Fracture of the distal radial epimetaphysis - The most common fracture of the bones of the upper limb. The distal end of the radius consists mainly of spongy bone tissue and has the smallest thickness of the cortical layer compared to the diaphysis. Much more often, such fractures occur in women, which is facilitated by a low, finely looped epimetaphysis with thin cortical crossbars.
The leading factor in the mechanism of fractures is a fall on an outstretched arm. The position of the brush at this moment determines the type of displacement of the fragments: with a straightened brush, the fragment is shifted to the rear and to the radial side (the so-called extensor fracture of the Wheel, which occurs in most cases), with a bent brush - to the palmar side (Smith's “flexion” fracture) (Fig. . 6.9). Fractures are, as a rule, intraarticular, are often accompanied by a separation of the styloid process of the ulna (in half of the observations), damage to the distal radial elbow joint, fractures of the head of the ulnar bone, wrist bones, etc. There is a wide variety of fractures in the nature of bone tissue damage (Fig. 6.10) . The data presented indicate the need for a careful individual approach to the treatment of such patients, rejecting the opinion of the "typical" damage. Diagnosis of fractures is not difficult. Patients complain of pain in the wrist joint, aggravated by attempts to move the brush. There is a swelling of the soft tissues on the back of the hand and in the wrist joint area, the characteristic “bayonet-shaped” and “fork-shaped” deformities of the forearm in fractures with displacement are noteworthy. Palpation is determined by sharp pain at the level of the distal epimetaphysis of the radius.
It is necessary to palpate the area of the head of the ulna. Sometimes sensory impairment may occur in the innervation zone of the median nerve, due to its compression.
Radiography in two projections clarifies the nature of the damage. In this case, the angles of inclination of the articular surface of the radius are of diagnostic value. Normally, its articular area is inclined to the palmar side at an angle of 10 °. The angle between the line connecting the apex of the styloid processes and the horizontal - the so-called radio-angle, is 20 °. In fractures with a shift, the inclination of the articular site of the radius decreases or the bone completely bends to the back. Reduces to zero or acquires a negative value of the radio angle (Fig. 6.11, 6.12). It is necessary to pay attention to the diagnosis of concomitant injuries of the ulnar bone and the distal radicular ulnar joint.
The leading treatment is conservative. For fractures without displacement after anesthesia, the fracture site 15-20 ml of a 1-2% solution of novocaine impose a back plaster cast from the elbow joint to the heads of the metacarpal bones with the hand on the axis of the forearm.
In fractures with displacement of fragments, reposition should be early, complete, simultaneous, painless and non-traumatic. In most cases, the introduction of 15-20 ml of 1 - 2% solution of novocaine at the fracture site is sufficient. Mandatory anesthesia of concomitant injuries. The basic principle of reduction is traction and traction. Numerous reposition apparatuses are rarely used at present. With an insufficient number of assistants, a soft loop can be used for anti-traction over the shoulder.
The forearm is bent at an angle of 70–85 ° in the elbow joint and laid on the table in the pronation position so that the fracture is above the edge of the table, putting a gauze bandage here. The fingers of the patient’s brush are pre-lubricated with cleol and wrapped with one layer of bandage. In case of extensor fractures, the doctor pulls the length of the hand with the first hand for the I, the other for the II — IV fingers, gradually extending the hand (for atraumatic separation of the fragments). Then, with a strong longitudinal thrust, the hand is bent, translating it into the palmar-elbow side, while they do not weaken the traction along the length of the II-IV fingers, with the released hand, additionally apply pressure in the palmar direction to the distal fragment of the radius, while controlling the degree of elimination of the displacement. Upon reaching reposition, the hands are placed in the position of palmar flexion by 10-15 ° and leads to the elbow side by 10-15 °. In flexion fractures with palmar displacement of the fragment, the reduction is performed in the opposite direction, and the hand is given a functional position: back extension by 10-15 ° and lead to the radial side by 10-15 °.
With concomitant damage to the radicular joint, it is necessary to squeeze this area in the transverse direction. After reposition of the fragments, a two-year gypsum dressing is applied: the back splint - from the metacarpophalangeal joints to the elbow joint, and the palmar - from the distal palmar fold to the elbow joint.
The spacers are fixed with a soft bandage. The two-long dressing retains all the positive qualities of the circular and at the same time lacks its negative aspects: the danger of impaired blood and lymph circulation in the limb, and by reducing reactive edema, the danger of secondary displacement of the fragments. The traction is stopped after the gypsum has hardened, then freedom of movement in the elbow joint and joints of the fingers of the hand is checked, and x-ray control is performed. The reduction is judged by restoring the correct ratios in the wrist joint and. normalization of angles: radial and tilt of the articular site of the radius in the palmar side by 9-10 °.
After applying the dressing, regular monitoring of the degree of edema is required: when it grows, a gauze bandage is cut and freer bandage is made, when the swelling subsides (usually on the 5-8th day), the dressing is bandaged. It should be borne in mind that the peripheral fragment of the radius is more firmly connected with the hand than with the proximal fragment, therefore, a particularly reliable fixation of the hand is necessary, excluding any movements in the wrist joint. The patient is recommended elevated position of the arm and exercise therapy. Movement in the fingers, elbow and shoulder joints is prescribed from the 2nd day. This is very important for the prevention of neurotrophic complications.
After the edema subsides (on the 8-11th day), control radiographs are made and the two-year bandage is turned into a circular one. If by this time a secondary displacement of the fragments has been revealed, when changing the dressing, their position is corrected. X-ray control after applying a new plaster cast is required.
Fixation lasts 3-4 weeks for fractures without displacement and at least 6 weeks for fractures with displacement. After removing the gypsum, the focus is on restoring the range of motion and strength of the hand. Prescribe mechanotherapy, baths, massage, exercise therapy, in the future - also mud applications, occupational therapy. Conductive blockades have a good effect. Disability is restored on average after 6-10 weeks, depending on the profession of the patient and the nature of the damage.
In some cases, even with correctly implemented conservative treatment, secondary displacement of fragments occurs due to the nature of the fracture. In case of trauma, a compression of the spongy bone metaphysis occurs, more pronounced from the radial and posterior sides. Radiologically this site is defined as a zone of enlightenment. The straightening of the bone beams does not always occur; in the metaphysis, after the reduction, a space filled with blood forms.
During the regeneration process, the distal fragment can gradually “settle”, which leads to radiation deviation of the hand. It is difficult to avoid this with metaphysis compression and conservative treatment. For oblique fractures with one distal fragment and a significant displacement of fragments, especially to the palmar side, as well as for concomitant injuries of the distal radiolbow joint and fractures of the head of the ulnar bone, it is difficult to keep the fragments in the plaster cast in the correct position, transdermal di-fixation with two knitting needles is shown (Fig. 6.13). After the fragments are repositioned in the operating room, aseptic rules are followed, the assistants hold the hand and forearm, and the surgeon transdermally holds two knitting needles in the area of the anatomical snuff box: the first - in the transverse direction, retreating 0.5-1.0 cm from the articular end of the radius through the metaphysis the radius, parallel to its articular surface, into the head of the ulna, the second in the oblique direction, at an angle of 60–65 ° to the axis of the radius through the metaphysis, the plane of the fracture, and both cortical layers of the radius. With concomitant injuries of the distal radiolbow joint, the second spoke is carried further, through both cortical layers of the ulna.
After clinical and radiological control, the needles bite under the skin. Additionally impose a back plaster cast in the position of moderate extension of the hand. After 2-3 weeks, the plaster cast is removed for the duration of the exercise therapy, baths.
Immobilization is completely stopped at the 5-6th week, then the needles are removed and the full range of rehabilitation measures is started. This technique is also indicated for open fractures of the distal epimetaphysis after reposition of fragments. Knitting needles should be carried through healthy areas of the skin. Depending on the nature of the fracture, other knitting options are possible.
It is especially difficult to treat fragmented, multi-fragmented fractures of the radius with a significant violation of the congruence of the articular surface. In such cases, as well as with significant compression of the spongy substance of the metaphysis in young patients, the use of the distraction method is indicated. With this localization can be used, in addition to standard, and distraction devices of lightweight construction (Fig. 6.14). In the transverse direction, with the average position between the pronation and supination, the position of the forearm is carried out by two spokes: one - through the II – V metacarpal bones, the second - on the border of the middle third of the forearm bones. A compression-distraction apparatus is mounted on these spokes. Distraction is carried out within 7-10 days by 1.5-3.0 cm, more from the radial side. Upon reaching reposition, the hand and forearm are additionally fixed with the palmar plaster longuet. The device is removed after 5-6 weeks and prescribe a functional treatment. The same method can also be used for concomitant fractures of the ulnar head with placement, and for fractures of the scaphoid. During the entire period of treatment, the patient must engage in exercise therapy (movements in the fingers, elbow and shoulder joints).
Thus, the favorable anatomical and functional outcomes of treating patients with fractures of the distal radial epimetaphysis depend on the nature of the fracture, the choice of treatment method, its competent use, followed by rational functional therapy.
1. Intra-articular comminuted fracture of the distal radial metaepiphysis with displacement of fragments. Type C3 according to AO classification.
Such a fracture requires the most accurate comparison of fragments to restore the articular surface. More attention should be paid to the lunar bone facet, as the main burden lies with it.
On the wrist, you can protect the sling. Ice can be applied to the wrist, and it can be raised until the doctor can examine it. If the injury is very painful, if the wrist is deformed or insensitive, or the fingers are not pink, you must contact the emergency department.
X-rays are the most common and widely available diagnostic method using images. An x-ray can show if the bone is destroyed, and if there is an offset. They can also show how many pieces of bone there are. White arrows indicate a fault in the distal radius. The treatment of bone fractures follows a basic rule: broken pieces must be put in place and their movement must be prevented until they are consolidated.
The radius of the radius, palmar inclination of the articular surface (radius tilt), and the maximum possible reposition of the articular surface were restored. In the distal row, pins (smooth posts) are used on the plate, not threaded screws.
2. Intra-articular fracture of the distal radial metaepiphysis with displacement of fragments. Type C1 according to AO classification.
In this case, the main problem is not the displacement of small fragments and the violation of the congruence of the articular surface of the radius, but the shortening and preservation of the posterior displacement, despite the attempt of reposition.
The choice depends on many factors, such as the nature of the fracture, its age and level of activity, as well as the personal preferences of the surgeon. If the broken bone is in the correct position, cast can be used until the bone is consolidated.
If your bone position is inappropriate and you are likely to limit future use of your hand, you may need to rebuild fragments of the broken bone. “Reduction” is the technical term for this process, in which the doctor moves the broken parts and replaces them in place.
Radial fracture with displacement. Type C1.
Radial fracture with displacement. Type C1. After a closed manual reposition.
After proper bone remodeling, a sling or cast can be placed on the arm. Slings are usually used during the first few days to form a small amount of normal swelling. Castings are usually added a few days later a week after inflammation. After 2 or 3 weeks, casting changes after the tumor drops, which leads to a weakening of adduction.
Depending on the nature of the fracture, your doctor can strictly control how the bone is welded with regular X-rays. If the damage was reduced or considered unstable, x-rays could be taken at weekly intervals for 3 weeks, and then every 6 weeks. X-rays can be taken less frequently if the damage has not been reduced and was considered stable.
The satisfactory position of the fragments was achieved only after open reduction and fixation by the plate.
3. Fracture of the radial diaphysis with dislocation of the ulnar head. Galeazzi fracture.
Fractures of the diaphysis of the bones of the forearm are, by definition, very unstable, require strict anatomical comparison of fragments, as well as intraarticular fractures.
The cast is removed approximately 6 weeks after the fracture. At this point, it is customary to begin physical therapy to help improve the movement and function of the damaged wrist. Sometimes the position of the bone is so inappropriate that it cannot be corrected or corrected in casting.
Surgery usually involves an incision for direct access to the fissured bones to improve alignment. The plate and screws hold the broken fragments in position when they are consolidating. Depending on the fracture, there are many options to keep the bone in the correct position during consolidation.
Performed osteosynthesis with LCP plate and 3.5mm screws. An anatomical comparison of fragments “tooth to tooth” and interfragmental compression on the plate are achieved. Locking screws around the edges for added stability.
Plaster Metal nails Plate and screws External fixation Any combination of these methods. Open fractures Surgery is required as soon as possible in all open fractures. Soft tissue and bare bone must be thoroughly cleaned and antibiotics can be prescribed to prevent infection. External or internal fixation methods will be used to keep the bones in place. If the soft tissue around the crack is badly damaged, your doctor may use a temporary external fixative. Internal fixation with plates or screws can be used in the second intervention in a few days.
After fixation of the fracture, the instability of the distal radiolar joint (DRUJ) was removed by two spokes held in the supination position.
A feature of the postoperative management of this fracture is immobilization using knitting needles and external immobilization for 6 weeks. This is necessary for the healing of the distal radiolactic joint.
Since the types of distal radius fractures are so diverse and the treatment options are so wide, the recovery for each person is different. Talk with your doctor to find out specific information about your recovery program and your return to daily activities.
Many patients find relief from pain when using ice, lifting, and simple over-the-counter drugs - this is all that is needed to relieve pain. Your doctor may recommend a combination of ibuprofen and acetaminophen to relieve pain and inflammation. The combination of two drugs is much more effective than each of them. Если боль тяжелая, пациент может потребоваться принимать лекарство по рецепту, часто наркотическое, в течение нескольких дней.
4. Внутрисуставной перелом головки лучевой кости со смещением. Тип В2.
Перелом головки лучевой кости может препятствовать ротационным движениям предплечья и боковой нестабильности локтевого сустава.
Anatomical comparison of fragments with a plate and 2.0 mm screws.
Movement in the elbow joint is allowed to minimize the likelihood of contracture of the elbow joint.
Plaster and wound care
In some cases, the original cast will be replaced because the swelling has decreased so much that the casting is free. During consolidation, castings and slings should be dry. A plastic bag that covers your hand during a shower should help. If molten is wet, it will not be easy to dry. It is possible to use a hair dryer with cold air.
Most surgical incisions should be clean and dry for 5 days or until the sutures are removed, whichever comes later. After surgery or after placing the throw, it is important that you achieve full finger movement as soon as possible.
Fractures of the pylon (pilon), shade (plafond) are synonyms that are used to describe intra-articular fractures of the distal metaepiphysis of the tibia. These fractures are often of a comminuted nature, accompanied by significant damage to the integumentary tissues with the formation of open fractures, severe closed soft tissue injuries. In 85% of cases with fractures of the distal metaepiphysis of the tibia, the fibula also breaks. Much less frequently, these damage occurs in combination with talus and calcaneus fractures.
Rehabilitation and return to business
Your doctor may loosen the casing or surgical dressing. Pain that does not recede may be a sign of a complex regional pain syndrome that should be treated aggressively with medication or nerve blocks. Most people resume all their previous actions after a distal radius fracture. The nature of the injury, the type of treatment received and the body's response to the treatment have an effect, so the response is different for each person.
This will usually decrease after a month or two of removal from the cast or after surgery and will continue to improve for at least 2 years. If your doctor considers it necessary, you will begin physical therapy within a few days or weeks after surgery, or as soon as you remove the last sheet. Most patients can resume mild activities, such as swimming or lower body training in the gym, within 1-2 months after the cast is removed or 1-2 months after surgery. Vigorous activities, such as skiing or playing football, can resume 3-6 months after surgery.
Mechanogenesis of injury
This type of damage occurs when axial compressive forces act, in contrast to the purely rotational mechanism during ankle fractures, and is associated with high-energy injury resulting from falls from a height or as a result of motor vehicle accidents. The combination of forces such as compression (this element is especially important in explosive fractures), rotation and elements of excessive back flexion lead to this severe type of damage.
Classification systems were developed in order to accurately describe the whole wide range of different fracture options for the distal metaepiphysis of the tibia, while treatment tactics and assessment of the prognosis of the outcome of such injuries should also be systematized in the classification.
Fractures of this area are classified by AO according to the degree of damage to the distal articular surface of the tibia into A, B, C types. In addition, each subtype is divided into 1, 2, 3 variants.
Type A fractures are extra-articular fractures of the distal metaepiphysis of the tibia. The division into A1, A2 and A3 is based on the number of fragments of the metaphysical region and the degree of fragmentation.
Type B fractures are incomplete intraarticular fractures in which the joint surface of the tibia is split, but part of it remains associated with the diaphysis of the bone. The division into B1, B2, B3 is based on the assessment of the impact (impression) of the articular surface and the characteristics of the fragments.
Type C fractures are complete intraarticular fractures of the tibia with a complete interruption of the fracture lines of the articular surface of the tibia from the diaphysis. The division into C1, C2, C3 is based on the assessment of the comminuted nature of damage to the articular surface and metaphysical part.
Another classification proposed by Ruedi and Allgower, which divides these damage into 3 categories:
Type I - comminuted fracture without displacement involving the articular surface.
Type II - comminuted type of fracture with a pronounced displacement of fragments of the articular surface.
Type III - fractures with multiple comminuted nature of damage to the metaphysical and articular zones.
X-ray examination is carried out in the anteroposterior and lateral projections, being an obligatory research method. The goal is to verify the diagnosis, select a treatment method, plan the type and extent of the intervention, and control the treatment.
It is an additional diagnostic method (Fig. 5.27). It is carried out with three-dimensional reconstruction in the axial, frontal, sagittal planes for greater visualization and assessment of the severity of damage, orientation of fracture lines, determination of the number, size and relative position of fragments. It is also possible to assess the degree of impact of bone fragments. The ability to create three-dimensional reconstructive images plays an important role in preoperative planning.
Magnetic Resonance Imaging (MRI)
Unlike computed tomography, MRI has the advantage of visualizing soft tissue damage, such as damage to the capsule-ligamentous apparatus of the ankle joint.
This method is applicable in assessing possible damage to vascular structures. High-energy fractures in this area will be options for fractures in which there is a high risk of damage to arterial structures.
- Closed low-energy fractures of the distal metaepiphysis of the tibia without significant displacement of fragments, without damage to the integumentary tissues.
- In case of low-energy injury in elderly patients with severe concomitant somatic pathology.
In most cases, conservative treatment is not indicated.
Essence of treatment
Closed reposition with fixation with a circular unlined plaster cast, followed by fixation for a period of 6 weeks without axial load. In the future, a gradual increase in axial load to full by the end of 8 weeks is allowed. After removing the gypsum fixation, an elastic bandage or orthosis is applied, a course of mechanotherapy, exercise therapy, and the development of movements are carried out.
Indications for surgical treatment
Most fractures of the distal metaepiphysis of the tibia require surgical intervention, but special attention should be paid to the condition of soft tissues and their careful attitude, since the degree of damage to them largely affects the outcome of treatment of this damage as a whole.
Types of surgical treatment
1. Open reduction, osteosynthesis, free bone grafting.
2. Closed reduction with the possible use of a minimally invasive system for bone osteosynthesis.
3. The use of external fixation devices for extra focal osteosynthesis and as an anti-shock measure.
4. The use of AVF with the additional use of bone osteosynthesis.
5. Amputation is indicated in rare cases with the development of complications, especially in the presence of concomitant additional trauma of the same limb.
In most high-energy injuries of this localization, it is first possible to perform extra focal osteosynthesis using an external fixation apparatus to stabilize the fragments (as an anti-shock measure), to restore the segment length, correct axial and rotational relationships. This is true for extensive damage to soft tissues, with bruising or crushing. External fixation usually lasts
2 or more weeks, since early internal fixation with high-energy damage is dangerous for the development of infectious complications of the wound process. In cases where internal fixation is not planned, it is possible to use AVF as the final method of osteosynthesis. In the long term, it is possible to perform an intervention to restore the articular surface.
Performing osteosynthesis using anterior-internal access, an intervention that is classic for rotational lesions in this area, is advisable only for low-energy lesions with good condition of the integumentary structures. Usually, to use this method, it is necessary to wait for a satisfactory state of soft tissues (epithelialization of epidermal blisters, etc.), which, in some cases, can take several weeks. Only simple fractures with minimal damage to the integumentary tissues are operated on in the first 6-8 hours after the injury. Impatience and early intervention is fraught with the development of complications of the wound process, necrosis, sepsis.
Standard osteosynthesis for pylon fractures should be performed according to 4-step tactics :
1) Restoration of the fibula.
2) Restoration of the articular surface of the ankle of the tibia.
3) Bone grafting of bone defects.
4) Osteosynthesis of the tibia with a support plate.
In the unsatisfactory state of the integumentary tissues with high-energy and / or open damage, it is possible to use AVF as a temporary anti-shock and fixing method. In the case of large soft tissue defects, their plastic should be carried out as early as possible.
- the anterior-medial approach (see Fig. 5.28) begins with a direct incision outside the crest of the tibia, then bends inwards over the ankle joint in the direction of the apex of the medial ankle,
- posterior-lateral access (see Fig. 5.29) a direct or slightly arched incision posterior to the crest of the fibula. Used for osteosynthesis of the fibula. It is especially important not to damage the superficial peroneal nerve.
NB! Between skin incisions, at least 7 cm of well-vascularized viable integumentary tissue should remain.
A standard implant for osteosynthesis of the fibula is a 1/3 osseous tubular plate, which is used on the posterior-outer surface in an anti-slip position. For complex fractures of the fibula, it is possible to use an LC-DCP 3.5 mm plate, or an intramedullary shaft in cases of severe soft tissue damage, which is carried out retrograde through the apex of the external ankle (a negative feature is the lack of control of rotational displacements).
For the tibia, the standard implant is a plate in the form of a “clover leaf”, which is installed on the front-inner surface of the tibia, performing a supporting function.
To restore the articular surface of the tibia, tightening screws of 3.5 and 4.5 mm are used, which are installed outside the holes of the plate.
1. Fibula recovery
Simple fractures are repaired openly using forceps. Stabilization is performed by 1/3 of the tubular plate on the outer or back surface of the fibula in anti-slip mode. It is possible to use a tightening screw to create inter-fragment compression between fragments. When performing this step, the lateral “key” fragment of the tibia is usually repositioned. Complex complex fractures are repaired indirectly with the restoration of length, axial and rotational relationships. A bridge-like fixation is made with a long plate.
2. Restoration of the articular surface of the ankle of the tibia
In the presence of several fragments of the articular surface with bone tissue impaction, it is advisable to use an external distractor, with which an indirect restoration of the length and axial relationships is performed. All fragments are repaired one after another, using the articular surface of the talus as a template for restoring the congruence of the articular surfaces of the tibia and talus. Intermediate fixation is carried out by knitting needles and / or repositioning forceps. The spokes are parallel to the joint surface to prevent the formation of a step during final stabilization. The final fixation is carried out by tightening screws with the creation of inter-fragment compression.
3. Bone grafting of bone defects
In all cases of subsidence of the distal articular surface of the tibia with the formation of a metaphysial bone defect, the latter should be replaced with autologous (preferably) or other types of bone grafting. Typically, plastic is performed before osteosynthesis with a support plate, which subsequently fits into the plastic.
4. Osteosynthesis of the tibia with a support plate
The plate before installation is pre-bent, according to the contour of the front or medial surface of the tibia, taking into account the place with the greatest bone defect.
Fixation of the posterior gypsum splint with an angle of 90 ° in the ankle joint to prevent equinus installation. The elevated position of the limb before the edema subsides, i.e. for 5-7 days.
After the edema subsides, walking with additional support is allowed. The axial load on the limb is allowed in the range of 10-15 kg. Full axial load is allowed after 8-10 weeks after osteosynthesis after x-ray control.
Often a fracture in the wrist is associated with a fall on a limb laid back.
All sources of violation are divided into traumatic and pathological. In the first case, the cause of damage to the elbow joints and bones lies in improper landing in the fall. Such injury is common in winter with icing. A bruise or fracture of the arm can also occur when striking in a different direction. Damage occurs after an accident, during sports training or when working with industrial or agricultural machinery. Particularly dangerous is a fracture with displacement or comminuted, in which the lesion is associated with exposure to the arm of heavy equipment. Soft tissues, joints and bones can be damaged by a gunshot wound.
The pathological causes of a fracture of the radius include:
- insignificant effect on bone tissue, due to which its density is reduced,
- endocrine disorders,
- disturbed metabolic process,
- primary cancer of the radius
- bone metastasis,
- progression of osteoporosis or osteomyelitis.
For each type of injury, various symptoms appear and a different approach to treatment is required. The radius of the left or right hand can be damaged. Re-injury is also distinguished, which occurred several times in the same place. The table shows the main types of injuries:
|In the direction of displacement of the damaged radius||Fracture of the Wheel or flexor||A broken fragment moves to the back of the forearm|
|It is a consequence of landing on an open palm|
|Smith or extensor damage||The chip moves to the surface of the palm|
|Injury occurs when falling with landing on the back of the wrist|
|By location||The neck and head of the radius||The consequence of a fall on an elongated limb|
|Central plot||The diaphysis is damaged by impact or falling|
|In a "typical place"||Landing with bent brush and outstretched arm|
Radial bone fracture is so popular that it is classified into types A to C, depending on the complexity of the lesion. All injuries in the joint are divided into several blocks:
- Open or closed fracture. In the first case, the epidermis is injured, and fragments of the radius are leaving the wound. With an injury of the second type, the skin remains unharmed, only edema is possible.
- Fracture with or without displacement. The latter is also commonly called injected, as a result of which cracks in the radius are noted. Such damage to the upper limb is most often diagnosed. With displacement, there is a likelihood of secondary movement of the torn fragments of the radius.
- Intra-articular or extra-articular fracture. In the first case, the injury enters the wrist joint. With extra-articular damage, the movable joint is not affected.
A fracture of the wrist in a child and an adult is manifested by pronounced symptoms, which are difficult to ignore. With an injury, the patient complains of such pathological manifestations:
- Pain syndrome. A person has a severe and severe pain in his shoulder, carpal region. Soreness intensifies when trying to move a limb.
- Swelling and redness. Manifestations are associated with the development of the inflammatory process and bleeding. With these symptoms, the hand becomes larger.
- Нарушенная двигательная функция. In the area of the fracture of the radial bone, the patient notes an incorrect back or palmar flexion.
- Crepitus. With a pathological sign, a characteristic crunch or crack is heard associated with the friction of the fragments of the radius.
- Shortening a sick limb. Such a symptom is often observed with a fracture with an offset, which leads to a visual shortening of the arm.
- Deformation processes in the area of injury. Bone fragments move and a pathological relief forms.
- Injury to nerve fibers. When the radius is damaged, the nerves are often affected, due to which the pain intensifies, and the sensitivity decreases.
During a fracture, blood vessels rupture, as a result of which the fingers may turn pale and become cold. An injury with such damage causes a decrease in blood pressure.
If there is a marginal fracture in the radius of the radius, then you need to immediately see a doctor who will diagnose and prescribe treatment. For minor injuries, a plaster cast is used to help keep the limb in one position. Plaster for fracture of the radial bone is used for 1-1.5 months. Often, control images on x-rays are required, which are performed on the 10th and 20th day after applying the plaster cast. Conservative therapy also includes medications that relieve pain and accelerate the recovery process.
What is osteosynthesis?
If timely surgical treatment is performed, then the fracture heals quickly. Often, recovery comes faster than with conservative therapy. Osteosynthesis is performed in several ways:
- by knitting needles
- using plates that are designed specifically for the distal radius of the radius,
- using distraction equipment, which is used in case of displacement or crushing of the bone.
Percutaneous fixation with knitting needles
Surgical manipulation of a fracture is performed under local anesthesia. The surgeon conducts reposition, in which he takes the necessary debris to the side. After surgery, a plaster cast is applied, fixing the arm in the correct position. The technique has advantages and disadvantages presented in the table:
External fixation devices
An operative technique for a fracture of the radius is performed using an electron-optical educator, with the help of which all actions are controlled and the possibility of leaving fragments is prevented.
An operational technique is used for conditionally infected open fractures. Also, manipulation is performed if there are contraindications for osteosynthesis. The procedure is carried out in the first 7 hours after the injury. First, the wound is washed with an aseptic solution. Then the surgeon sutures the wound and installs a special device that is worn for 1-1.5 months. Disadvantages of the operation:
- high price,
- protruding ends of the spokes over the epidermis,
- probability of infection.
If a person heals a fracture of an arm or leg in time, then recovery occurs 1-2 months after the injury. The recovery process can be delayed for various reasons:
- infectious lesions near localized tissues and bones,
- elderly age,
- signs of osteoporosis,
- renal and hepatic dysfunction,
- hormonal imbalance,
- malignant neoplasms,
- taking hormonal, cytostatic drugs.
At the recovery stage, physiotherapy and healing compresses are prescribed, in which herbal decoctions are used. It is equally important to stretch the arm, performing special exercises. Massage treatments are performed by a doctor. When treating a fracture, calcium-containing foods are added to the diet. Also, at the recovery stage, it is important not to avoid working at a computer, drawing, sorting out cereals or small items. Such actions restore fine motor skills.