Traumatology: diseases — симптомы, диагностика и лечение

A typical location for a radius fracture is a fracture of the lower end of the radius, two to three centimeters above the wrist joint. It ranks first in frequency among fractures in adults, and the scenario is almost always the same: a person falls and instinctively puts his arm forward. The most persistent misconception is: “if your fingers move, it means there is no fracture.” The fingers are moved by muscles in the forearm and not in the wrist, so they continue to work even with a completely broken bone, and a person can hold a cup, fasten a button and write. Only an x-ray in two projections can distinguish a fracture from a bruise, and it must be done on the first day: the sooner the displacement is eliminated, the better the hand will work in a year.

An ankle fracture is the most common fracture in the ankle area, and it almost always starts the same way: a twisted foot on a curb, on a staircase, on a rough road or on a sports field. The dangerous misconception here mirrors the story with the wrist: “I step on my foot, so it’s just a sprain.” In fact, when the lateral ankle is fractured without displacement, a person often walks home on his own, and sometimes continues to work for several days. The ankle is not just a junction of bones, but a load-bearing structure that with each step can withstand a load several times greater than the weight of the body. Therefore, even a slight displacement here changes the distribution of pressure in the joint and after years leads to arthrosis.

Shoulder dislocation is a condition in which the head of the humerus comes out of the socket of the shoulder blade and remains outside. The shoulder dislocates more often than all other joints of the body, and the reason is in its design: for the sake of a huge range of movements, nature sacrificed stability, and the head of the shoulder is several times larger in area than the socket in which it lies. Hence the most dangerous misconception: “you can straighten a dislocation yourself, and simply return the bone to its place.” It is forbidden. When a dislocation occurs, the cartilaginous lip almost always tears, the edge of the socket or the head itself often breaks, nerves and blood vessels pass nearby, and in older people the dislocation is often combined with a fracture of the humeral neck. An attempt to force such a shoulder into place in the yard or in the car turns a complex but correctable injury into an irreversible one.

The menisci are two cartilaginous crescents between the femur and tibia that act as pads: they distribute the load across the joint, absorb shock and keep the knee from excessive displacement. Their rupture is one of the most common findings in the knee joint and at the same time the most overrated. The statement “the meniscus is torn, which means surgery is needed” sounds logical, but has long been refuted: for a degenerative tear in a middle-aged person, the correct program of physical therapy gives results no worse than arthroscopy, and this has been confirmed by large international studies. Moreover, altered menisci are found on MRI in many people over fifty years of age who do not complain of anything at all. Therefore, they operate not on a snapshot, but on a specific situation: a true blockade of the joint, a fresh traumatic rupture in an active person, a displaced flap that mechanically prevents the joint from working.

The anterior cruciate ligament runs inside the knee joint and keeps the tibia from moving forward and from excessive rotation. Its rupture is an injury that almost always occurs without any contact with an opponent: a person brakes sharply, turns on the supporting leg or lands poorly, hears or feels a click, and after an hour or two the knee swells. There are two misconceptions here. The first is “if I walk, then the ligament is intact”: a torn ligament does not interfere with walking in a straight line, problems begin when turning and on uneven surfaces. The second is “I’ll lie down and it will heal”: a completely torn ligament inside the joint does not heal on its own, because it is washed by the joint fluid and its ends diverge. At the same time, not everyone needs surgery - and this is the third, most important detail, which is talked about least often.

Ankle sprain is the most common injury of the musculoskeletal system and at the same time the most underestimated. The name itself is misleading: the ligament does not stretch like an elastic band, tears in the fibers occur in it, and in case of severe injury, a complete rupture. Hence the main misconception: “stretching is nonsense, it will go away on its own.” Pain and swelling do go away in one or two weeks even without treatment, but a significant portion of people are left with a feeling of an unreliable leg, and they begin to twist it over and over again - on a curb, on a carpet, out of the blue. This condition is called chronic ankle instability, and it develops precisely because the first injury was considered a trifle and was not treated. The correct tactics in the first weeks are inexpensive and take a couple of months, but treating instability years later is a different story.

A concussion is the mildest form of traumatic brain injury in which the brain is temporarily disrupted without visible structural damage. That is why a computed tomography scan usually doesn’t find anything during a concussion, and this is normal: it is not the anatomy that suffers, but the function—the metabolism in nerve cells, the transmission of signals between them. There are more myths surrounding concussions than any other injury. The two most persistent: “a concussion occurs only with loss of consciousness” and “the victim should not be allowed to sleep.” Both are incorrect. Loss of consciousness with a concussion does not occur in most patients, and the prohibition on sleep is an outdated recommendation from an era when there was no tomography and the only way to notice a growing hematoma was to regularly wake the person. Today, the doctor makes the decision based on specific criteria, and sleep, on the contrary, helps the brain recover.

Injury to the urinary system occurs in road accidents, falls from a height, blows to the lumbar region and fractures of the pelvic bones. The kidney is protected by ribs and muscles, but is damaged by strong impact. The main sign that cannot be ignored is blood in the urine after an injury, even if it appears once and you feel satisfactory.