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.

X-ray confirms the diagnosis. It also determines the severity of the injury, the presence of displacements, fragments, and exact location. MRI and CT scans show whether joints and muscles are affected.

Consequences and complications

The most common complication of a fractured arm bone is malunion. The severity of the consequences depends on the bone/location of the fracture, the degree of its deformation and can manifest itself as:

Formation of a false joint at the fracture site.
Chronic pain syndrome.
Atrophy/weakening of muscle strength when squeezing the hand.
Instability of the radial/wrist joint.
Contractures of the radial joint with impairment of its function.
Deforming arthrosis of the radial/wrist joint.
Post-traumatic osteomyelitis .
Shortening of the forearm.

As a rule, complications are caused by the lack of adequate/timely treatment, ignoring the rehabilitation period, and non-compliance with doctor’s recommendations.

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.

Pathogenesis

The pathogenesis of a fracture of the arm bone may be based on various mechanisms. Most often, a fracture occurs under the influence of an external force on the bone: a blow directly to the bone, a load along the length of the bone (when falling on the hand), twisting of the bone, which occurs mainly in various injuries of the upper extremities. In the pathogenesis of bone fractures, significant importance is also given to damage to soft tissues, nerve fibers, vessels of tendons and fascia, which is accompanied by the development of inflammation/edema, blood loss with hemodynamic shifts, and acute pain syndrome.

Much less often, the pathogenetic mechanism of a bone fracture is based on structural and quantitative changes directly in the bone tissue, which negatively affect the strength of the bone. Such changes include structural changes manifested by disturbances in the structure of trabecular microarchitecture, accumulation of microfractures in trabeculae/increase in cortical bone pores, which has a significant impact on bone strength. Another pathogenetic mechanism of bone fracture is a decrease in its mass, which leads to a decrease in mechanical strength.

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.

General information

Bone fractures are usually understood as partial/complete disruption of the integrity of bone tissue, resulting from trauma (fall, direct blow), in which the destruction of bone tissue is caused by mechanical force that exceeds the hardness of the bones. Less commonly, a fracture is the result of a number of diseases, which are characterized by changes in the structure of bone tissue (pathological fracture in osteoporosis ).
At the same time, when a bone is fractured, rupture of the subcutaneous tissue/skin, damage to nerve fibers, blood vessels, tendons may occur, and the fracture site may come into contact with the external environment (open fracture) and fractures without damage to adjacent tissues (closed fracture). When the bone is damaged in two or more places, we are talking about a complex fracture, which is often accompanied by displacement of bone segments; when a bone is damaged without dividing it into segments, they speak of a simple fracture (crack). The severity and type of fracture are determined by the mechanism of injury, the direction of force and power of action on the bone, and the properties of the bone (bone type, strength). A fracture of the arm is one of the most common pathologies, accounting for about 65% of all bone fractures, and among the bones of the arm, the most common are fractures of the forearm (ulna, in particular the ulna/coronoid process of the ulna) and the radius - radial diaphysis bone, styloid process). Fractures of both bones of the forearm are less common.

Another common problem is fractures of the bones of the hand , which are caused by a fall with emphasis on the hand or a blow to the hand. The most common are fractures of the finger (phalanx), less commonly fractures of the metacarpal bones ( Roland / Bennett ) and quite rarely - fractures of the wrist bones (scaphoid, pisiform and lunate). Among the fractures of the phalanges of the fingers, the most common fracture is the nail phalanx, mainly the ring and little fingers. At the same time, with fractures of the diaphysis of the phalanges, the finger is often displaced with an open angle to the rear. Especially often, a displacement of a finger accompanies a fracture of the little finger on the hand. Displaced fractures are less common.

Elbow fractures

A fracture of the elbow joint occurs when a fall/hit to the elbow occurs, less commonly when falling on a straight arm. A special feature of the elbow joint is its complexity. In fact, this is one of the most complex joints, which is formed by three bones: the humerus, radius and ulna, moving in different planes, the articular surfaces of which are small and extremely fragile. Accordingly, even with minor displacements of their surfaces, a change in the volume/structure of the joint occurs, which almost immediately blocks any movements in it; if a fracture occurs with the formation of fragments of bones/cartilage, they immediately fill its cavity, and with an open fracture of the joint, the adjacent nerves are often damaged fibers and vessels. Due to the complex structure of the elbow joint, fractures of various joint structures can occur: fracture of the epicondyles of the humerus; olecranon; coronoid process of the radius; neck/head of the radius, each of which has its own clinical manifestations. In practice, a fracture of the elbow joint in a child is much more common.

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.

How to develop an arm after a fracture?

Once such a serious injury as a fracture has been received, it is unlikely that you will be able to forget about it forever. Most often, a limb requires competent rehabilitation aimed at restoring it and developing functions. Often, patients turn to doctors with the question of how to restore the functionality of their hand.

When the long-awaited moment comes and the plaster is removed from the limb, the patient is surprised to discover that the hand has become as if “alien.” Such conditions are explained by the fact that she was immobilized for a long time, her muscles were weakened, and the blood supply was insufficient. Swelling may occur.

In order to relieve swelling, you can try the following exercises:

First you should try to squeeze your palm. This will determine the degree of strength loss. You should not immediately try to use the limb, pick up cups of tea, or perform more complex actions. To begin with, you can practice on regular plasticine. To do this, you need to try to warm it up with your fingers, kneading the torn piece. If you manage to cope with the task, you can allow yourself to take a break. After the lesson you should repeat. This simple exercise should be performed for a month, several times a day.
The following exercise will help disperse the blood and make it circulate faster through the injured limb. To do this, you need to be in a sitting position and stretch your arms out in front of you. By turning your clenched palms to the right and left, you can feel how your hand gradually begins to function. But you should not put too much pressure on the broken limb or rotate it too actively. The exercise should be performed slowly and without jerking.
An ordinary tennis ball, which you just need to throw at the wall and try to catch, helps to relieve swelling. Again, you shouldn’t take on the task too actively and overload the limb too much. Otherwise you can only do harm.
You should place three tennis balls in your palm and try to move them with your fingers. You should not stop the exercise, even if they keep falling out of your hand. After all, its goal is to relieve swelling, which means movement is necessary, otherwise the blood will not fully circulate through the vessels compressed by the plaster.

These simple exercises are recommended, but not required. Those activities that the doctor recommends will need to be completed in full and without skipping. To develop the hand after an injury, there are specialized exercise therapy, as well as massage courses that are clearly aimed at rehabilitation. Specialized occupational therapy helps to develop your hand perfectly, which includes knitting, embroidering, drawing, and performing simple tasks around the house or garden. Gradually, the person will be able to return to the full life that he had before the injury.

Exercise therapy after a broken arm

Physical therapy is an effective way to regain lost mobility.

To do this, you should perform the following exercises:

Raising your shoulders up and lowering them down.
With support on the table: extension of the hand, elevation of the forearm, rotation with the palm hanging down, squeezing the fingers into the lock.
Circular rotations. To do this, you need to bend your elbows and rotate them in different directions. Rotations in the shoulder joint are performed in the same way, only the limbs in this case should not be bent.
Raise your arms to the sides and up above your head, then raise your arms in front of you and up again.
Exercise “fixing your hair.” The arm bent at the elbow must be rotated, touching the head clockwise and back.
Claps in front of you and behind your back.
Rotation with a hand, which can initially be held with a healthy limb.
Stretching the fingers. To do this, each of them needs to be seated, as it were, on a twine.
Exercises in water. To do this, you need to fill the pelvis, place your hand there, trying to bend and straighten the limb in it. You can squeeze and unclench your palm there.
Another effective exercise using a basin of water is lifting small objects, such as coins or buttons, from its bottom.

It is worth noting that depending on the stage of rehabilitation, exercises must vary. You should select them according to the principle - from simple to complex, gradually increasing the load:

To begin with, you can simply move your fingers, bend your arm at the joint, and swing it freely.
Afterwards, you should concentrate the main efforts on the wrists to restore the functions of the fingers and hand.
At the final stage, the load should be evenly distributed throughout the entire limb, with emphasis on the interphalangeal joints.

Massage after a broken arm

Massage is one of the basic components of treatment aimed at restoring limb mobility. You can start it even before the plaster has been removed. To do this, small holes are made in it and a targeted effect is applied to the damaged limb. This can be done with a special quartz druse with a blunt tip.

Working the muscles will promote blood flow to the arm, nourish it and saturate the tissues with oxygen. The swelling will go away faster, the hematomas will dissolve better, and the pain will decrease.

After I remove the plaster, the massage is carried out more intensely, but still carefully, with classic movements:

To begin with, you need to move along the entire length of the limb with your fingers, transverse and longitudinal strokes.
Then you should move on to rubbing. In this case, it is already possible to carry out some weighting.
This is followed by kneading with fingers, which promotes tissue regeneration.
Movements with vibration are the final stage of the massage. Pressing alternates with stroking.

To carry out manipulations, you can use special massagers, applicators and rollers. For better glide, certain oils are always used. For a fracture, fir is best suited. To enhance the effect, you can mix it with creams and ointments that eliminate swelling and have a warming effect.

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.

Anatomy of the hand

The human hand consists of many bone elements, which include the upper limb girdle and the free part. The largest formations are the clavicle, scapula, humerus, radius and ulna. Separately, it is worth highlighting the hand, which consists of the wrist, metacarpus and phalanges of the fingers. The long bones are tubular, as are the metacarpals and phalanges of the fingers, only the carpal bones have a spongy structure. The tubular bones are most often damaged.

The girdle of the upper limb, through the shoulder joint, is connected to the humerus; in addition to the capsule, it is held in place by only one ligament, which extends from the coracoid process of the scapula. The humerus is connected by the elbow joint to the bones of the forearm, which include the radius and ulna. Due to the wrist joint, the forearm is connected to the hand. The hand has many joints, the main ones being the interphalangeal and metacarpophalangeal joints, which provide finger mobility. The phalanges are also not the same number; if there are only two of them in the first finger, then the rest have three oblique phalanges.

How does a fracture differ from a crack?

This type of injury has practically no specific signs or differences, so it is very difficult to determine it without the help of a doctor - they are often confused with bruises and fractures. The difference is that when a crack occurs, bone tissue is damaged, but it does not form fragments and does not move away from its main part. The crack can manifest itself in the form of noticeable swelling and pain when trying to move, which over time not only does not subside, but also intensifies.

Bone tissue injury occurs due to external mechanical influence, for example, a blow or a fall, while its strength is inferior to the load force. You can understand whether it is a fracture or a crack by whether the supporting function of the bone is preserved: if there is a crack in the limb, it will still be possible to lean on it, but if there is a fracture, it will not.

When a crack occurs, severe pain occurs, which intensifies with any movement or attempt to palpate the site of injury. At rest, it may be muffled, dull, tingling or pulsating. It appears due to damage to the periosteum, which contains many receptors that signal that the bone is broken.

The second symptom is swelling in the area of injury. Most often, it gradually increases, but can go away within a day with first aid. Restricted mobility, bruising and hematomas are also observed, but may be less pronounced than with a fracture.

Important: a crack can be treated much easier and faster than a fracture. The prognosis for this injury is more favorable, and the period of rehabilitation and restoration of mobility takes less time and requires less effort.

Symptoms

Typical clinical manifestations of an arm fracture are:

Severe pain syndrome at the time of injury, any movements provoke increased discomfort with irradiation into nearby tissues or throughout the entire upper limb;
A decrease in temperature in the hand - the condition is provoked by rupture of the arteries and is a dangerous symptom;
Swelling of tissues, swelling in the area of injury, local subcutaneous hemorrhages - manifestations are characteristic of injuries to the wrist area;
Unnatural localization of the affected limb, a decrease in its length, visible deformation changes - with a displaced fracture of the arm;
Decreased range of motion of the injured upper limb;
Damage to nerve fibers and decreased sensitivity in certain areas of the hand;

An increase in temperature due to a broken arm is manifested by redness of the dermis. The body's response to the resulting state of shock when large bones are damaged leads to an increase in temperature.

The condition lasts for several days and disappears spontaneously. The above symptomatic signs do not always indicate fractures; they may appear with other injuries of the upper extremities. To accurately determine the type of pathology, a full diagnostic examination is necessary.