Wrist fracture

One of the common injuries is fractures of the bones that form the wrist joint. In the absence of proper treatment and rehabilitation, this damage can cause dysfunction of the limb and loss of performance.

If the fusion is incorrect, the wrist joint is deformed and its function is impaired. A person will constantly experience pain and arthrosis will develop.

Fig.1 a. schematic representation of a radial fracture in a typical location; b. appearance of the hand and radiographs showing a fracture of the distal metaepiphysis of the radius (in a typical location).

We possess all modern methods of treating fractures of the radius and ulna of any complexity, and also carry out comprehensive rehabilitation, which allows us to fully restore the function of the arm.

This allows you to achieve a positive result in almost 100% of cases.

Types of radial fractures

The most common situation is a fracture of the beam in a typical location. This is a violation of the integrity of the distal part involved in the formation of the wrist joint. The radius is not strong, and the weakest point is the styloid process.

Rice. 2 a, b. X-rays show different types of fractures of the styloid process and the distal radius.

When struck or dropped from a height, the radius bone is damaged in the middle section or near the elbow.

If the integrity of the skin is not broken, then the fracture of the ray is called closed; with an open injury, a wound is formed. This type of injury can damage muscles, blood vessels and nerves, and increases the risk of infection.

Based on the degree of integrity violation, a radius fracture, a fracture, and a crack are distinguished. In case of a fracture, the area of damage affects no more than 50% of the diameter of the beam, in case of a crack - more than half, in case of fractures there is a complete violation of the integrity of the beam. Fractures and cracks occur in children.

In children, there is a special type of injury - subperiosteal, or green branch type. The inner part of the bone is damaged, but the periosteum remains intact.

Displaced ray fracture

There are injuries with displacement of bone fragments and without displacement. An injury with displacement of fragments to the palmar side is called a Smith fracture, and to the back - a Colles fracture. If there is displacement, reposition and stabilization of the bone fragments is necessary; if this procedure is performed incorrectly, the function of the hand will not be restored.

Fig.3 a. Schematic representation of the Colles and Smith fracture; b. X-rays show a fracture of the diaphysis of the radius and ulna in c/3 with displacement.

Fracture of the ulna and radius

More often there is a violation of the integrity of both bones of the forearm in the diaphyseal part; this occurs with a strong blow. A fall can cause damage to the proximal portion of both bones. Such injuries are unstable, often accompanied by the presence of multiple fragments and a violation of their position. The victim experiences severe pain and deformity of the limb is noted.

A little about anatomy

The anatomical structure of the bony skeleton of the hand is varied. Therefore, the resulting injuries with a violation of its integrity can be of a different nature. It is necessary to have an understanding of the structure of the limb in order to understand the specifics of its fractures. The arms can move in different trajectories; they are very flexible and mobile due to the large number of articular connections between conventionally designated sections:

Shoulder girdle. This section includes paired bones - the scapula and collarbone. They are a transitional place from the torso to the limbs. These are not all their functions. With their help, a person can make rotational movements in the shoulder joint and raise their arms in different projections.
Shoulder. Includes the direct attachment of the humerus to the scapula by the acromion process (which is considered an integral part of the shoulder). As well as a large joint connecting the shoulder girdle and shoulder.
Forearm. This section is represented by two main bones: the radius and the ulna. It also connects the elbow joint to the humerus. They are unpaired, but are next to each other. At the elbow joint, their epiphyses are connected to form a strong contact with the shoulder. They participate in the organization of rotational movements and help maintain the mobility and functionality of the arm as a whole.
Brush. A complex and amazing education. Five fingers, each of which is formed by three phalanges. The connection between the hand and forearm is provided by many ligaments (radial collateral, pisiform-macula, semilunar, etc.). At the base of the hand lies a complex formation of eight bones, with the help of which rotation ability is maintained.

Interesting fact! Nature has protected such an important tool for humans as hands. She placed the muscle and tendon structures in a special protective “film” (fascia). With their help, the elements of the hand became more protected from mechanical influences.

Causes

The injury usually occurs when falling on an outstretched arm. If a person stumbles or falls into ice, then the probability of damage to the beam is very high. This injury often occurs in childhood or in people who play sports, which is associated with high mobility and a high incidence of falls. It may also occur in the event of an accident or at work.

In older people, the cause of the damage is osteoporosis. Even a minor impact causes a fracture.

First aid

Correctly provided first aid will speed up the healing process and eliminate the risk of negative consequences. Following the algorithm in the correct sequence will help reduce the patient’s suffering. What is this algorithm:

Anesthesia. Severe pain is the first symptom of an injury. To remove it, it is necessary to give the patient an anesthetic. This can be any painkiller that you have on hand. It is worth giving it according to the dosage, without exceeding it. It is better if it is possible to administer the drug intramuscularly. This will speed up the effect of the medicine.
Immobilization. It is necessary to apply a splint from available materials or at least apply a fixing bandage. The simplest option is considered to be a scarf bandage, for which you only need fabric whose width corresponds to the length of the forearm. If the fracture is localized in the hand, then it is necessary to fix all its elements so that it is impossible to carry out any actions.
Providing peace. After taking measures in case of a closed fracture, it is worth giving the victim a rest until the ambulance arrives.
Disinfection. An open fracture must be disinfected. Iodine, brilliant green, hydrogen peroxide, chlorhexidine digluconate, and alcohol are suitable for this.
Application of a tourniquet. If the bleeding is intense, then you need to apply a tourniquet 10-15 cm above the source of blood.

Important! When providing emergency care, do not try to dislodge fragments if they are palpable under the skin or visible in an open wound. This can cause damage to associated structures and cause additional consequences for the victim. It will be more difficult for doctors to correct the consequences and cure a broken arm.

Treatment

Treatment tactics include repositioning the fragments and fixing the arm for the period necessary for fusion. If the fracture is open, primary surgical treatment of the wound is required.

Depending on the characteristics of the damage, tactics can be conservative or operative.

Conservative treatment

If there is no displacement, conservative therapy is carried out. A fixing plaster bandage is applied to the forearm. For simple displaced fractures, closed reduction is sometimes possible.

It usually takes 4-5 weeks of immobilization to restore the integrity of the arm. During the process, control radiographic studies are carried out.

Rice. 4 Radiographs show a displaced fracture of the distal metaepiphysis of the radius; a – direct projection, b – lateral.

Fig.5 a, b. Radiographs of the wrist joint after closed manual reduction: the displacement has been eliminated, the position of the fragments is satisfactory.

Surgery

If the displacement is significant and unstable, or there are small fragments, then reposition is carried out surgically, and fixation is provided by metal structures: screws, plates. If the fragments can be combined without surgical access, then percutaneous fixation with knitting needles is used.

Rice. 6 a. fracture of the beam in a typical place with displacement; b. condition after osteosynthesis of the radius with a plate and screws.

How are radius fractures treated?

For proper fusion of bones, the doctor must precisely bring the fragments together along the fracture line. It is important to ensure complete contact between them so that there is no gap.

The next prerequisite for successful rehabilitation is complete immobilization of the damaged area (immobilization). For this, various fixing structures are used: plaster casts, orthoses.

To make sure that the comparison of fragments is correct, a repeat x-ray is taken. Restoring the integrity of the radius bone in a typical location most often occurs without surgery. The exception is complex cases when severe damage to bones and nearby tissues has occurred. The patient is sent for hospitalization to the trauma department.

To prevent complications, you must follow your doctor's recommendations. If drug therapy is indicated, medications should be taken according to the treatment plan. This will help relieve inflammation and speed up the healing process.

Don't forget about your diet. The diet should be balanced, high in calcium and vitamin D. A healthy lifestyle and following safety rules are the best way to prevent injury.

Rehabilitation

After removing the cast, the hand is practically motionless. This is due not only to injury, but also to prolonged muscle inactivity. A well-designed set of rehabilitation measures can completely restore limb function after a fracture of the radius. Physiotherapy, massage, and special exercise sets are widely used.

Thanks to accurate diagnosis, selection of an appropriate treatment method, correct reposition and reliable fixation, as well as a course of comprehensive rehabilitation, it is possible to achieve complete restoration of range of motion in the wrist joint.

We will help you restore the function of your wrist joint in a short time and return to an active lifestyle.

Diagnostics

When a patient with a suspected fracture comes to the doctor, he first performs a visual examination and palpates the damaged area. A fracture of the arm with displacement of fragments often manifests itself already at this stage of diagnosis, since fragments penetrate into the soft tissues and are palpated. Afterwards, radiography in different projections is required. This measure provides a complete understanding of the fracture pattern and allows us to develop a strategy for treatment and further rehabilitation. In addition to these measures, it is possible to use additional diagnostic tools:

General tests. They allow you to assess the patient’s current condition and help make predictions for the process of bone fusion.
Imaging methods - CT (computed tomography) or MRI (magnetic resonance imaging). Used when complications arise from other organ systems (nervous, circulatory, muscle groups, etc.)
Puncture. Used to diagnose intra-articular fractures. Determines the presence of blood and the need to extract it and stop bleeding.

Rehabilitation and how to develop a broken arm

The bone grows together within 1-1.5 months. The next 4.5 - 5 months are devoted to restoring the functions of the hand and strengthening the bones. Several methods are traditionally used for this:

Exercise therapy (physical therapy)
Physiotherapy.
Massage.
Proper nutrition, daily routine, etc.

Massage

Massage begins after the fixation is removed and after partial or complete healing of the wound. What are the goals of performing a massage:

Prevention of atrophy. During a long stay in a state of immobilization, the strength of the arm muscles decreases. Massage helps restore muscle strength and gradually return to its original state before injury.
Acceleration of blood circulation. Vibrations, claps, and pinches help increase blood flow in the area being massaged. Increased blood circulation helps accelerate the regeneration of damaged tissues and reduces the time spent on recovery.
Elimination of puffiness. Fluid that accumulates in soft tissues as a result of injury interferes with proper blood flow. Stroking and gentle vibrations help reduce excess fluid.

Example of massage technique:

Stroke areas of the arm just above and just below the injury.
After lightly patting, move in the direction from the shoulder to the hand.
Then apply vibrations - these are low-amplitude movements towards the injury.
The massage must be completed with stroking again.

Attention! All techniques, duration and intensity are determined by the attending physician. Self-indulgence in this matter can lead to irreversible consequences.

Physiotherapy methods

Such methods rely on the ability of bone tissue to be a dielectric and conduct electrical impulses. In addition, the effects of UHF therapy and magnetic therapy are used. Let's look at each of them in more detail:

UHF. Allows you to reduce pain and remove excess fluid from the surrounding soft tissues.
Magnetotherapy. Accelerates metabolic and regenerative processes and also fights pain.
Electrophoresis. Performed with local anesthesia for patients with persistent pain. Helps start regeneration processes.
Ultrasound. One of the few methods to improve the condition of joints after damage.
Laser. Used to stimulate metabolic functions.

Exercise therapy classes

The right hand is the dominant one for most people, so restoring fine motor skills is extremely necessary for a full return to normal life. Exercises are used in writing, drawing and other operations with small objects that are made at multiple magnification. Gradually, as the functions of the right hand are restored, pens and pencils are reduced, and abilities are improved. If the left arm of a left-hander is broken, then similar exercises are performed with it.

What tasks does exercise therapy perform:

Strengthening muscles. After prolonged immobilization, muscles lose their volume, endurance and strength. Exercise therapy exercises help you gradually return to your previous and even better state.
Restoring motor function of the hand. Each exercise is based on performing actions that help develop joints, restore muscle response to brain signals, and improve motor functions.
Acceleration of blood circulation. Any activity generates increased blood circulation, which in turn helps reduce rehabilitation time.
Launching metabolism.

Frequent complications

According to the observations of doctors, the more the bones diverge as a result of a fracture, the longer the period of time it will take to return him to his normal life. Complications can arise for various reasons:

poor metabolism;
late visit to the doctor;
non-compliance with recommendations during treatment.

As a result of improper fusion of bone fragments, a false joint can form, when bone mobility is observed in a place where there is no articulation. Other complications include:

bone deformation with deviation of part of the limb in an unnatural direction;
contracture or ankylosis due to intra-articular fractures;
shortening of the injured bone;
filling of the joint capsule with blood (hemarthrosis);
arthrosis, arthritis, degenerative changes in bone tissue;
disturbance of nerve conduction due to damage to nerve trunks.

What is offset

Displacement of bone fragments is a common manifestation of a violation of bone integrity. The degree of violation of the position of bone fragments can be of varying degrees of severity: from a slight shift to a significant deviation from the anatomical axis. In this case, the injured limb is deformed due to a change in length.

In practical orthopedics, primary and secondary displacement are distinguished. Primary occurs at the time of trauma. Secondary is caused by the traction of muscle fibers, which reflexively contract and “stretch” bone fragments in different directions. In addition, displacement can occur if the victim is not transported correctly to the emergency room.

There are several types of offset direction:

Oblique – characterized by the formation of an angle in the area of displacement. Most often occurs with a fracture of the body (diaphysis) of the bone, as a secondary complication.
Lateral – diagnosed when fragments diverge to the sides. This form mainly accompanies fractures with the formation of a transverse fault line.
Longitudinal - displacement along the length of the bone occurs when one part of the bone slides relative to another. Appears under the influence of muscle contraction and leads to shortening of the limbs.
Helical - observed when one of the fragments rotates along a spiral trajectory.