First aid for injuries and fractures

Historical aspects of injury treatment

The treatment of bone injuries has a rich history. As early as Ancient Egypt (according to the Edwin Smith Papyrus), fixation was used using papyrus leaves soaked in resin. In Ancient Greece, Hippocrates developed methods for reducing dislocations and splinting, and the Roman physician Galen described the injuries of gladiators.

In the Middle Ages, prosthetics actively developed for knights who lost limbs in battle. The term "orthopedics" was introduced by Ambroise Paré in the 16th century. In Russia, significant contributions were made by N.I. Pirogov, who popularized the plaster cast and military field surgery, and G.A. Ilizarov, who created the famous apparatus for transosseous osteosynthesis.

Prehospital care and immobilization

The main task in suspected fractures or dislocations is to immobilize the limb and relieve pain using analgesics.

• Injuries of the proximal humerus: application of a ladder splint extending from the healthy shoulder girdle to the fingertips of the injured arm is required. Soft fixing bandages (Desault, Velpeau, or a standard sling) serve as alternatives.
• Foot injuries (e.g., dislocation of the navicular bone): immobilization with a posterior plaster or transport splint from the fingertips to the upper third of the leg is indicated.

Features of pelvis and lower extremity injuries

Severe pelvic ring injuries are usually associated with high-energy impact and are often combined with traumatic brain injuries. In adolescent athletes, minor avulsion fractures in muscle attachment zones are more common.

In hip joint injuries in children, it is important to rule out damage to the Y-shaped (triradiate) cartilage of the acetabulum, as this disrupts its further growth. Hip dislocations (most commonly posterior) require emergency reduction to prevent avascular necrosis of the femoral head epiphysis. Diaphyseal femoral fractures are often accompanied by marked displacement due to the pull of powerful muscles, which requires mandatory reposition.

Diagnosis of knee joint and foot injuries

Acute knee injury in children requires radiography in the presence of strict indications: isolated pain in the patella or fibular head, inability to bend the leg to 90 degrees, or inability to bear weight on the injured limb. The presence of joint effusion smooths out fat planes on radiographs.

In the foot area, dislocation in the Lisfranc joint (tarsometatarsal articulation) is common, which in most cases is dorsolateral and accompanied by a fracture of the base of the second metatarsal bone. Clinically, such injuries manifest with sharp pain, deformity, swelling, and complete loss of weight-bearing capacity of the foot.

Fractures of proximal humerus

Among injuries of this zone, fractures of the surgical neck of the humerus are in the lead. They are most typical for elderly women against the background of senile osteoporosis and age-related thinning of the cortical bone layer.

Isolated fractures of the humeral tubercles result from direct impact or sharp muscle contraction. They are characterized by a specific clinical presentation:

1. Greater tuberosity fracture: the shoulder is internally rotated; attempting to rotate it outward causes sharp pain.
2. Lesser tuberosity fracture: the shoulder is externally rotated; active internal rotation is impossible.

Class and exam questions

What else to study on this topic

• Classification of femoral neck fractures (transepiphyseal, transcervical, etc.)
• Technique of closed reduction of foot navicular bone dislocation
• MRI and X-ray diagnostics of carpal navicular fractures
• Types of displacement in Lisfranc joint dislocations
• Contribution of domestic scientists (Turner, Vreden, Priorov) to the development of orthopedics

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.