The subperiosteal hemorrhage, which often accompanies a small, barely noticeable bone crack, is visible in the picture only if the irritated, exfoliated and tightly stretched periosteum begins to produce bone substance; a shadow is also obtained in cases where the blood is organized and subsequently saturated with lime salts. A distinctive radiological feature of the subperiosteal hematoma is the more or less regular spindle-shaped form of a bone sleeve surrounding an unchanged bone, or a semi-spindle-shaped, shell-shaped shadow that rises in one direction above the bone. By the absence of a fracture line and displacement, the subperiosteal hemorrhage differs from bone callus during a fracture, and the integrity of the bone and the superficial nature of calcification are different from a neoplasm.

Ossifying myositis

The traumatic ossifying myositis is not an inflammatory disease, as its outdated name indicates, but a metallastic one. Metaplastic calcification, and subsequently true ossification, does not undergo muscle fibers, but connective tissue layers in the thickness of the muscle. Therefore, this disease caused by trauma is not myositis in the literal sense of the word, but intramuscular fibrositis, and more precisely - intramuscular fibrous metaplastic process.

The immediate cause of the occurrence of ossifying myositis has not been elucidated. Often a hemorrhage is detected in the thickness of the muscle. Myositis is caused either by a single severe injury, most often a dull, crushing muscle tissue, or by repeated, often repeated sports or professional injuries of the same muscle. Myositis stands apart, which develops after changes in the nervous system during dryness of the spinal cord and syringomyelia, as well as after injuries of the central and peripheral nervous system, the so-called neurogenic ossifying myositis.

The favorite localization of traumatic myositis during its acute development is the brachial muscle, which ossifies with various injuries of the elbow joint, but most often due to dislocation of the ulnar bone or the entire forearm posteriorly, both in cases of timely and completely flawless bone reduction, and in complicated neglected and poorly treated cases of dislocation. One cannot refuse the impression that ossifying myositis anteriorly from the elbow joint actually occurs in some connection with the act of treatment itself. We observe its quite frequent development in some institutions and extremely rare in others, in which a different treatment system is carried out. Behler considers excessive extension of the limb in the elbow joint, too vigorous massage and early passive movements to be important factors. However, the refusal of massage and complete immobilization far from always prevent the development of this painful complication.

The second place in the frequency of damage is occupied by the muscles of the gluteal region and thigh, especially the middle gluteus, quadriceps and adductor muscles (Fig. 35). The group of adductors of the thigh is sometimes affected after the hip is repaired in muscular faces during a fracture or dislocation. Myositis usually affects men aged 20-30 years, of strong physique, with powerful muscles, often workers, athletes, and military. Especially characteristic are the traumatic myositis of the femoral musculature in football players, and among the female athletes, this is not a group of adductors that is affected, but an array of muscles outside the thigh, which is especially severely injured by players in their collisions. We observed extensive calcifications and more often ossification of the entire thickness of the muscles and lower leg years after fractures of the lower leg treated with commonly used methods. Finally, we also point out that we have seen significant peri-and paraostal ossifications in the muscle layers as a result of extensive incisions made in connection with a gas infection.

On radiographs (Fig. 35-37) a characteristic and at the same time very original picture is found. The pathological shadow is smaller than the palpable "tumor." Its shape and shape are extremely bizarre. At first, myositis gives a very gentle roundish, namely cloud-like, 1 shadow that resembles bone callus in its early stages in intensity and structure, then the shadow gradually thickens and can reach bone intensity in a few months. From vague-spotted, inhomogeneous, it becomes structural and even acquires a pattern of compact and irregular spongy bone tissue. The contours, initially vague and blurry, are further made clearer and sharply limited. Sometimes, along with an increase in the intensity of the shadow, its size decreases. In advanced cases, ossifying myositis presents a stationary picture of a bone strip or wing with a regular bone structure.

In the distinguishing-discriminatory respect, it is important that the shadow of calcified or ossified muscle lies isolated from the bone, only on one side of it, or when it is involved in the process and tendons, it acquires an anatomically predetermined shape of the muscle-tendon complex attached to the bone. The bone itself remains completely normal. The determination of the presence or absence of a connection of calcified or ossified muscle mass with the underlying bone is very important from a clinical point of view.

X-ray examination is also crucial for the recognition of those muscle calcifications and ossifications that are caused not by acute, but by repeated trauma; this includes, for example, the bones of riders in the thickness of the large adductor muscle of the thigh, the bones of gymnasts in the biceps of the shoulder, the bone of the shooters from the recoil of the gun in the right deltoid muscle, etc. These pathological formations may sometimes not cause particularly unpleasant subjective sensations, and in rare cases, leak generally painless.

The traumatic ossifying myositis, which is so booming at the beginning of the disease, over time takes a more calm, chronic, benign course. The pain subsides, and patients are forced to seek medical help mainly by limiting their mobility. As a result of persistent and systematic physiotherapy and massage, a significant improvement or cure usually occurs, objectively confirmed by a decrease or complete resorption of mineral deposits in the muscle, determined by x-ray. We saw excellent results in connection with the use of X-ray therapy: anesthesia quickly occurs, complete resorption or early “ripening,” that is, calcification in the form of ossification, restoration of lost function and performance.

Limited local ossifying traumatic myositis should not be confused with progressive ossifying myositis, a congenital systemic disease with an invariably fatal outcome. This is a rare disease, in the literature only about 200 cases are collected. It most often affects Children and is associated with various developmental abnormalities, for example, microdactyly. In all likelihood, the disease has a central nervous origin. The greatest early changes are the back muscles, especially the broad back muscle, trapezius muscle.

A single injury can also be complicated by calcification and ossification of only tendons and other periarticular soft tissues.

YabZh and Yabdpk - This is a chronic relapsing disease, accompanied by the formation of ulcerative defects in the stomach or duodenal bulb.

X-ray diagnosis of ulcer is based on direct (morphological) and indirect (functional) signs. Direct radiological signs- "niche" and cicatricial-ulcerative deformity.

An ulcer niche is a defect in the wall of the stomach or duodenum filled with a contrast agent. The niche has the appearance of a local protrusion on the contour or a contrasting spot (barium depot) on the mucosa relief (niche relief).

Localization: in 75% of cases, the ulcer niche in the stomach is localized along the lesser curvature at the border of the middle and lower third of the body, in the region of the angle of the stomach, in the pyloric department, as well as on the posterior wall of the stomach. the high location of the ulcer (directly at the cardia) on the posterior wall is characteristic of the elderly.

Subcutaneous hematoma

The formation of subcutaneous hematoma occurs in a limited space filled with subcutaneous tissue. The dimensions of the space are quite constant due to rigid fixation by connective tissue jumpers running vertically from the skin to the tendon helmet (aponeurosis epicranialis). The formation of a subcutaneous hematoma is possible if damage occurs not only to the blood vessel, but also to the jumpers. The rupture of connective tissue jumpers occurs directly due to trauma or as a result of excessive blood pressure in the damaged vessel, which is most often observed in people with high blood pressure. With closed injuries of the cranial vault, these fascial bridges contribute to a significant limitation of bleeding and the formation of subcutaneous hematomas, sometimes clearly round in shape.

Subaponeurotic hematoma

The formation of a hematoma is associated with the accumulation of blood in the subaponeurotic space and the detachment of supracranial aponeurosis (Fig. 3). Due to the extremely weak connection of the aponeurosis with the underlying layers due to the presence of a layer of loose subaponeurotic adipose tissue, delamination can occur in a significant area with the formation of a massive hematoma. It should be remembered that subaponeurotic hematomas are frequent companions of skull fractures, especially in children. If the vessels of the subcutaneous fat layer are the source of bleeding, then this is associated with a violation of the anatomical integrity of the aponeurosis. Subcutaneous hemorrhages are prone to suppuration, can mimic a depressed fracture. Abrasion - superficial damage to the skin, not extending deeper than its papillary layer. Abrasions can form on any part of the surface of the head, but most often they are found on the face. Due to the protective properties of hair and headgear, abrasions are less likely to occur on the scalp. The number of abrasions usually indicates the number of traumatic effects. With dynamic contact, the greatest depth and severity of a scratch is noted in the initial portion, whitish patches of exfoliated epidermis are visible at the opposite end of the abrasion. These morphological features make it possible to establish the direction of the force vector. Immediately after an injury, abrasion is a defect in the surface layers of the skin with a sunken, moist, shiny surface. Within a few hours, the bottom of the abrasion dries up and acquires a matte shade. Gradually damaged tissues are necrotic and, together with clotted blood, form a dense crust. Within 1 day, the crust reaches the level of the surrounding skin, on the 2nd day already exceeds it. In parallel with the formation of a crust from the periphery of the abrasion to its center, spontaneous epithelization of damaged skin begins. The newly formed epithelium from 3-4 days gradually exfoliates the edges of the crust. By the 4-8th day, the crust falls off, exposing the surface of the pinkish epidermis, which easily gathers when the skin is compressed into multiple small surface folds. By the end of the 2nd week, the site does not differ in color and texture from the surrounding skin. Wound - damage to soft tissues deeper than the papillary layer of the skin. There are chipped, bruised, ragged, bruised-ragged, cut, scalped and gunshot. Most often with traumatic brain injury, bruised, lacerated and bruised-lacerated wounds are observed. Bruised wounds formed from shock. Their morphological features are uneven, bruising, crushed and sagged edges, connective tissue bridges between the opposing edges of the wound. Torn wounds arise by the mechanism of stretching. The most typical laceration is formed from inside acting with the end or edge of a fracture of the bones of the cranial vault. Torn wounds are most often rectilinear or arched in shape, sometimes with additional tears that give them a complex configuration. The edges of the wound are uneven and are never sedimented. Connective tissue jumpers are missing. The bottom of the wound, as a rule, is a damaged bone. Bruised-ragged wounds arise from the combined shock and tensile action. The wound is formed most often from the action of a blunt object at an acute angle: at the first stage, a bruised wound component with sedimented bruising, sometimes crushed edges is formed, then the skin exfoliates from the subcutaneous fat layer or comes off in the form of flaps (lacerated wound component). Scalped wounds characterized by detachment of the skin and fiber with their complete separation from the underlying tissues. Extensive scalped wounds are dangerous due to the presence of significant blood loss and the possibility of subsequent necrosis of the flap. Chipped wounds occur when exposed to a sharp or limited surface of a wounding item. The total dimensions of such wounds do not go beyond the dimensions of the traumatic surface of the subject. Depth of wounds prevails over width and length. The bottom of the wounds is deepened, often reaches the underlying bone, can be represented by individual fibers of the connective tissue jumpers. Gunshot wounds can be bullet, shot, fragmentation, with a blind or through wound channel. The entry wound is characterized by three mandatory signs: a tissue defect, a sedimentation belt 1-2 mm wide and a rubbing zone (grease, soot). The exit wound may have a slit-like shape. The number of entry and exit wounds may not match. The features of injuries in gunshot wounds are associated with the occurrence of a shock wave and the formation of a “molecular concussion zone”. Tissues subjected to molecular shaking are necrotic, and therefore gunshot wounds always heal by secondary intention. According to the dynamics of changes in damaged tissues, we can tentatively assume the prescription of exposure to external damaging factors. Revision of wounds in some cases allows us to judge the nature and severity of neurotrauma (damage to the aponeurosis, bone structure of the skull, the presence of foreign bodies, bone fragments, an admixture of cerebrospinal fluid, cerebral detritus, etc.). Subaponeurotic hematomas as companions of fractures have a certain diagnostic value. Isolated staining of the skin with a hematoma in the behind-the-ear region is noted during a fracture in the lateral angle of the posterior cranial fossa with damage to the mastoid graduates. With significant venous bleeding, blood can spread down the vagina of the sternocleidomastoid muscle down, causing muscle irritation and the torticollis phenomenon. Well-known hemorrhages in the periorbital tissue, manifested in the form of bruises, "glasses" on the upper and lower eyelids. They can form without any local application of force like leakage hemorrhage from the area of \u200b\u200bthe fracture of the base of the skull. However, it should be remembered that their appearance is not a reliable sign of a fracture of the skull in the anterior fossa. Most often, this symptom occurs due to blood migration with hematomas of soft tissues of the frontal region or fractures of the nasal bones. The appearance of the symptom of “points” in the delayed period in the absence of a direct injury to the orbital region is alarming. The incontrovertible fact of the fracture will be in the presence of nasal liquorrhea. When examining the victim’s head, it is imperative to inspect the external auditory canals for cerebrospinal fluid expiration. Otoliquorrhea indicates a fracture of the base of the skull in the middle cranial fossa passing through the pyramid of the temporal bone. Sometimes these lesions are accompanied by nasal liquorrhea, since cerebrospinal fluid flows into the nasopharynx through the auditory tube. In the acute period, the cerebrospinal fluid flowing from the ear canal usually contains a significant admixture of blood, and it is often not possible to differentiate the isolated damage to the ear canal, eardrum, and even blood flow from an external wound. In such situations, it is preferable to follow the path of overdiagnosis and exclude otoliquorrhea only after a comprehensive ENT examination (glucose test, hearing acuity, air and bone conduction, nystagmus, etc.).

When examining a wound, in addition to determining the type of wound, it is necessary to take into account damage to the aponeurosis of the fronto-occipital muscle, since this symptom allows us to differentiate between closed and open head injury. It is imperative to identify possible damage to the underlying bone and medulla. Visual or digital examination of the bottom of the wound allows you to determine the deformation of the cortical layer of the bone or the presence of free bone fragments, indicating the presence of an impressed fracture. The expiration of cerebrospinal fluid or cerebral detritus from the wound reliably indicates the penetrating nature of the head injury. Features currents wound the process on the the head and high probability development formidable complications right up before lethal the outcome determined need final processing wounds only at conditions branches neurosurgical profile. When treating wounds and planning tactics to provide assistance to victims of head injury, the anatomical and topographic features of the soft integument of the head should always be taken into account. Even from small wounds, there is heavy bleeding, which leads to significant blood loss, up to hemorrhagic shock, which dramatically exacerbates the course of head injury. This is largely due to the unusually abundant blood supply to the soft tissues of the head and numerous vascular anastomoses. It must be taken into account that adventitia of blood vessels is firmly fused with fascial lintels, as a result of which the vessels do not fall off during an injury. The most effective and affordable way to stop bleeding at the prehospital stage is to apply a pressing aseptic dressing, with which you can squeeze the lumen of a bleeding vessel by pressing the soft tissues of the head to the bones of the skull. A similar effect can be obtained with finger compression of the vessel (Fig. 4). To enhance the compression effect of the dressing, gauze rollers can be used, which are placed on the edges of the wound. The adequacy of the bandage is determined by the intensity of bleeding from the wound. With a properly applied bandage, bleeding stops. In addition to stopping bleeding from a wound, the need for a pressure bandage is due to a whole series of anatomical and topographic features. A layer of adipose tissue located under the skin-aponeurotic flap prevents firm fixation of the flap with the underlying tissues (periosteum) and, even with minor injury, leads to the separation or detachment of the flap with the formation of extensive subaponeurotic hematomas and sagging. A timely applied pressure dressing will prevent the accumulation of blood under the aponeurosis. A contraindication to the application of a pressure bandage is the presence of an impressed comminuted fracture of the skull bones in order to avoid immersion of bone fragments in the medulla. The most convenient hemostatic dressings are nodular and "cap."

A nodular dressing is a pressure dressing, and it is usually used to stop arterial bleeding. When assisting the victim, bleeding from the damaged vessel is temporarily stopped by finger pressure, after which the area of \u200b\u200bdamage is covered with a sterile gauze cloth and a bandage is applied with a double-headed bandage. It is recommended that the bandage be started from the temporal region of the healthy side, circling the bandage around the head. In the area of \u200b\u200bdamage, a bandage is crossed, for which the right head of the bandage is taken in the left hand, and the left head in the right hand. Next, the head of the bandage lead to the temporal region of the healthy side, then they are carried to the area of \u200b\u200bdamage, where they again make a cross and lead the bandage around the forehead and neck. Further moves of the bandage are repeated. Cross bandages are placed each time over the area of \u200b\u200bdamage.

The bandage "cap" (Fig. 6) allows you to conveniently and firmly fix aseptic material to the scalp of the victim. Requires an assistant, the role of which can be performed by the patient himself. The bandage is formed as follows: a separate piece of bandage (eyebrow), about 1 meter long, is placed on the parietal-temporal region anterior to the auricles, and the assistant (or patient) holds the ends of the eyebrows in a taut state. A horizontal tour is made around the head and, reaching the eyeballs, they put a bandage over it, lead them to the eyeballs and are led back, covering the back of the head. On the other side, the bandage is again circled around the ligament and leading it anteriorly, covering the forehead and part of the crown to the ligament on the opposite side. The subsequent rounds of the bandage repeat the moves of the previous ones, but with each move they are more and more shifted towards the eyeballs. The end of the bandage is strengthened in a circular round or fixed under one of the ties. The ends of the tie are tied under the lower jaw. With extensive damage to the cranial vault, the application of a “returning” dressing is generally accepted (Fig. 7). To apply this bandage, first hold reinforcing tours (1) around the head, bend the bandage in the frontal region (2) as low as possible and lead it along the side of the head above the previous one. On the back of the head they form a second inflection and cover the lateral surface of the head with a bandage on the opposite side (3). Fix returning moves in a circular round (4). Subsequent returning rounds (5, 6, 8, 9, 11, 12, 14) cover the lateral surface of the head, making moves higher and higher until the whole head is bandaged. Returning tours are fixed with circular bandage moves (7, 10). It should be noted that the returning dressing is fragile, easily slides from the head and therefore it is used only for temporary fixation of the dressing. A stronger bandage bandage is the “Hippocratic cap” (Fig. 8).

The bandage “Hippocrates hat” (Fig. 8) is applied using a two-headed bandage, which is easy to make from a regular bandage, partially rewinding it, or using two bandages. Make a circular motion around the head (1) below the external occipital protrusion. After crossing the bandage in the occipital region with the right hand, the head of the bandage is passed through the arch of the skull to the forehead (2), where it is strengthened in a circular round (3). After crossing with a circular tour, the bandage through the cranial vault is returned to the back of the head (4), covering the left of the previous round half the width of the bandage. After a cross in the occipital region with this bandage head, the next round is made in the sagittal direction, placing it to the right of the previous ones (6). The number of returning bandage moves on the right (10, 14 ...) and left (8, 12 ...) should be the same. The head of the bandage, which is in the left hand, is always placed through the forehead and nape of circular rounds (5, 7, 9, 11 ...). The circular passages of the bandage, densely laid below the frontal tubercles, above the auricles and under the occipital tubercle, have a smaller perimeter than the head circumference in the widest part. Thanks to this, the bandage is firmly held on the head.

In the presence of pronounced psychomotor agitation, inadequate behavior of the victim, the Hippocratic cap bandage is additionally strengthened: in the frontal plane through the cranial vault in front of the auricles, under the lower jaw, 2-3 circular movements of the bandage are performed. On the parietal, parietal-temporal region, lower jaw, a bandage of the “frenulum” type is usually applied. A simplified version of this dressing (Fig. 9a) is imposed as follows: around the head, reinforcing tours are made. Having reached the temporal region, the bandage is bent and driven vertically up the parietal region to the opposite side down the cheek, under the lower jaw on the cheek of the other side and fix the place of the bend. The number of vertical rounds is arbitrary, as a rule, until the parietal region is completely closed. At the end of the bandage, an inflection is made in the temporal region, the course of the bandage is given a horizontal direction and the bandage is strengthened in a circular round. A similar bandage can be applied without kinks of the bandage (Fig. 9b). After two obligatory fixing horizontal rounds, the bandage is carried out over the left ear along the occipital region to the right lateral surface of the neck and from there - under the lower jaw. On the left side of the lower jaw, the bandage tours take a vertical direction and pass in front of the auricle. Bandage the entire parietal and temporal region with vertical strokes, and then from under the chin, bandages along the left side of the neck lead to the back of the neck and are transferred to horizontal rounds. The bandage is strengthened by circular fixing horizontal moves. To close the lower jaw after fixing rounds around the head, the bandage is led obliquely, closing the back of the neck, bypassing the lower jaw in front of the right surface of the neck and horizontal movements of the bandage, and then closing the parietal-temporal region with vertical rounds. The bandage is completed with circular horizontal strokes of the bandage, which are projected onto the first fastening.

Necessary remember, what overlay circular frontal moves bandage under lower jaw makes it difficult opening oral cavity and creates objective difficulties at carrying out reani mational events. Using dressings with like fixation special undesirable at affected with TBI at communication with high risk suction at vomit and possible lowered language. Bandage on the right eye (Fig. 10a). The bandage is strengthened by two horizontal circular passages around the head. Then, along the occipital region, they lower it down under the right ear and draw it obliquely up the lateral surface of the cheek, close the sore eye and the inside of the orbit. With a circular tour, the upward movement of the bandage is fixed. After that, the bandage again obliquely lead under the right ear and close the eye, slightly shifting the bandage outward. The oblique course of the bandage is fixed in a circular manner. Alternating circular and ascending bandage tours, close the eye area. Usually, after three returning tours, bandaging can be completed by securing the bandage in a circular motion. Bandage on the left eye (Fig. 10b). It is more convenient to bandage from right to left in a clockwise direction, holding the head of the bandage with your left hand. The alternation of rounds of the bandage is the same as when applying a bandage to the right eye. Bandage on the both eyes (Fig. 10c). The bandage is fixed with circular horizontal rounds around the head. The third round is conducted over the left ear obliquely along the occipital region under the right ear, under the right eye, then on the back of the head, above the right ear on the right temporal, frontal region, and then from top to bottom on the left eye. The bandage is directed under the left ear, along the occipital region under the right ear, on the right cheek and is held over the right eye, shifting the bandage one third of its width down and inwards from the previous round; , slightly higher than the previous round to the area of \u200b\u200bthe left eye, shifting inwards from the previous round. The dressing is completed with a circular horizontal tour through the forehead and the back of the head. When a blindfold is applied to both eyes, each round of the bandage covering the right or left eye can be strengthened in a circular motion. When applying a bandage to one or both eyes, do not apply tours to the auricles.

Neapolitan blindfold impose on the ear region and the mastoid process. The bandage moves resemble those with a blindfold. The bandage tours after the fixing moves lead above the eye on the side of the lesion, without grabbing the neck. At the end of bandaging, the bandage is strengthened in a circular tour. For minor injuries in the frontal, temporal or occipital region, circular or sling-like dressings can be used. It should be noted that if it is necessary to close the nose, the lower jaw it is more rational to apply a sling-like bandage, since it is simpler, reliably fixes the dressing, does not require significant time for manufacturing, and is economical. The dynamics of the wound process on the head is also largely due to the anatomical and topographic features. The presence of numerous anastomoses passing through the bones of the skull and connecting veins of the scalp with intracranial venous sinuses implies the transient development of such formidable complications as meningoencephalitis, brain abscess, venous sinus thrombosis, and osteomyelitis of the skull. Demand to asepticism dressings connected with prevention secondary infection. When assisting patients with infected and purulent wounds without signs of bleeding, the use of headscarves is quite acceptable (Fig. 12). A scarf is understood to mean a triangular piece of some kind of matter (better than calico), which is obtained after cutting a square of fabric about 100 x 100 cm diagonally. An impromptu scarf can be made of a female headscarf folded diagonally. The base of the scarf is placed in the back of the head, and the top is lowered onto the face. The ends of the scarf are held above the auricles on the forehead, where they are connected. The top is wrapped over the connected ends upwards and strengthened with a safety pin or stitched. If the wound is located in the forehead, then the aseptic material is covered with the base of the scarf, the top is laid on the back of the head, the ends of the scarf are tied behind and somewhat sideways, the tip is wrapped on them and strengthened. At the prehospital stage, in the absence of violations of the vital functions of the body, medical care can be limited to stopping bleeding from damaged external integuments of the head, respiratory support, prevention of aspiration, and drug therapy (symptomatic and specific). Prevention suction It is carried out by proper laying of victims with a head injury (Fig. 13), which should prevent secondary damage during transportation, the development of hemodynamic and respiratory complications and ensure maximum peace for the victims. In case of gross impairment of consciousness (at the coma level - GCS less than 7 points), tracheal intubation is indicated to adequately ensure airway patency and prevent aspiration.

Respiratory support carried out by inhalation of moistened oxygen in order to eliminate respiratory failure and prevent hypoxia. You should refrain from inhaling moistened oxygen through a mask if active or passive regurgitation is suspected. With a full stomach, pregnancy, obesity, inhalation of moistened oxygen is preferably carried out through a nasal catheter.

Medication therapy In severe TBI, against the background of stable hemodynamics, a low-volume infusion of solutions of low molecular weight colloids (with a rheological effect) is carried out, then saline solutions in a ratio of 1: 1. No glucose solution is used. The infusion is carried out under the control of hemodynamic parameters. When signs of hemodynamic instability appear, the volume and speed of intravenous infusion of plasma-replacing solutions increase to 12-15 ml / kg / hour. A bolus administration of 200 ml of a hypertonic solution of sodium chloride and corticosteroids is advisable. In the absence of effect, administration of adrenergic agonists is indicated for 10-15 minutes. Decreased systolic blood pressure less than 90 mm Hg does not provide adequate perfusion pressure to the brain. The upper values \u200b\u200bof systolic blood pressure should be kept within no more than + 15-20% of the working blood pressure (if history data are available) or no more than 160 mm Hg.

Symptomatic therapy -- Emetic syndrome - for the prevention of vomiting, the introduction of metoclopramide is sufficient; in the case of repeated vomiting or lack of effect after administration of metoclopramide, ondansetron is indicated. - Convulsive syndrome, psychomotor excitation - in the case of severe psychomotor agitation or the development of a convulsive seizure, the introduction of tranquilizers (sibazon) is indicated, drugs for general anesthesia (sodium thiopental, etc.) may be the drugs of choice for stopping a seizure attack. - Pain syndrome - preference is given to non-narcotic analgesics in connection with a minimal inhibitory effect on the respiratory center; with persistent pain and lack of effect from the introduction of NSAIDs, the introduction of narcotic analgesics is indicated; if necessary, short-term elimination of pain during the period of manipulation (intubation, immobilization, etc.), the optimal use of funds for general anesthesia (ketamine).

Sports and domestic injuries, a blow with heavy objects, and damage when dropped often cause a bruised lower leg. This condition sometimes seems harmless, but in some cases can have unpleasant consequences. The victim should seek medical help to rule out more serious problems and prevent serious complications.

How to recognize a bruised leg

Trauma is always accompanied by pain. Sometimes the suffering can be so intense that the patient loses consciousness.

The pain syndrome is intermittent and may intensify after several hours, when a bruise of the soft tissues of the lower leg will lead to the formation of a hematoma with swelling. The accumulation of blood compresses the muscles, ligaments, tendons, and this is accompanied by edema, swelling of the knee and ankle joint may appear.

A severe bruise causes the following characteristic symptoms:

• edema;
• impaired motor function;
• limping when walking;
• a lump appears at the site of the impact, which is replaced by a tightening of the muscle;
• subcutaneous bruising in the form of bruises;
• it hurts to step on a damaged leg.

Despite the fact that the pathological condition can be determined by clinical signs, you need to see a doctor. An examination will help to eliminate bruised bones of the lower leg, which without treatment will lead to serious consequences.

Bruising of the tibia often occurs due to the fact that it is poorly protected by the muscle layer. Injury in this case can be complicated by the development of periostitis and osteomyelitis. Infectious diseases of the skeletal system cause intoxication, a sign of this pathology is an increase in body temperature and a deterioration in the general condition.

First aid

If you receive a leg injury, you will need to provide first aid to the victim as soon as possible. In most cases, this helps to alleviate the course of the pathological process and accelerate recovery.

Immediately recommended to apply cold to a bruised area. This will help reduce inflammation, swelling. Low temperature significantly reduces bleeding due to vasospasm, the hematoma under such conditions will not be extensive.

If the patient is outdoors in the winter, cold compresses of snow or ice can be applied. In the absence of natural sources of cold, you will need to use the contents of the freezer. If there is no ice, it can be replaced with frozen meat or fruit. Periodically, the compress must be removed so as not to cause frostbite. The application time is determined individually, usually it is several hours. It is advisable to use the cold during the first day of injury. A damaged shin hurts significantly less after exposure to cold treatments. In the absence of ice, it is permissible to apply water from the refrigerator in a plastic or glass bottle to the affected area.

If the skin has scratches, abrasions, the bruise is treated with a solution of iodine, brilliant green. Antiseptic solutions are also suitable:

• chlorhexidine;
• hydrogen peroxide.

It is necessary to smear the damaged skin areas until they are completely healed.

A damaged limb must be elevated to reduce swelling and a bandage with an elastic bandage. The victim needs to reduce the load on the foot, he needs complete immobilization of the leg in the lower part.

Diagnostic measures

To exclude a fracture of the lower limb, it is necessary to take an X-ray picture of the tibia. To clarify the diagnosis and evaluate the compression of muscle fibers, the ligamentous apparatus of the hematoma, it is necessary to undergo ultrasound diagnostics and computed tomography.

Treatment

Therapeutic tactics after injury include the use of:

• conservative methods (drugs in the form of tablets, injections, ointments);
• surgical methods of treatment;
• folk methods.

The volume of interventions and the appointment of a course of treatment are determined by the attending physician after a clinical examination and additional studies.

Therapeutic measures

Severe pain after a bruise occurs immediately and causes the need for prescription painkillers. To reduce unpleasant sensations, analgesics of a central action are prescribed:

• Analgin;
• Dexalgin;
• Paracetamol;
• Solpadein.

To locally act on a painful focus, anti-inflammatory non-steroid drugs will be required:

• Ibuprofen;
• Diclofenac;
• Meloxicam;
• Indomethacin.

The appointment of these drugs will reduce pain and inflammation, will have an antipyretic effect.

Painful sensations can disturb the victim for a month after the injury, in addition to the course of drug therapy in tablets or injections, the patient can use ointments based on anti-inflammatory drugs.

Local medicines in the form of a cream or gel will help at home:

• improve vascular function;
• eliminate hematoma compressing soft tissues;
• reduce inflammation.

Apizartron, Lyoton, Diklak-gel, Indovazin have a good result. Their use must begin on the fourth day after the injury, when the hemorrhage from the damaged vessels stops. You need to rub them until completely absorbed by the skin. As a result of their use, puffiness decreases and the seal resolves.

The iodine mesh at the site of the bruise will help the fast healing of the hematoma. The use of thermal procedures is possible a week after the injury. For this purpose, compresses made of warm water or alcohol-based can be used.

To stimulate reparative processes, it will be necessary to prescribe drugs with an immunomodulating effect (based on echinacea, eleutherococcus, ginseng, deer antler extract, and royal jelly milk).

The complex of vitamins and minerals will contribute to a speedy recovery. Actovegin, Solcoseryl will help increase the intensity of metabolic processes at the site of a bruise.

Severe Case Management

An unfavorable situation develops as a result of a bruised periosteum of the lower leg and the development of the inflammatory process; without antibiotic treatment, blood poisoning may develop. In such cases, one can not do without the appointment of broad-spectrum antibiotics (cephalosporins, fluoroquinolones, macrolides).

Tissue necrosis leads to the formation of phlegmon. Only surgical excision of damaged areas can help the patient.

In case of damage to large vessels, a large hematoma is formed, which compresses the tissues of the lower leg. To restore normal limb function, it will have to be removed surgically.

Puncture of the knee joint is performed when blood enters the cavity.

Ligament rupture will require complete immobilization of the affected limb, in some cases it is necessary to restore damaged structures using surgical intervention.

With uncomplicated contusion, the pain disappears after a few hours or days. In a situation of progression of a painful condition and swelling, it is necessary to exclude a fracture or dislocation.

Patients with diabetes need special attention. They often develop a violation of trophic processes, which can result in gangrene and amputation of the limb.

Folk remedies

You can supplement the treatment with the help of an arsenal of alternative medicine. For resorption of the seal, compresses of grated raw potato, cabbage leaf wraps are recommended. A good effect is the imposition of pulp from garlic, mixed with apple cider vinegar.

Patients receive relief during the application of lotions from diluted powder of badiaga, plantain leaves.

A compress from equal parts of boiled water, vegetable oil and apple cider vinegar will help with the resulting compaction. This remedy must be applied to the lower leg daily for 10 days for one hour. After a two-week break, the course is recommended to be repeated.

Using the methods of traditional medicine, we must not forget that they can not be practiced without consulting a doctor.

Complications and rehabilitation

After carrying out the necessary therapeutic measures in the acute period and eliminating possible complications with the help of antibiotic therapy and surgical intervention, rehabilitation will be required. This process is aimed at improving the motor function of the affected limb and eliminating compaction in muscle tissue.

Heat in the form of warming compresses is indicated after the end of the active inflammatory process, this occurs 4-7 days after receiving the bruise.

Massage, physiotherapy exercises, physiotherapeutic procedures (ultrasound, electrophoresis with medicinal substances, magnetotherapy) improve blood circulation and metabolism in the tissues of the leg, helping to restore the normal functioning of her muscles.

Bruised tibia is one of the most common lower limb injuries. When injured, soft tissues are damaged without violating their integrity. The treatment of bruised bones of the leg should be treated with utmost care, since such damage is fraught with complications and consequences.

A bruised shin can be obtained in training and in domestic conditions by hitting a heavy object. It is impossible to take lightly even a small injury, because any bump on the lower leg after an impact without treatment leads to serious consequences.

The most common consequences of a bruise: purulent inflammation, necrosis of skin cells, periostitis.

Symptoms

Any bruise is manifested by severe pain and the formation of a hematoma.

The most severe bruising symptoms:

1. Swelling in the soft tissues.
2. The formation of hematoma of the leg.
3. Limited foot movement.
4. Increased pain within three hours after injury due to proliferating hematoma and edema.
5. Lameness.
6. Tendon rupture.

Damage to the periosteum on the leg is manifested by pain. If damaged, the front of the tibia is often injured due to its proximity to the skin surface. Therefore, the development of periostitis is possible.

Clinical signs of periostitis:

• severe throbbing pain;
• redness;
• on palpation and examination, tuberosity with an infiltrate is determined;
• if the patient’s immunity is weak, the process of cell division in this place is violated, they begin to grow randomly, resulting in calcium spikes;
• as a result, fusion of the bones of the leg occurs, the mobility of the limb is impaired or completely limited;
• if help is not provided in a timely manner, surgery is required.

Diagnostics

Diagnosis of the disease is carried out by a traumatologist on the basis of complaints and examination of the patient. Additional examination methods can help identify serious irregularities.

With the help of CT, radiography and ultrasound, damage to the periosteum is diagnosed. Ultrasound helps detect ruptures of blood vessels and tendons. CT also allows you to assess the condition of muscles and soft tissues.

In the differential diagnosis of fractures and bruises, clinical symptoms help. In contrast to a bruise during a leg fracture, a violation of the integrity of the bone occurs, which causes deformation and shortening of the limb. Movement and support on the foot become impossible. When you try to move a limb, severe pain appears. Changes in the bones of the lower leg during a fracture are clearly visible in the radiography photo.

First aid

With a bruised shin, it is important to provide first aid correctly, the success of further treatment depends on it in many respects.

Necessary activities:

• treat existing wounds and other skin lesions with an antiseptic, for example, iodine, alcohol or hydrogen peroxide;
• provide rest and immobility of the injured limb to relax the muscles;
• create an elevated position by placing a pillow or twisted blanket under your leg;
• apply cold to the bruised place for 15-20 minutes;
• with intolerable pain, you can take a tablet of pain medication: "Analgin", "Pentalgin",;
• after removing the cold compress, apply a bandage, it will firmly hold the ligaments and muscles in a fixed position and will not allow hemorrhage and swelling to grow.

Attention! The use of warming procedures and ointments in the first 3 days is prohibited! This is fraught with an increase in hematoma and increased pain.

Treatment

The tactics for treating shin bruise depends on the extent of the injury. If conservative treatment does not give results, then the resulting seal is removed by surgical intervention.

After exposure to cold and bed rest go to the next stage of treatment. Now, the bruise is affected by thermal procedures to resolve the hematoma. For warming use alcohol compresses, warming ointments or thermal baths.

Drug therapy includes the following drugs:

• to relieve pain, non-steroidal anti-inflammatory drugs and analgesics are prescribed - Ketanol, Dexalgin,;
• blood thinning ointments and creams - “Heparin Ointment”, “Rescuer”, “Lyoton 1000”;
• ointments with vasodilating properties - “Apizartron”, “Viprosal B”;
• to improve the regenerative processes in the tissues - Wobenzym, Flogenzim.

Rehabilitation includes a massage course, special exercises and manual therapy. These activities are aimed at developing a damaged area. Do not rely on self-medication. To achieve a positive result from therapy, all the instructions of the doctor must be followed.

How to treat severe contusion of the periosteum of the leg? In the absence of a purulent infection, antibacterial agents, cold and non-steroidal anti-inflammatory drugs are prescribed. The load on the inflamed periosteum is completely eliminated.

If the condition of the periosteum has turned into a purulent or ossifying periostitis, surgical intervention is necessary.

Folk remedies

Folk remedies are allowed to be used only as an adjuvant along with drug therapy. Prior consultation with a doctor is required.

1. Raw potatoes are washed, peeled and cut into slices. Apply to the bruise for 15-20 minutes.
2. One onion is crushed to a state of slurry and applied to the affected area for 20-30 minutes.
3. Cabbage leaves or plantain prevent the formation of a tumor at the site of injury. The main thing is to change sheets often.
4. Mix 2 tablespoons of dry badyagi with warm water, put on cheesecloth and apply periosteum to the bruise, which will help reduce the size of the edema.
5. Arnica tea has an anti-inflammatory effect.

Possible complications

With a bruise, the peroneal nerve can be damaged, which passes close to the bone, which will cause numbness and even paresis of the toes.

The most dangerous complication possible. Pathology is characterized by a pronounced inflammatory process in the periosteum and is accompanied by bursting, throbbing pain and fever.

The periosteum is an important part of the lower leg that performs the function of nourishing bone tissue. Tendons and ligaments are woven into it, contributing to bone growth in childhood and the formation of bone marrow in adult fractures.

Strong bruised bones can result in detachment of the periosteum and subsequent necrosis and purulent abscess under it. They treat this disease with antibiotics.

Another unpleasant complication is phlegmon. This is a purulent inflammatory process in the soft tissues, in which muscles, ligaments, joints and bones are often involved. Suppuration is caused by staphylococci, streptococci or Pseudomonas aeruginosa. As a result of the breakdown of necrotic tissues, the process is characterized by severe intoxication. Treatment of purulent inflammation is carried out by the surgeon.

Conclusion

To prevent injuries of the lower extremities, avoid traumatic situations, wear comfortable shoes, do gymnastics. Bruised shin refers to a serious injury to the lower limb, which requires timely access to qualified help.

At the initial stages of the disease with the help of conservative methods of therapy, there is a high probability of achieving a full recovery. Without treatment, a common bruise leads to complications.

A bruise is a closed damage to tissues and organs without a significant violation of their structure. This is the most common type of injury. Bruises can be caused, for example, by a fall with black ice, or a strong blow if it is applied with a blunt object and there is no significant damage to the skin. The integrity of the upper layers of the skin with a bruise is not violated, but swelling and hematoma (bruise) quickly appear at the site of the impact, pain is felt.

There are injuries of soft tissues, periosteum, joints, injuries of the neck, back, spine, chest, head. With a bruised joint (for example, a knee), several hours after the injury, its volume increases, function is impaired, pain intensifies (especially with movements). The leg in this case is slightly bent, its extension is sharply painful. The difference between a joint bruise and a dislocation is the preservation of movements in it.

With head injuries, only a slight swelling (“bump”) can occur, which does not cause much trouble. However, if the injury was accompanied by loss of consciousness, weakness, nausea, vomiting, etc. this may be a sign of a more serious injury - a concussion or even a brain injury.

With bruises of the neck, in addition to damage to the soft tissues, blood flow in the vessels passing here can be disturbed for the second time, which disrupts the blood supply to the brain.

With bruises of the back (spine), blood circulation of the spinal cord may be impaired (there is a decrease in sensitivity in the limbs, muscle function, etc.).

With chest injuries, only local changes in the superficial soft tissues can be noted, but with a strong blow, for example, as a result of a fall, breathing may be disturbed, with strokes in the region of the heart, it may stop. A contusion of the abdomen is sometimes accompanied by damage to internal organs (for example, rupture of the liver, spleen, accompanied by internal bleeding).

What happens with a bruise?

In case of a bruise, damage to the skin, subcutaneous fatty tissue and muscles occurs, and blood vessels and nerves passing into them can also be affected. Blood flows from injured vessels. With soft tissue injuries, a hemorrhage increases at the site of damage and a more or less pronounced swelling forms. Blood gradually impregnates the tissue, can accumulate (hematoma) or pour out into adjacent cavities, such as a joint (hemarthrosis).

Bleeding from small vessels spontaneously stops in about 5-10 minutes. From large - it can last more than a day. The color of the bruise depends on the duration of the injury: fresh has a crimson-cyanotic color, after 3-4 days it becomes blue-yellow, and on the 5-6th day it turns yellow. A swelling necessarily appears at the site of the bruise - swelling, pain occurs, which eventually passes, but the discomfort during movement or feeling remains for a long time. With severe bruises, disruption of the work of nearby organs is not excluded.

As a result of a bruised shin in places where the skin and subcutaneous tissue adhere to the bone, skin necrosis and its subsequent rejection are possible. When hitting bones with poorly protected soft tissues, not only very painful bruises of the periosteum with its detachment occur, but also damage to the bones (cracks and fractures). A strike in the direction oblique with respect to the skin surface can cause its detachment together with subcutaneous tissue with subsequent filling of the formed cavity with lymph and blood.

Symptoms and consequences of bruises

The main symptoms of a bruise are: pain in a damaged place, hemorrhage due to rupture of blood vessels, the formation of a hematoma and edema. Very severe pain after a bruise can mean that the bones are damaged. Pain, the first symptom of a bruise, appears immediately at the time of the injury and can be significant. Then the pain decreases slightly or is mild, and after 1 to 3 hours after the injury, it resumes or increases significantly. A change in the nature of the pain, an increase in their intensity is due to increased traumatic edema, hemorrhage or an increase in hematoma.

With a bruised joint, movements in the joints are initially preserved, they become impossible as hemorrhage and edema increase, especially with hemarthrosis. This bruises differ from fractures and dislocations, in which active and passive movements become impossible immediately after injury. The pain is especially sharp when the periosteum is bruised, for example, when the front surface of the lower leg or ulnar nerve is bruised. Due to severe pain, pain shock can occur. Hemorrhages at the site of a bruise can be point, both in the skin and in the subcutaneous tissue, in the form of bruises, as well as in the form of significant accumulations of blood in the underlying tissues (hematomas). Continued bleeding deep in the tissues often leads to additional trauma to neighboring tissues as a result of their compression, which is accompanied by a gradual increase in pain and impaired function.

The time of appearance of the bruise depends on the depth of the hemorrhage. With a bruise of the skin and subcutaneous tissue, it appears immediately, in the first minutes or hours. With muscle contusion, periosteum bruises appear on the 2-3rd day and sometimes away from the site of the contusion. The appearance of late bruising, especially away from the site of the bruise, is a serious symptom and requires additional investigation, for example, radiological, to exclude a fracture or crack in the bone. The color of the bruise undergoes certain changes due to the breakdown of hemoglobin. Fresh bruise has a red color, then it acquires a purple hue, turns blue, after 5-6 days it becomes green, and then yellow. By the color of the bruise, one can judge the prescription of the injury.

Periosteum injury - signs and treatment

A bruise is a closed tissue damage with a blunt object or as a result of a fall. In order for a periosteum bruise to occur, either the impact force must be high, or the blow fell precisely on those areas that are not protected by muscles and tendons and where a small layer of subcutaneous fat is observed. This is the anteroposterior surface of the tibia in the tibia, the lower part of the forearm, the elbow and the rear of the hand, also the sternum, the bones of the skull and the rear of the foot.

How does the periosteum bruise manifest?

The first symptom is pain at the site of injury; bruising and swelling also appear there. If the blow was strong enough, then hemorrhage or even a hematoma can occur in that place in the periosteum, which will exfoliate the periosteum from the bone itself in some part of it.

This will be manifested visually in the first hours after the injury in the form of tissue edema at a specific interval, this place becomes so painful that even with a light touch of a person, acute pain pierces. Bruising occurs at the site of the bruise, and sometimes slightly below it, by the second day after the injury.

When moving an injured limb, head (with a bruise of the bones of the skull) or the body (with a bruise of the periosteum of the sternum), pain almost does not occur, just as you can not hear the crunch that occurs with fractures. Pain and swelling persists for several weeks (sometimes months). With bruised bones, the legs are recommended not to walk.

What complications can cause a bruise of the periosteum?

In the absence of adequate first aid and treatment in the future, as well as with some concomitant diseases, bruising of the periosteum can be complicated by its inflammation (this is called periostitis), which can go to the bone covered by this part of the periosteum (osteoperiostitis).

Due to the active proliferation of cells of the inner layer of the periosteum after its bruising, ossifying periostitis can also develop when new bone growths appear on which calcium salts and scar tissue are deposited. Due to this process, fusion of adjacent bones can occur, which greatly complicates the movement in the damaged limb.

Very rarely, when a periosteum is bruised, its purulent inflammation (purulent periostitis) occurs, which is characterized not only by the occurrence of local pain and swelling in the bruised area, but also by an increase in body temperature and a deterioration in general condition. At first, the sensed swelling is hard, then it can soften, and if this area is seized from two opposite sides and when moving it to the sides, it can fluctuate (this means that this area contains pus or effusion fluid), but this is not an obligatory symptom .

Purulent periostitis can result in the formation of an abscess in the periosteum or go to the bone.

Diagnosis is carried out according to examination by a traumatologist and an x-ray picture.

First aid for bruising the periosteum is to immobilize a limb and raise it slightly above body level. An ice bladder or other cold object should be applied to the damaged area for 20-30 minutes (on a dry, clean cloth folded several times so as not to cause frostbite on this skin area).

If there is damage to the skin or mucous membranes, they are processed and a sterile dressing is applied, and bleeding is stopped. A person is given painkillers, which are subsequently taken for several days. Then the patient is transported to a surgical hospital.

Further treatment consists of applying ice for the first two days for 20-30 minutes with interruptions of 2 hours (this relieves pain, reduces swelling and reduces the likelihood of the periosteum exfoliating with a hematoma, as vessels are spasmodic). Painkillers and physiotherapy are accepted.

With purulent complications, surgical treatment and taking antibiotics are possible

Pharmaceuticals for bruises

In addition, ointments and gels with non-steroidal anti-inflammatory drugs (NSAIDs) can be used, applying them to the site of the injury according to the instructions. The ointment should include substances such as diclofenac sodium, ibuprofen and ketoprofen. These ointments should be applied to the site of injury at least 4 times a day, over the entire area of \u200b\u200bthe affected skin. If wounds or large abrasions occur during bruising, ointments with NSAIDs do not need to be applied to these places. With minor injuries, the amount of the drug may be small, but with serious, with large swelling, it will require more, because swelling makes it difficult for the product to penetrate into the skin. In the same case, ointment or gel can be applied more often than 4 times a day - at the discretion of the patient.

For severe pain, analgesics or NSAIDs are prescribed orally, in 2-3 doses: diclofenac potassium, ibuprofen, ketoprofen, naproxen. However, with persistent severe pain, specialist intervention is necessary, and self-medication is inappropriate here. After all, any simple injury can lead to serious consequences if it is not treated or treated incorrectly.

Treatment of bruises with folk remedies

Our ancestors - warriors and hard workers, knew how to treat themselves and loved ones with their folk remedies. Let's try and we turn to their wisdom and help ourselves with an injury. Man is connected with nature by invisible threads, and it is natural remedies that sometimes prove to be very effective. So, we list the methods of treatment of injury in order:

Flax patch from bruise. We will need a clean cloth made from natural linen. It must be pulverized, very fine. Then mix this powder with vegetable oil (1 part powder and 4 parts oil). We apply the mixture to the bruise and cover it with food or cellophane film. After an hour, wash off the product and gently wipe it dry. If there are unpleasant sensations - you can remove it earlier. If you have viper fat in your house, be aware that this is a great remedy for bruises. It just needs to be rubbed into the injury site with careful movements. In this tool - and anesthesia, and treatment. Inside with bruises take a decoction of Arnica flowers. You can also make compresses from Arnica infusion. This will relieve pain, inflammation and reduce the focus of bruising. Recipe for infusion: 1 teaspoon of Arnica flowers, pour 1 cup of boiling water and insist in a closed vessel for 2 hours, then strain. Drink 1 tbsp. l 3 times a day before meals. According to the same recipe, you can make an infusion of Arnica roots - it will have a similar effect. You can simply rub the injury site with camphor alcohol - it will relieve inflammation and produce a warming effect.

Bodyaga is one of the best remedies for bruises and bruises. It helps prevent bruising if used immediately after a bruise. Recipe for infusion from bodyagi: 2 tbsp. chop the herbs of the giardis powder, pour four tablespoons of boiled water and immediately apply this pulp to the site of the bruise. It can be wrapped in gauze or bandage, making a compress. It will begin to act after a little thicken. In order to quickly get rid of bruises, in a bruised place you can make hot baths from a concentrated solution of Epsom salts. The solution is as follows: 400 g of salt is dissolved in a bucket of water. You can lower the bruised limb directly into the bucket, or make a bath in another bowl. Bath time - from 40 minutes to 1 hour. With severe bruises, alcohol tincture of the flowers of wild rosemary or a decoction of it helps. Rub the bruised place with these funds 2 times a day. White cabbage is considered a good remedy for bruises. Cabbage leaf is applied to the sore spot and secured with a bandage or napkin. Keep this compress from 30 minutes to an hour, then change the sheet. You can take a break and attach another sheet in a few hours. Cabbage relieves swelling and inflammation.

Beans can also help with bruising. It needs to be boiled, mashed into gruel and applied to the bruised place several times a day for 30 minutes, then rinsed off. Raw potatoes are considered a good remedy for edema and inflammation. It can simply be washed, cut into thin slices and applied to the bruise. You can also grate it, put in cheesecloth and make a compress of gruel, changing it as it warms up. This will be the impact of cold, and treatment. Potatoes can be left in an injured place all night. Honey is considered an anti-inflammatory, absorbable and soothing remedy for edema. If you mix it in equal proportions with aloe gruel - you will get a good remedy for bruises. It will relieve pain and inflammation of tissues.
14.10.2013 676/22888

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Injury of the lower leg is a frequent phenomenon, and sometimes we take it lightly. Meanwhile, it can cause serious damage to the periosteum, soft tissues of the muscles and blood vessels, and treatment that is not started on time can cause serious damage to health.

A bruised shin is a common sports injury, and it can also be easily obtained in everyday life by hitting a foot against a protruding corner of a bed, bench, or falling from a ladder. A heavy object may fall on it.

Symptoms

After a bruise, a very severe pain occurs, which can subside for a while, and then resume. This is used for diagnosis, since the nature of the pain in a fracture or dislocation is a continuous, increasing character. In this case, the diagnosis is classified according to ICD 10 - the international classification of diseases classification 10 as a bruise of another unspecified part of the leg code S80.1 and others. Before you begin to treat the bruise, you must make sure that there is no fracture.

The first time after an injury, motor function is not impaired. Then, due to the growth of edema reaching the joint of the knee and foot, walking becomes difficult. From mechanical damage to blood vessels in the soft tissues of the muscles and periosteum, internal hemorrhage occurs.

Symptoms of a bruise are manifested as follows: a strong edema forms at the site of the bruise, a swelling appears directly at the site of the shock, painful hardening - a bump, which can then persist for several years, and is a hematoma filled with thickened blood or plasma. Hematoma of superficial tissues manifests itself almost immediately, and when deep muscles are damaged, it is completely formed on the second day, because if large vessels are damaged, blood can flow into the tissues for a long time, while squeezing nerves and intact tissues located nearby. The bump is very painful to the touch the first time.

Some time after the bruise, new symptoms appear: increasing edema of the tissues of the damaged muscle makes movement difficult. Blood builds up in the area of \u200b\u200bthe knee, as a result of which the mobility of the joint is limited, and movement causes severe pain. The blood from the joint itself does not absorb, if the blood reaches the articular bag, then you will have to undergo special treatment - pump it out with the help of medical procedures. A hematoma, a cavity in the soft tissues filled with blood, can appear much higher than a blow to the bloodstream with strong internal bleeding, as is the case with fractures. Initially, the place of the hematoma on the skin will be red-brown, and as it resolves, it will change color to yellow-green stains, which we observe when the bruises, which are also small hematomas, are absorbed.

In the international classification of diseases, ICD - 10 revisions of knee and lower leg injuries are included in class 19, have the code S80 - S89.

First aid after bruised shin

The treatment at the first stage is the correct provision of first aid, exactly the moment when applying a pressure dressing to the site of injury and applying cold can significantly reduce the power of hemorrhage, and therefore, the size of the hematoma, and thereby avoid complications.

First of all, as it is customary to say, the victim needs to provide rest, lay him down and give the leg a raised position, as well as apply a pressure bandage to the injury site or a tight bandage with an elastic bandage and apply ice on top of the bandage. You can use products frozen in the refrigerator as ice, well wrapped in polyethylene and a towel - the main thing is to ensure that the affected lower leg is cooled before the doctor arrives. Agree that not everyone stores pieces of ice in the freezer.

It is imperative that the doctor be called in to make a diagnosis and prescribe treatment. Ice is applied intermittently to prevent frostbite. It is recommended to cool the bruise the first day. It is necessary to ensure that under a pressure bandage, which can become too tight from a growing hematoma, blood circulation is not disturbed. Cold causes vasospasm and reduces bleeding and pain symptoms. And an elevated position causes an outflow of blood from damaged tissues.

You can give the victim anesthetic and sedative, as the pain can be severe up to loss of consciousness. If there is external damage, they must be thoroughly disinfected.

If there is at least some suspicion of a fracture, the leg must be chained from improvised materials before the doctor arrives, in any case, movement is contraindicated on the first day after the injury.

Shin Bruise Treatment

In the first two days, treatment consists of providing rest to the victim: he should not walk and load the injured leg, and in case of hematomas bed rest should be observed for a week. Cold is applied during the first day.

On the third day after a bruise, when all internal bleeding stops, you can start treatment with all the means that help increase blood circulation in the tissues and resolve bruises:

1. Warm water packs and baths.
2. Alcohol compresses.
3. The iodine network helps perfectly the resorption of the hematoma and at the same time disinfects the injury site.
4. Decongestant and absorbable ointments: repar gel, troxevasin, sports cream “Rescuer”.
5. Blood thinning ointments: heparin, hemoclar, lyoton.
6. Anti-inflammatory ointments: voltaren, ibuprofen, ketoprofen are good because they relieve pain and prevent the development of inflammation.
7. A massage course is necessary so that adhesions do not form and do not tighten muscles and tendons, which may limit movement after an injury.
8. Physiotherapy course, which includes UHF, electrophoresis, magnetotherapy.
9. Immunocorrection.
10. Vitamin Therapy.
11. Application of a patch nanoplast forte - an anesthetic patch for hematomas.

In order for the treatment to be successful, it is necessary to conduct a course of massage and developing gymnastics, which is recommended to be performed a week after the injury. Physiotherapy can begin on the third or fourth day. From the first day after the injury, it is necessary to wear a dull elastic bandage, which will compress the tissues, preventing increased swelling and the appearance of new hematomas.

Treatment of severe cases of bruised shin

Depending on the location of the leg injury, whether the blow hits the soft tissue of the muscle or the hard surface of the leg below the knee, the nature of the injury and possible subsequent complications depend on it. And how serious this injury can be, can be judged by the consequences that it causes.

The most dangerous is a bruise in the anterolateral surface of the lower leg, where the skin is adjacent to the bone, and it is not adequately covered with soft tissues, and all the force of the impact falls on the bone, because there are practically no muscles that could depreciate it.

It is here that there is the greatest danger of inflammation of the periosteum and bone. With a bruised shin in such a place, treatment should be aimed, first of all, at removing the inflammatory syndrome, with tissue damage, necrosis may even appear in this place, and it will be too late to treat, surgery will be needed.

The hematoma in the periosteum that occurs with a strong blow can begin to exfoliate it from the bone, and cause either inflammation of the periosteum itself - periostitis, or even inflammation of the bone - osteoperiostitis.

The severity of periostitis - inflammation of the periosteum depends on the strength of the impact and damage to the skin, on the age of the patient, related diseases. Symptoms of periostitis appear at the site of the bruise: redness, severe throbbing pain. To the touch this place is tuberous with infiltrates. With weak immunity, the process of cell division of the periosteum is disrupted, the cells begin to grow randomly, calcium thorns appear in different directions. As a result, the lower leg bones can grow together, which makes it impossible for a person to move normally, can grow into soft tissues, causing pain, and, as a result, can lead to surgery if timely treatment is not performed.

People with trophic disorders, including those suffering from diabetes mellitus and varicose veins, as well as those who lost time self-medicating and later consulted a doctor, may receive purulent periostitis as a result of a shin injury, the symptoms of which include fever, fever , swelling of the soft tissues of the entire limb, hard to the touch, unbearable pain, signs of intoxication. Pus appears in the tissue of the periosteum, which can break through in any direction. You may even need drainage.

The next stage in the development of a bruised lower leg becomes an abscess, and the inflammatory process goes to the bone. In this case, it is urgent to carry out anti-inflammatory therapy, to be treated with antibiotics that can penetrate deep into bone tissue.

It is after such bruises, on the hard side of the lower leg, that a bump often grows, which is felt as hardening on the bones, and may not last for years. What to do in such cases? Sometimes it can be left untreated, and the bump itself will go away in a year or two. The doctor may prescribe several physiotherapy sessions, the use of absorbable ointments. Sometimes it will be necessary to make a puncture to stretch the contents. If it does not grow, then only its appearance is usually worried, since the bump is painless. If you notice that the bump is starting to grow, a visit to the doctor should be mandatory, since the hematoma can develop into a tumor - organize the appearance of a tumor at the site of a bruise even after a long time after an impact is not excluded.

Folk remedies for the treatment of bruises

Bruises can be successfully treated with folk remedies. To prevent a tumor from forming at the site of the bruise, you need to chop 2 heads of garlic and insist in a dark bowl in 0.5 l of apple 6% vinegar for a week. Then you need to apply a compress twice a day for 10 minutes for six months.

An excellent tried-and-true remedy is a cod, plantain leaves, as well as tinctures and ointments from burdock. In order that there is no fluid left in the knee, you need to take one tablespoon of vegetable oil, vinegar and water, mix and make compresses, dampen a cotton cloth in the solution, apply it to the bruise, wrap it with a film and fix it. Do until the bruise passes.

Cabbage leaves have a good absorbing effect on soft tissue hematomas. It is necessary to apply them to a bruise, if possible, changing more often.

Bruised shin should be taken seriously

But having at least some idea of \u200b\u200bwhat is really happening under the skin, how soft tissues, bones, vessels, tendons suffer, you need to treat your leg with due attention, you must do all possible examinations and carry out the prescribed treatment!

After all, if you start to heal on time, the injury will be forgotten as soon as the bruise passes. A chronic neglected bruise can ultimately lead to the destruction of the bones of the leg, knee, chronic processes in the soft tissues.

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Bone injury, types of periostitis

Periostitis is an inflammatory process of the periosteum, which can be caused by various reasons. However, the most common cause is bone contusion. Inflammation develops in the inner layers of the periosteum, then spreading throughout the tissue. Since the periosteum is connected to the bone tissue, inflammation also passes to the bone tissue, osteoperiostitis develops. In traumatological clinical practice, bone contusion is quite common, and periostitis is divided into acute and chronic forms of the course of the inflammatory process. In addition, traumatic periostitis has various types, depending on the severity of the injury, the state of the skeletal system and the general health of the affected person. So, in diabetics, a bruise of the bone is fraught with purulent periostitis, in elderly people ossifying inflammation may develop. There are also serous, tuberculous, fibrous and simple periostitis.

Simple periostitis, as a rule, proceeds in an acute form, which is accompanied by swelling, redness of the skin in the contusion zone. The place of the bruise during palpation is palpated as thickened, bumpy, there is an infiltration. Simple periostitis is a typical complication that can lead to bone contusion. As a rule, other causes are less likely to cause it, among them can be called the proximity of foci of inflammation in muscle or bone tissue, not associated with contusion. Symptomatically simple periostitis is manifested by severe pain, localized swelling. Often the inflammation passes on its own, this happens with the active functioning of the immune system and provided that the bruise of the bone was weak. However, such a complication can provoke the growth of fibrous tissue, the formation of osteophytes (neoplasms in bone tissue), which is typical for the ossifying type of periostitis.

Periostitis, accompanied by the formation of growths, is called ossifying. This is due to the intensive reproduction of cells of the inner periosteal layers. New, atypical formations in the form of calcium salts and fibrous tissue begin to grow on the growths. The nearby bones begin to fuse with the damaged bone, which leads to a violation, and sometimes a strong limitation of motor activity.

Periostitis, which is called fibrotic, is formed as a disease, hidden, imperceptibly. This is a chronic, sluggish inflammatory process with periods of attenuation and relapse. Sometimes fibrous periostitis develops for many years as a result of constant irritation of the injured periosteum. Gradually, a kind of corns, fibrous tissue begins to grow on the meta of damage. The cause of the fibrous formation may not always be a bone injury, but contusion, not diagnosed in a timely manner and not supervised by medications, may well lead to chronic periostitis.

Purulent periostitis is quite rare in clinical practice, however, a later visit to a doctor and neglect of the disease, which led to a bone injury, can give an impetus to a purulent inflammatory process. Signs of such periostitis are specific: fever, sometimes up to 38-39 degrees, severe pain at the site of the bruise, acute pain on palpation of the affected area, swelling of the limb or body area, general deterioration of health. There may be no effusion and fluctuations, this is not typical for purulent periostitis, and a rather hard swelling on palpation is a typical sign of purulent inflammation of the periosteum. A complication may be an abscess that progresses rapidly and spreads to bone tissue.

Bone Injury: Treatment

The standard algorithm for bruising remains relevant for bone contusion. As a first step, it is necessary to ensure complete rest and immobilization of the affected part of the body. If a bruised bone occurred on the leg, the victim takes a horizontal position, and the leg rises slightly and is placed on the roller (pillow). A cold compress is applied to the injured area, it can be a heating pad or a container with ice, a bottle with very cold water. Cold is applied to dry tissue, covering the area of \u200b\u200binjury, to prevent excessive exposure of the cold to the skin. Cold packs should be changed periodically as they warm. If the skin is damaged (wounds, scratches), before applying a cold compress, the wound should be treated with an antiseptic. Then there is a cold and from above a tightening bandage fixing the limb. With a severe pain symptom, the victim is given an anesthetic drug (ketoral, ibuprofen, analgin). As a rule, the pain caused by a bruised bone is very intense and lasts several days, so taking anesthetics is acceptable for two to three days. Hospitalization is indicated for pain shock, severe swelling, and clear signs of sprain, dislocation, fissure, or bone fracture. Bone contusion, which provokes purulent periostitis, is also treated mainly on an outpatient basis using antibacterial therapy, an anti-inflammatory non-steroid drug. The exception is cases of acute purulent infection, which are accompanied by a threat of general intoxication and sepsis.

A bone injury, with all its prevalence and apparent routine, is an injury that affects a very vulnerable bone tissue - the periosteum. Therefore, if a concussion of bone tissue is manifested by severe pain, symptomatic dynamics, showing a deterioration, it is necessary to consult a doctor - a traumatologist, a surgeon.

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