Fracture of the radius of the wrist: causes, symptoms, conservative and surgical treatment

Diagnosis of a radius fracture

The first diagnosis occurs on the spot - upon injury. Usually, it's hard not to notice. A characteristic crunch and terrible pain arise immediately, the person himself realizes that he has broken his arm.

But for an accurate diagnosis, you need to consult a doctor. After all, wrist injuries are very different, and their treatment is also different.

Symptoms of a radial fracture:

crunching sound caused by a fall or injury;
immediately after a fracture of the radius, the hand does not bend, it is impossible to clench a fist and grasp an object;
swelling after 30-120 minutes;
if the joints are affected, then hemorrhage occurs and a hematoma is visible.

In some situations, the hand may only hurt during physical activity and show no other symptoms. This is dangerous because the bones may not heal properly. Then patients turn to Ladisten with a complaint: after a fracture of the radius, the arm is crooked.

Types of radius fractures

Doctors distinguish two main types:

Kollesa . Prevails in all cases. When a person falls, he leans on his palm reflexively. If a fracture occurs, the bone fragments are displaced to the back.
Smith . Occurs to a lesser extent. The exact opposite of the Colles injury is a fall on a hand that is concave inward. Therefore, the fragment moves towards the palm.

Both types are equally dangerous and risk causing complications if not treated promptly and correctly. Even if you visually do not see a fracture, your arm hurts only slightly, still consult a doctor after falling on your wrist.

Decoding the results

X-rays of the hands are interpreted by a radiologist immediately after the shooting is completed. He evaluates the relative position of the bones of the hand, their connection to each other, and integrity. Attention is also paid to assessing bone structure and density.

Normal indicators

Normally, the bones of the hands should have a uniform structure. There should be no shading in the white areas in the photographs. There should be a gap between the bones.

If only one hand is damaged, an X-ray of the healthy limb may be taken to more accurately diagnose the pathology. This will make it easier to compare and identify deviations.

Classification of fractures

How much your arm hurts after a fracture of the radius largely depends on the type of fracture. They can be complicated or simple. Pain of a different nature occurs, joints and soft tissues may be affected, or you may not feel the problem at all.

There are 5 main types of radial fracture:

Open. The skin is touched and damaged, bleeding occurs. There is a high risk of infection and urgent surgery is required to restore the limb. Additionally, they check whether the patient has a tetanus vaccination, if not, they will be vaccinated;
Splintered. A complex type that takes a long time to heal and is difficult to recover. The name means that the bone is crushed into several fragments - 3 or more. Without surgical intervention, it is impossible to “assemble the puzzle”;
With offset. The situation is complicated by the displacement of fragments inside the broken limb. They may fuse in the wrong position and prolong the treatment period. The limb becomes deformed and may remain that way forever without treatment. If a displaced fracture of the radius occurs, rehabilitation also becomes more complicated. The patient has to get used to the new position and shape of the bones;
Intra-articular. The injury affects the wrist joint, which also needs to be restored;
Extra-articular. It is considered the simplest, does not affect the joint, and is easily corrected if there are no fragments or displacements.

Most carpal radius fractures require surgery.

Fracture of the arm (Fracture of the upper limb, Fracture of the bones of the upper limb)

Shoulder fractures

Shoulder fractures account for about 7% of the total number of fractures.
The most common are injuries to the surgical neck of the shoulder. Elderly patients are more likely to suffer; the injury occurs when they fall on their arm. The joint is swollen, painful on movement and palpation, movements are severely limited. To confirm the diagnosis, an x-ray of the shoulder joint is performed. Treatment is usually conservative - closed reduction followed by application of a Deso bandage, abduction splint or Turner bandage. For non-reducible and unstable fractures in patients of working age, surgical treatment is indicated - osteosynthesis of the surgical neck of the humerus neck with a plate or wires. Fractures of the humeral shaft are usually detected in middle-aged and young people. The cause is a direct blow, twisting of the arm (“police fracture”), or a fall on the arm. There may be concomitant damage to the radial nerve. The injury is manifested by pain, swelling, deformation, pathological mobility, crepitus and severe limitation of movements. When the nerve is damaged, disturbances in sensitivity and movement are observed in the area of innervation of the radial nerve. The diagnosis is clarified using x-rays of the shoulder; if nerve damage is suspected, a consultation with a neurologist or neurosurgeon is prescribed.

Treatment can be conservative or surgical. When choosing a conservative tactic, traction is applied, which, after the formation of a primary callus, is replaced with a plaster cast. The absolute indication for surgery is an unsuccessful attempt to compare fragments using skeletal traction, interposition of soft tissues, old injury and the threat of nerve damage. In some cases, surgical intervention is carried out according to relative indications for early activation of the patient and prevention of the development of post-traumatic contractures. Osteosynthesis of the humerus with a plate or intraosseous nail is possible.

If the nerve is damaged and the bone fragments are well aligned, conservative treatment is possible: immobilization, exercise therapy, physiotherapy, taking medications that promote nerve regeneration. If there are no signs of nerve regeneration within several months, surgical intervention is indicated - neurolysis and plastic surgery of the nerve trunk using an autograft from the superficial nerve.

Injuries to the lower end of the shoulder can be extra-articular (supracondylar) or intra-articular (condylar). Supracondylar fractures include extension and flexion injuries, transcondylar fractures include head fractures, as well as V- and T-shaped trochlea fractures. Usually the injury is the result of an indirect injury - a fall on the elbow or on an abducted and outstretched arm. They are manifested by swelling, pain, joint deformation and severe limitation of movements.

The diagnosis is confirmed by radiography of the elbow joint. For arm fractures without displacement, immobilization is performed. If there is a displacement, an operation is performed to restore the congruence of the articular surfaces - osteosynthesis of the condyles or epicondyles with a plate, screws, knitting needles and tie bolts. During the recovery period, for fractures of the upper and middle third of the shoulder, physiotherapy and exercise therapy are prescribed. For intra-articular injuries, physiotherapy is contraindicated.

Forearm fractures

Forearm fractures account for 11-30% of the total number of fractures. More often they occur with a direct mechanism of injury; the immediate cause of a broken arm is usually a blow to the forearm, a fall from a height or an accident. As a rule, both bones break, less often one (radius or ulna). Characterized by severe pain, swelling, limitation of movement and deformation at the site of injury. With diaphyseal fractures of the arm, crepitus and pathological mobility are often detected. To clarify the diagnosis, radiography of the affected segment is performed.

In case of isolated fractures of one of the forearm bones, Galeazzi and Monteggia injuries should be excluded. Galeazzi's injury is a fracture of the diaphysis of the radius in combination with displacement of the head of the ulna in the area of the wrist joint. In such cases, an x-ray of the forearm and an x-ray of the wrist joint are performed. A Monteggia injury involves a fracture of the ulnar shaft and dislocation or subluxation of the radial head at the elbow joint. For such injuries, radiography of the forearm and radiography of the elbow joint are necessary.

For arm fractures without displacement, a blockade is performed, a plaster cast (regular or plastic) is applied, and after immobilization is stopped, physiotherapy, massage and exercise therapy are prescribed. For displaced diaphyseal fractures, surgery is indicated - osteosynthesis with a pin, plate or Ilizarov apparatus. In case of Galeazzi and Monteggi injuries, closed reduction and immobilization with a plaster cast are performed; if reduction is impossible and unstable fractures are performed, surgical interventions are performed.

Fractures of the bones of the hand

They account for more than 30% of the total number of skeletal injuries. Occurs as a result of a fall or blow to the hand. Injuries to the carpal bones are rare. A complicating factor in cases of damage to the scaphoid bone is the high number of ununited fractures, resorption of fragments, formation of cysts and false joints. Treatment is conservative; in the absence of fusion and the development of complications, operations are performed - open osteosynthesis, removal of a fragment deprived of nutrition, or arthrodesis of the wrist joint. Fractures of other wrist bones usually heal without complications.

Fractures of the metacarpal bones are common and can be open or closed, multiple or single. They are manifested by swelling, cyanosis, pain and difficulty moving. Sometimes pathological mobility and visible deformation are detected. To confirm the diagnosis, an x-ray of the hand is prescribed. Treatment is conservative - closed reduction, plaster. In case of unstable arm fractures and unsatisfactory results of reduction, open osteosynthesis, skeletal traction or closed fixation with knitting needles are performed.

Finger fractures are also common. They can be closed or open, extra- and intra-articular, comminuted, helical, transverse or oblique. The diagnosis is confirmed using radiography of the fingers. Treatment is often conservative. If it is impossible to compare or hold the fragments, closed or open fixation with a pin is used, and sometimes skeletal traction is applied.

Causes of fractures

The main reason is a fall on an outstretched arm. This is an innate reflex that a person uses when he loses his balance. When falling, people stretch out their arms to support and protect their internal organs, face, and head. But the protective mechanism does not always work; the radius bone cannot withstand the force of the blow or the weight of the body and breaks.

Trauma can happen to anyone at any age.

Risk group : athletes, people over 50 years of age, patients with diseases of bones and joints.

X-ray of the hand - what is it and what does the examination include?

18.10.2021

X-rays of the hand are most often done in case of injury to this area. X-ray is a painless and quick examination. Pain, stiffness and noticeably decreased joint may also be indications for an X-ray of the arm. In what cases should I refuse an x-ray of my hand, how much does the examination cost and do I need a referral to a doctor ? This is a quick, easily accessible and non-invasive examination, thanks to which the patient can be further diagnosed for possible diseases of the musculoskeletal system. X-rays of the hand can also be used as a control test due to its repeatability.

X-ray of the hand - what is it and what does the examination include?

An X-ray of the hand is one of the main examinations to which a patient is referred with complaints of pain and swelling in this area. With the help of ionizing radiation, a specialist can see in the photo disturbances in the structure of bones and joints , as well as violations of their integrity (for example, a fracture ). Most often, the test is performed on digital cameras, which means the photo is sent directly from the imaging room to the physician's , and then the person being tested receives it on a CD/DVD. Standard photographs are taken in an anteroposterior projection, in an oblique projection, and (much less often) in a lateral projection. X-rays can be done individually (on the right or left hand) or in comparison with both. Properly taken photographs will show finger bones bones and bones .

X-ray of the hand - indications for examination

The most common indications for x-rays are to exclude inflammatory and post-traumatic changes (eg, bruises, fractures) and to examine bones after injury. A patient suspected of having a foreign body in the soft tissues of the hand will also be sent for an x-ray . In addition, X-rays are used to detect rheumatoid changes in the joints , such as rheumatoid arthritis - RA and osteoporosis (bone loss). The doctor will also refer the patient for an x-ray if he suspects bone or a neoplasm.

On the other hand, in case of growth disorder in children, such as stunted growth, an x-ray to determine their bone age. This is a method for determining the so-called biological age of a child based on assessing the maturation of his skeletal system. Patients who primarily experience pain, stiffness and limited joint will be referred for evaluation.

X-ray of the hand - contraindications for examination

The only contraindication to the examination is pregnancy . In this case, other, safer imaging methods, such as ultrasound or magnetic resonance imaging, should be performed. However, pregnancy is a relative contraindication, meaning that if the test is absolutely necessary to diagnose the patient, it will be performed. Before the examination, the patient must tell the radiologist if she is pregnant. If she is unsure, she should refuse the test and take a pregnancy .

X-ray of the hand - what the examination looks like

The patient does not need to prepare for an x-ray of the arm. If he has previous test from the study area, he should take them with him. Before the examination, remove all objects (including rings, watches, bracelets) from your hand and wrist. During an x-ray , the patient sits with his arm extended in front of him, placed on the detector (a device that processes ionizing radiation). The arm is placed at the level of the subject's shoulder, and the X-ray tube is placed over the part of the body being examined. The total duration of the study is from 5 to 10 minutes.

X-ray of the hand - the most common diagnostic terms in test descriptions

When describing an X-ray examination of the hand, the specialist uses the names of individual fingers, starting with the thumb (1st finger) and ending with the little finger (V-finger). One of the most common pathologies is degenerative changes. Osteoarthritis of the hands (arthrosis) mainly affects the last joints of the fingers (distal interphalangeal joints ) and the joint at the base of the thumb. They can also be characterized as changes in overload and can be seen in photographs, for example as joint space narrowing and bone . If there is visible bone loss, a specialist will diagnose osteoporosis . Unfortunately, the early stages of this disease are not visible on x-rays. When a fracture , the radiologist will use terms such as "fissure rupture", "complete union" or "ossification nucleus". bone healing after a fracture .

An x-ray of the arm must include a referral for a test, paid for by the National Health Fund and carried out privately. This is due to exposure to ionizing radiation, which is used during X-rays. A referral can be obtained from a GP (primary care) or specialist doctor. The price of the test depends on the number of photographs taken and the diagnostic laboratory in which the patient wants them taken.

Published in Diagnostics and examinations of Premium Clinic

Treatment (conservative, surgical)

There are two treatment options:

Conservative. It is used for simple fractures, without fragments or displacements. The patient is given a plaster cast, and the arm heals under it on its own. Sometimes conservative treatment is used to restore fragments and displacement. The procedure may fail and the limb may become deformed over time. The entire treatment takes from 4 to 6 weeks plus a rehabilitation period.

Operational. It is carried out under anesthesia, cutting the arm and restoring the anatomical structure of the bone. The fragments are fixed with special titanium plates and screws. Transosseous osteosynthesis according to Ilizarov is also performed, and a special fixation apparatus is used to restore the arm. At the Laditsen Medical Center, the operation is performed using Dr. Veklich’s improved design, without the use of traumatic needles. After the operation, you do not need to wear a cast, just an elbow bandage. Recovery occurs faster, and the patient returns to his usual lifestyle.