ShINYROVANIE — an immobilization of the damaged or affected areas of a body by means of special devices and devices — tires.
The first data on splintage at injuries belong to an extreme antiquity. Used it at damages and diseases of the musculoskeletal device A. Tseljs and K. Galen, is later than A. Paré. During World War I for III. widely used a cardboard, and in the subsequent — plywood tires.
The tires used now divide according to the destination on transport and medical. Transport tires use for a temporary immobilization (see) at first-aid treatment (see) and for transportation you will suffer shy in to lay down. establishment, medical — for fixing of the damaged body part or a segment of an extremity in optimum situation until the end of the term of treatment.
By the principle of action distinguish fixating and distraktsionny tires. By means of fixating tires create an immovability in the damaged segment of an extremity or area of a body at the expense of external elements of fixing. Distraktsionny tires allow to carry out also extension (distraction) of the damaged segment that provides reposition of fragments and creates stability them in the tense situation.
Sheena, let out by the industry, call standard (organic), and produced in conditions to lay down. institutions in single copies and not accepted on supply — non-standard. Highway can be carried out by means of the improvised tires from make-shifts and materials (a board, a stick, etc.). The improvised splintage can consist in fixing of the injured extremity to a healthy extremity or to a body. E.g., at injury of an upper extremity the improvised splintage can be reached by fixing of a hand to a trunk by means of the jacket tail which is turned in in the form of a kerchief or the soldier's blouse fastened by safety pins.
Modern standard tires make of metal, a tree, plastic and other materials. Medical and, more rare, transport splintage can be carried out by means of plaster bandages and plaster tires (see. Plaster equipment). In a crust, time the effect of splintage is quite often provided by an immobilization of segments of extremities with the help distraktsionno-kompres-sionnykh devices (see) though they in strict understanding are not tires since provide implementation of structural elements in body tissue. Also conditionally it is possible to carry methods of a submersible osteosynthesis to splintage (see).
Transport Sh. is carried out most often by fixating tires. The main of them are ladder tires (the modified Kramer's tires). They are applied to an immobilization of upper (fig. 1) and the lower extremities as independently, and to strengthening of plaster bandages and tires. The main advantage of ladder tires — a possibility of their modeling. In recent years the air splints from a two-layer polymer film supplied with a fastener «lightning» and the valve for forcing of air are applied. There are air splints for a forearm and a brush, for foot and a shin
of Fig. 1. The ladder tire imposed on an upper extremity: and — an anterior aspect
— the back view *
(fig. 2), for a knee joint. Their small weight, simplicity of imposing and an opportunity to watch a condition of the injured extremity through a transparent wall of a cover camera belong to advantages of such tires. The main shortcoming is limited term, during to-rogo an air splint can be on an extremity since it can cause a prelum of fabrics and local disturbance of blood circulation. Plastic tires have limited use for a transport immobilization since they are modelled during the heating that not always perhaps in actual practice. In some cases plywood fixating tires continue to be used to a transport immobilization. Their main shortcoming — impossibility of modeling.
From distraktsionny transport tires the greatest distribution was gained by Diterikhs's (fig. 3) tire and its modifications. The tire consists of two side parts (branch) and the plywood sole fixed to foot. Both branches sliding; at splinting outside, longer branch, rests against an axillary hollow, internal — against a crotch. Both branches connect P-shapedly on the distal end a mobile plate. Extension of an extremity is carried out by means of
Fig. 2. Medical air splint for a shin and foot: 1 — the valve
device; 2 — a fastener «lightning»; 3 — a two-layer plastic cover camera *
the cord turning attached to a plywood sole. Branches fix to a trunk and among themselves special belts or gauze bandage, and for long transportation — plaster bandage.
Brown's tire, Beler's tire, Shulutko's tire, the taking-away tire CYTO, etc. belong to the most widespread medical tires. Shin Brown for an immobilization of the lower extremity represents the support from metal rods executed so that by means of «gamachok» made of cloth the extremity can be placed on it in srednefiziologichesky situation. Sheena Belera unlike predydu-
Fig. 3. Distraktsionny transport tire of Diterikhs. The victim with the imposed tire fixed by plaster rings.
Russian cabbage soup has four blocks on brackets, with the help to-rykh it is possible to choose the direction of extension for each of segments of the lower extremity (fig. 4). The main advantage of these tires is simplicity, the shortcoming consists in impossibility to change the angles of bending in coxofemoral and knee joints. This defect is eliminated in functional medical tires for the lower extremity, napr, in the functional tire of Shulutko, edges allows to make the movements in a knee joint (fig. 5).
The standard taking-away tire for an upper extremity (the tire CYTO) is intended for treatment of fractures of humeral bone, and also fractures of a clavicle. It represents the support for a hand adapted for extension of a shoulder and providing freedom of movement in elbow and radiocarpal joints, edges is attached to a semi-corset from material (fig. 6), permeable for x-ray emission.
The main indication to splintage — damages of the musculoskeletal device, most often — fractures of bones, at to-rykh splintage allows to eliminate or limit mobility of bone fragments, warns an additional injury of vessels and nerves in the center of damage, promotes the prevention of traumatic shock (see), reduces danger of development inf. complications and a fatty embolism
(see). Splintage — one of the leading components of treatment of many orthopedic diseases (arthritises, osteomyelitis, etc.), at to-rykh it provides rest and optimum position of the affected bones and joints. Splintage is used also for the purpose of an immobilization at treatment of many damages and diseases proceeding with defeat of soft tissues and vessels (thrombophlebitises, phlegmons, etc.).
Splintage of elements of a musculoskeletal system demands observance of a number of the general principles and requirements. The philosophy of splintage consists in fixing, in addition to the damaged segment of an extremity, not less than two adjacent joints that provides a full-fledged immobilization. Before splintage to the victim enter the anesthetizing pharmaceuticals. On area of bone ledges (an anklebone, crests of ileal bones, epicondyles of a humeral bone, etc.), especially during the imposing rigid (metal or wooden)
Fig. 4. Sheena Belera.
Fig. 5. Skeletal traction at a fracture of a femur with use of the functional medical tire of Shulutko.
Fig. 6. The taking-away tire CYTO for an upper extremity: 1 — a support for a hand; — the semi-corset strengthened on a trunk by means of belts (3).
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tires, in order to avoid decubituses is enclosed by protective wadded and gauze laying. The styptic plait is imposed so that it could be removed, without breaking the reached immobilization. Flexible tires, e.g. wire, shall be well otmodeliro-vana; whenever possible they are modelled at first on a healthy extremity, and then imposed on damaged. Attach the tire to the damaged part of a body bandage or special belts, but not too drawing an extremity. During the transportation of the victim in cold season the extremity subjected to splintage is warmed.
Splintage of separate segments of a trunk and extremities has a number of features. Transport splintage of the head, cervical department of a backbone can be carried out by a myagkotkanny bandage, napr, Shants's collar. At damages of other departments of a backbone and pelvic bones splintage is made by means of a special stretcher with not caving in bottom. The victim is stacked on a back and fixed to a stretcher gauze bandage. Also make-shifts can be used. Optimum means of splintage in these cases is the plaster bed.
The transport immobilization of an upper extremity in the absence of standard tires can be carried out by its pribintovyvaniye to a trunk or by means of make-shifts. From standard tires the ladder tire is most widespread for this purpose. At fractures of a humeral bone this tire is imposed from medial edge of a shovel to fingers of the injured extremity. At the same time the shoulder shall be taken away to 30 °, the hand — is bent in an elbow joint to 90 °, and the brush — to be in situation, an average between pronation and supination.
At fractures of a forearm splintage is carried out from an average third of a shoulder to metacarpophalangeal joints during the bending in an elbow joint to 90 °. Splintage of a radiocarpal joint is made at its dorsiflexion. To Shin impose from an elbow joint to finger-tips on palmar side of a forearm. For splintage of fingers of a brush they are given halfbent situation for what put in a hand of vatu, bandage, etc., as a rule, carry out splintage by means of the plaster tire.
Transport Sh. of the lower extremity, especially at fractures of a femur, is the most successful during the use of dist-raktsionny tires. At fractures of bones of a shin the best results are achieved by means of the ladder tire imposed from the middle of a hip. The same tires are used at damages of foot — impose them from a popliteal space to finger-tips at installation of an ankle joint at right angle. Transport splintage of extremities at an opportunity is well carried out by means of plaster tires (splints) and bandages.
Medical splintage is made most often by means of plaster shiniruyushchy bandages, beds. At the same time optimum modeling and reliable fixing of the damaged segments of the musculoskeletal device is reached. In recent years polymeric materials — polivik, polyethylene foam, polyurethane, etc. are successfully applied to this purpose. The tires manufactured of these materials are easy, strong, convenient for processing. Their main shortcoming is not - hygroscopicity and lack of ventilation.
Medical splintage is carried out also g by the help of special standard tires. So, at a fracture of cervical vertebras use the tire for fixing of cervical department of a backbone manufactured of skin with metal details (fig. 7). The taking-away tire CYTO, used at fractures of a humeral bone and clavicle, provides at the same time extension of a humeral bone and its fixing at preservation of free movements in elbow and radiocarpal joints.
At fractures of a femur and bones of a shin most often use Beler, Bogdanov, Shulutko's tires, with the help to-rykh an extremity physiological situation is given, and also extension of the damaged segment and its fixing is carried out. For treatment of congenital dislocations of a hip (see. The hip joint, pathology) use, in particular, the standard medical tire in the form of a metal strut
of Fig. 7.
Fig. 8 which was injured with the imposed tire for fixing of cervical vertebrae and the head». The taking-away tire for treatment of congenital dislocation of a hip at children.
with cuffs for fastening on shins of the child (fig. 8). Highway of bones of a brush and foot demands use: the special tires operating gyu to the principle of distraktsionny. At the same time extension is carried out usually for phalanxes of fingers (fig. 9).
Fig. 9. Skeletal traction at a fracture of plusnevy bones by means of the medical tire.
Possible complications at disturbance of the technology of splintage — a prelum of the main vessels and nerves of an extremity with development of peripheral disturbances of blood circulation, paresis and paralyzes. Insufficiently effective splintage can lead to the shift of fragments of a bone, damage of vessels and nerves, and also is the moment provoking traumatic shock or aggravating its weight.
Metal, plastic, air and wooden splints are, as a rule, reused. At the same time they are subject to obligatory processing. At radioactive infection their deactivation (see) with the subsequent radiation control is necessary (see), at hit on tires of O B — their decontamination (see). Wooden tires at hit on them radioactive or toxic agents, and also at pollution burn purulent separated.
See also Sh inirovaniye in stomatology.
Bibliography: See bibliogr. to St. Immobilization, Surgery field.
A. B. Rusakov, S. A. Rusanov.