The first snow was falling outside the window. The kids sculpted a snowman and threw snowballs at each other, laughing merrily and squealing with delight. I was not laughing. On the table were fifty X-rays with fractures of the wrist and ankle joints. And traumatologists took another patient with a suspected fracture of the beam in a typical place on X-ray. Winter took its bloody tribute.

In this post I will try to compose an algorithm of actions in case of injury.
1. Trouble comes unexpectedly, but you can prepare for it.
First, get to know the doctor you can call in case of an emergency. He will definitely tell you who to contact and what to do. Every self-respecting physician has connections among colleagues that allow them to solve problems in related specialties. In addition, "by acquaintance" you will be served much faster and better.
Secondly, study location of the nearest emergency centers. Find your emergency room.
Thirdly, always carry with you an OMI (compulsory health insurance) policy or, better, VMI (voluntary health insurance). In my practice, I have met with cases when a patient was denied help on the basis of the lack of a policy. But this is a gross violation. You are OBLIGED to provide first aid at the place of treatment, even if you are a visitor from neighboring countries.
2. Usually, a fracture occurs when falling on the palm, when the hand is directed posteriorly and towards the radial side. The main symptoms of a fracture are: this is a "fork-shaped" curvature of the forearm, sharp pain, swelling, dysfunction of the hand and fingers.

Algorithm of action in a trauma center.
Reception of a traumatologist.
What should be done: The traumatologist must make an outpatient card for you (name, place of residence, circumstances of the injury, etc.), issue a referral to the X-ray room.
Problems: 1) queue at state trauma centers 2) you do not have a compulsory medical insurance policy
Solution: 1) just skip the line. At this stage, only a referral for an X-ray is required from the traumatologist. There is an option to immediately go to the X-ray room and try to take a picture "in private." The cost of a picture on average in Moscow is from 300 to 500 rubles.
2) You must be accepted without a policy. Also at the place of contact. The arguments “go to your emergency room” or “we do not serve nonresidents” are a gross violation.
Reception of the radiologist.
What should be done: You can take pictures on film or in digital format. I don't see much difference. The time you spend in the X-ray room is usually 5-7 minutes. It will take another five minutes to develop the image and enter your coordinates into the database. Be sure to get the pictures in your hands and keep them with you.
Problems: 1) "Wet" development of pictures (increase the waiting time for pictures up to an hour) 2) Do not hand out pictures. 3) Lack of X-ray protection
Solution: 1) A traumatologist / radiologist with a large crowd of people can look at your pictures immediately after the end of the fixation process, or as it is called in the professional jargon "wet". This will reduce the waiting time to 10 minutes. After that, the staff of the X-ray room carries out standard manipulations with X-rays, and if there is no fracture, they give you recommendations, or, if there is still a fracture, they are sent for reduction and plastering.
2) You are not obliged to issue X-rays, but I strongly advise you to have them on hand. Especially if you plan to contact another institution in the future. You can simply ask the radiologist about this. Usually doctors go to an appointment and give out pictures about the painting.
3) When carrying out an X-ray examination, a protective apron or skirt is worn on the patient. Sometimes it is "forgotten" to do it. And despite the fact that the dose of AI is scanty (0.001 mSv), you should remind the X-ray technician about the need for protection.
Reduction and plastering.
If the fracture is without displacement, a plaster splint is applied. When the fragments are displaced, reposition is performed under local anesthesia, followed by immobilization with a plaster cast. A plaster splint is applied from the metacarpal heads to the level of the elbow and held in this position by applying circular plaster bandages. The plaster cast should not go beyond the horizontal fold of the palm, which is the level of the metacarpophalangeal joints.
Problems: The plaster cast has many disadvantages. It is heavy, fragile, afraid of moisture.
Solution: overlay instead of a plaster cast Softcast or better BorkeCast. Advantages: lightweight, very durable, not afraid of moisture, does not cause skin maceration, it comes in different colors. Disadvantages: the cost of imposing (including the cost of a bandage) on average in Moscow is 1500-2500 rubles.
Re-admission with the execution of X-rays appointed in 5-7 days. Full fracture consolidation there is a flow 4-5 weeks, and with displacement of debris - up to 6-8 weeks.

I would be glad to see additions and clarifications of this post from fellow traumatologists and radiologists. If you have any questions, I will try to answer them.

X-ray- the classical method of instrumental diagnostics, examination of organs and tissues using X-rays. It is the leading diagnostic method in traumatology and orthopedics. It is widely used at the stage of diagnosis, determination of treatment tactics, monitoring the effectiveness of surgical interventions and conservative therapy (reduction, reduction, skeletal traction), tracking treatment results in the long term. X-ray is prescribed for fractures, dislocations and dislocations, arthrosis, osteochondrosis, congenital anomalies, other diseases and pathological conditions.

Modern traumatology and orthopedics cannot be imagined without an X-ray examination. X-ray has been and remains the most common and most informative method for diagnosing injuries and diseases of the musculoskeletal system. In 1895, German physicist Wilhelm Konrad Roentgen discovered that X-rays are absorbed in different ways by tissues of different densities, and, passing through the human body, they leave an image of internal organs on a special film. Based on this image, the doctor can determine the localization, shape, size and structure of the examined organ, identify pathological changes, assess their severity and diagnose a disease or injury.

Indications

The indication for X-ray examination in orthopedics and traumatology is suspicion of:

• Traumatic injury to the musculoskeletal system.
• Damage to the organs of the chest cavity with chest injuries.
• Consequences of skeletal injury.
• Violation of the development of the musculoskeletal system.
• Inflammatory and degenerative-dystrophic diseases of bones and joints.
• Tumor-like formations and tumors of the joints and bone tissue (if malignant neoplasms are detected, further treatment is carried out by oncologists).

The density of the skeleton differs from the density of soft tissues, therefore, in most cases, special preparation and administration of contrast agents are not required for examining bones. The only exception is fistulography (a type of X-ray examination for osteomyelitis). The density of muscles, tendons and subcutaneous adipose tissue is practically the same; therefore, radiography, as a rule, is not used to diagnose diseases and traumatic injuries of soft tissues.

The boundaries and structure of the lungs are clearly visible on X-ray images, which makes it possible to widely use X-ray to identify complications in rib fractures (hemothorax, pneumothorax). X-ray examination is carried out not only during the initial diagnosis of injuries and diseases of the skeleton. Repeated radiographs performed during treatment make it possible to assess the quality of reduction, the degree of fracture union, the effectiveness of conservative or surgical treatment.

Contraindications

During the X-ray examination, the patient receives a certain dose of ionizing radiation, therefore, the X-ray examination should be performed strictly according to the indications and in compliance with the radiation protection rules of the patient. There are no absolute contraindications to the procedure. Relative contraindications are pregnancy, breastfeeding, childhood, open pneumothorax, pulmonary hemorrhage, and the patient's serious condition. In the latter case, shifting can further aggravate the patient's condition, so he is left on a gurney or on a bed, and X-ray is performed using a mobile X-ray machine.

Description of the procedure

The patient is placed on a special table in accordance with the rules established for taking pictures of certain anatomical areas. Sometimes X-rays are taken while lying or standing. During the study, it is necessary to follow all the instructions of the X-ray technician, since changes in body position or movement can worsen the quality of X-rays or even make the pictures unsuitable for a diagnosis. After completing the procedure with analog image processing, the laboratory assistant develops the images for 5-10 minutes, and then transmits the radiographs to the doctor. Digital image processing is also possible, but this method requires the use of special equipment and is not yet so widespread.

Today, X-ray is the most effective and absolutely painless diagnostic method. In the modern world, even veterinary clinics are equipped with an X-ray machine. X-rays of the lungs are the most widely used today. This procedure is carried out not only for adults, but also for children, if extremely necessary.

With the help of a special apparatus and special rays, the doctor receives an image by which he can determine the presence of a particular pathology. Of course, a photo taken with an X-ray will be understandable only to a professional. An ordinary person would hardly be able to determine the pathology of the lungs or any other organ from such a picture, but the image gives the doctor a complete picture of the state of the internal organs of the body of an adult and a child.

A doctor who has chosen to treat animals as his profession will also be able to determine the presence of pathology in our younger brothers, if the veterinary clinic has special equipment.

Unfortunately, X-ray examination is not always carried out systematically and planned. Sometimes it becomes necessary to take an x-ray at night. Is there such a possibility and where can you take x-rays around the clock?

Where can x-rays be taken

There is rarely a need for an adult night X-ray, because responsible people try to monitor their health. Most often, these situations concern children. This situation also applies to animals that have to be urgently taken to the veterinary clinic.

With an adult, everything is simple: he can take an X-ray at the emergency room around the clock and absolutely free. However, such establishments are often famous for queues and not very good-natured doctors. Therefore, despite the fact that there is an adult 24-hour emergency room with an X-ray in almost any locality, many are worried about an alternative solution to the problem.

The only alternative at night may be the passage of an X-ray of the lungs or other organs for a fee. In the capital cities there is a service to call a doctor at home, but more often you have to go to private medical centers (for example, Invitro), which take x-rays of the lungs and other internal organs for a fee. At the same time, paid x-rays at home or in a clinic are absolutely the same in terms of information content as free. There is no difference. Therefore, you should not assume that paid is the best.

In any case, if you prefer an X-ray to the emergency room for a fee at home or a private round-the-clock clinic, then look at the reviews on the Internet and make your choice. Quite a decent network of private clinics, according to many, is Invitro.

Where can an animal be x-rayed around the clock

Often a situation arises in which it is necessary to make an urgent x-ray, namely with animals. After all, our smaller brothers cannot provide themselves with health, and even more so around the clock to solve their health problems, if suddenly such have arisen.

Here the options are about the same as with people:

• calling a veterinarian at home;
• search for a veterinary clinic where you can take x-rays around the clock;
• make an appointment with a veterinarian the next day and wait for an appointment.

As for the animals, there is no option to go to the emergency room. Since there are no such medical facilities for cats and dogs. In addition, an X-ray examination of an animal, at least during the day, at least at night, will be paid. When is it worth sounding the alarm and immediately looking for an opportunity to see a veterinarian?

When an urgent X-ray is needed

Signs that should prompt you to question the health of your animal include a wide variety of symptoms. However, not every symptom will require a 24-hour X-ray.

Here are the most serious manifestations of diseases in animals, in which it is worth looking for an opportunity and a place where X-rays are taken around the clock:

• the animal reacts painfully to touch;
• hemoptysis;
• heavy and uneven breathing during sleep and wakefulness.

These symptoms should be pronounced, only then they will indicate the presence of a serious cause for concern. However, it is better to overdo it with an attentive attitude to your pet than not to overlook.

X-ray of the foot is a diagnostic research method that allows to identify various traumatic injuries, infectious and inflammatory diseases, degenerative changes in the tissues of the foot. The procedure allows to establish the presence of congenital and acquired defects of the bone system of the foot, to assess the consequences of mechanical damage, to prevent the development of pathological processes requiring surgical treatment.

An X-ray of the foot reveals the following diseases and conditions:

• congenital or developed flat feet;
• congenital or acquired as a result of acute or chronic trauma, bone deformation;
• consequences of foot injuries (dislocation, fracture, cracks);
• systemic diseases (gout, arthritis, arthrosis).

In traumatology, an X-ray of the foot is performed if there is a suspicion of dislocation, subluxation, fracture and fracture-dislocation of the bones of the foot. A standard examination is performed in 2-3 projections.

Indications for X-ray of the foot

The main indications for performing an X-ray examination of the foot are:

• intractable pain in the foot;
• swelling, edema of the foot;
• pathological discoloration of the skin of the foot;
• suspicion of flat feet;
• deformation, an increase in the bones of the foot;
• the appearance of visible changes in the size, shape of the foot (tumors, bone enlargement, the appearance of pathological growths on the heel bone and the bones of the fingers).

How is a foot x-ray done?

The X-ray of the foot does not require specialized patient training. It is enough to perform standard hygienic procedures immediately before the examination. Before the examination, it is required to expose the foot and remove jewelry and metal accessories.

There are several types of X-ray images of the foot: anteroposterior, oblique, lateral, examination of the heel bone, dorsal-plantar projection.

To take a picture in a direct (anteroposterior, dorsal-plantar) projection, the patient lies on his back and bends his legs at the knee; the feet rest on the X-ray table. To perform an oblique projection, the patient lies on his side, bends his legs; a pillow is placed between the knees. For oblique scanning, the patient is placed on the side with bent legs, and the healthy leg is pulled forward. The patient's legs are scanned one by one; in the future, the images of the diseased and healthy feet are compared. In some cases, the study is carried out under mechanical stress.