Orthopedics - Oleksa A.P. 2006

Occupational musculoskeletal disorders
Electrical injuries

During an Electrical Injury, Muscles undergo tetanic contraction, causing the victim either to be thrown aside or to experience violent Muscle spasms. Depending on The Effect of the electric current, Three types of bone injuries are distinguished: mechanical, resulting from tetanic Muscle contraction; thermal, caused by a voltaic arc; and mixed-type injuries, where an instantaneous Temperature spike inside the bones produces explosive fractures. Violent muscle spasms during trauma lead to compression fractures, as well as fractures and fissures of the long bones. Initially, these fractures often go undiagnosed because X-ray examinations are rarely performed on patients who have suffered electrical injuries. Bone fissures may not always be detectable by X-ray in the first few days following the injury. Only after 10-12 days, with the appearance of resorption bands at the site of the incomplete fracture, does the fracture line become more clearly traceable.

We observed a case of subtotal fractures of the necks of both femurs resulting from tetanic muscle contraction caused by an electrical injury from an iron.

When bones are damaged by a voltaic arc (most commonly affecting the hands and forearms), perforating fractures occur. Sometimes the path of the current is visible as a jagged line resembling a lightning bolt, along with a small, rounded defect in the cancellous Bone tissue.

The mechanical (dynamic) action of high-amperage current can lead to tissue delamination, ruptures, and even traumatic amputation of body parts due to its explosive effect.

Given that electric current exerts both specific and non-specific effects on The Human Body, the patient requires a thorough examination.

As previously mentioned, the biological effect of current action consists of the excitation of striated musculature, which induces tonic spasms with the consequences described above. Meanwhile, the tonic contraction of smooth muscles leads to elevated Blood pressure, disrupts the normal bioelectrical conductivity of The Heart, impairs endocrine gland function, and alters blood protein fractions, among other effects. The Central Nervous system, which has a high Water content, suffers to a significant degree.

According to the Joule-Lenz law, the thermal effect of current depends on tissue resistance, current intensity, and the duration of contact with it. The amount of heat released during the passage of current is proportional to the product of the squared current intensity (in amperes), resistance (in ohms), and time (in seconds). According to Ohm's law, current intensity is inversely proportional to tissue resistance. The smaller the contact area, the greater the current density in a specific area of the body.

The thermal effect of the current causes Burns with tissue necrosis up to the point of charring. Skin and bones suffer the most because their density and resistance are the highest among all Tissues. Bone changes caused by high-voltage current cannot be visualized by X-ray earlier than 3-4 weeks after the injury.

Radiographs reveal characteristic bone changes resembling a "pearl necklace" or "bone necklace," first described by Reuter in 1911. These are caused by the melting of bone tissue and the release of calcium phosphate.

During the passage of electrical current through tissues, the ionic balance and biological potential within the Cells are disrupted. Electrolysis, resulting from the polarization of Cell membranes, leads to protein coagulation on the anode side (the accumulation of positively charged particles causes an acidic reaction, leading to dehydration and The conversion of Proteins into a gel) and liquefactive necrosis on the cathode side (an alkaline reaction causes colloid Swelling).

In addition, platelet and leukocyte aggregation occurs, the conglomerates of which can cause thrombosis of small vessels and pulmonary thromboembolic complications.

Direct current and low-voltage alternating current exhibit the greatest electrochemical effect.

Considering the specific and non-specific effects of electric current on the human body, patients must undergo a comprehensive, thorough examination and receive multimodal Treatment.

First aid for electrical injuries. The victim must be immediately disconnected from the current source in such a way as to avoid falling victim to it oneself. If the victim experiences cardiac and respiratory arrest, cardiopulmonary resuscitation (chest compressions and Artificial ventilation) should be performed, and the paramedic must carry out resuscitation measures.

In a hospital Setting, the patient undergoes comprehensive general treatment. Once the patient is stabilized from a critical state, local treatment is initiated. Its main objectives are to promote the rapid cleansing of affected tissues from necrotic masses, reduce pain, perform necrotomy in cases of circular dry necrosis to decompress the limb segment, perform necrotectomy after the demarcation of necrosis, and apply skin grafts.

In cases of circulatory impairment within a segment or its charring, amputation is performed.

When wound suppuration occurs along with abscesses or intertissue phlegmons, the patient is treated according to the General Principles of purulent surgery. If the patient sustained avulsion-marginal fractures near muscle attachment sites or Other types of long bone fractures during convulsions, conservative treatment is applied, supplemented by surgery if necessary.

Intraosseous necroses caused by the action of electric current do not require treatment, as they undergo resorption, remodeling, and sclerosis.