GAPS

From Big Medical Encyclopedia

GAPS (rupturae) — the closed bruises of soft tissues or bodies with disturbance of their anatomic continuity. Rubles result usually from action of force stretching fabric out of limits of its elasticity. As skin considerably surpasses other bodies and fabrics in elasticity, it at this type of an injury can remain whole; in case of a simultaneous rupture of soft tissues or bodies and skin the wound is formed (see. Wounds , wounds).

R. of hypodermic cellulose, a fascia, muscles, sinews, vessels, nerves, hollow and parenchymatous bodies are possible.

Rupture of a hypodermic fatty tissue (see) is followed by internal bleeding (see) in the form of hemorrhage (see) with formation of hemorrhagic infiltrate or a hematoma (see). A peculiar kind of R. of hypodermic cellulose is the separation (amotio) of skin from the subject fabrics observed at transport and other injuries. R.'s treatment hypodermic cellulose is begun with conservative actions (rest, cold, and then thermal procedures). In the presence of a hematoma make punctures, and sometimes a section, at its suppuration — a section and drainage (see).

Rupture of fastion (see) represents a cross or slanting crack, to-ruyu at relaxation of a muscle it is quite often possible to define palpatorno; at a tension of a muscle through defect of a fascia the limited soft elastic swelling (so-called muscular hernia) eminates. R.'s treatment fascia generally conservative. At dysfunction of a muscle defect of a fascia is sewn up; in some cases operation is made with the cosmetic purpose.

Fig. 1. The diagrammatic representation of the matratsny stitch (is specified by shooters) put at a rupture of an abdomen of a biceps of a shoulder.

Ruptures of muscles (see) happen full or incomplete. Are localized, as a rule, in a muscle belly or transition of a muscle to a sinew. The muscles which are in the reduced state, e.g. R. the four-head of a muscle of a hip and direct muscle of a stomach during the falling back, a gastrocnemius muscle at a jump with running start, a long head of a biceps of a shoulder at a raising of weights are subject to R.'s thicket. Rubles of muscles are often observed also at fractures of bones with the considerable shift of fragments and at dislocations. At R. sharp local pain and dysfunction of a muscle of various degree are noted; on site R. can be palpatorno defined defect of a muscle which increases at its reduction. At full R. of one end of a muscle or its separation from a bone the muscle is reduced towards other place of an attachment and eminates in the form of the dense roller. At an incomplete rupture of muscles favorable results are yielded by conservative treatment (rest, a compressing bandage, later compresses, massage, physiotherapeutic procedures). At full R. of a muscle its sewing together (fig. 1) with the subsequent immobilization of an extremity a plaster bandage during 3 weeks then appoint physiotherapeutic procedures, massage, LFK is shown. At old R. connection of strongly dispersed and atrophied stumps of a muscle is possible only with use of plastic material — free rags of a wide fascia of a hip, mylar tapes, etc. (see. Plastic surgeries ).

Fig. 2. Diagrammatic representation of a rupture of a sinew four-head of a muscle of a hip (a) and imposing of a matratsny tendinous seam: 1 — edges of the broken-off sinew; 2 — a patella; 3 — a matratsny tendinous seam; 4 — a clip for fixing of a patella.

Ruptures of sinews (see) occur, as a rule, in places of their transition to a muscle and attachments to a bone; at the same time a part of an adjacent muscular or bone tissue comes off. Restretching is his convulsively reduced muscle R.'s reason of a sinew, the direct injury is less often possible. R. of an Achilles tendon at a heel are more often observed (see. Achilles tendon ), separations of a sinew the four-head of a muscle of a hip (see) from a patella (see) or muscles, separations of a ligament of patella from tuberosity of a tibial bone and a patella, a sinew of a tricipital muscle of a shoulder at an elbow shoot, a separation of sinews of razgibatel of fingers at nail phalanxes of fingers (see). Clinically R. of a sinew is shown by the loss of function of a muscle, the vicious provision of the corresponding segment of an extremity caused by the action of an antagonistic muscle, defect in a sinew defined at a palpation, the shift of a muscle belly towards the unimpaired attachment of a muscle. R.'s treatment sinews operational — imposing of a tendinous seam (fig. 2), a podshivaniye of the torn-off sinew to a bone with an immobilization a plaster bandage on 4 — 6 weeks.

Ruptures of nerves are observed at fractures and dislocations (e.g., at a fracture of a humeral bone the beam nerve can suffer, at a fracture of base of the skull — visual, trigeminal or front within bone channels). Clinically R. of a nerve is characterized by disorder of function of the muscles and bodies innervated by it. The diagnosis is specified by means of an electromyography (see) also by checks of electroexcitability of the muscles innervated by this nerve. Treatment at full R. of a nerve operational. The nerve is sewed sometimes with use of the microsurgical equipment (see. Microsurgery , Nervous seam ).

Ruptures of large vessels are observed at injuries, including — at fractures of bones, dislocations. Full or partial R. of vessels are possible. In a wedge, a picture symptoms of the closed bleeding and blood loss prevail (see). R.'s treatment vessels operational — an angiorrhaphy (see), bandaging of blood vessels (see), plastics of vessels.

Ruptures of internals are possible at a stupid injury of a stomach, lumbar area, changes of pelvic bones, etc. For R. of parenchymatous bodies — a liver (see), spleens (see), a pancreas (see), kidneys (see), etc. — a characteristic symptom is bleeding; for R. of hollow bodies — a stomach (see), a gall bladder (see), intestines (see), intraperitoneal R. of a bladder (see), etc. — symptoms of peritonitis (see). At R. of a diaphragm (see) perhaps infringement in the formed crack of a stomach and intestines, a cut there can be not at once, and later a nek-swarm time after an injury. The diagnosis is specified by means of X-ray and tool inspections — peritoneoskopiya (see), tsistografiya (see), etc. For this purpose also apply punctures of an abdominal cavity a trocar with introduction to it of the so-called rummaging catheter to receiving contents (blood, bile, contents of intestines, urine). R.'s treatment internals operational (mending of wounds of a liver, stomach, a gut, a bladder, removal of a spleen at its gap, etc.).

Stupid injuries of a thorax can be followed by R. of a lung (see), a trachea and large bronchial tubes (see).


Bibliography: Dolinin V. A. and Bisenkov N. P. Wounds and injuries operations, page 19, 36, L., 1972; Kaplan A. V. The closed injuries of bones and joints, M., 1967; The Multivolume guide to orthopedics and traumatology, under the editorship of N. of the Item No-vachenko, t. 3, page 201, 537, M., 1968; H and C and and V. D. Operational orthopedics, page 359, M., 1951.

A. E. Dmitriyev.

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