Fracture of the radius: treatment, healing time of the radius, rehabilitation after a displaced fracture

General information

A radial bone fracture is a violation of the integrity of the radial bone caused by various types of traumatic effects.
ICD-10 radial fracture code: S52.1; S52.3; S52.5. A fracture can occur at different levels of the radius: in the head/neck area, in the lower/middle third, or a fracture of the styloid process. Fracture of the radius occurs in people of both sexes and of any age, however, fractures of the diaphysis/damage to the upper part of the radius are found more often in children and young/middle-aged people, and fractures in a typical location (fracture of the distal metaepiphysis) are found more often in elderly people. In 75% of cases, a closed radial fracture occurs. In practice, the most common occurrence is the so-called fracture of the radius in a typical location. By “typical location” we mean fractures of the radius in the area slightly above the wrist (distal part of the radius, with the damage localized closer to the hand). It accounts for about 72% of all radial fractures. A fracture in a typical location is most common in women aged 70-75 years, which is largely due to the phenomenon of osteoporosis (decreased bone mass, structural disorders - disruption of trabecular microarchitecture/appearance of microfractures, increased porosity of the cortical bone), which contributes to a decrease in bone strength and structural impairment / quality of bone tissue.

The radius of the arm is a long, fixed paired tubular bone within the bones of the forearm, having a triangular shape with anterior/posterior and lateral surfaces and anterior/posterior/interosseous edges. It is located on the side of the first finger, next to the ulna bone with which they are interconnected and dependent on each other. These bones connect below with the bones of the wrist, forming the wrist joint, and at the top these bones participate in the formation of the elbow joint. The radius is responsible for the functional mobility of the forearm at the elbow joint. However, at the same time, fractures of the radius are much more common than the ulna. The figure below shows the radius and ulna bones and their dislocation relative to each other.

Radial fractures can be either isolated or combined with other injuries. In practice, combined fractures of the shoulder (radius/ulna) are more common. At the same time, complete fractures of the radius/ulna are usually accompanied by displacement of bone fragments along the length, width, at an angle or around the longitudinal axis. With an atypical mechanism of injury (fall from a great height, road/work injuries), combined injuries to other bones of the extremities are possible (fractures of the spine, ribs, pelvic bones, damage to internal organs, kidney damage, chest damage, bladder damage and blunt abdominal trauma).

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.

Pathogenesis

The pathogenesis of a pathological fracture is based on quantitative/structural changes in bone tissue, which significantly reduce bone strength. These include a decrease in bone mass and, as a consequence, a decrease in the mechanical strength of the bone and structural changes - disturbances in the microarchitecture of the trabeculae, an increase in the porosity of the cortical bone and the accumulation of trabecular microfractures, which directly affects the strength of the bone, regardless of its mass. Thus, the pathogenesis of pathological fractures involves a significant decrease in bone mass per unit volume and a violation of the strength/structural characteristics of bone tissue.

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.

Classification

The classification of radial fractures is based on factors such as the nature and nature of the fracture, fracture lines, displacement of fragments, the presence of fragments, the presence of a fracture of the ulna, etc., according to which the following types of radial fracture are distinguished.

According to the nature of the fracture, there are:

Traumatic fractures with and without displacement that occur when the radius is exposed to a mechanical factor in the form of a fall, twisting, blow, or excessive physical activity.
Pathological fractures resulting from a decrease in mineral density/impairment of the strength/structural characteristics of the bone (osteoporosis).

Depending on the fracture line, transverse, oblique, helical (spiral fracture), longitudinal, impacted, T-shaped, and comminuted fractures are distinguished.

Depending on the presence/absence of a violation of the integrity of the skin, the following are distinguished:

Open fracture with damage (violation) of the skin. In this case, fragments of the radial bone come out.
Closed fracture without skin damage.

Depending on the relationship of the radial bone fragments, the following are distinguished:

Fracture of the radius without displacement of bone fragments (crack-type damage); Fractures of this type in most cases do not require additional interventions (except for fixation).
Displaced fracture of the radius (complicated fracture with a high risk of re-displacement).

Anatomical classification, according to which:

extra-articular fractures - fracture of the body (diaphysis) of the bone;
intra-articular fractures - fracture of the head of the radial bone (neck);
fracture of the styloid process.

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.

Causes of radial head fracture

The most common cause of a radius fracture is a household/work/sports injury. Less commonly, fractures are caused by osteoporosis. The level of fracture of the radius is determined by the nature/location of the traumatic impact:

Fractures of the lower third of the radius - the main cause is a fall of a person with emphasis on the palm/dorsum of the hand, less often the injury is provoked by a strong blow at the level of the dorsal surface of the wrist.
Fractures of the middle third of the radius—the main cause is a blow to the radial side of the forearm.
Fractures of the upper third—the main cause is a person falling on an outstretched, slightly abducted arm.

Fractures in a typical location without displacement/with displacement of fragments usually occur in cases of a person falling while leaning on an outstretched arm. Taking into account the nature of the displacement, it is customary to distinguish several types of injuries - Colles fractures , in which the distal fragment is displaced to the rear, and Smith fractures , in which the distal fragment is displaced to the palm (Fig. below).

The main cause of a fracture of the radius in the diaphysis area is a blow to the radial side of the forearm.
A fracture of the radial bone in the head region usually occurs as a result of a person falling onto an outstretched, slightly abducted arm. In 60% of cases, there is combined damage to other anatomical structures with dislocation of the bones of the forearm.
Combined fracture of the radius with dislocation in the wrist joint of the ulna? (Galeazzi damage) are formed when a person falls on an extended pronated hand, accompanied by concomitant compression of veins, arteries and nerves by edematous soft tissue. Factors that significantly increase the likelihood of fracture include:

Osteoporosis / osteomalacia (decreased bone density/impaired ossification of the bone matrix).
Weakness of the muscles/ligaments of the forearm and hand.
Insufficient physical training.
Increased body weight.
Diseases of the elbow/wrist joint.
Previous history of upper extremity injuries.
Taking medications that affect bone metabolism (cytostatics, glucocorticoids, antidepressants, anticonvulsants, etc.).

The reasons that increase the likelihood of falls as a main factor can be divided into external and internal:

External reasons are due to everyday and situational factors: uneven/slippery surface, poor lighting, etc.
Internal causes are caused directly by the physical condition of a person: poor vision, asthenia , hearing loss, orthostatic disorders, dementia , decreased joint mobility, low physical activity, and the use of medications that affect the neurological status.

In what cases is a hand x-ray prescribed?

It is worth consulting a doctor if you experience swelling, deformation and hyperemia (redness) of the hands . These symptoms can signal various pathologies: lymph stagnation, allergies, heart disease, kidney disease, liver disease, etc. With such pathologies, the structure of bone tissue can be disrupted. To exclude pathology of bone tissue, it is necessary to take an x-ray of the hands and wrists.

The most common types of hand deformities are the so-called Heberden's nodes (formed on the joints of the outer phalanges of the fingers) and Bouchard's nodes (formed on the middle phalanges of the fingers).

Therefore, the procedure can be prescribed not only by a traumatologist, but also by a rheumatologist.

X-ray of the hands allows you to diagnose:

arthritis
arthrosis;
tendon inflammation;
osteophytes (these are pathological growths that form along the edges of the joints).

X-rays of the hands are also prescribed if osteomyelitis is suspected. With this pathology, bacteria enter the bone tissue, causing it to rot and collapse. The cause of the development of such an infectious disease can be injuries, as well as diseases such as purulent tonsillitis, pneumonia, measles, and furunculosis.

In our multidisciplinary clinic, traumatologists, radiologists, ENT doctors and other specialists are ready to see you. As a team, treatment is quick and convenient; you can take all the tests and get the necessary advice from us.

You should also consult a doctor if you have a tumor on your hand. One of the most common is hygroma.

When children experience a delay or, on the contrary, an advance in growth and development, an x-ray is taken to determine bone age. The study is prescribed by endocrinologists.

Despite the fact that the dose of X-ray radiation in modern X-ray machines is minimal, there are a number of restrictions under which X-rays should be avoided unless absolutely necessary.

Contraindications to x-rays of the hands:

pregnancy;
age up to 15 years (although x-rays can determine bone age, this study should only be performed as prescribed by a doctor).

A pregnant patient can undergo ultrasound and MRI instead of radiography.

What to choose: radiography or MRI?

As we have already said, x-rays allow you to see the bone structure, detect pathologies, injuries and displacements.

MRI allows you to evaluate the condition of bone tissue, muscles and ligaments. The study is prescribed if pathologies such as cancer, abnormalities of the hand, etc. are suspected.

Depending on the medical history and examination results, the doctor will refer you to the necessary specialist.

How is the research conducted?

No special preparation required. The main thing is to remove all metal jewelry before the examination, because... they can affect the information content of the images. The radiologist will tell you about this.

X-ray of the hands is a painless, non-invasive examination that is performed in a few minutes or even seconds. Those. the radiation dose is minimal. The patient first bends his arm at the elbow and then places it on the tabletop with the back side down. The radiologist takes 2 pictures.

We conduct research using a modern digital X-ray machine ITALTAY CLINODIGIT COMPACT. It is produced in Italy jointly with the USA.

The development and description of x-ray images, as a rule, takes no more than 15-20 minutes. The images are immediately handed over to the patient.

Symptoms

The main symptoms of a radius fracture include:

Soreness. Patients complain of acute pain, which intensifies when attempting to rotate the forearm (perform rotational movements). The pain syndrome is especially intense with an open fracture, especially with displacement of fragments.
Crepitation of bone fragments. It appears under the fingers when trying to move the bones in the form of a characteristic crunching sensation, however, it is not recommended to check for the presence of crepitus on your own as this can lead to even greater displacement of bone fragments.
Local tissue swelling. It is caused by a cascade of reactions that contribute to the development of the inflammatory process, in which there is an expansion of blood vessels and partial sweating of fluid into the tissue, which contributes to the appearance of swelling. If a hematoma appears at the fracture site, over time the swelling site acquires a purplish-bluish tint.
Pathological mobility in the hand. It is an absolute sign of a fracture, but only a medical professional can check it.
Shortening the arm. The symptom occurs in cases of fracture of the radius/ulna with displacement of the fragments along the length.

However, each location of the radial bone fracture is characterized by specific symptoms. Thus, in the case of a fracture of the head of the radial bone, sharp pain appears in the elbow joint, which intensifies with palpation or an attempt to bend/rotate the arm. On examination, there is joint deformation, limitation of movements, hemarthrosis and swelling . A particularly sharp limitation is observed when performing rotational movements with the forearm. In cases where a fracture of the head of the radius is combined with a dislocation of the forearm, a more severe deformity is present, movements in the joint are completely absent, and there is often a disturbance in the blood supply/sensitivity in the distal parts (numbness of the fingers).

In isolated fractures of the diaphysis of the radius, the symptoms are often erased: swelling occurs in the area of the fracture, complaints of pain, which intensify with rotational movements and palpation of the fracture site. Pathological mobility/crepitus is usually absent, which is due to the retention of radial bone fragments by the interosseous membrane/whole ulna.

A radial fracture in a typical location is accompanied by severe pain, hemorrhage and swelling. Possible pathological mobility and crepitus. In cases of displacement of fragments, there is a visible deformation in the projection slightly above the wrist joint. Palpation/movement is sharply painful.

If Galeazzi is damaged, there is pain in the middle/lower third of the forearm, and when pulling on the fingers, the pain syndrome increases, the appearance of pronounced swelling, and the formation of subcutaneous hematomas is possible. Any movement in the wrist joint is extremely limited. Distinctive features of this type of fracture are frequent nerve damage, as well as the development of compartment syndrome, manifested by compression of nerve fibers, veins and arteries by edematous soft tissue. Often accompanied by loss of sensitivity/movement in the hand area. Increasing tension of soft tissues, excruciating increasing pain indicate the presence of compartment syndrome.

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.

Tests and diagnostics

The diagnosis of “radial bone fracture” is made on the basis of anamnesis (presence of exposure to a traumatic factor), physical examination (pain/swelling in the forearm, forced position of the arm, deformity in the forearm, shortening of the upper limb, pathological mobility, crepitus of fragments, etc. ) and instrumental examination data - an x-ray in several projections, allowing to assess the nature and severity of the fracture (localization, with or without displacement, the presence of intra-articular injuries and concomitant fractures of the ulna). If soft tissue damage (muscles, blood vessels, nerve fibers) is suspected, CT/MRI may be prescribed.

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.

Diet

Diet for fractures

Efficacy: therapeutic effect after a month
Timeframe: 2 months
Cost of food: 1600-1800 rubles per week

Throughout bone fusion, dietary nutrition is indicated, the main task of which is to accelerate the fusion process. The diet for fractures should contain animal protein in an amount of about 100 g/day, which includes amino acids involved in the formation of bone tissue ( arginine , lysine , glutamine , proline , glycine , cystine ). The main products containing animal protein are dietary red meats, chicken, fish, chicken eggs, cottage cheese and dairy products.

Calcium, magnesium, phosphorus and zinc play a vital role in the formation of bone tissue, so the diet should include foods containing these elements. Sources of calcium are dairy products (cottage cheese/cheese), milk, fermented milk products, hazelnuts, lettuce, sesame seeds, spinach. It should be taken into account that for effective absorption of calcium, the diet must contain foods rich in vitamin D (fish oil/fatty sea fish).

The main sources of organic phosphorus compounds are meat, fish, milk, beef liver, beans, yolk, sturgeon caviar, walnuts, buckwheat/oatmeal, and dairy products. The required amount of magnesium in the body will be ensured by the inclusion in the diet of such products as wholemeal products, legumes, wheat, oatmeal and buckwheat (kernels), hazelnuts, milk powder, bananas, coffee beans, almonds.

And zinc is rich in bran, yeast, legumes, seafood, cereal grains, beef, dairy products, mushrooms, cocoa, sesame seeds, pumpkin seeds, peanuts, sunflower seeds, potatoes, onions.

B vitamins in the diet ; D ; WITH ; A , E , which are catalysts for the reactions necessary for the healing of fractures. Thus, vitamin D from fish oil, chicken yolk, fatty sea fish (sprats); vitamin C is found in rose hips, sea buckthorn, fruits/berries; group vitamins in offal (kidneys, pork/beef liver), cereals, walnuts, sweet peppers, hazelnuts, milk, yeast, garlic; vitamin E - in cold-pressed vegetable oils. A fracture of the radius heals on average in 27-35 days, and throughout this entire period, as well as for another 1-2 months, you must follow a diet.

Consequences and complications

The most common complication of a radius fracture is its malunion. At the same time, the severity of the consequences can vary widely depending on the location of the fracture/degree of bone deformation and can be represented by:

Sudeck-Thurner syndrome (chronic pain syndrome/reflex sympathetic dystrophy). The pathology is progressive in nature and is accompanied by chronic pain syndrome, limb deformation with impaired function, trophic disorders, development of stiffness of adjacent joints/osteoporosis and often ending in disability.
Instability of the wrist joint/impaired rotational function of the wrist joint.
Shortening the forearm.
Decreased grip strength in the hand.
Slowing growth of the radius/development of radial clubhand.
Deforming arthrosis of the wrist joint.
Volkmann's contracture , developing against the background of long-term compartment syndrome.

Complications are observed mainly in the absence of timely/adequate treatment for complex radial fractures and non-compliance with recommendations for the duration of bone fixation and lifestyle correction for the healing period.

List of sources

Ashkenazi A.I. Fractures of the radius in a typical location // Carpal joint surgery. - M, 1990.- P. 124-138.
Vorontsov P.M. Treatment of fractures of the distal metaepiphysis of the forearm bones / P.M. Vorontsov // Man and his health: Materials / Russian National Congress. - St. Petersburg, 1997. - P. 80.
Angarskaya, E.G. Features of fractures of the radius in a typical location / E.G. Angarskaya, B.E. Munkozhargalov, Yu.N. Blagoveshchensky // Siberian Medical Journal. - 2008. - No. 3. - P. 33-35.
Ardashev, I.P. Surgical treatment of improperly consolidated fractures of the distal metaphysis of the radius / I.P. Ardashev, V.N. Drobotov, A.V. Ivanov et al. // Modern high technology. - 2009. - No. 12. - P. 19-21.
Bakhovudinov, A.Kh. Current state of the problem of complex pain syndrome with a fracture of the radius in a typical location / A.Kh. Bakhovudinov, V.A. Lanshakov, A.A. Panov et al. // Siberian Medical Journal. - 2009. - No. 3. - P. 104-110.