The anatomy of the nose

External nose formed bone, cartilage and soft tissue. Bones of the right and left sides of the nose are joined in the midline, forming the back of the nose. The side surface of the outer nose consist of processes of the upper jaw. By the bones of the nose adjacent cartilage. Lateral cartilage reach the tip of the nose, and thence directed to the nasal septum. The nasal septum has its own quadrangular cartilage.

Nasal septum is also part of the bone and cartilage. The partition divides the nasal cavity into two unequal parts. In the tissues of the nose is well developed blood supply and innervation, making any injury very painful and bloody.

Nasal cavity performs a variety of functions, including olfactory, respiratory, protective, speech.

As it may be a broken nose

Damage to the nose, arising from the blunt impacts or falling, are often closed nature but, nevertheless, they generally occur in cartilage or bone fractures of the nose. At the same time the skin is not damaged. Such damages are always proceed with profuse bleeding, soreness, changes in the nasal cavity, and often the shape of the nose as a whole.

For small fractures of the lateral edges of the nasal bone is not always the external nose reshaping. Often, such a violation can only be determined at a palpation, when you can feel the crepitus Crepitus - a very serious symptom   (crunch) and after X-ray examination. Fracture is usually in the area of ​​the nasal bones and frontal process of the maxilla. In some cases there is only discrepancy bone joints.

In case of damage of the nasal septum are possible consequences in terms of its curvature dislocation Dislocation - Prevention and Treatment Partial and complete fracture. Damage to the cartilage of the nose cause a breach of less due to good elasticity.

How to proceed

If there was a blow to the nose in front, it is longitudinal fracture of the nasal bone, which in turn leads to deformation - the nose becomes flattened due to retraction of the back, there is significant bleeding and rupture of soft tissues.

The most frequent shifts of the nose laterally in one direction or in another direction. From injury can disperse the seam between the bones of the nose and frontal process fracture occur maxilla. There are also nasal septum fracture and dislocation of the nasal bones of the frontal suture.

A special place is occupied by gunshot and shrapnel wounds that penetrate the paranasal sinuses, cranial cavity, the eye socket and so on. Large nasal fracture with soft tissue injuries and bone parts of the face is observed for shrapnel wounds. In such cases, the possible separation of the nose or just parts of it with the trauma of the paranasal sinuses.

The trauma of the nose accompanied by severe pain and sometimes even painful shock, epistaxis, severe edema Prevention and treatment of edema - it is important to understand the root cause   soft tissue, and bleeding in the nose and the surrounding parts of the face, sometimes release Discharges in women when there is cause for concern   cerebrospinal fluid in the case of a crack in the top wall of the nasal cavity. When you break the soft tissues of the nose while blowing your nose air can get under the skin of the eyelids, face and neck. Swelling of the skin and mucous membranes of the nose usually increases rapidly, making it difficult to diagnose.

In open wounds in the order of first aid bleeding from the external part of the nose is stopped by pressure bandage or ligation of the larger vessels. With significant bleeding from the nasal cavity requires front, the surface of the nose tamponade. If the bleeding does not stop resorting to a deeper rear nasal tamponade.

The wounds of the nose due to the abundant blood supply to heal well, but you should always keep in mind that the earlier trauma of the nose will be provided medical care, the more favorable will be the consequences.

Galina Romanenko

As a "constructed" elbow

The elbow joint is complex, it is formed by the articulation of three bones: the humerus, ulna and radius, between which are formed three joint inmates in a common joint capsule - humeroulnar, brachioradialis and radioulnar.

Joint capsule of the elbow joint - the total for the three joints, relatively free, slightly stretched, thicker along the sides than the front and rear. It is reinforced by three ligaments: two strong side or collateral (radius and ulna) and the ring.

Types of dislocations of the forearm

Dislocations forearm fall into dislocation of both bones of the forearm (posterior, anterior, outwards, inwards), divergent (diverging) and sprains isolated radius and ulna. Dislocations of the forearm may also be complete and incomplete (subluxations) retaining partial contact between the articular surfaces. Almost half of the forearm dislocations combined with intra- or periarticular fractures, elbow joint components.

For all dislocations are characterized by pain, change in shape of the joint and impaired function. Damage to the large vessels and nerve trunks are rare.

Dislocation of both bones of the forearm posteriorly

This kind of dislocation Dislocation - Prevention and Treatment   - The most frequent of all the dislocations of the elbow joint. It usually occurs in the fall on an outstretched hand, and the torn anterior part of the joint capsule, the shoulder muscle, and often lateral ulnar ligament. With this injury often occurs fracture process of the ulna. Victims complain of pain in the elbow and forearm support his good hand. The hand is slightly bent at the elbow, the shoulder seems to be extended, forearm - shortened. Active movements of the elbow sharply limited and painful. With gentle passive (moves hand is not the victim, and the other person) is determined by a spring resistance movements.

The diagnosis of dislocation of both bones of the forearm posteriorly confirmed by X-ray diffraction. Reduction of dislocation produced under general or local anesthesia, followed by X-ray control. If the joint is normal right and impose a plaster Longuet (long strip of several layers of plaster bandage) from the wrist to the upper third of the arm (the elbow is bent at an angle of 90˚) for a period of 10-12 days (but no more than 3 weeks). On the 2nd day start active finger movements and hand movements in the shoulder joint. After removing the splints prescribed gymnastics and physiotherapy

Other types of dislocations of the forearm

Dislocation of both bones of the forearm anterior observed only rarely. Full front dislocation is usually associated with a fracture of the upper end of the ulna.

Dislocation of both bones of the forearm outward as is rare, more common posteroexternal dislocation. External sprains are complete and incomplete, and often associated with a tear of the internal fracture of the lower end of the humerus. Other types of dislocations of the elbow joint (dislocation of both bones of the forearm medially divergent dislocation of the bones of the forearm, the ulna posterior dislocation, dislocation of the radial head) are very rare.

All of these reduce a dislocation followed by the imposition of immobilization, which is carried out after removing the regenerative treatment.

Subluxation of the radial head

Subluxation of the radial head is a frequent injury of the elbow, especially in children aged 1 to 4 years. Subluxation occurs when sudden and strong jerk the child's wrist straightened arms. Thus there is a partial pullout and infringement of the radial head in the ring together with the simultaneous infringement of the joint capsule folds between the head of the bone and the head of the humerus.

The deformation of the elbow joint is absent hand is in a state of mild flexion, rotation outward (supination) fails and causes increased pain. On radiographs are usually not seen any abnormalities.

Reduction is carried out without anesthesia: the bent elbow produce pressure on the radial head and the rotation of the forearm outward. On coming reposition indicates a click, the disappearance of pain and restoration of movement in the joint. Immobilization is not needed.

Nevpravimye and chronic dislocations of the forearm

Irreducible dislocation of the forearm bones are found in 10% of cases arise from the displacement of the soft tissues (capsule, ligaments scraps) or bone fragment. If you can not straighten dislocation under general anesthesia, it shows rapid reduction in the first two days. Often this reduction is unstable due to soft tissue damage, so in such cases, conduct joint fixation with special needles. Spokes removed after 10-12 days. Applied as a plaster splint for up to 3 weeks.

Chronic dislocations of the forearm bones develop 2-4 weeks after injury in connection with the formation of dense scar tissue in that area. Up to 3-4 weeks, recommended a gradual Closed (metered) reduction by means of special devices (eg, device Volkova - Oganesyan) or open reduction followed by the imposition of the machine. In later periods conducted plastic surgery on a joint.

Remember: you can not reduce a dislocation of their own in any case. The victim should be put anesthetic, applied to the site of injury cold, hang a hand on the scarf and transported immediately to the emergency room.

Galina Romanenko