Wrist fracture. Treatment of wrist fractures in Moscow

Symptoms and types of fracture

Fractures of the wrist bones can be varied:

intra-articular – the fracture line covers the wrist joint;
extra-articular – does not cover the joint area;
open;
closed;
comminuted – the bone is broken into 3 or more parts.

The second to fifth metacarpal bones (there are eight in total) are mostly susceptible to fracture. When they are damaged, the natural functions of the hand are severely limited and severe pain occurs. When the scaphoid is fractured, the wrist joint on the side of the thumb swells, and the pain makes it impossible to clench the hand into a fist. Wrist fractures may be accompanied by displacement of bone fragments. When displaced, the fracture is easier to diagnose; the deformation of the hand is usually visible to the naked eye; a crunching sound is heard when you try to move. A fracture of the wrist without displacement can sometimes not be detected even by an x-ray in three projections, then an MRI or computed tomography is additionally prescribed.

First aid in case of injury

Immediately after a traumatic situation occurs, emergency medical assistance should be called. After this, it is necessary to promptly and correctly try to help the victim, since first aid for fractures of the hands ensures a quick diagnosis and rapid healing of the resulting injury.

If the fracture is open, it is important to immediately try to stop the bleeding that occurs. To do this, you will need a tourniquet, which can be an ordinary trouser belt, and a sterile or clean bandage made of gauze or bandage. You need to step back 15 centimeters from the wound and bandage your hand. Also, in the case of open fractures, you should remember to disinfect the wound.

After stopping the bleeding or immediately after the injury, if the fracture is closed, you should apply the broken arm to something cold to prevent the swelling from growing. If the arm has taken an unusual shape, hangs atypically or sticks out to the side, it is important to promptly understand that a displaced fracture has occurred and apply a handy splint to the affected bone. The hand on the hand must be completely immobilized (immobilized), for which it must be placed between two small boards and wrapped tightly.

If severe pain occurs, the victim should be given a painkiller to drink. If it is impossible to call an ambulance, the patient with the injury in question should be transported to the hospital independently.

When providing first aid and until medical control is established over the victim, make sure that he is conscious.

Loss of consciousness can occur due to pain, shock, blood loss and other factors. It is dangerous because during a long period of unconsciousness, the victim’s internal processes may be disrupted, as well as the tongue may become stuck, which is why he begins to choke when returning to consciousness. If all recommendations for first aid for a broken hand are followed, treatment will proceed quickly and without complications.

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.

One of the most common injuries are fractures of the hand bones. The most commonly affected fractures are the phalanx and metacarpal bones. These injuries may result from a fall on the hand, a blow from the hand against a hard object, twisting, or direct impact (impact) during sports.

Symptoms

The following symptoms and signs are typical for a bone fracture:

Edema

Soreness

Deformation

Inability to move a finger

Shortening and deformation of the finger

When bending the fingers into a fist, one of the fingers goes under the other, as a result of a change in the axis of the bone

“Recession” of the metacarpal head

A subcapital fracture of the 5th metacarpal bone, in which there is a “retraction” of the head, is most common and is called a “boxer’s fracture.”

Diagnostics

During the examination, it is important to pay attention to the position of the fingers and the condition of the skin. It is also necessary to determine the volume of passive and active movements, as well as changes in finger sensitivity, if any, which may indicate nerve damage. An X-ray examination will help determine the location and nature of the fracture, as well as the type of displacement of the fragments.

Conservative treatment

A large number of closed fractures of the metacarpal bones and phalanges of the fingers do not require surgical intervention, and are treated with closed reposition of bone fragments and their fixation using a plaster cast, splint or special brace. To treat each type of fracture, different types of plaster casts are used, depending on the location of the fracture and the type of displacement. A week after the incident leading to the fracture and the application of a plaster cast, a repeat x-ray should be performed. This is necessary so that the doctor makes sure that the fragments are held in the correct position and there is no secondary displacement. The cast must be worn for 3 to 6 weeks, depending on the location and type of fracture. Exercises aimed at developing the hand and uninjured fingers begin immediately after pain decreases and continue until complete recovery. Damaged fingers are included in the rehabilitation process immediately after the cessation of immobilization, that is, after removal of the plaster cast. The end result may be slightly shorter or slightly deformed fingers, which should not in any way affect the function of the hand needed to perform daily tasks.

Surgery

Some fractures of the bones of the hand require surgical treatment, the tasks of which are reposition (elimination of displacement) and stabilization of broken bone fragments. To fix fragments, knitting needles, screws, pins and plates are used. The choice of fixator depends on the type of fracture and the preference of the operating surgeon.

X-ray before surgery Fractures of the 2-3-4-5 metacarpal bones and the main phalanx of the 1st finger of the right hand with displacement

X-ray AFTER surgery - osteosynthesis with pins Fractures of the 2-3-4-5 metacarpal bones and the main phalanx of the 1st finger of the right hand with displacement

X-ray before surgery Intra-articular fracture of the main phalanx of the 4th finger with displacement

X-ray AFTER surgery Intra-articular fracture of the main phalanx of the 4th finger with displacement

Photo BEFORE the operation Fractures of the 3rd-4th metacarpal bones of the right hand healed with rotational displacement. As a result, when bending 3-4 fingers, they “overwhelm”

Photo BEFORE the operation Fractures of the 3rd-4th metacarpal bones of the right hand healed with rotational displacement.

Photo AFTER surgery 3 months Fractures of the 3rd-4th metacarpal bones of the right hand healed with rotational displacement.

If the fracture heals displaced, the finger may lose some function.

Once the fracture has completely healed, the surgeon may remove the implants (fixators) or leave them in place for life if they do not cause limited hand function. After postoperative pain subsides, in order to prevent the formation of joint contracture, it is necessary to begin physical therapy exercises. Joint stiffness may result from prolonged immobilization. Special exercises can help restore the previous range of motion in the joints. Classes must be conducted under the supervision of an experienced instructor. Physiotherapy also helps achieve good treatment results.

We do not express a preference for any of the treatments, procedures, medical products, or restorative treatment options that were previously mentioned. This information is posted for general educational purposes and is not intended to be a recommendation. Anyone who wishes to receive specialized advice should consult a doctor.

Establishing diagnosis

Initially, the determination of the type of injury is based on external manifestations. The traumatologist examines the damaged area, listens to the victim’s complaints, and clarifies the time and details of the injury. Considering that, in general terms, a fracture of the hand is in many ways similar to a dislocation and severe bruise, a hardware examination is carried out using an X-ray.

In this case, for greater information content, radiography is prescribed in two projections. In some cases, due to severe swelling, signs of a fracture are not visualized. Then the diagnosis is postponed for 8-10 days, and while waiting, the hand is immobilized using a rigid plaster bandage or polymer bandages.

If a repeated x-ray confirms the fracture, the traumatologist determines the method of further treatment, taking into account the nature of the injury, age and health of the patient.

Classification

In practical traumatology, there are several types of bone damage. Taking into account the violation of the integrity of the skin, a closed and open fracture are distinguished. In turn, an injury as a result of which the deep tissues of the skin, muscles, and connective tissue communicate with the environment (earth, air, surface of objects) are considered infected.

According to the nature of the damage:

Simple - the bone is destroyed in one place, but no fragments are formed.
Fragmented - as a result of the injury, 2 fault lines are obtained, as a result of which a fragment of bone tissue is formed between the fragments of the destroyed bone.
Comminuted - in the area of damage, the bone is crushed, surrounded by small fragments.
Crushed - severe injury leads to disruption of the anatomically correct shape of the parts of the bone formation, which makes it difficult to compare them.

In addition to the direction of the fracture line, the severity is determined by the presence of displacement of bone fragments. A displaced injury is more difficult to treat than an uncomplicated injury.

By type of damage:

complete – with a bone fracture in one or more places;
incomplete – formation of cracks;
“green twig” type - more common in childhood, integrity is preserved in the periosteum area.

In addition, destruction in the middle of the bone is called diaphyseal, in the area of the heads - epiphyseal. If the bones break inside the joint, the injury is diagnosed as intra-articular (Bennett and Rolando fracture), or extra-articular if the fracture line is outside the articulation.

A Bennett fracture is characterized by destruction of the bone at the base of the big toe. This breaks off a triangle-shaped piece of bone that remains immobile. Rolando's fracture - fragments appear at the site of the fracture (metacarpal bone of the thumb), and on the x-ray a slit hole in the shape of the letter “Y” is visible in the injured area.

If a fracture of the hand occurs as a result of serious trauma, the bone is destroyed under the influence of an external force. When in older people damage is observed without a reason or after a weak impact, we are talking about the pathological etiology of the fracture.

Treatment of the consequences of hand injuries

A special place in this practice is occupied by the treatment of old injuries and their consequences. These are precisely the cases when, instead of seeing a doctor, the victim leaves the injury to heal on its own. However, this is a very dangerous decision that can lead to unpleasant consequences and complications. Among them:

improper fusion of bones;
formation of scar tissue on ligaments and tendons and surrounding tissues;
pinched tendons and nerves;
vascular damage;
deformation of the hand and fingers;
development of other pathologies.

Along with this, pain, discomfort, and numbness of the limbs arise. Mobility and hand function may be limited.

Elimination of the consequences of injuries is a complex process that requires highly qualified orthopedic traumatologist. It is important to correctly determine the degree of pathology and select those methods that are suitable in each individual case and will help 100%.

A competent orthopedic traumatologist is able to eliminate any hand injuries and their consequences. The likelihood of recovery is very high if you turn to a truly experienced specialist.

Do you have questions about hand injuries or their consequences? Call +7 or send a message from the Contacts section. I will help you understand the nuances and tell you what needs to be done specifically in your case.