.
Переломы проксимального и дистального концов кости бывают эпифизарными или метафизарными. Если сломана нога в месте сустава, то наблюдается сопутствующее повреждение суставных структур, а также хряща, капсулы и связок. Данный перелом может сочетаться с подвывихом или вывихом.
Околосуставные переломы ног появляются в переходной зоне между суставным концом и диафизом и часто бывают вколоченными.
Диафизарные переломы располагаются в средней части кости и в этом случае отломки смещаются.
Симптомы
Появление переломов при получении травм характеризуют следующие относительные признаки перелома ноги:
- В зоне повреждения при осевой нагрузке на ногу усиливается болевой синдром.
- В месте травмирования появляется отечность. Данный критерий является относительным и, не входит в основные симптомы перелома.
- Гематома на месте травмы возникает через определенное время и у каждого пострадавшего проявляется индивидуально.
- При аномалии функциональных особенностей ноги, симптомы проявляются в виде ограничений подвижности конечности.
- У людей с переломом ноги может произойти повышение температуры тела. Это обычно связано с разрушением мягких тканей, костного мозга и процессом всасывания крови. Температура при переломе ноги возникает не у всех больных и продолжается не более недели не причиняет сильный вред здоровью.
Как определить перелом ноги самостоятельно, до приезда скорой помощи, если ребенок сломал ногу?
Любые симптомы повреждения зависят от степени тяжести и к относительным признакам переломов добавляются абсолютные. Распознать слом можно по следующим показателям:
- сломанная нога располагается неправильно, присутствует явное отклонение от анатомического вида;
- аномальная подвижность конечности в непредусмотренных для этого участках ног без взаимодействия с суставом;
- при пальпации места повреждения слышен характерный звук — крепитация;
- если произошел открытый перелом ноги у ребенка или взрослого, то в ране могут быть видны обломки кости;
- если произошел излом надколенника, то отек появляется моментально, ногу невозможно согнуть и разогнуть и если отломки кости не разошлись больше, чем полсантиметра, то пострадавший сможет наступать на ногу.
- при повреждении стопы появится незначительная отечность, и больной не сможет встать на ногу.
Первая помощь при переломе
Что делать при переломе нижних конечностей? Первая помощь при переломе ноги начинается с осмотра пострадавшего. Если помощник способен распознать повреждение, он может отличить степень травмирования и знаком с видами переломов, то он сможет, не причиняя вред здоровью, осуществить при переломе ноги первую помощь.
И так, что делать, если сломал ногу человек на улице или дома, или на предприятии? Алгоритм действий стандартен, главное понимать и соблюдать ход действий:
- Вызов бригады скорой помощи.
- Если у пострадавшего имеется кровотечение из крупных сосудов ноги, то необходимо наложить жгут на ногу, сроком не более чем на 2 часа.
- Если после перелома ноги человек испытывает сердечную или дыхательную недостаточность, то ее следует купировать.
- При наличии болевого синдрома допускается прием обезболивающих медикаментов.
- Иммобилизация поврежденной нижней конечности производится при помощи подручных средств, в виде косынки, куска ткани и веток, досок.
- Госпитализация пострадавшего в медицинское учреждение.
Понять, какой именно произошел перелом можно только в травмпункте.
Диагностика
Лечение перелома ноги проводится после проведения диагностики патологии.
Диагноз выносится на основании:
- Сбора анамнеза.
- Жалоб пострадавшего.
- Визуального осмотра.
- Инструментальной диагностики.
Назначая рентгенологическое исследование, врач указывает, что снимок необходимо сделать в двух проекциях. Благодаря прямой и боковой проекции вероятность постановки неправильного диагноза сводится к минимуму, так как на полученных снимках можно увидеть локализацию и характер перелома, расположение осколков и инородных тел.
Опираясь на полученные данные, лечащий врач объяснит своему пациенту и его близким, какой произошел перелом – без смещения или с ним, какой вред здоровью может причинить полученная травма. Так же специалист расскажет, сколько заживает перелом ноги, необходим ли гипс и если да, то, сколько ходить в гипсе при переломе ноги.
Лечение
Лечение заключается в приведении поврежденных костей ног в анатомическое положение с обязательной фиксацией. Необходимо это для того, что бы срослись правильно косточки.
При поступлении в больницу в качестве первой помощи медики купируют боль пациенту при помощи обезболивающих препаратов через капельницу или ингаляционную маску, а также обеспечивают неподвижности конечности посредством шины. После постановки диагноза, специалист назначает лечение.
Если перелом без смещения и отеков, и серьезный вред здоровью не выявлен, то лечение ограничивается наложением гипса. При сильном отеке, накладывается шина.
Перед фиксацией, если кости сместились, то необходимо произвести репозицию закрытого вида. При ее проведении пострадавшему могут назначить местный или общий наркоз, при котором полностью отсутствуют болевые ощущения. После того как кости были приведены в анатомическое положение, больному накладывается гипс, сколько ходить после перелома в нем, будет зависеть от того, как срастаются кости.
Переломы ног с осложнением необходимо лечить при помощи хирургического вмешательства с последующей внутренней фиксацией кости с помощью спиц, пластин, винтов. Металлические конструкции в будущем удаляют полностью или частично. Оставляют их в том случае, если они являются основными фиксаторами и заменителями утраченных или раздробленных участков костной ткани.
Очень редко специалисты прибегают к использованию внешних каркасов. Это дает возможность закрепить кость в нужном положении при помощи болтов, которые снимают после того, как срастется травма. Данная методика довольно сложная, по времени лечение длится дольше, но результат дает положительный.
Важно! Гипсовую повязку после перелома ноги накладывают практически в 100% случаев. Как долго его необходимо носить зависит от перелома.
Сроки ношения гипса варьируются и зависят от степени тяжести и месторасположения излома, а так же от того сколько срастается перелом.
- При переломе левой или правой лодыжки, но без смещения, гипс придется носить от 3,5 до 7 недель. Срок может увеличиться, если пострадала внутренняя часть лодыжки. При наличии смещения, гипс на ноге остается на 3 месяца. При переломе большеберцовой кости нога будет обездвижена 4 месяца.
- Нога после перелома голени без смещения остается в гипсе 3 месяца. Если смещение имеется, то конечность обездвиживают на четыре месяца.
- При переломе стопы без смещения, гипс накладывается на 1,5 месяца, при наличии смещения на три месяца.
- Фаланги пальцев заживают намного быстрее остальных костей ноги, поэтому загипсованы они будут приблизительно в течение 2 недель.
Данные сроки условны и могут варьироваться с отклонением в большую или меньшую сторону.
Терапия медикаментами не проводится. Больной получает обезболивающие препараты во время проведения основных лечебных мероприятий. Иногда врач назначает прием препаратов кальция. Необходимо это для ускорения срастания костной ткани.
Продолжить процесс заживления костей при неосложненной травме, пострадавший сможет в домашних условиях, если будут в точности соблюдать все предписания лечащего врача.
Довольно часто больной жалуется, что болит нога после перелома. Интенсивность болевых ощущений индивидуальна, главное, после снятия гипса соблюдать все рекомендации по реабилитационному периоду.
Реабилитация
Большое значение в периоде реабилитации до заживления перелома уделяется обучению хождения на костылях. При неправильном распределении физической нагрузки на ногу и несоблюдении правил ходьбы, больной может упасть и вторично повредить ногу. Что бы это избежать пациент руководством реабилитолога должен научиться ходить по больничному коридору с двумя костылями и только когда он приобретет данный навык и почувствует уверенность, можно аккуратно спускаться и подниматься по лестнице. Далее человек может переходить к использованию одного костыля и трости при ходьбе.
В программу реабилитации также входит:
- ЛФК.
- Массаж.
- Физиопроцедуры.
- Дыхательные упражнения.
Важно! Перелом нижней конечности – это травма, которая сопровождается нарушением костной целостности. Своевременное обращение за помощью, правильный выбор методики лечения и реабилитации значительно увеличивают прогноз заболевания и предупреждают развитие осложнений. Важно помнить, что чем взрослее пострадавший, тем сложнее будут срастаться кости и в дальнейшем, во время ходьбы, будет дискомфорт.
Отзывы
Алевтина, 37 лет
Если вы не болели переломом ног, то вы не поймете, что это такое. Сначала я лежала на растяжке, а потом училась ходить заново. Это очень тяжело.
Не стоит тянуть с диагностикой и лечением заболевания!
Войти
Не такая, как все, — три недели в гипсЕ!
Что-нибудь все время со мной происходит неожиданное: то пить брошу, то на актерские курсы пойду, то вот ногу, например, сломаю. И, разумеется, обо всех приключениях мне хочется красочно и многословно повествовать.
Как именно я стала техно-ветераном-инвалидом, было изложено в предыдущем посте. Сегодня же речь пойдет обо всех прелестях и прочих нюансах жизни в гипсе.
На самом деле, это уже мой третий гипс. Первый был так давно, что известно о нем только по рассказам старших родственников. Как-то раз на пути моего хаотичного передвижения по квартире внезапно возник популярный среди советских молодых семей стиральный агрегат «Малютка». Машинка отделалась легким испугом, а мне досталась трещина на запястье правой руки и прозвище «партизан» от тетеньки-врача, не распознавшей во мне будущую представительницу прекрасного пола.
Второй гипс я заполучила благодаря собственному скудоумию: поленившись тащиться к подземному переходу, попыталась перебежать Селезнева напрямки. Возникшая на пути моего хаотичного передвижения по проезжей части «копейка», отделалась выбитым моей задницей лобовым стеклом, я на сей раз заполучила порванные связки, гипс от бедра до щиколотки на правой ноге и прозвище «идиотка безмозглая» от водителя.
Кстати, да — правой стороне моего тела всегда больше не везет, чем левой.
Первый взгляд на снимок
Перелом — штука довольно неприятная, но куда менее болезненная, чем я себе это представляла, ибо еще полтора дня после приснопямятных танцев босиком я свято верила, что это всего лишь вывих или вроде того. Но уже с первого взгляда на ренгеновский снимок стало понятно — надежды не оправдались, меня приговорили к гипсу и отправили к хирургу приятной кавказской наружности, по фамилии Нехай. Он сначала пригрозил уложить меня в больницу на пару дней, но потом сжалился и прямо с места в карьер воткнул в мою многострадальную конечность укрепляющую спицу.
Вот тут, дорогие мои, я познала боль! Но не от спицы, как можно предположить, а от местного наркоза, ей предшествовавшего. Саму ногу от меня отгородили занавесочкой, и я могу только догадываться, как все это выглядело, но судя по ощущениям, после двух уколов ступня стала раздуваться, и еще раздуваться, и еще. И когда я уже решила, что вот сейчас она просто лопнет в туче кровавых брызг и осколков костей, анестезия внезапно подействовала. Последовавшее за этой пыткой вкручивание спицы чем-то сильно похожим на обычную электродрель я почти не почувствовала.
Дальше началось веселье: ни я, ни Тимур почему-то не догадались взять у медсестер коляску, а про то, что такси на территорию больницы может проехать только с разрешения дежурного врача, мы узнали уже на выходе. Почему-то подниматься обратно на четвертый этаж мне показалось более утомительным, чем самостоятельно добираться ко въезду на территорию поликлиники. На заметку: травматологический корпус от этого въезда предусмотрительно располагается дальше всех остальных.
#фотоног
Это надо было видеть, снимать и сразу выкладывать на ютуб! Но Тимур был занят: держал меня за руку, пока я, неистово размахивая другой рукой, упражнялась в прыжках на одной ноге. Потребовалось всего-то минут пятнадцать, включая две остановки на лавочках, чтобы добраться до такси. Посетители и обитатели больницы мне не аплодировали, но, кажется, многим хотелось.
Наркоз оказался основательный — отпустило только посреди ночи. Я глотала Кетанов и скулила в тимуровых объятьях. Но это, пожалуй, были последние на данный момент болезненные ощущения, связанные с переломом.
На следующий день Тимур раздобыл мне костыли, к счастью, вполне современный комплект из легкого металла, а не тяжеленные деревянные ходули. И, тем не менее, это только кажется, что ходить на них — раз плюнуть! Несколько дней моей основной задачей был расчет угла упора здоровой ноги в пол по отношению каждому костылю. Зная свою волшебную привычку даже трезвой промахиваться спросонья мимо дверного проема, поначалу я будила Тимура для сопровождения меня в уборную.
Любопытный факт: когда к вечеру второго дня я решила «примерить зеленый костюм», выяснилось, что терапевтический эффект данного метода обезболивания на переломы, по всей видимости, не распространяется. Вместо ожидаемого блаженного облегчения, я полтора часа подряд силой воли пыталась унять судорожные сокращения загипсованной стопы, из-за которых спица и сама сломанная кость давали о себе знать самым неприятным образом. Потом это прошло.
Тем временем, жизнь моя повседневная претерпела существенные изменения.
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Из положительных моментов можно отметить, что я теперь работаю удаленно, как давно мечтала. Правда, дома вместо сплита вентилятор, интернет один на двоих, а писать тексты и постить посты приходится, полулежа на горе подушек, водрузив сверху немилосердно горячий ноут и регулярно спихивая с себя не менее горячего кота. Но это мелочи.
В остальном все, по меньшей мере, забавно и не без приключений. Тимур постепенно осваивает навыки медбрата — перевязки у него получаются не хуже, чем у тетеньки из травмпункта, и от вида торчащего из моей ступни прута ему совершенно не плохеет. А я учусь заново делать привычные вещи непривычным образом, преодолевая различные неудобства.
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Прежде всего, в гипсе неудобно лежать и сидеть, приходится все время держать ногу на возвышении вроде свернутого в рулон пледа, отчего все остальное тело постоянно перекашивается и съезжает набок с подушечного трона.
Еще в гипсе неудобно купаться. А ввиду того, что на Кубани наступило, наконец, настоящее лето вместо дождливого не пойми чего, в душ хочется часто. И связано это с такими чудесами эквилибристики, что хоть в программу художественной гимнастики включай.
Ирония судьбы или С легким паром!
Неудобнее всего в гипсе тусить! А сидеть четырех стенах три недели подряд, выгуливаясь только в травмпункт, выше моих сил. Предписанный и, в основном, постельный режим я нарушила уже не раз: сначала приковыляла на корпоратив, где все те же опасения внезапно потерять равновесие с перспективой сломать и вторую ногу помогли мне не превышать нормы выпитого в количестве одной бутылки сухого белого. А потом продолжила банкет в другом месте с другими людьми, но это уже другая история.
Парадно-выходной вариант
А еще мы праздновали 10 000 дней с Рождества Сивкиного. Вечеринка была масштабная с различными развлечениями организма на выбор. Основная часть присутствующих предпочла алкоголь, мясо и танцы на верхнем недостроенном этаже. Я же прочно осела в чилауте и, не имея физической возможности преодолеть приставную лестницу, время от времени «одевалась в зеленое», потягивала винцо и передавала приветы дяде Альберту, который, кстати, настоятельно не рекомендует кататься на велосипеде в закрытом помещении.
Кроме уже упомянутого, в гипсе неудобно заниматься домашними делами. Гладить белье приходится сидя, готовить еду — опираясь одним коленом на табуретку, а про уборку в квартире я просто стараюсь не думать.
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Ну и наконец, в гипсе неудобно заниматься сексом. В первую неделю пришлось ограничиваться всего одной позой. Сейчас уже доступна вторая, но о былом разнообразии пока приходиться только мечтать.
Вот так и выглядит жизнь человека, временного ограниченного в возможностях. Что удивительно, я не почему-то не впала в глубокий сплин в стиле «лето-коту-под-хвост-обожемой-жизнь-гомн о!» и даже стала меньше обычного ныть и стонать по любому поводу. Наверное, умные ученые могут объяснить это с какой-нибудь гормонально-замороченной точки зрения, мне же остается только поддерживать «неунывачесть» в ожидании окончательного срастания.
Все путем, гайз! 😉
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