The wrist joint connects the hand to the forearm. It is formed by several bones, two of which - the lunate and scaphoid - are injured most often. Wrist fractures are more common in women, especially older women, due to calcium deficiency and weakened bones. Men have stronger and larger bones, and age-related hormonal changes are less pronounced.
Lack of proper and timely treatment can subsequently cause:
- Pain during functioning;
- Limitations on the volume of movements performed;
- Development of arthrosis;
- Weaknesses of the hand.
Injury to the hand joint is a consequence of increased stress as a result of a fall or sudden emphasis on the hand.
Another reason is osteoporosis, a disease that is accompanied by increased bone fragility.
Symptoms of a fracture
- The brush loses the ability to perform its functions. Swelling occurs.
- A fracture of the bones of the wrist joint is accompanied by severe pain.
- After a fracture, the deformation of the joint is visually determined. There is a tingling sensation in the area of the fracture and numbness in the fingers.
- With an open fracture, hemorrhage may occur.
Treatment of metacarpal fractures
For the first stage of self-care, the main goals are pain relief and swelling prevention. To do this, give your hand a comfortable position, apply ice, try to hold your hand as high as possible. You should not delay seeking qualified help for more than 2-3 days. After taking x-rays, you can decide on treatment tactics.
Most metacarpal fractures can be treated conservatively or by closed reduction using wires. Sometimes, especially for intra-articular fractures, mini-implants are used: plates, screws, special rods.
Conservative treatment
If the displacement of the fragments is considered insignificant, then immobilization with plaster or other materials can be used. Minor displacement is a somewhat vague concept, this means that there is no large shortening, angular deformation, displacement along the articular surface, or rotational displacement. The latter is determined to a greater extent not by x-rays, but by the position of the fingers when they are bent. For metacarpal fractures, you should always ask the patient to try to make a fist to avoid crossing the fingers. A sunken knuckle or a small bump on the back of the hand is much less of a hassle than crossing your fingers.
Immobilization is applied from the proximal interphalangeal joints to the middle third of the forearm in a position of flexion at the metacarpophalangeal joints of 70-90 degrees and extension at the wrist of about 45 degrees. This position is the most physiological; it is important that the fingertips remain mobile. The immobilization period is usually about 4 weeks. The most convenient, lightweight and comfortable immobilization is obtained from micro-perforated low-temperature Orfit NS plastic with a thickness of 1.6 or 2 mm.
Diagnostics
Since the fracture has signs similar to a bruise or sprain, only a specialist can make a diagnosis.
Depending on the signs of the disease, you can contact a doctor:
- to a surgeon or traumatologist - if the patient has a mechanical injury;
- rheumatologist, therapist, urologist or dermatologist - for arthrosis, arthritis or bursitis.
Diagnostics include:
- Medical examination;
- X-ray of the hand;
- Ultrasound.
For an intra-articular fracture, an MRI is prescribed.
If necessary, additional examination is carried out.
First aid consists of the following:
- Anesthesia;
- Immobilization of the hand by applying a splint to the palmar surface and bandaging the hand;
- Hospitalization in the inpatient department (trauma department).
Symptoms of a displaced wrist fracture
The signs of the described damage are quite obvious and they affect, first of all, the following:
- The occurrence of swelling in the hand area;
- Visually noticeable deformation;
- A feeling of sharp pain in the injured area, which increases when you try to move your fingers. Very often this syndrome makes even the slightest movement of the fingers impossible;
- In some cases, the color of the hand changes to blue, which occurs due to internal hemorrhage in the soft tissue area.
Thus, any attempt to make any wrist movements, including minimal ones, turns out to be practically impossible for the victim, which should be considered an eloquent sign of damage. In order to clarify the diagnosis, it is necessary to take an x-ray.
For displaced fractures of the hand, it is most often advisable to take pictures in three projections at once. In more complex cases, their number may increase. If the signs presented above do not quite coincide with what the victim feels, then this indicates that he only has a sprained hand or a standard hand bruise. It is quite easy to confuse these damages without being a specialist. In order to preserve human health, it is recommended to exercise caution in the process of fixing the limb and minimize any attempts to move the hand. This will make further treatment much easier.
Treatment of a wrist fracture
For fractures of the bones of the wrist joint, conservative or surgical treatment is used, depending on the severity of the disease. Fixation is performed using an orthosis (fixator).
If the patient has a closed fracture without displacement, a plaster or polymer bandage is applied for several weeks until the bones heal completely. In case of a displaced fracture, when fragments are formed, it is important to give them the correct position and fix them in order to exclude arthrosis. In some cases, surgery is performed. At this time, a control x-ray is necessary to avoid repeated displacement.
After applying the fixing bandage, painful sensations are possible. In this case, apply cold compresses and use anti-inflammatory drugs.
The plaster should not put pressure on your hand. If your hand becomes numb and your skin becomes pale, you should consult a doctor.
Publications in the media
Fractures of the hand bones account for 35% of all fractures. Classification • Fracture of the carpal bones •• Fracture of the scaphoid bone •• Fracture of the lunate bone •• Fractures of other bones of the wrist • Fractures of the metacarpal bones • Fractures of the phalanges of the fingers. Fracture of the scaphoid • Causes: fall on an outstretched, extended arm, direct blow to the palmar surface of the hand • Pathomorphology . The scaphoid bone breaks at the tubercle area. The peculiarities of the blood supply determine poor healing of the fracture • Clinical picture : swelling in the area of the anatomical snuffbox, limitation of movements in the dorsoradial direction, inability to clench the hand into a fist. To confirm the diagnosis, an X-ray examination is performed in three projections: direct, lateral and oblique • Treatment: plaster cast for 6–8 weeks in the position of thumb abduction and slight dorsal extension (150–160°). If the fracture heals poorly, surgical treatment is required.
Fracture of the lunate bone • Causes : fall on the hand abducted to the ulnar side • Clinical picture . Swelling in the middle of the wrist joint on the back side, retraction in the area of the third metacarpal bone when clenching the hand into a fist, pain with axial load on the third and fourth fingers • Treatment . Plaster cast for 6–10 weeks. Surgical treatment - for false joints and aseptic necrosis.
Fracture of the metacarpal bones . The most commonly observed fracture is the base of the first finger • Pathomorphology •• Bennett's fracture is a longitudinal fracture at the palmar-ulnar edge of the base of the first finger, while the triangular fragment is held by ligaments, the metacarpal bone is displaced in the proximal direction •• Roland's fracture is a comminuted fracture of the base of the first metacarpal bone • Clinical picture: pain, deformation and swelling of the metacarpal joint area; pain occurs with axial load on the finger. With a fracture of the first metacarpal bone, the thumb is adducted and slightly bent • Treatment. Accurate comparison of fragments, plaster cast with thumb abduction. For Roland's fracture - arthrodesis, transosseous remote osteosynthesis.
Fracture of the phalanges of the fingers • Causes: direct and indirect injuries • Pathomorphology: displacement with the formation of an angle open to the back • Clinical picture : deformation, shortening and swelling of the finger, subcutaneous hematoma, pathological mobility, pain with axial load • Treatment: reposition, plaster cast for 4–5 weeks, exercise therapy, physiotherapy, skeletal traction on a Beller splint, osteosynthesis with a Kirschner wire.
ICD-10 • S62 Fracture at the level of the wrist and hand
First aid
Injury that results in a fracture of the hand can occur at home and on the street, at the workplace or during leisure. Wherever an unpleasant event occurs, the victim needs qualified help. The deterioration of the condition can develop quickly, so it is important to carry out pre-medical measures on site before meeting with a medical specialist.
Emergency assistance involves the following actions:
- The injured hand needs to be examined. If you have jewelry, carefully remove it unless you have to force it to do so. When the rings are not removed, there is no need to force it, so as not to complicate the fracture.
- If the skin is damaged, the wound is carefully cleaned of foreign objects. The damaged area can be treated with an antiseptic solution (3% hydrogen peroxide) and covered with a sterile cloth to prevent further infection.
- The brush must be immobilized. A splint is not used for immobilization. The hand is fixed to the body, suspended on a scarf or other fabric in the form of a “kerchief” at a right angle. Another option is to bandage the arm to the body without touching the hand, so as not to cause displacement of bone fragments.
- In case of severe pain, the victim is given an anesthetic (Tempalgin, Ketorol). If you suffer from a psycho-emotional state, valerian extract is suitable as a sedative.
After the manipulations, the victim is taken to the nearest trauma center.
Rehabilitation and recovery after a wrist fracture
As part of rehabilitation and recovery, it is necessary to carry out special exercises that:
- will strengthen muscles;
- will significantly increase the range of motion in the wrist area.
In case of a healed displaced fracture of the hand, you should seek advice from a physiotherapist. It is he who will indicate the list of exercises, but it makes sense to do this only after the bones have again received a sufficient degree of strength. It is best to forget about playing sports for the next two to three months - until the wrist as a whole is completely stronger.
A course of physiotherapeutic procedures will help speed up rehabilitation and recovery. Experts recommend signing up for a regenerating hand massage. This will enable all those ligaments and vessels that have managed to “stagnate” to resume optimal functioning.
Diet during rehabilitation
In order for the bones to heal well during rehabilitation and become strong, in addition to rehabilitation, you must follow a diet. The diet should contain foods that help stimulate the body's production of its own collagen.
The menu should include:
- vegetables and fruits,
- greens that contain a vitamin-mineral complex,
- It is necessary to provide the body with the microelement calcium,
- eat different types of cabbage (cauliflower, broccoli, cabbage),
- fish,
- dairy products.
In addition to proper nutrition, it is useful to do handicrafts: knitting, embroidery, sewing, sawing or burning.
Prevention
To avoid serious injury, you must adhere to safety rules when performing various manipulations. To prevent falls, wear comfortable shoes. Use protective equipment when playing sports. Proper nutrition and timely treatment of chronic diseases will prevent bone fragility, which contributes to the development of injury. If an accident occurs, a visit to the doctor should not be delayed. A fracture of the hand can lead to immobility, so the assistance provided must be effective and immediate.
Characteristic symptoms
Violation of the integrity of one or several bones of the hand leads to the development of a vivid clinical picture, the diversity of which depends on the location of the fracture. All manifestations can be divided into general and specific signs.
Classic symptoms:
- piercing pain – there are numerous pain receptors on the palms and in the fingers;
- swelling that is not limited to the injured hand, but extends to the wrist joint and forearm;
- hematoma - subcutaneous hemorrhage can be localized or occupy a large area;
- bluish skin over a broken bone;
- hand movements are impossible;
- unnatural deformation of part of the hand or finger, as well as protruding bone fragments visible under the skin;
- open fractures are characterized by the presence of a wound in which damaged muscles and bones are visible;
- The skin on the injured area is hot to the touch.
A fracture of the hand is easy to suspect if there is a history of a fall or crushing of the upper limb.
Considering the localization, the following specific signs are observed:
- Wrist area – the victim’s fingers “do not work”; it is impossible to clench the hand into a fist. When trying to move, a piercing pain impulse appears with irradiation into the phalanges of the 3rd and 4th fingers, as well as into the scaphoid bone.
- If the bones at the base of the fingers are destroyed, attempting to move 2 fingers causes acute pain. In this case, the first finger takes a forced position: pressed to the hand in a bent form.
- Violation of the integrity of the fingers is accompanied by deformation of the phalanges with deviation from the vertical axis.
When bone fragments are displaced, a hard formation is noticeable under the skin.
On palpation, it is painful and easily moves with a crunching sound, which indicates crepitus due to friction of parts of the broken bone against each other.
Causes
In most cases, hand injuries occur as a result of mechanical action from an external force. Compression by heavy objects as a result of a falling load or pinching of the distal arm between hard surfaces. A fracture of the hand can be caused by a strong blow or a fall with emphasis on the hand.
In older people, a bone fracture appears after an injury, which in a healthy person cannot cause a similar reaction. Increased traumatism is explained by a decrease in bone mineral composition after the development of the following conditions:
- osteoporosis;
- leaching of calcium after uncontrolled use of diuretics;
- hormonal disorders;
- degenerative processes due to age.
A large percentage of injured patients are children, which is explained by their high mobility and passion for outdoor games.
Recovery
As part of rehabilitation measures, the main directions are used:
- massage;
- physiotherapy;
- physical therapy.
The recovery period begins from the moment the plaster cast is removed. After prolonged physical inactivity, blood circulation in the hand and fingers deteriorates, range of motion decreases, muscles atrophy, and there is no possibility of performing complex manipulations.
To improve the functioning of muscle fibers and enhance hemodynamics, therapeutic massage is performed. In addition, passive physical impact develops joints, gradually increasing their mobility. At the same time, the doctor selects therapeutic exercises for the hand. Initial exercise therapy sessions are supervised by an instructor, and subsequent classes are conducted independently.
To speed up recovery, a course of physiotherapy is carried out. The techniques can be used not only for therapeutic purposes during the rehabilitation period, but also to maintain a lasting therapeutic effect every six months.
For a fracture of the hand, the following is prescribed:
- magnetic therapy;
- electrophoresis;
- laser exposure;
- treatment with ultrasonic waves.
The prognosis after an injury depends on the type of fracture, severity, speed of contacting a doctor, age and general functional state of the patient. Most often, if the recommendations are strictly followed, the hand is completely restored.
Restoration of wrist bones
In the complex of measures for treating a wrist fracture, the rehabilitation period is very important. In the first months after removing the cast, it is not recommended to lift heavy objects with the affected arm or make sudden movements. During the recovery period, it is advisable to undergo therapeutic massage and exercise therapy. To relieve pain, you can use special pain-relieving ointments, gels and compresses. At home, you should regularly do light exercises to develop your hand and restore its mobility. For example, you can knead plasticine, squeeze a special expander or tennis ball with your sore hand. Another effective exercise is tilting the closed, straight palms towards the wrists.
After complete restoration of wrist mobility and the disappearance of pain, you should avoid falling on a straight arm and do not lift heavy objects with one hand.