thuranna odivukal

ozhinja odivukal, samyuktha odivukal ennum ariyappedunnu, odicha ellinaduthulla charmmatthil thuranna murivulla oru tharam asthi odivukalaanu (takarnna asthi). charmmatthinte uparithalathiloode asthi pottunnathaanu saadhaaranayaayi charmmatthile murivu undaakkunnath. thuranna odivukal adiyanthiraavasthakalaanu, palappozhum rooad traaphik apakadangal polulla uyarnna oorjja aaghaatham moolamaanu undaakunnath, koodaathe ellinum aduthulla sophtt tissuevinum uyarnna alavil kedupaadukal sambhavikkunnu. aazhathilulla anubaadhaykkum koodaathe/allengil rakthasraavathinum saadhyatha ullathinaal oru thuranna odivukal jeevanu bheeshaniyo avayavangalkk bheeshaniyo (vyakthikk oru avayavam nashtappedaanulla saadhyathayund) aakam. asthiyude malyooniyon allengil asthiyude nonyooniyan ennivaykkulla saadhyatha ulppedeyulla mattu sankeernathakal. thuranna odivukalude theevratha vyathyaasappedaam. thuranna odivukal kandethunnathinum tharamthirikkunnathinum, gasttilo-aandezhsan ooppan odivukalude vargeekaranamaanu ettavum saadhaaranayaayi upayogikkunna reethi. chikitsa nayikkanum klinikkal phalangal pravachikkanum ithu upayogikkaam. thuranna odivukal kaikaaryam cheiyunnathilum aaghaatha kesukalil jeevan apakadappeduthunna mattu avasthakal thallikkalayunnathilum aadya gattamaanu advanced troma life support. anubaadhaykkulla saadhyatha kuraykkunnathinu aaa vyakthikk kuranjathu 24 manikorengilum antibioticukal nalkunnu. sephalosporins saadhaaranayaayi antibioticukalude aadya nirayaanu. chikitsa jalasechanam, murivu kedaakal, neratheyulla murivu adaykkal, asthi sthireekaranam ennivayaanu thuranna odivukalude pradhana maanejment. anubaadhayude saadhyatha kuraykkuka ennathaayirunnu eee nadapadikalellaam lakshyamidunnathu. ettavum saadhaaranayaayi parukketta asthi tb jolie cheiyunna praayathilulla cheruppakkaaraanu thuranna odivukalkku ettavum kooduthal apakadasaadyathayulla aalukalude koottavum. austioporosis, sophtt tissue prasnangal ennivayulla praayamaayavarkkum apakadasaadhyathayund.
adayaalangalum lakshanangalum.
parikkinte theevratha valare vyathyaasappedaamennathil thuranna odivukalude savisheshathakal undu. mikka thuranna odivukalum charmmatthil ninnu ottikkunna oru takarnna asthiyaanu, ennaal valare cheria "pokku-hole" charmmatthile murivumaayi bandhapetta oru takarnna asthiyum undakam. eee rund parikkukaleyum ooppan fractureukal ennu tharamthirichittundu. chila thuranna odivukalkku ganyamaaya raktha nashtam sambhavikkam. mikka thuranna odivukalkkum asthikalkku sameepavum chuttumulla mriduvaaya tissukalkku valia kedupaadukal sambhavikkunnu, athaayath njarambukal, tendonukal, peshikal, rakthakkuzhalukal enniva.
sankeernathakal.
oru asthi thakarukayum puram paristhithiyodu sanbarkkam pulartthukayum cheyyumbol anubaadhaykkulla saadhyatha vardhikkunnu. chuttumulla mriduvaaya tissuekalkkum austiomylitis ennu vilikkunna asthikkum rogam pidipedaam. adhika sankeernathakalil, modiya asthi attangal sukhappedaathathum, noonn-union ennu vilikkappedunnathum, takarnna asthi thettaaya ooriyanteshanil sukhappeduthunnathum ulppedunnu, ithine malunian ennu vilikkunnu. neelamulla asthikalude thuranna odivukal thudarnnu chuttumulla tissue kedupaadukalkk kaaranamakum, ithu compartment syndromine kaaranamakum. koodaathe, kozhuppu embolism vikasippikkanulla saadhyathayund, randinum kadutha edapedal aavasyamaanu. avasaanamaayi, aaghaathakaramaaya anubhavangalude krameekaranathilaanu saadhaaranayaayi thuranna odivukal sambhavikkunnath, eee sambhavangalude sahavarthanam vittumaaraatha vedanayilekkum maanasikaarogya vaikalyangalilekkum nayichekkaam. thuranna odivukalude parikkinte krameekaranam allengil samvidaanam anubaadhayude apakadasaadhyathaye badhikkum, udaaharanathinu, baahya vasthukkalo murivile azhukko anubaadhayude saadhyatha vardhippikkunnu.
kaaranagal.
uyarnna oorjja shaareerika sakthikal (aaghaatham), motor vahana apakadangal, thokkukal, uyarathil ninnu veezhal thudangiya nerittulla prathyaaghaathangal kaaranam thuranna odivukal sambhavikkam. paroksha samvidaanangalil valayal (tortional parikkukal), nilkkunna sthaanathu ninnu veezhal enniva ulppedunnu. eee samvidaanangal saadhaaranayaayi mriduvaaya tissuekalude ganyamaaya apachayavumayi bandhappettirikkunnu, ennaal oru cheria pokku dwaaram, tissuekalil kattapidicha raktham shekharikkal enniva upayogichu sookshumamaaya roopavum undakam. aaghaathathinte swabhaavathe aashrayich, ithu vividha tharatthilulla odivukalkku kaaranamakum
saadhaarana odivukal.
asthiyil kaaryamaaya aaghaatham undaakunnathaan asthi odivukalkku kaaranamaakunnath. nerittulla praharam, aksheeya loading, koneeya sakthikal, tork allengil ivayude misritham enningane vividha shakthikalil ninnaan eee aaghaatham undaakunnath. adanja, thuranna, sammarddam, lalitham, communeut cheytha, greenstikku, sthaanabhramsham, transwers, charivu ennivayulppede vividha tharatthilulla odivukalundu.
rogalakshanaparamaaya odivukal.
cheria aaghaatham muthal rogamulla asthi vare. metaastaattik shathangal, asthi sisttukal, advanced austioporosis muthalaayava eee munkaala prakriyakalil ulppedunnu.
odivukal-sthaanachalanangal.
odivum sthaanachalanavum oresamayam sambhavikkunna gurutharamaaya parikk.
vediyetta murivukal.
athivega projectylukal moolamundaakunna avaa, dvitheeya shock tharamgatthiloodeyum arakaliloodeyum tissueviloode kadannupokumbol kedupaadukal varuthunnu.
roganirnayam.
thuranna odivukalkkulla praadhamika vilayiruthal jeevanu bheeshaniyaaya mattethenkilum parikkukal thallikkalayuka ennathaanu. atharam parikkukal thallikkalayunnathinulla prarambha protocolaanu advanced troma life support (eiii. tii. ell. ezz). rogi sthiratha kaivarichukazhinjaal, oru vargeekarana samvidaanam upayogichu parikkinte theevratha nirnnayikkunnath ulppede orthopedic parikkukal vilayiruthaam. rogiyilekku kaimaattam cheyyappedunna oorjjathinte alavum malineekaranatthinte alavum arian parikkinte samvidaanam pradhaanamaan. mattethenkilum maranjirikkunna parikkukal vilayiruthunnathin oro avayavavum thurannukaattanam. murivukalude savisheshathakal vishadamaayi rekhappeduthanam. eathenkilum naadi allengil rakthakkuzhalukalude parikkukal ozhivakkaan neurology baadhicha avayavathinte rakthakkuzhalukalude avasthayum pradhaanamaan. call, kaimutt odivukalkku compartment syndrome samshayathinte uyarnna soochika nilanirtthanam.
vargeekaranam.
gasttilo-aandezhsan ooppan fracture vargeekaranam, shern vargeekaranam, odivukalude mullar eoo vargeekaranam thudangiya ooppan fractureukale tharamthirikkaan sramikkunna niravadhi vargeekarana samvidaanangalundu. ennirunnaalum, gasttilo-aandezhsan ooppan fracture vargeekaranamaanu ettavum saadhaaranayaayi upayogikkunna vargeekarana samvidaanam. parikkinte oorjjam, mriduvaaya tissue kedupaadukal, malineekaranatthinte alavu, odivukalude koottam enniva anusarichu gusttilo sisttam odivine tharamthirikkunnu. grade ethra uyarnnuvo athra moshamaaya falamaanu pottal.
ennirunnaalum, gasttilo systethinu athinte parimithikalilla. eee samvidaanathinu interobservarinte 50 muthal 60 sathamaanam vare parimithamaaya vishwaasyathayundu. charmmatthinte uparithalathile parikkinte valuppam aazhathilulla mriduvaaya tissue parikkinte vyaapthiye prathifalippikkunnilla. athinaal, gasttilooyude yadhaartha grading ooppareshan thiyettaril maathrame cheyyaan kazhiyoo.
maanejment.
theevramaaya maanejment.
parikkinte pradesham vrithiyaakkunnathinum anubaadhaykkulla saadhyatha kuraykkunnathinum chikitsa jalasechanavum murivu kedupaadukalum ulppedeyulla adiyanthira edapedalukal palappozhum aavasyamaanu. kaalathamasam varuthunna edapedalinte mattu apakadasaadhyathakalil aazhathilulla anubadha, rakthakkuzhalukalude vittuveezhcha, poornnamaaya avayava nashtam thudangiya deerghakaala sankeernathakal ulppedunnu. murivu jalasechanathinu sesham, bacteria malineekaranam thadayunnathinu varandatho nananjatho aaya gass murivukalil purattanam. murivukalude foto edukkunnathu vedanaajanakamaaya vividha doctormaarude onniladhikam parishodhanakalude aavasyakatha kuraykkaan sahayikkum. odivukal nischalamaakkunnathinu kaikaalukal kuraykkukayum nannayi pothinja oru splintil vaykkukayum venam. payarvarggangal kuraykkunnathinu munbum sheshavum rekhappeduthanam.
roga baadhitharude 22 sathamaanam pree-debridment samskaarangalilum 60 sathamaanam poost-debridment samskaarangalilum murivu samskaarangal positteev aanu. athinaal, pree-operative samskaarangal inii shupaarsha cheiyunnilla. shasthrakriyaykk sheshamulla samskaarangalude moolyam anjjaathamaanu. clostridium tetaanikkethire rogaprathirodha prathikaranam vardhippikkunnathinu tetanus prophylaxis pathivayi nalkunnu. prathirodha kuthivayppu charithramillaattha valare malinamaaya murivukalullavarkku maathrame aanti-tetanus immunoglobulin soochippikkukayulloo. udanadi prathirodhasheshi nalkunnathinu 3000 muthal 5000 yoonit vare tetanus immunoglobulin enna otta intramuscular doses nalkunnu.
thuranna odivukalude acute maanejmentile mattoru pradhana klinikkal theerumaanatthil thadayaan kazhiyunna vichedanam ozhivakkaanulla sramamaanu, avide avayavathinte pravarthanaparamaaya raksha vyakthamaayi abhikaamyamaanu. eee theerumaanam parikk theevratha tool skorine maathram adisthaanamaakkiyullathalle urappakkaan shradhikkanam, marichu doctormaarum vyakthiyum avarude kudumbavum cair team thammilulla oopshanukalekkurichu poornnamaaya charchayethudarnnu edutha theerumaanamaanu.
antibioticukal.
anubaadhaykkulla saadhyatha kuraykkunnathinu broad-spectrum intravinus antibioticukal ethrayum vegam (oru manikorinullil) nalkendathu aavasyamaanu. ennirunnaalum, thuranna viral odivukalilum kuranja vegathayilulla thokkukalude parikkukalilum antibioticukal aavashyamaaya aanukoolyangal nalkanamennilla. thuranna odivukalude chikilsaykkaayi aadya thalamura sephalosporin (sephasolin) aadya nira antibioticukalaayi shupaarsha cheiyunnu. gram positteev kokki, gram negatteevu vadi aaya "escherichiya koolii", "proteus mirabilis", "clebsyella pneumonia" ennivaykkethire antibiotic upayogapradamaanu. type III gusttilo odivukalil kooduthal bakteeriyakalkkethire antibioticukalude kavarej vipuleekarikkunnathin, onnaam thalamura sephalosporin, aminoglycoside (gentamisin allengil tobramycin) ennivayude samyojanam allengil moonnaam thalamura sephalosporin enniva "seudomonas erujinosa" polulla nosocomial gram negatteevu basillikalkkethire cover cheyyaan shupaarsha cheiyunnu. vaayurahita baakteeriyaya clostridium perfringence moolamundaakunna gyaas gangreeninu pensilin cherkkunnath oru vivaadaparamaaya sanbradaayamaanu. clostridial anubaadhakalkk saadhaarana antibiotic rejimen mathiyakunnathinaal atharam pariseelanam aavasyamillennu padanangal theliyichittundu. tobramycin impregnated poolii (methyl methacrylate) (pii. emm. emm. eiii) muthukal, antibiotic boonn simant thudangiya antibiotic impregnated upakaranangal anubaadhayude nirakk kuraykkaan sahayikkunnu. shasthrakriyayude samayat implaant kottingukalulla agiranam cheyyaavunna kaariyarukalude upayogavum praadeshika antibioticukal athikkunnathinulla phalapradamaaya maargamaan.
antibioticukalude opttimal dairkhyathekkurichu oru dharana undayittilla. moonnu divasamo anchu divasamo antibioticukal nalkunnathumaayi thaarathamyappeduthumbol oru divasam antibioticukal nalkumbol anubaadhaykkulla adhika gunangalillenn padanangal theliyichittundu. ennirunnaalum, nilavil ithinu kuranjathum mithamayathumaaya thelivukal maathrameyulloo, kooduthal gaveshanam aavasyamaanu. chila rachayithakkal gasttilo grade I odivukalkku moonnu dosukal, grade II odivukalil murivu adachu oru divasam, grade III odivukalil moonnu divasam, grade IIIB, IIIC ennivayil murivu adachu moonnu divasam ennivaykku antibioticukal nalkanamennu shupaarsha cheythu.
murivulla jalasechanam.
murivu jalasechanathinu ettavum anuyojyamaaya parihaaratthinaayi oru karar undayittilla. saadhaarana lavanamo mattu vividha tharatthilulla vellamo (vaattiyedukkukayo thilappikkukayo tapp cheiyukayo cheyyuka) upayogikkunnathiloode anubaadhayude nirakkil vyathyaasamillenn padanangal kandethi. jalasechana murivukalil saadhaarana lavanavum basitrasinum upayogichu saadhaarana lavanavum upayogikkumbol anubaadhayude nirakkil vyathyasamilla. jalasechana murivukalile uyarnna mardhamullah pulse lavejumaayi (echpiel) thaarathamyappeduthumbol loow presher pulse lavej (elpl) upayogikkunna anubadha nirakkil vyathyasamillennum padanangal theliyichittundu. jalasechanathinu ettavum anuyojyamaaya draavakathinte alavum sthaapichittilla. odivukalude theevratha anusarichu jalasechana laayaniyude alavu nirnnayikkaan shupaarsha cheiyunnu, type I odivukalkku 3 littar, type II odivukalkku 6 littar, type III odivukalkku 9 littar.
murivu kedupaadukal.
charmmam, subcutaneous kozhuppu, peshikal, ellukal ennivayulppede malinavum pravarthanarahithavumaaya ellah tissuekalum neekkam cheyyuka ennathaanu murivu kedaakunnathinte uddeshyam. asthikaludeyum mriduvaaya koshangaludeyum pravarthanakshamatha nirnnayikkunnath avayude rakthasraavam nadathaanulla seshiyaanu. athesamayam, peshikalude pravarthanakshamatha nirnnayikkunnath niram, churukkam, sthiratha, rakthasraavam nadathaanulla kazhivu ennivayiloodeyaanu. murivu kedakunnathinum adaykkunnathinumulla ettavum anuyojyamaaya samayam charcha cheyyappedukayum parikkinte theevratha, labhyamaya vibhavangal, antibioticukal, vyakthigatha aavasyangal ennivaye aasrayichirikkunnu. debridment samayam 6 muthal 72 manikkoor vare vyathyaasappedaam, adachupoottal samayam udanadi (72 manikkooril thaazhe) allengil kaalathamasam (72 manikkoor muthal 3 maasam vare) aakam. parikk pattiyitt 72 manikkoor vare sasthrakriya nadathumbol 6 manikorinullil sasthrakriya nadathumbol anubaadhayude nirakkil vyathyasamilla. valare malinamaayatho dhaaraalam rakthasraavamullatho aaya odivukalkku (vascular romas) udan thanne sasthrakriya cheyyanamennu nalla maargganirddeshangal soochippikkunnu. apakadatthinu sesham 12 manikorinullil shasthrakriyayiloode kedupaadukal varuthaanum 24 manikorinullil mattu thuranna odivukalkku vendiyum uyarnna oorjjamullathum malinamallaathathumaaya odivukalkku nalla maargganirddeshangal nirddeshikkunnu. 
shasthrakriyayude maanejment.
neratheyulla odivukal nischalamaakkalum sthireekaranavum kooduthal mriduvaaya tissue parikkukal thadayaanum murivukalum asthikalum sukhappeduthaanum sahayikkunnu. sandhikalude kaadinyam thadayaan neratheyulla sthireekaranam sandhikalude aadyakaala chalanathe anuvadikkunna intraarttikkulaar odivukalude chikilsayil ithu prathyekichum pradhaanamaan. odivukalude paripalanam vyakthiyude mothatthilulla kshemam, odivukalude reethi, sthaanam, mriduvaaya tissue parikkinte vyaapthi ennivaye aasrayichirikkunnu. remade cheythathum raymed cheyyaathathumaaya intramedullary nailing ooppan tbl odivukalkkulla shasthrakriya chikilsakalaanu. rund saankethikavidyakalkkum shasthrakriyaykk sheshamulla rogashanti, shasthrakriyaykk sheshamulla anubadha, implaant parajayam, compartment syndrome ennivayude samanamaaya nirakkund. baahya sthireekaranavumaayi thaarathamyappeduthumbol upariplavamaaya anubaadhayudeyum malyooniyanteyum kuravu ullathinaal ariyappedaatha intramedullary neyil prayojanakaramaanu.  ennirunnaalum, shasthrakriyaykk sesham oru vyakthiyude bharam aduthu niyanthrikkunnillengil, ariyappedaatha intramedullary nailing uyarnna hardware paraajayathinu kaaranamakum.  baahya sthireekaranavumaayi thaarathamyappeduthumbol, raymed intramedullary nailinginu aazhathilulla anubadha, shasthrakriyaykk sesham kaalathamasam varuthiya union, nonyooniyan ennivayude samanamaaya nirakkund. kuttikalil thuranna tbl odivukalkku, baahya sthireekaranathekkaal orthopedic kaast upayogikkunna pravanatha vardhichuvarikayaanu. asthi graphting odivukal nannakkaanum sahayikkunnu. ennirunnaalum, plettukalum scrookalum upayogichu aantharika fixation shupaarsha cheiyunnilla, kaaranam ithu anubaadhayude nirakk vardhippikkunnu. amgavichedanam oru avasana resort edapedalaanu, ithu tissue pravarthanakshamathayum coverage, anubadha, rakthakkuzhalukalude systethinu kedupaadukal sambhavikkunnathinte vyaapthi thudangiya gadakangalaal nirnnayikkappedunnu.
murivu kaikaaryam cheyyalum adaykkalum.
ashupatri sambaadicha anubaadhayude nirakk kuraykkunnathinu murivu neratthe adaykkaan shupaarsha cheiyunnu. grade I, grade II odivukalkku, murivu dvitheeya uddeshyathiloodeyo praadhamika adachupoottaliloodeyo sukhappeduthaam. negatteevu-presher vrana chikilsayude (vaakvam dressing) falaprapti soochippikkunnathinu vairudhyamundu, niravadhi srothassukal anubaadhayude apakadasaadhyatha kuravaanennu udharikkunnu, mattullava theliyikkapetta nettamonnum soochippikkunnilla.
phalangal.
anubadha.
thuranna odivukalude anubadha nirakk parikkinte savisheshathakal, chikilsayude tharam, samayam, rogi gadakangal ennivaye aasrayichirikkunnu. uyarnna thothilulla anubadha uyarnna gusttilo vargeekaranavumaayi bandhappettirikkunnu, avide grade III odivukal anubaadhaykkulla saadhyatha 19.2% vareyum grade I allengil II odivukal anubaadhaykkulla saadhyatha 7.2 sathamaanavumaanu. parikk nilanirthunnathinum antibiotic administration idayil vardhichuvarunna samayathode aazhathilulla anubaadhaykkulla saadhyatha kooduthalaanu. pukavalikkunna allengil pramehamulla rogikalil anubaadhaykkulla saadhyatha kooduthalaanu. rogabadhithamaaya thuranna odivukalil ulppedunna ettavum saadhaaranamaaya rogakaariyaan "staphylococcus ooriyas".
epidemiology.
krash parikkukal ettavum saadhaaranamaaya parikkukalaanu, thudarnnu nilkkunna uyarathil ninnu veezhukayum rooad traaphik apakadangal sambhavikkukayum cheiyunnu. sthreekalekkaal purushanmaaril 7 muthal 3 vareyulla anupaathathilum 40.8,56 vayass vare praayatthilum ooppan odivukal sambhavikkunnu. shareeraghadanayude sthaanam kanakkiledukkumbol, viral falaamgukalude odivukal saadhaarana janasamkhyayil prathivarsham 100,000 aalukalkk 14 enna nirakkil ettavum saadhaaranamaanu, thudarnnu prathivarsham 100,000 janasamkhyayil 3.4 enna nirakkil tbia odivukal, prathivarsham 100,000 janasamkhyayil 2.4 enna nirakkil vidoora aaram odivukal. gusttilo grade I odivukalude anubadha nirakk 1.4 sathamaanavum grade II odivukalkku 3.6 sathamaanavum grade III odivukalkku 22.7% umm grade IIIB, IIIC odivukalkku 10 muthal 50 sathamaanavum aanu.
charithram.
purathana eejiptil, doctormar thuranna odivukal kandethukayum chikilsikkukayum cheiyukayaayirunnu. shaareerika neekkangaliloode takarnna asthi veendum nereyaakkukayum thudarnnu splintukalum topical thailangalum prayogikkukayum cheiyunna maanuval reduction chikilsayil ulppedunnu. linan sttikkukalum maratthinte puramtholiyum upayogichaanu splintukal nirmmichathu. thaine, grease, pachakkari naarukalil ninnu nirmmicha lint enniva adangiya oru topical thailam thuranna odivilekku divasena puratti. ennirunnaalum, purathana eejipthukar thuranna odivukal moshamaaya roganirnayamaanennu rekhappeduthukayum thuranna odivukal moolam maricha aalukal adangiya anchaamathe rajavamsha shavakudeerangal kandethukayum cheythu.
pathonpathaam noottaandile crimean yudhathil, thurannathum adachathumaaya odivukalude sthirathaykkaayi plaasttar-oof-paarees upayogikkunnathinu thudakkamittu. puthiya saankethikavidya avatharippicha pioneering russian sarjan shilpikal kalaasrishtikal srishtikkunnathu kandathil ninnu prachodanam ulkkondathayi reportund.
1850-kalkk munbu, shasthrakriyakkaar saadhaaranayaayi thuranna odivukalullavarude kaikaalukal murichumaattunnu, kaaranam ithu jeevanu bheeshaniyaakunna gurutharamaaya sepsis, gangreen ennivayumaayi bandhappettirikkunnu. irupathaam noottaandil, joseph listtar shasthrakriyakalil aseptik saankethikavidya sweekarikkunnathuvare maathramaan thuranna odivukal moolamulla marananirakk 50 sathamaanathil ninnu 9 shathamaanamaayi kurachathu.

