REPOSITION (late lat. repositio from armor. to put reponere back, to set; synonym: reposition, comparison) — recovery of anatomic ratios of the displaced fragments of a bone at a change. Exact R. of fragments is one of the main conditions of successful treatment changes (see). Elimination dislocations (see) it is accepted to call reposition, but not River.
The oldest way P. never losing relevance — manual, i.e. hands of the doctor. However already at the time of Hippocrates special lever devices and devices for extension and comparison of the damaged segments of extremities were known that was considered as an indispensable condition of successful treatment of changes. From 19 century R. carried out by means of skeletal extension (see). In the subsequent began to apply open R.'s methods (see. Osteosynthesis ), and also distraktsionno-compression devices (see). Nevertheless at the majority of changes manual R.
Indications and contraindications
Indications is still successfully used and contraindications to R. and the choice of its method are defined by localization and a type of a change, age and the general condition of the patient. The river is shown at the vast majority of changes with the shift of fragments. At changes without shift and the driven R.'s changes do not make. The general serious condition of the victim connected, e.g., with shock or an internal injury, a decompensation of somatopathies can be a temporary contraindication to R.
The easiest comparisons of fragments reach at early R. — in the first 2 — 3 hours after an injury. In the presence of temporary contraindications it is postponed by force (a hook naz. the delayed reposition). The river executed in several days and more long term after a change in connection with the late address to the doctor or lack of conditions for treatment call late. The delay with R. does it more difficult in connection with reduction of muscles of the damaged segment, hypostasis of fabrics, and later — with development of a connective tissue callosity around the displaced fragments. At an open change in case of late R. danger of development of an infection in the field of a change increases.
The river concerning the repeated shift of fragments is called repeated. The first R. in that case call primary. Reposition can be single-step — in one step. So reponirut usually fragments at a fracture of anklebones, a beam bone in the typical place, at the most part of changes at children. Gradual reposition is carried out by means of skeletal traction, distraktsi-onno-compression, etc. devices, most often at diaphyseal fractures of bones of a shin and shoulder.
It is rational to carry out manual R. at most relaxed muscles of the damaged segment. For this purpose make moderate bending in the joints, next to a zone of damage, i.e. give extremities so-called physiological situation. Full anesthesia is important for relaxation of muscles (administration of solution of novocaine to the area of a change, local conduction anesthesia, an anesthesia).
At the majority of changes apply the closed R. (without exposure of fragments). At the closed manual R. hands make extension on length of a bone with consecutive elimination of all types of shift. For carrying out the closed reposition a number of special devices-reponatorov is offered.
Interposition of soft tissues between fragments of a bone does the closed R., as a rule, ineffectual. In such cases apply open R. for what bare fragments of bones and reponirut them by means of tools (see. Osteosynthesis , Orthopedic tools ). Open R. is quite often shown at the repeated shift of fragments, at nonremovable in the closed way shift, napr, at unstable slanting fractures of both bones of a forearm, at medial fractures of a neck of a femur, at the most part of intra joint changes.
R.'s results control clinically on recovery of an axis and length of a segment of an extremity, and also given to a X-ray analysis, to-ruyu carry surely out after end of any kind of reposition.
R.'s Complications at its correct performance are extremely rare. At the closed R. damage of a vessel or a nerve, break of skin by acute fragment of a bone, an additional change at rough manipulations, suppuration of a wound is possible at the open River. The rough (violent) closed R., unreasonable repetition of R. can lead to considerable posttraumatic hypostasis of fabrics in a zone of a change, sometimes to a necrosis of skin.
Bibliography: See bibliogr. to St. Changes .
V. F. Pozharisky.