Wrist fracture treatment and rehabilitation period. Mis-union and non-union fractures of the radius in a typical location Treatment of mal-union fracture of the radius

Fracture of the distal metaepiphysis of the radius ("beam in a typical place")

The distal metaepiphysis is the lower end of the radius, located next to the hand.

A fracture of the “beam in a typical place” usually occurs with a direct fall on an outstretched arm. In addition to a sharp pain in the arm, a bayonet-like deformity and a change in the position of the hand may appear. The nerves and vessels of the wrist are involved in the fracture process, which can be compressed by fragments, which is manifested by numbness in the fingers, coldness of the hand.

To clarify the nature of the fracture and the choice of further treatment tactics, radiography is used, in some cases, computed tomography. Sometimes an ultrasound of the wrist joint is required.

Since the radius adjoins the hand, it is very important to restore the anatomy and range of motion in the joint in order to avoid problems with it in the future. Previously, such fractures were treated conservatively, i.e. in a plaster cast, but often the fragments were displaced, the bone healed incorrectly, which later affected the function of the limb - the arm did not bend and / or did not unbend to the end - stiffness of the joint formed (contracture), remained pain syndrome. In addition, a long stay in plaster had a negative effect on the skin.

The duration of the 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 related to physical activity, the period of incapacity for work may be extended.

Conservative treatment of a fracture of the radius in a typical location (plaster cast)

For fractures without displacement, conservative treatment can be offered - in a plaster cast. The average stay in plaster is 6-8 weeks. This rarely passes without a trace for the limb - after conservative treatment, the joint requires the development of movements, rehabilitation. In the treatment of a fracture, even with 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 fractures of the radius with displacement require surgical treatment - comparison and fixation of bone fragments - osteosynthesis. It is this method that allows you to restore the function of the hand most fully and achieve good functional results.

The radius is completely fused in about 6-8 weeks. After this period, the patient can begin to fully use the hand. But it is possible to develop a hand with the help of certain exercises recommended by a doctor, thanks to the use of fixators, already 1-2 weeks after the intervention. Light sports physical activity can be started approximately 3 months after the operation.

Depending on the type of fracture (comminuted, multi-comminuted, with significant or insignificant displacement), several possible options for fixation can be distinguished - plate fixed with screws; external fixation device; screws; knitting needles.

In some cases, with severe edema, an external fixation device is applied, and after the edema subsides, it is replaced with a plate (or other fixator, depending on the type of fracture).

Osteosynthesis of the radius with a plate

With a significant displacement of fragments, osteosynthesis of the radius is used with a metal plate specially made for this segment. After comparing the fragments, the plate is fixed with screws to the damaged bone. After installation, the plates are superimposed on the skin, sutures are applied for 2 weeks, as well as a plaster cast for about the same period. After the operation, drug therapy is prescribed: painkillers, calcium preparations for faster bone fusion, if necessary, topical preparations to reduce swelling. The average length of stay in the hospital is 7 days. Stitches are removed on an outpatient basis after 2 weeks. The hand is worn in an elevated position on a kerchief bandage. There is no need to remove the plate.

External fixation device

In some cases, in the elderly, with severe swelling of the hand and wrist joint, it is undesirable to make access to install the plate due to various factors (edema, skin condition). In such cases, an external fixation device is installed - it fixes the fragments with the help of spokes that pass through the skin into the bone. The device protrudes above the skin in 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 the device must be monitored - dressings should be done so that the spokes do not become inflamed.

After the operation, the arm is in the splint for 2 weeks, then the patient begins to develop the wrist joint in the apparatus, which does not interfere with this.

The external fixation device is removed after about 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 hospital stay is 5-7 days, the duration of the 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 kerchief bandage.

Fixation with knitting needles or screws

With a slight displacement of fragments, the radius is fixed with knitting needles or screws through small skin punctures. 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-absorbable implants, which do not need to be removed.

Chronic, malunion fractures of the radius

In case of chronic incorrectly fused fractures, pain may be disturbed, there may be movement restrictions - stiffness of the joint, and other unpleasant consequences (numbness and swelling of the fingers). In such cases, surgical treatment is recommended, most often with fixation with a plate. The bone is disengaged, placed in the correct position and fixed. If there is a zone of bone defect - for example, if the bone has grown together with shortening, this defect is filled either with the person's own bone (the graft is usually taken from the iliac crest), or with artificial bone, which is rebuilt in 2 years into its own bone tissue.

Further postoperative and restorative treatment for chronic and improperly fused fractures of the distal metaepiphysis of the radius are similar to those described above. However, given the chronic nature of the damage, a longer rehabilitation may be required.

Anesthesia in the surgical treatment of a fracture of the distal metaepiphysis of the radius

For 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 movement) pass, and the arm becomes completely numb. Such anesthesia is quite easily tolerated, lasts 4-6 hours. In fact, this is a kind of local anesthesia. In addition, premedication is done - a soothing injection, and during the operation the person sleeps with his sleep. General anesthesia may be used. The final choice of anesthesia method is determined by the anesthesiologist on the eve of the operation.

Every person with a broken bone dreams of restoring the anatomical integrity of the bone tissue in a short time and without complications. And what to do if nonunion of bones is found or bone fragments grow together incorrectly and a false joint is formed? We will try to answer this and other questions in our article.

Physiological processes during bone fusion

In a fracture, two main biological processes take place: the resorption of tissues that have died as a result of injury and the restoration of the bone.

In the first week after the injury, granulation tissue is formed at the site of bone injury, the influx of minerals gradually increases to it, and a certain amount of fibrin filaments falls out. A little later, collagen fibers are formed, from which the main stroma of the bone is formed. A large amount of mineral salts is deposited in it every day and as a result a small piece of new bone tissue appears.

3 weeks after the fracture, on the radiograph of the victim, the first signs of fusion of bone fragments are clearly visible, they look like a small callus. It is still very fragile and thin, although the callus restores the continuity of the damaged bone, the mobility of the bone fragments is still preserved. Over time, more and more calcium salts are deposited in the formed "young" callus and it becomes harder and stronger, like the bone itself. With the process of gradual compaction of the callus, the mobility of all bone fragments significantly decreases, and then completely disappears.

The true (or secondary) callus itself in a patient is formed only after 2 months. The excess and unnecessary part of the callus by this time is gradually absorbed and the bone marrow canal is restored.

Modern methods of treating this pathology is compression osteosynthesis with the help of special compression-distraction devices.

In modern traumatology, surgical correction of improperly fused intra-articular fractures, as well as fractures located in close proximity to the joint, is used. In case of bone fractures inside the joint, the main goal of surgery is to correct the axis of the damaged limb. In children, this operation is a prerequisite, since in all people with age the deformation of bones and joints increases, their physiological function is disturbed.

Quite frequent cases of surgical intervention are incorrectly fused fractures of the clavicle. They are usually accompanied by significant deformity, pain and compression of blood vessels and nerves.

During the surgical intervention, the doctor separates the bone fragments and then compares them again; in this case, a metal rod or a special Kirschner wire is used for reliable fixation.

In case of improperly fused fractures of the bones of the lower limb in the femur or lower leg, bone fragments after separation can be fixed using bolts, screws, spokes and rods. After the operation, the patient must be covered with a plaster cast. After surgical treatment, a rehabilitation course is prescribed, which includes exercise therapy, physiotherapy and massage.

Magnetic therapy for fractures

One of the most effective and common methods of treating bone fractures is magnetotherapy.

Let us consider the mechanism of physical and biological effects of magnetic therapy on the human body: when exposed to a small area of the body, a non-uniform magnetic field penetrates, which has a variable frequency and a given induction.

The cells of the human body are the ultimate receivers of electromagnetic signals, they activate metabolism, conduct impulses, and thus start the recovery mechanism.

There are several reasons why magnetotherapy is used for bone fractures:

Anti-inflammatory effect;
Anti-pain effect;
Affects the main pathophysiological links of the disease;
Enhances local blood flow;
Accelerates the excretion of decay products;
Stimulates the ganglia of the autonomic nervous system;
Improves microcirculation;
Enhances the regeneration of damaged tissues;
Accelerates the process of wound healing.

Like any method of treatment, magnetotherapy has contraindications, which can be described in detail by a physiotherapist or a rehabilitation specialist. Magnetotherapy is used in cosmetology, urology, traumatology. It is under the influence of a magnetic field that a rapid fusion of bones occurs.

Ununited fracture

An ununited fracture is a pathology based on slowing down or stopping the healing process of a fracture. At the same time, scarring of opposing fragments of a broken bone is observed, they are covered with fibrous tissue on top, which over time can turn into fibrous cartilage in some patients.

If the patient has elements of mobility in the fibrocartilage, then fibroid necrosis develops and a false joint may form. The process of delayed fracture healing is characterized by prolongation of the period of callus formation. The maturation and remodeling of the callus does not fit into the usual time frame.

In the event of a bone fracture, each person wants the bone tissue to recover without any complications and as quickly as possible. But there are cases when the bones grow together incorrectly or do not grow together at all, forming. In order to understand what to do if an incorrectly fused fracture occurs, it is necessary to understand in detail the most popular types of fractures that a person can have.

What fractures can be

Fractures may not properly heal in different parts of the body. The most common are fractures of the hands, fingers, and jaw. A broken leg is much less common.

After a person has received a fracture, his body gradually begins the process of recovery after injury, it includes two stages - the resorption of tissues that died as a result of the injury and the second - the restoration of the bone itself.

These stages provide for the necessary period for recovery. In the first week, the patient develops a special tissue called granulation tissue. It pulls mineral substances to itself, thus extra fibrin strands fall out. With the help of collagen fibers that appear later, the bone itself is formed in the proper form. Every day more and more mineral salt appears in the bone, which allows the development of new bone tissue.

In three weeks, the fusion of bones will be visible on the x-ray, it will be visible. It is precisely at this stage that incorrect fusion of various parts of the body can be detected. To understand what needs to be done with this, you need to consider each type of fracture separately.

Misaligned fractures of the jaws

If after the fracture of the jaw does not grow together correctly, this means that the treatment was carried out with violations. Jaw fragments could be incorrectly compared or incorrectly fixed, as a result of which there is a repeated displacement of these very fragments, which subsequently grow together incorrectly.

It is important to note that in this form, cell activity increases, and the compound provides an increased influx of fibroblasts, which will later be contained in the tissues surrounding the fracture. Regeneration of a single layer is significantly reduced, since most of the tissue is resorbed.

If it so happened that the fracture did not grow together correctly, changes in the jaw system itself may occur. The load on the jaw bones increases in this case and the pressure changes its direction, which can lead to bad consequences.

If such serious violations are noticed in time, then the situation can be corrected with the help of prosthetics. You need to take a prosthesis and train bites, thus distributing the load on other jaw bones. Alignment is achieved in the case of the correct direction of the load on the prosthesis. These include both metal crowns and caps.

4 reasons why a broken arm healed incorrectly

They can be both open and closed. With a closed fracture, the body begins to grow together without problems for the patient himself. Incorrect accretion in most cases occurs due to improper treatment. When the patient may face other difficulties, such as infection or the development of osteomyelitis.

It may grow incorrectly for the following reasons:

treatment was performed incorrectly;
displacement occurred in the bandage;
the traumatologist did not install the loops that set the bone;
during surgical treatment, the fixators were installed not according to morphology.

As you can see, only an error in the treatment itself can serve as the cause of improper fusion. It is important to remember that with such questions, you should immediately contact a traumatologist and make sure that he puts the loops. This is the main stage at which the bones will definitely grow together incorrectly.

If the patient feels something is wrong in the area of the fracture, you need to make sure that it grows together correctly, for this you can familiarize yourself with the symptoms in order to confirm or refute this fact.

Fracture symptoms include:

hand deformity;
the physiological axis is broken;
physiological function is impaired;
limb shortening;
x-ray shows unsatisfactory data;
pain in the joints under and over the fracture;
the hand is not fully functional.

Fractured toe heals incorrectly

If a finger is broken, you should immediately consult a doctor. Our fingers perform very precise movements and until one of them is broken, a person cannot fully function. Moreover, the later the patient goes to the doctor, the worse it will be for his finger during treatment.

Finger fractures, like hand fractures, can be classified into two types - open and closed. In addition, in another classification, traumatic fractures are also distinguished, in which the fracture was caused by a previously received injury and pathological fractures, caused by the action of a tumor or some disease.

A broken finger is a very delicate problem. With it, you must immediately contact the emergency room, where specialists will take x-rays. Thus, not only the place where the fracture was performed, but also its type is determined. Unfortunately, the bones on the fingers break in several directions - in a spiral, in fragments, transverse, multi-splintered or even destroyed.

Surgery on an ill-union fracture should only be performed if there is a clear problem with healing or if the fracture itself was created in such a way that conventional treatments would be powerless against it.

Treatment of malunion fractures

Fractures can be treated only after consultation with a traumatologist. It is he who performs all the actions with a patient who has received a fracture. In fact, almost nothing needs to be done during the treatment. The traumatologist will take the first steps, the patient should not intervene in the fracture on his own, since only a qualified specialist can do this.

There are methods of external fixation that are widely used in medicine. After the operation, the patient should observe the norm of movements of the affected part so that the fracture heals correctly. If, nevertheless, this happened, the incorrectly fused fractures should first be examined by a specialist again.

A fracture of the radius has grown together incorrectly - the most common problem. In case of a fracture of the arm, special attention should be paid to rehabilitation so as not to cause problems in the future. An improperly healed fracture of the radius can also be treated like all other fractures. Most often, it can still be corrected with simple force pressing to give the bone a chance to find the right direction.

Misaligned fracture. Surgical treatment of malunion fracture.

After a fracture, with improper treatment or lack of it, the bone can grow together incorrectly, change its anatomically correct position. Quite often, the bone does not grow together properly in a cast due to insufficient fixation of the fragments.

Characteristic features malunion fracture is a deformation of the bone and, as a result, a violation of the functionality of the limb (if this bone is in the limb), pain in the bone itself and the nearest joints.

Diaphyseal fracture, i.e. fracture in the middle of a bone, which has grown together incorrectly, requires opening the bone and repositioning its fragments again. To improve bone regeneration, the joints are treated with a chisel, applying special notches.

If bone fragments are well identified and easily compared, then intramedullary fixation is used. Fixation is carried out using a special metal rod, autoplasty is also performed with grafts from the ilium.

If, as a result of an improperly fused fracture, the bone is severely deformed and its fragments are noticeably displaced, then one osteotomy of the bone is not enough. Osteotomy in this case is also complicated by the fact that the neurovascular bundle in the muscles is wrinkled and there are fibrotic changes. The treatment of such malunion fractures is that doctors try to avoid neurological damage while restoring the bone. Therefore, for such cases, a partial resection of the bone (removal of a portion of the bone) or osteotomy is more often performed. The operation is thought out in advance, with the help of X-ray examination, the surgeon decides what type of operation to perform. It is important to take into account the location of blood vessels and nerves, as well as the physical characteristics of the muscles.

In rare cases, when an incorrectly fused fracture is still fresh, a closed bone refraction is performed, after which a plaster is applied or a permanent skeletal traction is applied.

Intra-articular malunion fractures also require surgery. To restore the bone in these cases, osteotomy or bone resection, various osteoplastic operations are also performed. Especially the treatment of improperly fused intra-articular fractures is important for children, because. the deformity may increase as they mature. In the future, this can lead to limited functionality of the joints.

It is worth noting that malunion fractures amenable to surgical treatment are mainly limbs(more often lower - lower leg and thigh) and collarbones. Faster rehabilitation in those patients who underwent physical therapy and massage courses, as well as exercise therapy. Patients are strongly advised not to neglect any doctor's instructions after surgery.

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The wrist joint is the articulation of the 3 bones of the wrist and the radius.

A fracture of this joint is a violation of the anatomical integrity of one or more bones due to injury. After receiving it, you must definitely consult a doctor in order to avoid negative consequences.

Common causes of injury

The most common cause of wrist injury is injury or a fall onto outstretched arms. It can also be a direct hit. The following factors can contribute to damage:

Lack of calcium in the body;
Hormonal disorders;
Osteoporosis;
Age over 60 years.

Most often fractures of the wrist joint are observed in older people. This is due to the fact that bone tissue becomes weaker over time. Also often such injuries are at risk for women during menopause.

Men are much less prone to wrist fractures. Hormonal changes in them are not so pronounced, and the bones are stronger and more voluminous than in women.

Classification

There are 2 types of fractures:

Smith's fracture. Most often it occurs as a result of a blow with straight palms or a fall on outstretched arms. In this case, the bone is damaged above its distal ring by several centimeters. In this case, bone fragments move in the opposite direction from the palm. Due to the fact that the blood circulation in this area is quite active, the injury quickly grows together;
Colles fracture. It is much less common and occurs as a result of a fall on the back and a direct blow to the forearm. In this case, the fragments of the radius are shifted to the palm.

Also, a fracture of the wrist joint is classified as follows:

Closed;
Open. In case of injury, the skin is damaged;
Intra-articular. Fracture of the bone in the area of the wrist joint;
Extra-articular. In this case, the articular surface is not affected.

Fractures of the hand in the wrist (wrist joint) are with or without displacement. And also a fracture can be comminuted, when as a result of a blow the bone is broken into more than 3 segments.

Diagnostics

In order to diagnose a fracture, it is necessary to immediately seek help from a traumatologist after an injury, since the symptoms may resemble a dislocation, sprain, or bruise.

After a visual examination and palpation, the doctor prescribes additional research methods.

X-ray in 2 projections is mandatory. If necessary, the doctor may prescribe a CT scan. It is performed if the fracture is intra-articular, with a displacement, or surgery was performed to remove fragments.

Symptoms

The following signs and symptoms indicate a wrist (wrist) fracture:

If the fracture was displaced, then the deformation of the bone in the area of the wrist joint is outwardly noticeable.

With the extensor mechanism of a wrist injury (Colles fracture), a bayonet-shaped bulge appears on the palm. The patient feels numbness of the hand or fingers, he has a feeling of "goosebumps". The characteristic crunch of broken bones may also appear.

With an open fracture, a wound forms at the site of injury, bone fragments are visible.

Treatment of wrist fracture

In case of a fracture of the wrist joint, the patient must be given first aid, fix the hand in one position and, in the case of a closed fracture, apply cold to the injured area in order to reduce swelling and pain. Anesthesia is also carried out with the help of analgesics: Ketanov, Dexalgin.

In the future, after the diagnosis, the doctor will determine whether the patient will need conservative therapy or surgery. If the fracture was without displacement, or it is not so critical, then after anesthesia, parts of the bone return to the anatomically correct position. Then the arm is fixed with a plaster or polymer bandage.

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How long to wear a cast for a broken wrist: the bandage is worn for 4-5 weeks for Coless's fracture, and for 6-8 weeks for Smith's fracture.

If there is a fracture of the wrist joint with a displacement, then it is necessary to take an x-ray on the 10th, 21st and 30th days to make sure that after applying the bandage there was no re-displacement of the bones.

When applying a bandage, special attention is paid to blood circulation in the affected arm. The fingers remain open, and at the first sign of numbness, it is necessary to inform the doctor about it.

If the fragments of the bones cannot be kept in a normal position or a large number of fragments are observed, then a surgical operation is performed. Reposition can be of 2 types:

Closed reposition. In this case, the fragments are fixed with the help of knitting needles. Disadvantages: an infection can penetrate through the wounds in the skin at the base of the spokes, and the movement of the hand is limited for a long period;
Open reposition. This is a full-fledged surgical intervention, in which the skin is dissected, and bone fragments are removed. The displacement is eliminated with screws and titanium plates. In this case, plastering is not required.

Rehabilitation for a fracture of the wrist joint

After an injury to the wrist joint, rehabilitation is required, which should last at least a month. This is a very important stage during which the working capacity of the hand is restored.

On the 2nd day after the plaster is applied, you can begin to perform exercises for the joints free from the bandage. You can bend and unbend the fingers, elbow and shoulder joint.

Exercise therapy to restore joint mobility should be prescribed by a rehabilitation doctor, depending on the severity and location of the fracture, as well as the age and health of the patient.

Exercises after a wrist fracture(perform sitting, forearm should be on the table):

Rise alternately one finger at a time;
Raising all fingers at the same time;
Squeeze your fingers into a fist;
Fold your fingers, simulating the rise of a "pinch of salt";
Imitate rings with fingers;

Finger snaps;
Imitation of playing musical instruments;
Press palms to each other and hug with fingers;
Rotate the hand in the wrist joint;
Grab objects of various diameters with your hand;
Having fixed the hand in the elbow joint, turn the hand with the back side down;
Gather and straighten a piece of fabric with your fingers.

During immobilization, muscle atrophy occurs, this can be seen if you carefully examine the hand: the wrist decreases. In order to cope with this, it is necessary to massage the wrist joint. It is designed to restore processes in muscle tissue. The procedure is carried out daily or every other day for a month.

Also, during the recovery period, proper nutrition is important, you can learn more about this.

Possible Complications

The danger of injury to the wrist joint is that with improper fusion, deformation occurs.