Fracture of the distal metaepiphysis of the radius (“radius in a typical place”)
The distal metaepiphysis is the lower end of the radius, located next to the hand.
A “beam in a typical location” fracture usually occurs from a direct fall onto an outstretched arm. In addition to sharp pain in the hand, a bayonet-shaped deformity and a change in the position of the hand may appear. The fracture process may involve the nerves and vessels of the wrist, which can be compressed by fragments, which is manifested by numbness in the fingers and coldness of the hand.
To clarify the nature of the fracture and select further treatment tactics, radiography is used, and in some cases computed tomography is used. Sometimes an ultrasound of the wrist joint is required.
Since the radius bone is adjacent to the hand, it is very important to restore the anatomy and range of motion in the joint in order to avoid future problems with it. Previously, such fractures were treated conservatively, i.e. in a plaster cast, but often the fragments were displaced, the bone healed incorrectly, which subsequently affected the function of the limb - the arm did not bend and/or did not straighten to the end - stiffness of the joint formed (contracture), which remained pain syndrome. In addition, a long stay in a cast had a negative effect on the skin.
The duration of sick leave for a fracture of the distal metaepiphysis of the radius depends on the type of activity of the patient. For example, for office workers the average period of disability is 1.5 months. For professions involving physical activity, the period of incapacity for work may be increased.
Symptoms and signs
Only a specialist can recognize a fracture of the left forearm according to ICD 10. However, you can independently identify the most characteristic symptoms of injury. It is their active manifestation that is the reason for immediate contact with traumatology.
Signs of a forearm fracture are as follows:
- severe pain, especially when trying to feel your hand, strain or make any movement with it;
- swelling at the site of a possible fracture;
- the appearance of a hematoma;
- numbness;
- inability to move your fingers normally;
- limited mobility of the elbow or wrist joint;
- change in limb shape;
- bleeding and viewing bone fragments with an open wound.
Under no circumstances should you endure pain and rely on the fact that it is just a bruise and everything will go away on its own soon. In some cases, the symptoms of a bruise and a fracture are indeed similar, but with serious injuries, delay can lead to a number of complications.
Conservative treatment of a radius fracture in a typical location (plaster cast)
For non-displaced fractures, conservative treatment can be offered - in a plaster cast. The average stay in a cast is 6-8 weeks. This rarely goes away without a trace for a limb - after conservative treatment, the joint requires the development of movements and rehabilitation. When treating a fracture with even a slight displacement in the cast, secondary displacement of the fragments can occur.
Surgical treatment of a fracture of the radius in a typical location (osteosynthesis)
Almost all displaced fractures of the radius require surgical treatment - comparison and fixation of bone fragments - osteosynthesis . It is this method that allows you to restore hand function most fully and achieve good functional results.
The radius completely heals in about 6-8 weeks. After this period, the patient can begin to fully use his arm. But it is possible to develop your arm with the help of certain exercises recommended by your doctor, thanks to the use of clamps, already 1-2 weeks after the intervention. Light sports physical activity can be started approximately 3 months after surgery.
Depending on the type of fracture (comminuted, multi-comminuted, with significant or minor displacement), several possible fixation options can be distinguished - with a plate fixed with screws; external fixation device; screws; knitting needles
In some cases, with severe swelling, an external fixation device is applied, and after the swelling subsides, it is replaced with a plate (or another fixation depending on the type of fracture).
Osteosynthesis of the radius with a plate
If the fragments are significantly displaced, osteosynthesis of the radius is used with a metal plate specially made for this segment. After matching the fragments, the plate is fixed with screws to the damaged bone. After installation, the plates are applied to the skin, sutures are applied for 2 weeks, and a plaster splint is applied for approximately the same period. After the operation, drug therapy is prescribed: painkillers, calcium supplements for faster bone healing, and, if necessary, topical medications to reduce swelling. The average length of hospital stay is 7 days. Sutures are removed on an outpatient basis after 2 weeks. The hand is worn in an elevated position on a scarf. There is no need to remove the plate.
External fixation device
In some cases - in old age, with severe swelling of the hand and wrist joint, it is undesirable to make access to install the plate due to various factors (swelling, skin condition). In such cases, an external fixation device is installed - it fixes the fragments using knitting needles that pass through the skin into the bone. The device protrudes above the skin as a small block (about 12 cm long and 3 cm high). The advantage of this type of osteosynthesis is that there is no need to make large incisions, but you need to take care of the device - make dressings so that the needles do not become inflamed.
After the operation, the arm is in a splint for 2 weeks, then the patient begins to develop the wrist joint in a device that does not interfere with this.
The external fixation device is removed after approximately 6 weeks, after X-ray control, in a hospital setting. The operation of removing the external fixation device does not take much time and is quite easily tolerated by the patient. The average length of hospitalization is 5-7 days, the duration of sick leave is about 1.5 months. Dressings should be done every other day, on an outpatient basis. The hand is worn in an elevated position on a scarf.
Fixation with knitting needles or screws
If the fragments are slightly displaced, the radius bone is fixed with knitting needles or screws through small punctures in the skin. A plaster splint is applied for about 2 weeks, then the person begins to develop the arm. After 6-8 weeks, the needles are removed.
In some cases, it is possible to use self-resorbable implants, which do not need to be removed.
First aid and diagnostics
In any case, it is important to seek medical help as soon as possible.
In order to avoid causing harm to the victim until professional assistance is provided, it is necessary to learn the following rules:
- do not try to set the bone yourself;
- limit any hand movements;
- if there is severe bleeding, it is necessary to apply a tourniquet above the wound;
- in case of severe pain, it is recommended to take (or inject) a painkiller;
- apply something cold to the damaged area.
- secure your arm with a splint or simply tape it to your body in a bent position.
Further examination should be carried out by a specialized doctor. Diagnosis consists not only of a physical examination, but also of special measures.
The main one is radiography, since bone tissue defects are clearly visible in the image. To more accurately study the bone structure, tomography is prescribed.
Old, malunited fractures of the radius
With old, improperly healed fractures, pain may occur, there may be restrictions on movement - joint stiffness, and other unpleasant consequences (numbness and swelling of the fingers). In such cases, surgical treatment is recommended, most often with plate fixation. The bone is separated, placed in the correct position and fixed. If there is an area of bone defect - for example, if the bone has fused with shortening, this defect is filled either with the person’s own bone (the graft is taken, as a rule, from the iliac crest), or with artificial bone, which is rebuilt into its own bone tissue in 2 years.
Further postoperative and restorative treatment for old and improperly healed fractures of the distal metaepiphysis of the radius are similar to those described above. However, given the long-standing nature of the injury, longer rehabilitation may be required.
Causes of injury
A variety of factors can provoke a fracture of the bones of the forearm (ICD 10 code S52). Most often these are traumatic injuries, although the pathological nature of the violation of the integrity of bone tissue cannot be ruled out.
This is possible with the development of diseases that affect the absorption of calcium and disruption of bone structure. Most often it is oncology, osteoporosis, osteomyelitis.
With osteoporosis, forearm fractures can occur due to minor injuries and even when pressure is applied to the limb.
Among the causes of traumatic nature, it is worth highlighting the following:
- a fall;
- accidents;
- bone compression;
- unsuccessful rotation;
- a strong blow to the hand;
- sports injury;
- lifting too much weight;
- violation of safety regulations at work;
- gunshot wound.
Most often, children and the elderly suffer from fractures. However, if for a young body such an injury does not pose a particular threat, since it heals quickly, for the older generation it can become a serious problem due to the worse course of regenerative processes.
Very often, forearm fractures occur in athletes and people who enjoy active recreation (bicycling, mountaineering, rollerblading). A large percentage of injuries occur during active summer recreation and the winter period when ice appears.
Anesthesia for surgical treatment of a fracture of the distal metaepiphysis of the radius
To carry out all the above operations, as a rule, conduction anesthesia is used - an anesthetic solution is injected into the brachial plexus area, where the nerves that innervate the entire upper limb (responsible for its sensitivity and movements) pass, and the arm becomes completely numb. Such anesthesia is quite easily tolerated and lasts 4-6 hours. In fact, it is a type of local anesthesia. In addition, premedication is given - a sedative injection, and during the operation the person sleeps normally. General anesthesia may be used. The final choice of anesthesia method is determined by the anesthesiologist on the eve of the operation.
Anatomical structure
First, you should become more familiar with the anatomical structure of this area. The human hand in the forearm area is divided into 2 main parts: the ulna and the radius. A fracture of the left forearm code ICD may be accompanied by damage to one or both of them.
The body, upper and lower parts of both bones are also isolated separately. On the ulna there are coronoid and ulnar processes, on the radius there is a spinous process. The wrist joint is formed in the lower part, and the elbow joint is formed in the proximal part.