The structure of the hand in the musculoskeletal system is one of the most complex. The small size of the bones, their large number and close location in relation to each other explain the rather high level of potential injury. Sometimes a wrist fracture cannot be immediately identified even after an x-ray. And the high mobility of this part of the arm can cause long-term fusion of the bone. A fairly long recovery period is required for the limb to return to its previous activity.
Anatomy of the wrist bones
The wrist is made up of eight spongy bones arranged in two rows. The first row (proximal) is formed by the scaphoid, lunate, triquetral and pisiform bones. Of these, the first three form an elliptical articular surface that articulates the wrist with the distal radius. The wrist joint is surrounded on all sides by a connective tissue capsule containing synovial fluid, which acts as a lubricant. The necessary density and amount of fluid provide the articular surfaces with the ability to fully move.
The pisiform bone does not participate in such an articulation, because it developed in the tendon and is separately connected together with the triquetrum. All interosseous flat spaces are filled with a thin layer of articular cartilage.
The distal row consists of the trapezium, trapezoid, capitate and hamate bones. Each name reflects their shape. The articular facets located on the surface articulate the bones with each other.
All the bones in their entirety are a convex arch on the back side and a concave groove-like arch on the palmar side. The mobility of bones is limited by ligaments, which perform a protective function.
Possible complications
Timely and competent treatment does not always guarantee successful recovery of the injured bone. Prolonged immobility of a plastered arm can lead to muscle atrophy. In some cases, the wrist and scaphoid bones fuse incorrectly, and they have to be broken again and fixed in the correct position. Otherwise, the mobility of the wrist joint is limited.
Cysts can form at the fracture site, which impair blood circulation and cause bone necrosis. This condition requires long-term complex treatment.
Causes
When a fracture occurs in the wrist area, in most cases the scaphoid bone is affected. Its integrity is compromised as a result of falling onto an outstretched arm with emphasis on the open hand. Most often, the bone splits into two parts, but sometimes a crushed fracture occurs.
In other cases, a fracture of the wrist bone occurs as a result of a strong direct blow to this area of the limb or as a result of compression. In such a situation, a fracture of the pisiform bone is inevitable. Such bruises and injuries are not uncommon in car accidents, sports (boxing, hockey, golf, basketball, martial arts) and all kinds of emergencies.
A strong blow to the surface with a fist can result in a fracture of the neck of the metacarpal bone and a fracture-dislocation of the fourth or fifth carpometacarpal joint. Trapezium fractures are quite rare. Additional potential causes for any violation of bone integrity are also hormonal imbalances, lack of calcium, bone tuberculosis and oncology.
Differences between a fracture and a dislocated arm
Any injury is accompanied by a reaction from the receptors of the peripheral nervous system - pain occurs after the blow. It is possible to differentiate a dislocation from a wrist fracture based on characteristic signs. The traumatologist conducts a physical examination (external) of the injured limb; if a violation of the integrity of the bone is suspected, additional diagnostics are prescribed.
Signs of dislocation:
- Acute pain when moving in the joint area;
- The mobility of the hand is limited;
- The damaged arm is visually different from the healthy one - shortening of the limb;
- The position of the limb is unnatural - the patient spares the injured arm, choosing the most painless position;
- Swelling in the joint area.
Normally, the joints are adjacent to each other; dislocation leads to complete divergence of the articular ends. Traumatic dislocation occurs as a result of a sharp contraction of muscles; its main difference is the localization of the damage - remote from the joint area.
Attention! Only a doctor should correct a dislocation; independent manipulations will lead to complications in the form of rupture of the joint capsule or tendons.
Signs of injury
Signs of a wrist fracture are that immediately after the injury the victim feels pain in the wrist joint and especially with any movements of the hand. The mobility of the joint is significantly limited, and sometimes swelling of the fingers occurs. Attempts to clench your fingers into a fist increase pain sensitivity, and noticeable swelling with a bluish tint forms in the area of the radial fossa. The pain is especially pronounced with dorsiflexion.
A displaced fracture is usually easy to recognize by the disrupted anatomical shape of the hand. Sometimes, when moving the injured hand, a crunching sound is heard, which occurs from the friction of fragments of the destroyed bone.
Classification
Wrist fractures are divided into two main groups: Colles fractures and Smith fractures.
Colles' fracture. The injury is diagnosed by a fall with the palm resting on the hand, resulting in a fracture of the distal part of the radius. The broken fragment is displaced to the back of the forearm.
Smith's fracture . Injury occurs when falling on a dorsally bent hand. The fragment moves towards the palm.
In addition, there is a classification depending on the location of the split in the bone:
- Diaphyseal - on the body of the bone;
- Metaphyseal - in the growth zone.
Based on the variety of types, fractures are divided into:
- simple - one fracture line, no fragments;
- splintered - there are several fragments in the damage area;
- crushed - under the influence of force, a section of the bone is crushed;
- with an intermediate fragment - two lines of fracture, in the tissues between the fragments there is a separate fragment.
How to distinguish between a sprained or fractured wrist
Assess wrist mobility. Despite the fact that movements are accompanied by pain, with a grade 1 or 2 sprain, the mobility of the joint is well maintained. The third degree already leads to instability of the injured area. And in the event of a fracture, the victim feels a certain obstacle that does not allow him to turn the hand in the desired direction.
Analyze your reaction to ice. If there is a fracture, the cooling effect will be very short-lived, and the pain will return again. At the same time, in a situation with a sprained ligament, ice is a good pain reliever.
Listen to the nature of the pain. A fracture is usually characterized by aching pain at rest and sharp pain when attempting to move. At night it is more intense. When stretched, the pain is uniform and does not depend on the time of day.
Symptoms of a wrist fracture a few days after the injury. A day or two of complete rest with regular cold compresses will greatly improve the sprain. The situation with a fracture is completely different. At best, there is no positive dynamics and the victim’s condition remains unchanged. And at worst, the symptoms get exceptionally worse.
Gymnastics
The first training begins on the second day after the injury - finger movements. When the swelling goes away completely and there is no pain, exercises for the elbow joint are added. The first workouts begin with passive movements in order to gradually return the muscles to activity.
Gymnastics for wrist joints
You can actively work out the joints only after the cast is removed; the exercises are performed at home.
Set of exercises:
- Fingering on a flat surface (“running”);
- Handling or putting away small objects (matches, cereals);
- Imitation of taking a pinch of salt;
- Alternately touching each finger to the thumb;
- Clenching and unclenching fingers;
- Moving the little finger to the side while simultaneously touching the other fingers of the thumb.
During the rehabilitation period, hand braces or elastic bandages are used to reduce excessive load on the joint. After complete recovery, they gradually move on to weight-bearing exercises.
Timely medical care minimizes the risk of complications and helps to fully restore the damaged limb. Restorative techniques will accelerate bone regeneration and return to your normal lifestyle in a short time.
First aid
A wrist fracture cannot in any way be classified as a fatal injury, but the algorithm for pre-medical care should be as competent as possible. This will help to avoid complex and unpleasant complications in the future.
- For a closed type of fracture, apply ice to the injury site. But it must first be wrapped in thick cloth to prevent frostbite on the skin.
- The joint must be completely immobilized. This can be done, for example, from a scarf and a small stick, which will serve as a splint. Thus, the risks of displacement of bone fragments and subsequent damage to blood vessels and nerves are minimized. To relieve tension from your arm and relieve pain, secure the limb with a long scarf or bandage, tying it to your neck.
- Offer the victim analgesics if the pain is too sensitive.
- In case of an open fracture, treat the injury site with an antiseptic. In case of heavy bleeding, the wound must be clamped with a cloth soaked in an antiseptic and changed as it gets wet with blood.
Medications
Drug therapy is prescribed for any type of fracture and can speed up the process of bone tissue regeneration.
Medicines:
- Non-steroidal anti-inflammatory drugs (Nise, Movalis) – relieve pain, relieve swelling and inflammation;
- Calcium preparations (Calcium gluconate, Complivit - calcium) - prescribed together with vitamin D, for better absorption of the macronutrient;
- Antibiotics – used for open fractures or after surgery, as a prophylactic agent;
- Chondroprotectors (Rumalon, Arteparon) – synthesize components of cartilage tissue, prevent degenerative changes in bone tissue.
The drugs help restore bone tissue from the inside and launch natural protective and regenerative processes in the body. Drug therapy is prescribed only by a doctor; the dosage of drugs is selected individually, taking into account the age and severity of the injury.
Diagnostics
A detailed history of the injury and a thorough examination in any case will not allow us to accurately determine the fracture. An x-ray is required, and first of all, in the lateral and anteroposterior projections. However, this is often not enough, and therefore an additional three-quarter image is taken. This projection allows us to assess the condition of the scaphoid bone in profile.
It happens that a crack in the body of a bone is not visible even with a detailed study of the image using a magnifying glass. However, the patient still complains of local pain in the wrist. In such a situation, the x-ray must be repeated after three weeks. During this time, against the background of decalcification, the gap between the fragments will widen, which will make it clearly visible on the image.
For any suspicion of an inaccurate diagnosis, as well as for an intra-articular fracture, CT or MRI results will be needed.
How long does it take to heal and how long to wear a cast?
How long you will need to wear a cast for complete healing of the damaged bone depends on the type of fracture and the treatment method chosen by the traumatologist. For uncomplicated injuries of the scaphoid or lunar bone, immobilization with a plaster splint is carried out until the fracture heals completely - this takes from 1 to 1.5 months. For other uncomplicated fractures, a control x-ray is performed after 3 weeks and if there are signs of successful bone tissue regeneration, the plaster is removed.
After surgical reposition, the injured limb is also immobilized using plaster (except for the hardware fixation method), X-ray control is carried out no earlier than two months later. For a Koless injury, the limb is fixed for 5 weeks, and for a Smith fracture, up to two months. If callus does not form during this time, the plaster is left in place for another month, followed by diagnostic monitoring.
Treatment
In each case, the treatment method for wrist fractures depends on the nature and complexity of the injury. If the diagnostic result shows a displaced fracture of the arm, it is unlikely that it will be possible to do without surgery. If the fracture is closed and without complications, treatment is carried out conservatively using a plaster cast.
Conservative treatment
After reliable diagnostic results confirming the fracture on an outpatient basis, the traumatologist applies a plaster cast to the damaged area of the limb. Plastering begins with the area of the head of the metacarpal bone and ends with the third part of the forearm area. In some cases, it becomes necessary to fix the arm up to the elbow joint. The plaster covers the thumb to the middle of the nail phalanx. After application, the arm must be bent at the elbow and secured with a special bandage around the neck. For the most reliable fixation, the hand should be placed in a special bandage.
Therapeutic measures
Treatment for a fracture of the wrist joint bone is aimed at restoring its anatomical position and ensuring complete rest for the injured limb. Further treatment tactics and the need for inpatient observation depend on the severity of the injury. Typical fractures that do not have complications are monitored on an outpatient basis.
Conservative treatment
The conservative method is used for uncomplicated fractures; the traumatologist administers local anesthesia and sets the bone (if it is displaced, but without signs of pathology). Fixation of the anatomically correct position of the bone is ensured using a plaster splint (from the fingers to the elbow joint). The thumb on the injured hand must also be fixed. To ensure complete rest, the injured limb is placed in a scarf or orthopedic bandage.
Surgical treatment
Bone deformation, or a fracture with multiple splintered fragments, is an indication for instrumental intervention. Comparison with a bone fragment (reposition) is carried out using auxiliary devices.
Types of surgical reduction:
- Closed - needles or plates are passed through the skin, necessary for fixing the fragments (local anesthesia is used);
- Minimally invasive – bone fragments are fixed with screws in the bone and a plate located subcutaneously (local anesthesia is used);
- Open - the skin layers are cut to remove small fragments manually. The bones are given an anatomically correct position using staples and pins (medicated sleep is used);
- Compression-distraction fixation – a device is used for external fixation of bone fragments (general anesthesia).
After removal of the fixing devices, follow-up diagnostics (X-ray or CT) are performed to check the adequacy of bone restoration and evaluate the reduction performed.
Rehabilitation
Without full rehabilitation after a fracture, the limb takes much longer to develop, the pain remains for a long time, and the risk of unpleasant consequences increases. During this period, the patient needs a course of physiotherapy, special massage and individual therapeutic exercises.
Physiotherapeutic procedures
As part of complex therapy, physiotherapeutic procedures help to return the injured limb to work as quickly as possible and speed up its healing. They relieve swelling and pain, activate microcirculation and act as a good preventative against the formation of contractures and muscle atrophy.
Thanks to a properly selected set of such procedures, the drug load can be reduced. Each procedure is prescribed depending on the stage of bone tissue regeneration and the rate of fracture healing. The required effect occurs only after a certain number and combinations of physiotherapy procedures, therefore it is strongly not recommended to suspend their regularity.
Based on the nature of the fracture and the individual characteristics of the patient’s body, the following are prescribed:
- heating with ozokerite or paraffin;
- iontophoresis;
- magnetic therapy;
- UHF therapy;
- laser exposure;
- amplipulse therapy;
- mud therapy;
- acupuncture.
To enhance the effect of the procedures, warming gels and ointments can be applied to the wrist.
Gymnastics for wrist joints
- Bring both palms together, maintaining pressure on one another. In this position of the hands, bend the wrists left and right, forward and backward.
- The hands are positioned edge-on on a hard surface. The task is to smoothly turn the palm to the surface, touching the table only with your fingertips, and return to the starting position.
- Palm on the table surface. Turn the hand up and down again until slight pain appears.
- The arm is bent at the elbow on the table, the hand is positioned vertically. Rhythmic clenching of fingers into a fist.
- Use the fingers of your healthy hand to form a ring around your wrist. With the injured limb in this position, make smooth movements forward and backward. Hold each deviation for 4 seconds.
For an effective result, the duration of such gymnastics should be at least half an hour. It is advisable to repeat each movement 3 cycles with repetitions 6-7 times.
Physical therapy for the hand
After removing the cast, it is extremely important to restore full motor activity of the limb. For this purpose, the attending physician selects several exercises to develop the wrist.
- Flexion and extension of the hand with a gradual increase in speed.
- Kneading plasticine in the palm of your hand.
- Throwing a tennis ball against a wall, collecting scattered matches into a box, or laying out certain shapes from them.
- Bringing the thumb and index finger together with the other fingers as relaxed as possible.
- Connecting all fingers together except the little finger. He must stay away.
- Interlace the fingers of both hands with moderate tension.
- Lacing.
- Playing the piano is an imitation of finger movements on the keys on a hard surface.
- Rolling a small bead between your fingertips.
- Rotate the brush in different directions.
- Imitation of caterpillar movements - pulling the wrist towards the distal phalanges.
- Rolling a ball with the palm of your hand on a hard surface.
Rehabilitation activities
Rehabilitation after a fracture is necessary to restore hand mobility and relieve pain. The recovery period for severe injuries is quite long and can take about a year. Rehabilitation includes a set of different techniques, which the rehabilitation doctor selects individually, depending on the type and severity of the injury.
Rehabilitation methods:
- Physiotherapy (paraffin, electrophoresis)
- Massage;
- Physiotherapy.
These methods allow you to restore blood circulation and prevent muscle atrophy due to prolonged forced immobilization of the limb. After completing the full course, motor functions are restored after 2 months (for typical fractures), physical activity can be resumed only after 6 months.