There are classification of fractures, such as the classification for Kaplan (1968), classification for C.S. Neer (1970).

In a day in the Bagatokh region, the classification was adopted, proponated by M. Muller (AO / ASIF 1993). We should be aware of the type of fracture and the tactics of a falsified abuse (Müller M.M. Algover, R. Schneider, H. Villinger).

The fundamental principle of the universal classification of fractures of AT / ASIF is that the fractures in all segments of the cards are divided into three types and further away, into three groups and those of the groups, as well as the fractures in all segments of the cards What type? .. Yaka group? ... Yaka pidgroup? .. There are three meals and three different types of nutrition on the skin and a key to the classification. Three types are called: A, B, C. Kozhen type of divisions into three groups: A1, A2, A3; B1, B2, OT; C1, C2, SZ. In such a rank, there are 9 groups. Oscillations of the skin group are divided into 3 subgroups by numbers. 1, .2, .3, Fig. 27 pidgroup for the skin segment. Tsi pidgroup represent three types of fracture characteristic of the skin group. The colors of greens, oranges and chervonia, as well as a larger dark color of arrows, will contribute to an increase in severity: A1 is the simplest fracture with a shortened forecast, and SZ is the most folding fracture with a bad forecast.

Anatomical localization.

There are two numbers, one for the card and one for the її segment.

Dovgі kіstki, littova and exchange brush, as well as tibial and small homilky kіstki can be taken in one brush. Tomu mi maєmo 4 dovgy kistki:

1 = shoulder

3 = stegnova

4 == tibial / fibular.

Segments of the brush.

The dermal spine is divided into three segments: proximal, diaphragm and distal segment. Lodge segment є vinyat and classify, as a quarter segment of the great / small-sized list. Segments are identified by numbers: 1 = proximal, 2 = central, 3 = distal. The size of the proximal and distal segments of the cysts begins with a square; Before that, as a turning point will be introduced to that segment, it is necessary to establish a center in front of it. In a simple fracture, the localization of the center is obvious. In case of wedge-shaped fractures of the jog, the center of the seam is located on the flats of the widest part of the wedge. With folding fracture

the center of yoga can be made without writing repositories. Whether it is a fracture, it will be superfluous to the wisdom of a dalyanka of a dark surface, it is classified as an internal fracture. As a fracture without the substitution of a slit, as the reach of the deep-lying surface, it is classified as metaphizarny or diaphanous, in the depletion of the localization of the center.

For the classification of AO / ASIF, all diaphragmous fractures change

on 3 types on the basis of the visibility of the contact between the two ulamami

for reposition: A (simple fracture) - contact> 90%, B (wedge-shaped

fracture) - є contact, C (folding fracture)

Contact відсутня.

Simple fracture (type A) - single circular line to the fracture

diaphiza with small pieces of kortikala, warehouse mensh

10% of the circumference of the brush, which you can eat, as it stinks

do not pour on the forecast and the forecast. A1 - spinal fracture, A2 - oblique

fracture, A3 - transverse fracture.

Wedge-like fracture (type B) - splinter fracture of diaphysis s

with one or more intermediate fragments, when

reposition є a good contact between ulamami, B1 - wedge-shaped spinal fracture, B2 - wedge-shaped spinal fracture

fracture, VZ - wedge-shaped fragmentation fracture.

Folding fracture (type C) - splinter fracture of the diaphysis with one

and more intermediate fragments, when repositing

outward contact between proximal and distal

fragments, C1 - folding spinal fracture, C2 - folding segmental

fracture, NW - folding irregular fracture.

Break type A є with the simplest tools

the best forecast for general functional renewal

kintzivki. Fractures of type C - the best folding

with a bad forecast. Fractures give the greatest number

unrepentant, unjustified slopes and severe post-traumatic contractures

great slopes.

Proximal and distal segments

Fractures of the proximal and distal segments є either "lateral" (type A) or "internal". Intra-angular fractures є either “non-flat hinged” (type B) or “raised hinged” (type C).

For the deterioration of the inferior alternatives, for those who are guilty of the new ones = for the early classifications of the critical or extreme fractures, we have widely widened the classification of AT for the most recent cases. , Closed Integument = Open Integument = Open Integument; MT = Muscles, Tendon = muscle mass and tendon.

2.2 AT classification of soft tissues in case of fractures:

For the description of the shkіri bula, the letter "I" is drawn for the zvnіshny pokrivu (INTEGUMENT). The word for goodness is transformed into a large number of mov. Letters "З" are indicated on closed (Closed) and "O" - on open (Open) fractures. In such a rank, for critical fractures:
IC1 = school day per day.
IC2 = shkіra not rozіrvan, ale clogged.
IC3 = interconnected by shkiri.
IC4 = widened, closed shkiri view.
1C 5 = necrosis due to impact.

Postage shkiri O (emerging fractures)

IO1 = opening the center from the middle of the name,

IO2 = torn wound of the skin less than 5 cm of the root, hammered in the edge.

IOЗ = shkіri shkіri more than 5 cm zadovzhka, more extensions of slabs, not

zdatnі edge

IO4 = significant impact for the whole production, protection, defect of the skin

IO5 = widened view of the scale

A fracture of the bristle - the price of the destruction of the wholeness, the wickedness by violence or a pathological process (chubby, burning). Fractures of cysts are often supervised by small tissues, nerve stubs, great blood vessels, brain, legends, liver and other organs.

Classification of fractures

Fracture of the handles can be as good as nabuty.

Congenital fractures occur internally in utero, due to the inconsistency of the cyst skeleton of the fetus, and as a result of stagnation of strength when the fetus is in good shape before the hour is flat.

In addition, fractures occur on traumatic and pathological.

Traumatic fractures occur under the influence of mechanical factors.

Pathological fractures occur in a pathologically changed cyst (osteomyelitis, tuberculosis, syphilis, echinococosis of cysts, malignant swelling). Smells are generated with minor injuries, and only without injuries.

For a non-smart person, or for a poor education, turn to break at close and open.

It is always the case that the localization of fractures spreads into the epiphyseal, metaphysical and diaphilous.

Epifizarny fractures of the greatest importance; the stench is not easy to lead to the mercy of the lumpy surfaces and vivikhiv. As soon as the brush goes to the edges of the bag, then it sounded like the inner corner. With cich fractures, there is a sharp ailment and the function of the corner is broken.

Metaphizarny fractures (navkolosuglobovyh) є fixed in memory of one ulamka with іnshim, or hammered fractures. With such fractures, it is most often not possible to fail.

Fractures occur as a result of the mechanism of the mechanism of pressure, squeezing, as a result of twisting and cutting.

Mechanism of destruction of the integrity of the hand to the degree of elasticity (springiness) and crispness. In a childish vice, the handy is more elastic, but not among the grown-ups.

Fractures from huddle and squeeze can be seen in late and lateral to the axis of the brush straight.

Longer tubular parts of the basket are easier to ear when pressed in a transverse direction, lower in lateral direction. In the case of late delay, puncture fractures are more likely to occur.

Typical fracture due to delay є flattening of the cysts in case of compression fractures (compression fracture), often occurs in flat cysts. With great mechanical force, when the brush is healthy, it can happen outside the fragmentation of the brush.

The turning points of the crime are being brought about as a result of direct and indirect violence. The brush is curled up for the boundaries of its springiness. On the opuque side of the winery, there are a number of troughs and a bunch of flaps.

Fractures from twisting along the late axis are called spinal or guint. Fractures are often seen in the great tubular knuckles (quilts, shoulders, great bristles). At the same time, there are 1 sets of fixings, and the number of directions is twisted, so that it is wrapped around its axis.

Vіdrivnі fractures occur as a result of strong meats very quickly, but it is rapt to advance; to add tendons, tendons, ligaments, mucous membranes (fracture of the ankles, p'yatkovocystka, pnekolinka and іn.)

Falling down the steps of the pooled fracture can be higher - for the entirety of the brush and incomparable, if there is less damage to the integrity of the brush.

Trischina (fissura) - not completely damaged cysts, with any fracture area it is not possible to twist.

If the fracture goes straight across the area to the front axis of the hand, the fractures are transverse, right down to the straight edge up to the axis of the hand. The superficial fracture is serrated. Some transverse fractures can be combined with the later trilogy, so called. T-shaped or U-shaped fractures.

Later fractures will be established only if the area of ​​the fracture is formed by the long end of the tubular chain. The stench is pretty awful.

Fractures, or spinal, fractures occur as a twisting of the brush on its axis. Ploshchina fracture may be spiraly.

Falling from several fractures, the stench can be lonely, like a fracture in one basket, and multiple, if there are many fractures in one basket or in a decal basket.

Fractures of the bristles are unstable and accelerated. Complicated fractures are considered to be a fracture of the cranial cysts from the ears of the brain, fractures of the cysts of the pelvis from the intra-pelvic organs, fracture of the cysts from the opening great Sudins.

Before combined, there are such fractures, as they come together with the problems of their organs, which are far from the point of fracture, for example, a fracture of the skull and the opening of the liver.

See the substitution of cyst ulamks:

1.replacement from the cut, if the axes of the ulamkiv set up the cut at the Messet fracture;

2. the child ssuv spares when the ulamkiv of the brush is loose in the right direction of the brush diameter; zazvychay vono be aware of transverse fractures;

3. Substitution on additional, late substitution, - the most common type of substitution in case of fractures of large tubular cysts, a symptom of an increase in traction of fast-moving joints;

4. Zsuv along the periphery is seen as a result of the turn of one of the ends of the hand, partly of the peripheral, near the next axis.

The rupture of the ulamki in the stretching of the hand є is even more familiar to the fracture of the hand, especially in case of diaphragmatic fractures and may not be rotated in case of fracture of the ribs.

Crunching and abnormal crumbling of the ulamics, but one of them alone give the appearance of cyst crunch. With the appearance of these reliable signs of a fracture of the cyst, the symptom does not occur, so as a result of a severe pain, a shock is possible.

Ethiology

Non-mediated causes of fractures and mechanical injuries. Tse all the blows, falling, going to vehicles, wounds in the fires, raping a stuck child, razor blasts, for example, in case of electrical trauma and іnshі.

Friendly factors є: mineral and vitality deficiency, sickness of cysts, as well as deyakі physiological conditions, such as vagіtnіst, oldness.

Classification of fractures

1. In an hour, the verdict is broken: vrodzheni and nabuty.

You are born in the uterine period because of injuries of the mother, or as a result of a very fast uterus. To screw up to such fractures the internal uterine pathological changes of the cyst system - rickets, anomalies in the development of the fetus, osteomalacia in the mother.

Prydbani fractures winnayut either at the time of the people, for example, with the addition of the breed, or, most often, even when the people are stretching out their life. The stench comes on: traumatic and pathological (or mimovilny), to that, the stench, as a rule, is generated without visible mechanical reasons.

2. Behind the character of the game, the breaks are broken: open and close.

In case of severe fractures, the hospitality of the knots of the stocks will shrink the tissue and the skinny curvature, or the slimy sheath with the winners of the middle-aged and the middle-aged ones.

at shrank fractures of tissue flesh can also often be damaged, but the health of the skin is less likely to occur.

I am not safe to develop open fractures, since the stench is easy to become infected with pathogenic microphlora and is often slowed down by phlegmon, osteomyelitis and gangrene. Close the fractures and the aseptic ones.

• 3. Due to the anatomical nature, fractures are differentiated, epiphyseal or internal corners and metaphysical. Over the course of the breakdown, the most agreeable are the epiphysical fractures, as the stench can cause the function of the corner to be destroyed.
• 4. Behind the character of the game, there will be some breakthroughs.

Incomplete fractures are characterized by partial damage to the integrity of the cyst. To them are admitted:

Tricycle (Fissurae), when it is split, the main speech of the cistka is split, and the edges of the chain are preserved. Trіschini are frankly - for the whole comrade of brushes and superficial (i.e., X-ray).

Infaction (Infactiones) - is a breakdown of the integrity of the cortical ball and around half the diameter of the cyst. Occur with a strong cyst (on the drooping side of the ribs).

Vidlam - tse edge defects of cysts; more often they occur on flat cysts (at the edges of the cyst of the scapula, humps of the cysts of the pelvis, spinous or transverse costal ridges of the ridges).

Subperiosteal fractures - damage to the integrity of the cyst without damage to the integrity of the eye.

Particular fractures or breakdowns - are found, mainly as a result of the fire-felted mules stabbing the wounds.

Ovnі fractures are characterized by povnіy roz'єdnannyam kіstki for the whole її dzhinu or width.

• 5. If the deterioration of the integrity of the hand is seen in one moment, then such a fracture is called a single one, in two places - subordinate. It may be a multiple fracture.
• 6. In the fallow state of the line of evil to the later axis of the brush, there are coming types of breaks:

transverse - the line for evil to pass across the brush;

oblique - the line to the fracture to pass along the edge; the surface of cyst ulamks is often gosted; wicked and traumatized fabrics, the stench may be vicious as a result of a fracture;

late - the line to the fracture of the first axis; such fractures are very rare;

spiral - line to fracture є spiral; the whole result of twisting the brush;

toothed - vidlamki may be incorrectly sharpened, tooth parts of the edge;

vkolochenny - sposterіgaєtsya during the last few hours; most often such fractures are either metaphysical, if the diaphysis of the cyst is pressed into the epiphysis;

splinter fracture - characterized by statements from one to three ulamkiv;

fracture fracture - characterized by the statements of the great number of ulamkiv; develop in case of severe injuries or in the gepal wounds of the large tubular cysts;

roztroshchennya fracture - a combination of a fractured fracture with crushing of soft tissues, if the cysts are mixed with soft tissues; This kind of fracture is the most unpleasant, since it is practically uncomfortable to change the anatomical integrity of the cyst;

vidrivny - a fracture, which is characterized by a bend or tubercle of the cyst as a result of strong meat quickly; Most often it is the appearance of the calcaneal and lactic humps, the coronal extension of the cystic fibrosis.

In case of fractures of the cyst, there can be a change in one thing. It is possible to recover from a traumatic factor, as well as a quick response. Kintzi kistkovykh ulamkіv can change downhill, to the side, as well as with shortened ones, or even more.

Classification of critical fractures in most cysts

(Look around the literature) E.T. Zhunusov1, Sh.A. Baimagambetov2, R.S. Botayev2

Classifications of open fractures of long bones

(Review of literature)

1 2 + 2 E.T. Zhounousov, Sh.A. Baimagambetov, R.S. Botayev

"Kazakh State Medical Academy (Rector - Doctor of Medical Sciences, Professor Zh.A. Doskaliev); 2Scientific Institute of Traumatology and Orthopedics (Director - Doctor of Medical Sciences, Professor N.D. Batpenov), Astana , Kazakhstan

There are some fractures of some of the most important cases of the supporting-arm apparatus.

Unimportant with great respect, as they come to the last rock of trauma, the development of this problem, and require a detailed introduction and fake scientific development.

One of them is the classification of critical fractures in many cysts, as it is more important for prevention of acceleration, statistics of critical injuries, tactics, and also for the further generation of results in the treatment.

A lot of different classifications of critical fractures have been proponated, some have become old, and some have learned the sutta of their changes.

With the knowledge of the robots that mean the animals, I respect the breakdown of the points from the main food: how do I visualize the current classifications of the critical breaks in the most recent cysts, the dynamics of how to overcome the post-traumatic period of time?

On the territory of colish SRC, the ethological classification of critical fractures in some of the first was proponated by A.D. Ozerov (1936) and V.V. Gorinevskaya (1936), who saw fractures in a small area of ​​the ear of soft fabrics (up to the whole category, a puncture of the brush from the middle), and a large area of ​​the ear of soft fabrics and rosters.

The middle of the foreign prelates of the Persha of the Classification is to be found in the pen of L. Bohler (1937), the author of the author of the disclosure of the fracture

"The classification is correct only todi, if you won’t be able to handle the severity of the hand and serve as a basis for the evaluation and assessment of its results"

Moris E. Muller, 1988 1

fatty from the wound and from the appearance of a fracture from the vision of only blood.

In his own classifications M.O. Fridlyand (1938), L.I. Shulutko (1940), T.S. Grigor'ev (1946) and V.A. Chernavskiy (1958) does not give the meaning of punctuate wounds resulting from a fracture in the middle of the day, and the lack of such a fracture in a group of critical fractures [quotation from G.S. Yumasheva and V.A. Apifanov, 1983].

I.F. Byalik (1984) all the useful in the literature of the classification is cleverly combined in simple and folding. On the author's thought, the classification of Vives (1971), Wehner (1973), Voorhoeve (1974), Ritter (1976), Knapp (1979), Widenfalk (1979), can be referred to as simple, deceptive fractures due to the severity of injuries can be divided into two or three groups :

1.perforation of the shkіri from the middle of the brush;

2. hammer shkiri or perforation її zzovnі;

3.Reducing shkіri and soft fabrics from the ears of the judges and nerves, or without them.

In the above-mentioned classifications, they did not know the image of the steps of the small and cyst tissue, the size of the wound and the nature of the fracture.

1. Wounds of soft fabrics up to 1 cm, puncture from the middle - do not go into surgical treatment.

1 Universal classification of fractures / Booklet No. 1.

Information.-1996. -27 s.

2. Rani of middle size - from 1 to 4 cm, which require a head in surgical treatment.

3. Large wound sizes - from 4 to 8 cm from significant complications.

4. Rani ponad 8 cm - great because of the tricky hardships.

5. Injuries to the destruction of the life of the film.

However, on the territory of the SND, the classification of Kaplan-Markovoi is widespread (Table 1).

A.V. Kaplan, O. N. Markova and V.M. Melnikova, persuading the classification into practical activity, held a discussion and discussed it on the sidelines of the magazine "Orthopedics, traumatology and prosthetics".

In the course of the discussion, the acts of the author indicated that the classification of A.V. As for the plan and for the development of the authors, it does not represent all the developmental problems of the woman's fractures, the growth in them does not take care of it, for it does not take care of the restlessness of the ear, the stage of severe fracture, the feet

“Mi vazhaєmo, but in reality, in our classifications, they couldn’t be transformed into all the useful factors, but because of the serious the type of fracture, the size of the wound and the nature of the soft tissue) ".

Besides, one of the participants in the discussion A.F. Baturin (1968), having proponated his classification of critical fractures:

1. non-fracture fracture with a stab wound.

2.non-fracture fracture due to hammered

Classification of critical fractures in the past

3. non-fracture fracture with a defect in soft tissues.

4. Fracture growth with a stab wound.

5. Fracture growth due to clogged early.

6. Development of a fracture with a defect in soft tissues.

7. Fracture with a defect of the cyst and a clogged wound.

8. Fracture with a defect of the hand and soft tissues.

Having passed the bags of the passed discussion, the editorial board of the journal "Orthopedics, Traumatology and Prosthetics" also meant that the classification of critical fractures in the tubular cysts A.V. Kaplan, O. N. Markova and V.M. Melnikova is guilty of a sham butti is thoroughly honored.

In this hour, the classification of Kaplan-Markovoi is widely used in the professional work of surgeons and traumatologists.

Classification of G.N. Zakharova and N.P. Topi-Linoyu (1974) can also be carried to folding. The author sees the primary fractures: a) with small ears of soft tissues and early early 3-10 cm, b) with great ears of soft tissues and early early more than 10 cm; Suddenly fractures and discoloration of pictures. On the thought of the authors, the stasis of the given classification in practical efficiency was true to itself, and at the same hour I mean, well, as well as a lot of them, I didn’t get it right.

In 1980, S.S. Tkachenko and G.V. Akimov (1980) broke the classification of critical fractures in several cysts (Table 2).

Table 1

their copies (according to A.V. Kaplan and O.N. Markova)

Localization of the fracture Upper or lower meta-epiphysis of the brachial, lithogenic, promenade, stegnous, tibial and small homylcytic cysts. Upper, middle, lower third of the diaphysis of the shoulder, littovo, promenova, stegnovo, great and small homilk cysts

The type of fracture is transverse, oblique, ginto-like, curly-splintered, fine-splintered, sub-junctional (without substitution and for changes)

The nature of the soft fabrics Rosemir Rani IV Special (in the edge of importance)

I (up to 1.5 cm) II (from 2 to 9 cm) III (from 10 or more)

A - ruptured and pricked 1-A 11-A Sh-A For the ruin of the life of the picture (crushing of the brush and the breaking of the soft fabrics on the great stretch, the destruction of the great magistral court arteries)

B - hammered and ragged 1-B 11-B Sh-B

В - crushed and roasted 1-В 11-В Ш-В

Table 2

Classification of critical fractures in ductal tubules according to S.S. Tkachenko and G.V. Akimov

For raids Pervinno vіdkritiy Suddenly vіdkritiy

By type of fracture Non-recurrent fracture Secondary fracture

Craiovy Trіschina Non-fragmented fragmented multi-fragmented Segmental

For localization fracture Upper third of the Middle third of the Lower third

Shoulder, in front of it, stegno, gomilka

By zsuv ulamkiv Without a favor

For insignificant compensations

For significant changes

For fellow Great Judge Nervi Suglobi

poshkojen Z poshkojennyam

without ushkojennya

Behind the character of Kolot's wound Torn, ravaged

and surgical tactics hammered, rooting out pictures

No need for surgery

The step of gravity Rose of the wound

up to 4 cm (small) out 4 to 8 cm (middle) down 8 cm (value)

I shard

Nonslip

II multi-splintered, segmental splinter

III multi-splintered,

segmental

IV On the ruin of the life of the film

Author to identify fractures in fallowness due to the mechanism of injuries at primary or in the event of fractures. In this classification, localization of the ear, the substitution of the ulamks, the supporter of the problem (Sudin, nerves, etc.) and singular surgical tactics are promoted.

In 1982, V.G. Rindenko proposes the most optimal classification of critical fractures.

Classification of critical fractures according to V.G. Rindenko On the Mechanism of Education:

Primarily seen;

Suddenly it appears;

In the fires.

For length and character of soft fabrics: -1 type A, B, C;

II type A, B, C;

III type A, B, C;

Behind the nature of the warming of the rani of the soft fabrics:

Smooth: first tension;

accelerations:

♦ necrosis of the crotch tissues: dry, vologous;

♦ suppuration of hematoma;

♦ state-of-the-art local necrotic acceleration;

♦ state widening necrotic accelerated;

♦ with generalization of infections: gnіynі arthritis, sepsis;

♦ gangrene of the kidney through thrombosis of the magistral vessels;

♦ gas gangrene;

♦ chronic disease-necrotic acceleration;

♦ chronic latent infection. Behind the nature of the growing kistka:

Without collapse of consolidation;

Trust in the growth;

Growth rate;

Pomilkovy atrophic slope;

Pomilkovy hillock is hyperplastic;

In case of severe injuries, it is possible to cause infection acceleration in fallowing due to the interruption of the ignition process. The quality of the classification is acceptable for an unremarkable fracture, accelerated by infection.

Classification of critical fractures in several cysts according to I.F. Bialik (1984) often appears from the proponated species. The author vvazhaє, scho in practical robots slid orinuvatsya not only on the anatomical type of

relomov, ale and on the steps and the nature of the production of soft fabrics. The author of the link in case of severe fractures has 4 types of wounds:

1) wounds with a small ear zone, the edges of which can be sewn without tension;

2) wounds from the middle zone of the ear, in the direction of the soft fabrics, and for the closing of the ulamk in the need to allow the development;

3) the spread of wounds in the great zone of ear and great results of soft tissues, which are uncomfortable without transplantation of shkiri;

4) wounds with massive tissue, magical vessels, nerves, which obstruct the life of children, traumatic amputations.

A classification is given that allows to determine the tactics and the volume of medical visits, clarify the diagnosis and correctly go to the assessment of the results of the treatment.

1) type alpha - without the neuropathy bundle;

2) type beta - z poshkojennyam sudin;

3) type of gamma - from the number of nerves.

The authors guided the results of the treatment of 85 ailments to those who are more stagnant in the classification of the degree of severity of the abdominal nerve bundle. Yakshcho vrahuvati, in case of severe fractures, the development of magistral vessels is found in 10.0%, in case of peripheral nerves - in 12.5%, the need for a further development of the classification of herbal judgments in view of ...

Judging from the results of the last few years, try the establishment of new variants of the classification in the SND, and the progress in practical activity was not successful.

In our opinion, the head reason was those who were skinny authors, who flashed and smelled their variations of the classification of these critical fractures in the new cysts, which were based on the changes in the classification of A.V. Kaplan and O. N. Markovoy for good reason, not vrahovyuchi the fact that she has firmly gone into the professional activity of the deceased generation of surgeons-traumatologists, and in connection with the cym, having proclaimed an absolutely new class of memory "unhappily wicked"

In foreign countries, the classification of critical fractures is widely stagnated, proponated by R.B. Gustilo et all. (1976, 1984).

Classification of critical fractures in certain cysts according to R.B. Gustilo et all., (1984)

I type. The trauma is insignificant, the wound of the soft

fabrics mensh nіzh 1 cm.

II type. The wound is large, at least 1 cm, with the inner ears of soft fabrics.

IIIA type. Deliver soft fabrics to close the wound.

IIIB type. Few of soft fabrics to close the wound.

IIIC type. Immediately shredded fabrics and arteries.

Author vvazhayut that the classification given is more acceptable for assessing the severity of critical injuries and the choice of rational methods of treatment. However, R.J. Brumback і A.L. Jones (1994, 1995), it means that the middle of foreign preliminaries is aware of the fact that the current classification in clinical practice is not very common, as it is unreasonable to assess the type of emerging On the idea of ​​authors, tse is the main reason for criticism.

At the clinic of Lorenz Beller (Week), like N. Schwarz, one can see the following classifications of critical injuries:

1) clean or aseptic wounds;

2) contaminated traumatic wounds, resulting in fractures;

3) clean contaminated wounds in case of combined injury of the skeleton with the organs of organs;

4) unclean and infectious wounds (badly crumbled, blatantly granular).

Crazy, such a classification can not be stuck in the current traumatology and vimag of the box.

Type 1. Great business case for saving without interruption from the intact small business case for transferring to the office.

Type 2. Preserving the continuity of more homogenous cysts, ale to osteosynthesis for renewal of building and transferring to renewal.

Type 3. Defect of the large-scale brush< 6 см при интактной малоберцовой кости.

Type 4. Defect of the large-sized brush> 6 cm in the lesions of the small-sized brush.

However, it is hardly possible to solve the problem in such a way. Classification of an accelerated and without that for a rogue, it is not easy to remember a great number according to the segmental classification of critical injuries.

In the early days of traumatologists in the near and distant foreign countries, the classification of critical fractures has become widespread, proponated by M.E. Muller et all. ... Piznish M.E. Muller and sp_authorization of urahuvannya hapless children

Variants that are guilty of being brought into account in the case of the establishment of the classification of both critical and extreme fractures, have widely adopted the classification of AT for new cysts from the classification of soft-tissue fabrics.

Classification of critical fractures AT and E. Muller et al., (1990,1996)

10 - open integument - open integument.

МТ - Muscles, Tendon - for a muscle and tendon.

NV - for neurovascular disease.

There are 5 options for the severity scale, in terms of the number of cases of growth, there are emerging and critical breaks:

Poshkojennya shkiri:

10-1 - cutting out the middle of the name.

10-2 - the wound of the shkіri is torn less than 5 cm of the head, hammered in the edge.

10-3 - shkiri more than 5 cm of the head, more extensions of slaughter, non-published land.

10-4 - a significant blow to the whole trade, siege, defect of the shkiri.

10-5 - widened view of the screen.

Poshkojennya m'yaziv:

MT-1

МТ-2 - obmezhene pozhkozhennya m'yaziv, deprived of one m'yazov group.

МТ-3 - the meaning of muzyazov, two myazov groups.

МТ-4 - defect of musculoskeletal tissue, tearing of the tendon, enlargement of sloughing muscles.

MT-5 - compartment syndrome.

Neurovascular training:

NV-1 - neurovascular training on a daily basis.

NV-2 - Isolation of the nerve transmission.

NV-3 is a local business of Sudini.

NV-4 - a wider segmentary design of the Sudini.

NV-5 - subtotal or total detachment.

The challenge of the given classification in relation to the children (RB Gustilo et all., 1976, 1984; N. Schwarz, 1984; E. Muller et all., 1987, 1990; JW May et all., 1989 and in.) ear for the period up to the skin cover, myazo, tendon tissue and neurovascular tissue.

However, in the classification of the day-to-day scale of severity according to the ratio to the cyst fabric. In the case of severe fractures of the cyst tissue, it doesn’t matter less than a small-sized case, and the principle of immorality prompts the fracture. In addition, the classification is given to our glance, it is not invisible in

zastosuvannі, there is a bunch of, zanatto detailed and is difficult to remember.

It can be seen that the classifications are proponated in the SND, so that behind the cordon you will be able to work in the main character and steps of the ear of soft fabrics at the time of the nurturing of the patients at the hospital. The home, with a prolonged traumatic ailment, in case of a severe fracture, is difficult to reach a trivial and advanced condition, as a result of a high-quality traumatologist who has experienced a long-term illness

According to the peculiarities of the mechanism of establishing critical fractures in the most of the cysts, the length and the heavy processing of the surface, soft and cyst tissues, we will be able to explain the details of the options

classifications of critical fractures in the past

kistok kintzivok.

When the classification was broken, the size of the tissue was damaged, the severity of the delicate and cyst tissue, as well as the destruction of the forehead stubbour, appeared in the process of failure due to the failure of the operation.

A graphical picture of the classification of critical fractures in several keystones is presented in Table 4.

In tsіy klasifіkatsії krіm zagalnovіdomih 10 Main tipіv vіdkritih perelomіv Dovgy kіstok de rozmіri shkіrnoї Rani i poshkodzhennya m'yakih tkanin vkazanі rіznimi poєdnannyami Perche troh rimskih numbers i Perche troh great lіter alfavіtu, rozrіznyayut defіtsit shkіri i m'yazovoї tkanini defect kіstkovoї tkanini, as well as the management of magistral vessels and nerves. Schooling and soft fabrics, tassels, magistral vessels and nerves designated by the great English letters - S, G, M.

The letter S (eu) (from the word "scarcity" in the English translation - instability, shortage) means the steps of instability or a shortage of soft tissues, in the presence of a lack of weak fabrics, in the absence of the appearance of a lack of development: S0 - shkіrnykh pokrivіvі m'yazovaya weaving nemє, S | - deficit of shkiri from 2 to 4 cm and meat tissue in the boundaries of one group of seeds, S2 - deficiency of shkiri from 4 to 6 cm and meat fabric in the boundaries of two groups of seeds, S3 - deficiency of six cm in larger and more than two groups of textiles.

Table 4

Classification of critical fractures in most cysts

Size of the wound I up to 1.5 cm II from 2 to 9 cm III from 10 or more IV Special

The nature of the wound A - laceration and stabbing, B - hammered and lacerations, C - crushed and broken

Shkiri and soft soft fabrics S (ec) B0 - deficiency of nemans -deficiency of shkiri from 2 to 4 cm + yarn tissue in the boundaries of one group of fabrics - tissue deficiency in shkiri from 4 to 6 cm + fabrics from 4 to 6 cm between two groups of m'yaziv - deficiency of shkiri more than 6 cm + m'yazovaya fabric and more than two groups of m'yaziv

Sealing of knitted fabrics G (ji) 00 - for a defect of a non-ma 01 - a defect in 2 to 4 cm 02 - a defect in 4 to 6 cm 03 - a defect greater than 6 cm

Post-hocification of magistral vessels and nerves M (e) M0 - post-cranial nerves and nerves;

Type of fracture I-ASGM I-B SGM I-C SGM II-ASGM II-BSGM II-BSGM III-ASGM III-BSGM III-BSGM IVSGM

The type of fracture is transverse, oblique, ginto-like, splinter, sub-line

Localization of the fracture Upper, middle, lower third of the diaphysis of the shoulder, littovo, promenade, stegnoy, great and small homilky cysts (without substitution and for substitutions)

Decreased necrosis of shkiri gliboke suppuration osteomyelitis

dry vologue of subfascial interstitial cystic canal

The letter G (ji) (from the word "gap" in the crossbar from English - a break, a break, a gap) denotes a defect of the knuckle tissue, in the presence of the appearance of a clear defect: G0 - a defect in the case cm, G2 - brush defect from 4 to 6 cm, G3 - brush defect larger than 6 cm.

The letter M (it) (from the word "mutilate" in the English translation - caliber, created) denotes the manifestation of the magical judge, the nerve, or even later, the release: іntimi) judgment, M2 - pockmarking (strus, hammering, pressurizing or rearing) of the nerve stovbur, M3 - postponing of the magistral judgment and nerve.

For the inclusion of food from the hour of discussion, we would like to explain that, in the scale of the severity of the scale of the severity of the problem, we didn’t take a small amount of skin defects, soft fabrics and defects in the hand.

According to the literature, the frequency of post-traumatic deficiencies in soft tissues becomes 18.0% to 44.1%. Deficiency of soft fabrics from 2 cm of sutures from quiet mirkuvan, where the edge of the wounds of soft fabrics with a deficiency less than 2 cm of pliable and application of seams for surgical treatment of wounds of moss. If there is a shortage of soft fabrics more than 2 cm, in our version from 2 to 4 cm, from 4 to 6 cm and more than 6 cm, it is necessary to replace them with these other plastic methods3.

In clinical post-traumatic practice (removal of cystic fragments at the time of injury, resection of obstructed debris, when visually recumbent obstructions are seen, or to sequestrate the ulcers of the wrinkle, 60% It is accepted that the "defect of the brush" is used to fit into the distance of the brush on a stretch larger than 2 cm. Shevtsova and spіvavtorіv (1996), a defect of the brush, the need to be respected, whether the brush is visible, is unaffected by the amount and size of the defect. In any case, in case of new critical fractures of the small cysts, the knowledge of the exact size of the cyst defect will be used to fix the singing tactics.

As it was meant, in case of severe fractures of the first cysts, the decrease in the magistral vessels and nerve stings is observed in 10.0% and 12.0% of the cases as a result. That is why a four-degree scale with the values ​​of a specific type of ear of the forehead stovbur is easy to fix and handy for a traumatologist.

In our opinion, the classification of the mother is proponated, which depicts the dynamism of overcoming the fracture of the most recent cysts of references. Otzhe, vona will be cinnamon in the selection of the most optimal way of drinking.

lіkuvannya, can be discussed only if the classification is accepted and vimagayut close to the gaze.

LITERATURE

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18. Abrahamyan, G. G. Kilka for the drive of the statty "Discussion of nutrition in case of critical diaphragmatic fractures" I G. G. Abrahamyan II Orthopedist, Traumatology. - 1967. - No. 12. - S. 48-49.

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23. Kanlan, A. V. Prior to the discussion about the development of critical diaphragmatic fractures I A. V. Kanlan, O. I. Markova, V.M. Melny-kova II Orthopedist, Traumatology. - 1968. - No. 11. - S. 92-94.

24. Baturin, A.F. - 1968. - No. 3. - S. 81-82.

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26. Kanlan, A. V. Oncritical fractures of tubular cysts (not accelerated or accelerated infection) I A. V. Kanlan, O. I. Markova. - Tashkent, 1975 .-- 194 p.

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Fractures are a pathological camp, in case of any kind of deformation of the cysts for the time of a shy bureaucrat, for the power of changing the cyst tissue. Traumas often occur in a childish and latin life, which is tied to the anatomical and physiological features of the body.

The child of the cistka is more elastic and less powerful than the older ones. Cerebral injury of the skeleton to the extent of traumatic factors. A high rizik is formed of fractures in children of dressing due to the crumbling of a child and a weak development of self-protection. In young people, due to the changes from the cysts, calcium salts are taken into account, which can lead to osteoporosis and decreased skeletal function. Damage to cerebral blood circulation, which leads to failure of cerebral blood flow and loss of damage, failure to walk and part of the disease.

In young people, there is a risk of deformation of the dressing cysts due to seasonality (oily), professional performance (intensive physical training), and sports (professional athletes). In the current international classifications of ailments (quickly ICD 10), fractures are assigned to class 19 - injuries, loss and inheritance in case of additional factors.

Classification

The classification of breaks in the ball is designed to facilitate the setting of diagnoses, the purpose of determining the tactics of diagnosing and predicting ill health. Injuries are caused by etiology (reasons for resemblance), form of defect of cysts, replacement of cysts, fixing cysts and other factors. If there are fractures, it is clearly lower and it is possible to imagine the classifications of skeletal injuries.

From the left to the right of the images, the fracture is in the middle of the slope, in the middle of the crease and in the close of the trauma

Through the development of fractures:

• traumatic - in case of infusion of an intensive traumatic factor on the health of the cyst with a sufficient degree of health;
• pathological - they are diagnosed with an infusion of a traumatic factor with an insignificant ear, or a pathological change in the cyst with a low potential for muscle loss.

Traumatic defects of the handles are caused by a direct blow, fall from the hanging, violent acts, unreported ruffs, and wounds in the fire. Such fractures are called straight fractures. In some cases, the application of force or the area formed by injuries can be overdone on the day of the return. Tse indirect fractures. Pathological defects of the cysts are found on aphids, which can lead to weakening of the cyst tissue and reduce the quality of the tissue. A high risk of skeletal injuries is associated with cysts, swelling and metastasis, osteomyelitis, osteoporosis, impaired osteogenesis during the period of membranous development, chronic painful ailments.

For the news of the cyst ulamks navkolishnіm middle breaks:

• відкриі - supervise over different calls;
• zakriti - win without coverage of the wound.

Critical defects of the bottles can be primary and secondary. Pervinnі is characterized by wounds in case of infusion of a traumatic factor. Secondly, there is a moment of injury as a result of the tearing of the curved edges of the cysts with improper transport of the sick person to the emergency room, or not too far away the cysts during an hour of abuse.

Fractures of the handles are directly related to the defect of the handles

Close the fractures will blow:

• not - to be formed according to the type of trough without replacing the ulamk_v of the brush;
• povni - characterized by the appearance of the keys of the hand and the changes in the shape of the sides;
• one by one - injury to one hand;
• many - trauma of decilkokh;
• onset - the diagnosis of a cyst defect as a result of the infusion of negative factors (mechanical, radioactive, chemical);
• combined - injuries to the skeleton are caused by the reduction of visceral organs.

Incomplete fractures occur as a result of insignificant trauma. Most often, such defects are found in children, bristles of which are covered with good and elastic ointments. For a child, traumas of the type of "green gilka" are characteristic - the trauma of cysts without the substitution of ulamki. Up to incomplete defects include edge and part fractures, fractures and tremors. An additional appearance of cyst cells develops when there is a significant shock force or a defect in the cyst dyles with good muscular muscles. The speed of muscular tissue should be brought up to the substitution of cyst ulamks in the small sides along the traction traction of the muscular fibers.

Fracture due to changes is caused by an important injury, such as a tricky treatment and the most common period. Please also apply to the whole group. In addition, the stench supervises the primary infections of the wound, which can lead to osteomyelitis and sepsis. Zsuv ulamkіv ulamkіv іskojennykh kіstok wiklikє development іskladnen, tied from the bundles of textile fabric, nerves and sudin.

Fracture in the middle of the slope

As a result, there are emergencies and closings of bleeding, deterioration of innervations of ideas, parallel and decreased sensitivity. The shock of soft tissues and great blood-bearing deaths can lead to painful and hemorrhagic shock, which will accelerate the treatment of injuries and may result in a fatal result. Fracture without zsuvu don’t lead to undesirable inheritances and in a large number of cases we have a successful result.

For a localization defect of the brush, the following types of fractures are seen:

• forming in the lower, middle or upper third of the cyst (in case of trauma to the tubular cysts);
• hammering abo Іmpresіyna (in case of injuries of the labial cysts, for example, ridges);
• diaphizarni (roztashovany between the ends of the pipe-parts);
• metaphizarny (roztashovany close to the slopes);
• epіfіzarnі (roztasovani in empty slopes);
• epіphіzіolіz (in the area of ​​growth of the brush in a child's life).

Epiphany injuries can be attributed to the type of fracture, which may lead to an accelerated recovery and recovery period. Epiphysiolis in case of inadequate therapy for the early close of the zones of skeletal growth and shortness of the growth of the skeleton.

The following types of fractures are seen in the form of a line defect in the brush:

• mow,
• transverse,
• later,
• gwint,
• fragments.

A splinter fracture is superseded by the statements of one or more deciduous cyst fragments, which tend to emerge from the brush and be found in soft tissues. Such injuries can be avoided surgical treatment and trivial period of rehabilitation. A splinter fracture with the formation of multiple splinters is taken to be fractured. Win wiklik is a significant defect in the kit. Fragmented fractures can be fragmented and large.

Defects in the transverse rasheshuvannya line evil be brought to stable injuries from the child's worms. Reshta vidi zlamіv produce up to the substitution of ulamkіv for the thrust of trauma caused by injuries and included in the group of unstable fractures. It is correct to transport the sick person to the emergency room and adequate methods of treatment are in advance of the development of an accelerated rate of recovery of cystic ulcers.

The classification of fractures in the supply of additional help to the correct tactics of treatment, to outstrip the development of non-essential inheritances, to predict the triviality of therapy and rehabilitation period. Setting an accurate diagnosis, depending on the current classification, will reduce the prognosis of injuries and reduce the development of important acceleration.

heritage

When a fracture is diagnosed, it is necessary to return for medical assistance. In case of important injuries, such as supravodzhuyutsya wounds, or wounds of wounds, bleeding, multiple lesions of the cysts, degradation of the victim's body due to hemorrhagic and painful shock, additional symptoms of shyness. In case of ill-health of ailing physicians, they independently transport themselves in traumatology when providing additional assistance and overlapping transport tires.

With the methodology for the treatment of immobilization of tires, the rules for providing long-term assistance and methods for the treatment of fractures.

Internal blood loss to form a hematoma

Negligible signs of a fracture are due to improper transportation of the patient to the hospital, due to medical assistance, inadequate therapy choices and disruption of the patient regimen. If you are suspected of being diagnosed with injuries, it is necessary to consult with a doctor, to undergo an X-ray diagnosis and to promptly check for a cyst defect.

The results of the growth of fractures:

• outside of the renewal of the anatomical bud and function of the leg or part of the body;
• outside the renewal of anatomical budov and interchange of functional possibilities;
• incorrect growth of the cysts due to the damage to the function of the painting or of the part of the file (deformation, shortening of the image);
• unforgiving kistkovyh ulamkiv with the approval of the grave slope.

Decrease, such as occurring during the start of injuries, to lay down on the basis of the correct reposition (setting) of the cells and sufficient fixation of the set, the sub-ears of the soft tissues, carrying out the rehabilitation of the first steps See the fracture of the cysts pouring into the term of injury. More trivial medical immobilization is necessary for critical injuries, closed ears, against cysts and cyst splinters, as well as in the case of internal fractures.

Correct information about those, how to recognize the fracture, clinical signs of injuries and diagnostics of illness.

Folding fractures can be divided into 3 main groups:

1. Static damage from the side of the knotted fabric (visibility or improper firing, deformation or short legs, illumination of the grave slope).
2. Damage from the side of soft tissues (loss of blood flow and innervations, atrophy of mucous membranes, bleeding).
3. Mistseve infection in diseases of the disease (wound, cysts) or an increase in the infection by organism (sepsis).

Deformation of the brush as a result of improper brush growth

Non-overgrown cyst fractures are formed with incorrectly inserted blisters, in which case the cyst callus is destroyed. If the soft tissue comes in between the kidneys, a pseudo-corner can be detected, which can lead to pathological crumbling in the context of injuries and the deterioration of the normal function of the picture. In case of pathology of the consolidation of the cyst, it develops in a short or deformity of the cysts, which can lead to invalidity.

Bleeding from large vessels in case of ruptured integrity by the edges of the cysts of the wikklica, the development of bleeding. In case of close injury, the stegna of blood loss should be 1-2 liters, the cysts of homilka - 600-800 ml, the cysts of the shoulder - 300-500 ml and before the preparation - 100-250 ml. In case of severe blood loss in the area of ​​great blood-bearing vessels (sleepy, inguinal, stegnous arteries and aorta), bleeding can result in blood loss (more than 2 liters) and lead to a lethal result.

The fracture of the cysts with the nerve stubs of the wikipedia, the rupture of the rudder function and the sensitive sphere. For the development of a defect, a large blister may be established, as it will help the blood-bearing vessels and nerves. As a result, parallels and paresis develop, congestion in the tissues, which can be produced to the point of incapacity.

Trivial immobilization of the infection with the atrophy of mucous membranes and the formation of the impairment of loafs (ankylosis). Pislya nobility hips, vityagnenya or the apparatus of new physicality. In order to prevent the formation of certain inheritances in the fracture of the symptoms, to carry out adequate therapy and stasis rehabilitation, enter at the advanced stages of injury.

Formation of a grave slope

Infectious acceleration is characteristic for all types of cases. As a result of injuries, ailing microorganisms are consumed in the wound, such as the suppuration of soft tissues, cysts (osteomyelitis) or generalization of infections (sepsis). It is more common to form gniniks in the interior of internal or external osteosynthesis (insertion of knobs behind additional knitting needles, plates, gvints). For the antibiotics to carry out an aseptic treatment of the wound, suturing the defect of the skin curvatures, to assign a course of antibiotics.

Wrong aboot the triviality of starting the fractures of the wikipedia of the establishment of the scars, as to repair the grip on the blood-bearing judgment and nerves. It can lead to chronic pain syndrome from the consolidation of cystic ulcers and turning to specific physical activity. more views You can enjoy the trivial walking, transferring important objects, changing the weather minds, you can feel sleepy and psychic visceral to the body. Significant decrease in prasezdatnost і in case of persistent pains to bring to іnvalіdizatsії.

Fractures of the stocks are due to the change in parameters. For setting an accurate diagnosis and selection of the correct method of treatment of the ball, a classification has been established, which represents the specific features of these injuries. The inheritance of fractures lies in the gravity of the ear, the hourly provision of dolikarskoy additional aid, in every way according to the tactics of treatment and rehabilitation. With the help of the doctor's recommendations in a large number of clinical vipads, it will be necessary to increase the anatomical functionality of the kit and the functional activity of the kit, or part of the subject.