Fracture of the radius: treatment, healing time of the radius, rehabilitation after a displaced fracture

General information

A radial bone fracture is a violation of the integrity of the radial bone caused by various types of traumatic effects.
ICD-10 radial fracture code: S52.1; S52.3; S52.5. A fracture can occur at different levels of the radius: in the head/neck area, in the lower/middle third, or a fracture of the styloid process. Fracture of the radius occurs in people of both sexes and of any age, however, fractures of the diaphysis/damage to the upper part of the radius are found more often in children and young/middle-aged people, and fractures in a typical location (fracture of the distal metaepiphysis) are found more often in elderly people. In 75% of cases, a closed radial fracture occurs. In practice, the most common occurrence is the so-called fracture of the radius in a typical location. By “typical location” we mean fractures of the radius in the area slightly above the wrist (distal part of the radius, with the damage localized closer to the hand). It accounts for about 72% of all radial fractures. A fracture in a typical location is most common in women aged 70-75 years, which is largely due to the phenomenon of osteoporosis (decreased bone mass, structural disorders - disruption of trabecular microarchitecture/appearance of microfractures, increased porosity of the cortical bone), which contributes to a decrease in bone strength and structural impairment / quality of bone tissue.

The radius of the arm is a long, fixed paired tubular bone within the bones of the forearm, having a triangular shape with anterior/posterior and lateral surfaces and anterior/posterior/interosseous edges. It is located on the side of the first finger, next to the ulna bone with which they are interconnected and dependent on each other. These bones connect below with the bones of the wrist, forming the wrist joint, and at the top these bones participate in the formation of the elbow joint. The radius is responsible for the functional mobility of the forearm at the elbow joint. However, at the same time, fractures of the radius are much more common than the ulna. The figure below shows the radius and ulna bones and their dislocation relative to each other.

Radial fractures can be either isolated or combined with other injuries. In practice, combined fractures of the shoulder (radius/ulna) are more common. At the same time, complete fractures of the radius/ulna are usually accompanied by displacement of bone fragments along the length, width, at an angle or around the longitudinal axis. With an atypical mechanism of injury (fall from a great height, road/work injuries), combined injuries to other bones of the extremities are possible (fractures of the spine, ribs, pelvic bones, damage to internal organs, kidney damage, chest damage, bladder damage and blunt abdominal trauma).

In children

The variety of hand fractures in a child and their mechanisms is due to the presence of growth zones (wide strips of cartilage) between the metaphysis/epiphysis and the elastic periosteum. Therefore, a child may have both complete fractures and bone fractures, “green stick” type fractures (subperiosteal fractures), when bone fragments do not move and are held by the entire periosteum or are located at an angle relative to one fragment to another. Displaced fractures of the arm bones are less common than in adults. Often it is not the arm bone that breaks, but the growth cartilage, which is located next to the joint. These features contribute to the smoothness of clinical symptoms in a large number of hand injuries, which complicates diagnosis.

Pathogenesis

The pathogenesis of a pathological fracture is based on quantitative/structural changes in bone tissue, which significantly reduce bone strength. These include a decrease in bone mass and, as a consequence, a decrease in the mechanical strength of the bone and structural changes - disturbances in the microarchitecture of the trabeculae, an increase in the porosity of the cortical bone and the accumulation of trabecular microfractures, which directly affects the strength of the bone, regardless of its mass. Thus, the pathogenesis of pathological fractures involves a significant decrease in bone mass per unit volume and a violation of the strength/structural characteristics of bone tissue.

Prevention

Preventive measures for hand bone fractures include:

Prevention of injuries (domestic/sports), for which it is necessary to use protective equipment/follow safety precautions during sports, as well as follow rules of behavior that reduce the risk of injury when in potentially dangerous conditions (slippery roads, poor visibility, crossing traffic routes, etc. .).
Improve bone tissue trophism by including a diet of foods containing sufficient amounts of complete protein, microelements/vitamins, and collagen .
If there is a risk of developing pathological fractures, adequate/timely treatment of osteoporosis .

Classification

The classification of radial fractures is based on factors such as the nature and nature of the fracture, fracture lines, displacement of fragments, the presence of fragments, the presence of a fracture of the ulna, etc., according to which the following types of radial fracture are distinguished.

According to the nature of the fracture, there are:

Traumatic fractures with and without displacement that occur when the radius is exposed to a mechanical factor in the form of a fall, twisting, blow, or excessive physical activity.
Pathological fractures resulting from a decrease in mineral density/impairment of the strength/structural characteristics of the bone (osteoporosis).

Depending on the fracture line, transverse, oblique, helical (spiral fracture), longitudinal, impacted, T-shaped, and comminuted fractures are distinguished.

Depending on the presence/absence of a violation of the integrity of the skin, the following are distinguished:

Open fracture with damage (violation) of the skin. In this case, fragments of the radial bone come out.
Closed fracture without skin damage.

Depending on the relationship of the radial bone fragments, the following are distinguished:

Fracture of the radius without displacement of bone fragments (crack-type damage); Fractures of this type in most cases do not require additional interventions (except for fixation).
Displaced fracture of the radius (complicated fracture with a high risk of re-displacement).

Anatomical classification, according to which:

extra-articular fractures - fracture of the body (diaphysis) of the bone;
intra-articular fractures - fracture of the head of the radial bone (neck);
fracture of the styloid process.

Treatment. Elbow joint. Fractures

Classification of elbow joint fractures, their treatment and complications

Treatment of the elbow joint after a fracture
An elbow joint fracture is a pathological condition caused by a fracture of one of the bones involved in the formation of the joint. Due to the peculiarities of the anatomical structure, fractures of the elbow joint are also classified. The following types are distinguished:

1) Fracture of the olecranon

2) Fracture of the epicondyles of the shoulder

3) Intra-articular fracture of one of the bones

Read more about the treatment of elbow fractures

Despite the anatomical disunity of these formations, they are all included in the collective concept of a fracture of the elbow joint. It should be said that an elbow fracture can be open or closed. The latter is much more favorable in 90% of cases.

Causes

A fracture of the elbow joint is accompanied by the use of strong mechanical force, leading to destruction of bone tissue. However, if the patient has osteoporosis (softening) of the elbow joint, the intensity of that same force is no longer so strong. This means that a fracture can occur not only from a fall from a great height, a traffic accident and much more, but also from a simple, light everyday blow, for example, on the corner of a table. An elbow fracture has also been described as spontaneous, when a severe degree of osteoporosis led to almost complete resorption of bone tissue. Currently, the problems of osteoporosis in the light of the discovery of new replacement pharmacological drugs are discussed in scientific circles, and, obviously, if humanity fails to get rid of this disease in the foreseeable future, its consequences will be monitored by doctors. It should be said that treatment of an elbow fracture caused by osteoporosis or complicated by it is extremely difficult, and if surgery is not required, the medication load will be more pronounced, which the patient should expect.

Symptoms

The symptoms of a fracture of the elbow joint are simple, visually visible, but require a differential approach in some cases. Pain is a frequent companion of all pathological conditions in traumatology, and with an elbow fracture it is no exception. Tissue swelling also occurs in the next few minutes from the moment of injury. Of fundamental importance is the blood supply in the place below the site of bone fracture. The anatomical proximity of the bone and the neurovascular bundle, on the one hand, serves as a protective factor; on the other hand, if the latter is fractured, it additionally injures it. It is important to feel the pulse, which will indicate some preservation of blood flow, and as a result, the absence of urgent surgery. Treatment of a fracture of the elbow joint in case of injury to blood vessels or nerves is carried out only surgically for health reasons, this must be remembered. The diagnosis is confirmed by x-ray, after which a set of therapeutic measures is started.

The basic principles of treatment for elbow fractures are:

precise reposition of fragments;
strong fixation;
early function.

In recent years, in the treatment of fractures of the elbow joint bones in our country and abroad, the method of transosseous osteosynthesis with external fixation devices has been widely used, which makes it possible to successfully reduce bone fragments, firmly fix them and begin early therapeutic exercises. Currently, the priority of surgical methods of treatment of fractures of the elbow joint over conservative methods is recognized.

In case of extensive damage, bone fragments are fixed using Ilizarov pins or a rod apparatus. This is done to allow the soft tissue to heal before final surgical fixation of the fracture. In this case, the risk of infectious complications and limb amputations is less.

Conservative therapy

A non-displaced olecranon fracture usually requires conservative treatment. During the first 6 days after injury, swelling may increase and persist, so a posterior plaster cast is applied with the forearm flexed at the elbow joint at an angle of 80–90 degrees (see figure below). The bandage should extend from the upper third of the humerus to the wrist joint, with the forearm in a supinated position (palm up). Immobilization of the arm in a scarf continues for 3 weeks from the moment of injury. Immobilization can be continued in the splint, periodically removing it to develop the elbow joint. Or replace the plaster with a rigid fixation orthosis with adjustable range of motion. Fracture of the head and neck of the radius may occur. Such fractures of the arm in the elbow joint are possible both with displacement and without displacement. It should be said that possible displacement of bone fragments creates an obstacle for doctors, and treatment of a fracture of the elbow joint is delayed, i.e., such patients have to be hospitalized in the hospital for at least a week.

Operative therapy

A fracture of the olecranon process, which has a pronounced displacement of fragments, requires mandatory surgical intervention by a trauma surgeon. Otherwise, the forearm will not fully extend; this is a serious violation of the function of the upper limb. The success of the operation depends on the accurate comparison of bone fragments and their fixation in the correct anatomical position. And further success depends on the correct development of the elbow joint. But more often surgery is necessary. Treatment of a fracture of the elbow joint is carried out using various surgical approaches, depending on the location of the fracture. The patient is given general anesthesia.

With a simple fracture of the proximal end of the ulna, treatment of an elbow fracture is reduced to tightening the bone using a wire loop, having first repositioned the bone with or without Kirschner wires. If an intra-articular fracture of the elbow joint has occurred and fragments have formed, then it is most difficult to reposition the ulna. In this case, they resort to bone grafting. In case of comminuted fractures, tightening with a wire loop cannot be performed, otherwise the articular surfaces will be shortened, then special dynamic compression plates are used. A wedge-shaped fracture of the elbow joint with displacement of the head of the radial bone is anatomically compared, especially when the articular surface is displaced by a “step” of more than 2 mm. There are also displacements of part of the articular surface by more than a third of the cross-section of the head in diameter. If the fracture capsule is not damaged, its secondary stretching as a result of the hematoma causes very severe pain. This means that the exudate from the joint needs to be evacuated urgently. For osteosynthesis, a set of small screws is used, and with the lateral approach according to Koher, adequate exposure of the fracture zone is ensured.

If the fractures of the articular part of the humerus are in the nature of crushing, then the surgeon can replace the elbow joint with a prosthesis. This type of fracture of the elbow joint with comminution is more common in elderly patients. Implants are made of metal and plastic and are attached with special bone cement. A fracture of the elbow joint after surgical treatment may be complicated by damage to the ulnar nerve. This happens relatively rarely and nerve function is often restored almost completely.

The best treatment method for an intra-articular fracture of the olecranon process, which allows maintaining movement in the joint, is osteosynthesis (elimination of displacement and fixation of fragments with a metal structure). In the case of a comminuted fracture with displacement and separation of the apex of the process of the ulna, the fragments are fixed with a special titanium structure, restoring the integrity of the olecranon and the articular surface of the ulna.

So, treatment for a fracture of the olecranon, taking into account the nature of the damage, is as follows:

restoration of the destroyed area of the elbow joint;
fixing the position of the injured area until fusion occurs.

The following methods are used to fix the injured bone:

orthosis or plaster cast (splint);
titanium plate with screws for fixation (operation);
screws without additional retaining element (operation);
fixation with knitting needles and a tightening loop (Weber osteosynthesis).

Causes of radial head fracture

The most common cause of a radius fracture is a household/work/sports injury. Less commonly, fractures are caused by osteoporosis. The level of fracture of the radius is determined by the nature/location of the traumatic impact:

Fractures of the lower third of the radius - the main cause is a fall of a person with emphasis on the palm/dorsum of the hand, less often the injury is provoked by a strong blow at the level of the dorsal surface of the wrist.
Fractures of the middle third of the radius—the main cause is a blow to the radial side of the forearm.
Fractures of the upper third—the main cause is a person falling on an outstretched, slightly abducted arm.

Fractures in a typical location without displacement/with displacement of fragments usually occur in cases of a person falling while leaning on an outstretched arm. Taking into account the nature of the displacement, it is customary to distinguish several types of injuries - Colles fractures , in which the distal fragment is displaced to the rear, and Smith fractures , in which the distal fragment is displaced to the palm (Fig. below).

The main cause of a fracture of the radius in the diaphysis area is a blow to the radial side of the forearm.
A fracture of the radial bone in the head region usually occurs as a result of a person falling onto an outstretched, slightly abducted arm. In 60% of cases, there is combined damage to other anatomical structures with dislocation of the bones of the forearm.
Combined fracture of the radius with dislocation in the wrist joint of the ulna? (Galeazzi damage) are formed when a person falls on an extended pronated hand, accompanied by concomitant compression of veins, arteries and nerves by edematous soft tissue. Factors that significantly increase the likelihood of fracture include:

Osteoporosis / osteomalacia (decreased bone density/impaired ossification of the bone matrix).
Weakness of the muscles/ligaments of the forearm and hand.
Insufficient physical training.
Increased body weight.
Diseases of the elbow/wrist joint.
Previous history of upper extremity injuries.
Taking medications that affect bone metabolism (cytostatics, glucocorticoids, antidepressants, anticonvulsants, etc.).

The reasons that increase the likelihood of falls as a main factor can be divided into external and internal:

External reasons are due to everyday and situational factors: uneven/slippery surface, poor lighting, etc.
Internal causes are caused directly by the physical condition of a person: poor vision, asthenia , hearing loss, orthostatic disorders, dementia , decreased joint mobility, low physical activity, and the use of medications that affect the neurological status.

Causes

The most common cause of fracture of the arm bones is trauma of various origins (at work, at home, during sports). This is predominantly a fall of a person on an outstretched/abducted arm; much less often, the injury is caused by a strong blow to the arm. Less common are fractures whose pathological process is based on osteoporosis .

Factors that significantly increase the risk of fracture include:

Impaired ossification of the bone matrix/reduced bone density ( osteomalacia / osteoporosis ).
Physical overload.
Weakness of the muscular-ligamentous apparatus of the hand.
Excess weight.
Poor physical fitness.
A history of upper extremity injuries.
Diseases of the joints of the hand (elbow/wrist)
Long-term/uncontrolled use of medications that affect bone metabolism (antidepressants, cytostatics, anticonvulsants, glucocorticoids, etc.).
Overload in athletes due to excessive training.
Genetically determined disorders of the osteogenesis process.
Osteoporosis (mainly in older people, which is caused by metabolic disorders in bone tissue).
Bone tumors/bone cysts .
Tuberculosis of bones /joints.

Symptoms

The main symptoms of a radius fracture include:

Soreness. Patients complain of acute pain, which intensifies when attempting to rotate the forearm (perform rotational movements). The pain syndrome is especially intense with an open fracture, especially with displacement of fragments.
Crepitation of bone fragments. It appears under the fingers when trying to move the bones in the form of a characteristic crunching sensation, however, it is not recommended to check for the presence of crepitus on your own as this can lead to even greater displacement of bone fragments.
Local tissue swelling. It is caused by a cascade of reactions that contribute to the development of the inflammatory process, in which there is an expansion of blood vessels and partial sweating of fluid into the tissue, which contributes to the appearance of swelling. If a hematoma appears at the fracture site, over time the swelling site acquires a purplish-bluish tint.
Pathological mobility in the hand. It is an absolute sign of a fracture, but only a medical professional can check it.
Shortening the arm. The symptom occurs in cases of fracture of the radius/ulna with displacement of the fragments along the length.

However, each location of the radial bone fracture is characterized by specific symptoms. Thus, in the case of a fracture of the head of the radial bone, sharp pain appears in the elbow joint, which intensifies with palpation or an attempt to bend/rotate the arm. On examination, there is joint deformation, limitation of movements, hemarthrosis and swelling . A particularly sharp limitation is observed when performing rotational movements with the forearm. In cases where a fracture of the head of the radius is combined with a dislocation of the forearm, a more severe deformity is present, movements in the joint are completely absent, and there is often a disturbance in the blood supply/sensitivity in the distal parts (numbness of the fingers).

In isolated fractures of the diaphysis of the radius, the symptoms are often erased: swelling occurs in the area of the fracture, complaints of pain, which intensify with rotational movements and palpation of the fracture site. Pathological mobility/crepitus is usually absent, which is due to the retention of radial bone fragments by the interosseous membrane/whole ulna.

A radial fracture in a typical location is accompanied by severe pain, hemorrhage and swelling. Possible pathological mobility and crepitus. In cases of displacement of fragments, there is a visible deformation in the projection slightly above the wrist joint. Palpation/movement is sharply painful.

If Galeazzi is damaged, there is pain in the middle/lower third of the forearm, and when pulling on the fingers, the pain syndrome increases, the appearance of pronounced swelling, and the formation of subcutaneous hematomas is possible. Any movement in the wrist joint is extremely limited. Distinctive features of this type of fracture are frequent nerve damage, as well as the development of compartment syndrome, manifested by compression of nerve fibers, veins and arteries by edematous soft tissue. Often accompanied by loss of sensitivity/movement in the hand area. Increasing tension of soft tissues, excruciating increasing pain indicate the presence of compartment syndrome.

What are the dangers of fractures in old age?

Despite innovative technologies in the field of bone healing and an extensive arsenal of painkillers, fractures are still very dangerous for older people. Among such patients, each illness is severe, and even a seemingly mild injury can lead to death.

Bones take much longer to heal than in young people due to slow metabolism and insufficient blood supply to skeletal tissue.
Temporary immobilization and mandatory bed rest weaken the body and negatively affect the emotional state.
The risk of thromboembolism increases - the formation of blood clots in the lower extremities and, as a result, blockage of the pulmonary artery.

Elderly people who have suffered fractures often lose faith in recovery

Tests and diagnostics

The diagnosis of “radial bone fracture” is made on the basis of anamnesis (presence of exposure to a traumatic factor), physical examination (pain/swelling in the forearm, forced position of the arm, deformity in the forearm, shortening of the upper limb, pathological mobility, crepitus of fragments, etc. ) and instrumental examination data - an x-ray in several projections, allowing to assess the nature and severity of the fracture (localization, with or without displacement, the presence of intra-articular injuries and concomitant fractures of the ulna). If soft tissue damage (muscles, blood vessels, nerve fibers) is suspected, CT/MRI may be prescribed.

Diagnostics

Most fractures are accompanied by severe symptoms - pain, swelling, displacement of a bone fragment, and the presence of a hematoma. However, X-rays are always ordered to confirm the type of injury. This diagnostic method is considered the most accessible and widespread.

In severe cases, traumatologists may refer the patient for a computed tomography or magnetic resonance imaging scan. These methods are mainly used to assess combined injuries, as well as before and after surgery.

Diet

Diet for fractures

Efficacy: therapeutic effect after a month
Timeframe: 2 months
Cost of food: 1600-1800 rubles per week

Throughout bone fusion, dietary nutrition is indicated, the main task of which is to accelerate the fusion process. The diet for fractures should contain animal protein in an amount of about 100 g/day, which includes amino acids involved in the formation of bone tissue ( arginine , lysine , glutamine , proline , glycine , cystine ). The main products containing animal protein are dietary red meats, chicken, fish, chicken eggs, cottage cheese and dairy products.

Calcium, magnesium, phosphorus and zinc play a vital role in the formation of bone tissue, so the diet should include foods containing these elements. Sources of calcium are dairy products (cottage cheese/cheese), milk, fermented milk products, hazelnuts, lettuce, sesame seeds, spinach. It should be taken into account that for effective absorption of calcium, the diet must contain foods rich in vitamin D (fish oil/fatty sea fish).

The main sources of organic phosphorus compounds are meat, fish, milk, beef liver, beans, yolk, sturgeon caviar, walnuts, buckwheat/oatmeal, and dairy products. The required amount of magnesium in the body will be ensured by the inclusion in the diet of such products as wholemeal products, legumes, wheat, oatmeal and buckwheat (kernels), hazelnuts, milk powder, bananas, coffee beans, almonds.

And zinc is rich in bran, yeast, legumes, seafood, cereal grains, beef, dairy products, mushrooms, cocoa, sesame seeds, pumpkin seeds, peanuts, sunflower seeds, potatoes, onions.

B vitamins in the diet ; D ; WITH ; A , E , which are catalysts for the reactions necessary for the healing of fractures. Thus, vitamin D from fish oil, chicken yolk, fatty sea fish (sprats); vitamin C is found in rose hips, sea buckthorn, fruits/berries; group vitamins in offal (kidneys, pork/beef liver), cereals, walnuts, sweet peppers, hazelnuts, milk, yeast, garlic; vitamin E - in cold-pressed vegetable oils. A fracture of the radius heals on average in 27-35 days, and throughout this entire period, as well as for another 1-2 months, you must follow a diet.

Prevention of fractures in old age

Orthopedists recommend thinking about this problem without waiting for old age. At any age, it is advisable to lead an active lifestyle, choose feasible sports, and eat right. In order to prevent osteoporosis and fractures, you can stick to a diet that resembles diet therapy for arthrosis. It is necessary to add sea fish, dairy products, butter, cottage cheese, cheese, yogurt, all types of cabbage, nuts and spinach to the menu.

A special vitamin and mineral complex for bones will also not be amiss. If you are already worried about joint pain, get diagnosed to know the enemy by sight. Degenerative-dystrophic changes in cartilage tissue contribute to bone fractures, so coxarthrosis or gonarthrosis should not be ignored. Timely courses of intra-articular injections of liquid endoprosthesis will help avoid complications.

Consequences and complications

The most common complication of a radius fracture is its malunion. At the same time, the severity of the consequences can vary widely depending on the location of the fracture/degree of bone deformation and can be represented by:

Sudeck-Thurner syndrome (chronic pain syndrome/reflex sympathetic dystrophy). The pathology is progressive in nature and is accompanied by chronic pain syndrome, limb deformation with impaired function, trophic disorders, development of stiffness of adjacent joints/osteoporosis and often ending in disability.
Instability of the wrist joint/impaired rotational function of the wrist joint.
Shortening the forearm.
Decreased grip strength in the hand.
Slowing growth of the radius/development of radial clubhand.
Deforming arthrosis of the wrist joint.
Volkmann's contracture , developing against the background of long-term compartment syndrome.

Complications are observed mainly in the absence of timely/adequate treatment for complex radial fractures and non-compliance with recommendations for the duration of bone fixation and lifestyle correction for the healing period.

List of sources

Ashkenazi A.I. Fractures of the radius in a typical location // Carpal joint surgery. - M, 1990.- P. 124-138.
Vorontsov P.M. Treatment of fractures of the distal metaepiphysis of the forearm bones / P.M. Vorontsov // Man and his health: Materials / Russian National Congress. - St. Petersburg, 1997. - P. 80.
Angarskaya, E.G. Features of fractures of the radius in a typical location / E.G. Angarskaya, B.E. Munkozhargalov, Yu.N. Blagoveshchensky // Siberian Medical Journal. - 2008. - No. 3. - P. 33-35.
Ardashev, I.P. Surgical treatment of improperly consolidated fractures of the distal metaphysis of the radius / I.P. Ardashev, V.N. Drobotov, A.V. Ivanov et al. // Modern high technology. - 2009. - No. 12. - P. 19-21.
Bakhovudinov, A.Kh. Current state of the problem of complex pain syndrome with a fracture of the radius in a typical location / A.Kh. Bakhovudinov, V.A. Lanshakov, A.A. Panov et al. // Siberian Medical Journal. - 2009. - No. 3. - P. 104-110.