Rehabilitation after a fracture of the radius with displacement. How to choose a bandage for the wrist joint Osteosynthesis of the radius when to remove the plate

How justified are the plates for fractures, which are increasingly being installed by doctors after an injury? Recently, there has been a tendency among doctors that any fracture must be operated on, which in most cases involves the placement of plates. There are certain contraindications for the operation, and for each site, their own implants have been developed. After metal osteosynthesis, a certain rehabilitation is required.

A fracture, especially with a displacement, takes a person out of strength for a very long time, depriving him of all the joys of life. A significant displacement, the presence of a large number of fragments are an indication that titanium plates are used for fractures, since normal union with the help of gypsum in such conditions is impossible. The most optimal method of treatment in such a situation is osteosynthesis, in which the fragments are fastened together with plates.

After the operation, a person is able to rehabilitate faster, putting an early load on the injured limb. With the help of plates, the fracture is compared most correctly, then the most favorable conditions for fusion are created. Early conditions are created for movement in the joints, thereby reducing the conditions for the formation of osteoarthritis and contractures.

What it is

At the present stage in traumatology, a variety of plate options are used. They can have a different shape, which is due to the area of ​​\u200b\u200bthe bone where they should be installed. Significant differences have holes in which the screw securely fixes the fracture due to the cap.

All plates have certain functions:

• restoration of normal bone anatomy;
• acceleration of union;

But in order to install the plate on the bone, a large number of instruments are required. And they were designed to make the operation go faster.

All fracture plates are designed depending on the fracture and its location, as well as the functions that they must perform. Allocate:

• protective (neutralization);
• supporting (supporting);
• compression (tightening);
• with partial contact;
• with full contact;
• microplates.

The process of applying a plate to a bone is called metal osteosynthesis. All implantable plates are designed for lifelong use after surgery.

Many injuries are an indication for surgical intervention, but not always the operation can be performed. Regardless of which plates are placed for fractures, there are certain indications for surgery. The doctor will suggest intervention in certain cases, namely:

1. Significant displacement of fragments after fracture.
2. The presence of several fragments.
3. The absence of concomitant pathology, which is a contraindication to surgery.
4. The return of a person to an active lifestyle.
5. There are no contraindications for general anesthesia.
6. Persons with osteoporosis.
7. Elderly patients with no contraindications who do not want bed rest.
8. Restoration of the normal anatomy of the articular surfaces.

But sometimes setting the plate leads to undesirable consequences. There are situations when the plate is rejected after a fracture. Under such conditions, intervention can do more harm than good. Contraindications are:

1. Wound, abrasions at the fracture site, intervention is possible only after it has healed.
2. Purulent processes or inflammation at the site of injury.
3. Osteomyelitis.
4. Tuberculous lesions of the bones.
5. If the patient did not move before the injury (paralysis).
6. Severe forms of mental illness.
7. Insufficiency of the heart, kidneys, liver in the stage of decompensation.
8. Severe, decompensated diabetes mellitus (a postoperative wound heals for a long time).

In which areas are installed

Each bone has its own plates, some are superimposed with a skull defect, separate fixators exist for pertrochanteric fractures or hip injuries. The industry offers plates for the synthesis of bone fractures that make up the knee joint. Their variants are designed for the synthesis of fractures of the bones of the lower leg, shoulder, pelvis, collarbone, on the back or palmar surface of the hand or foot, and even for fixing the spine.

On the bones of the skull

Bones in the head are extremely strong and can be very difficult to damage. Most often this occurs as a result of a direct blow to the head with a heavy sharp or blunt object. The result is depressed or comminuted fractures that require surgical intervention. The result of the operation is most often a saved life, however, a defect in the bones of the skull is formed, which must subsequently be closed.

For these purposes, titanium plates are used, they, closing the defect, protect the brain and its membranes. Subsequently, the removal of the plate after the fracture is not carried out, and it remains in its place for the rest of your life. If the bones of the facial skull are damaged, then the plates do not make sense due to their impracticality. The bone is juxtaposed with a cerclage wire, which performs the same function as the plates.

upper limbs

Different shapes and sizes have plates that are installed for fractures of the upper limbs. Microscopic plates have been developed that can be placed on the phalanges of the fingers if there is misalignment. On the palm, the plate is placed only on the back surface, this is due to the proximity of the bones to the skin surface. Vessels, nerves, as well as tendons, which are easy to injure, pass along the palmar surface in large numbers.

Of particular interest are fixators implanted for injuries in the area of ​​the elbow and wrist joints. Plates of this type take into account the anatomy of the articular surfaces of the bone. Often, ligaments are torn off in the area of ​​​​the joints along with bone fragments, they can be fixed in place with the help of anchors.

Implants are installed for about a year, after which they must be removed during a second surgical intervention. But sometimes the question arises as to whether it is necessary to remove the plate after a fracture; in general, it is designed for permanent use. The doctor resorts to removal only if it interferes or causes certain inconveniences. If a person intends to remove the implant, then there must be full confidence that a callus has formed and the bone does not need to be fixed.

If the clavicle is damaged, a titanium or nickel plate is applied, which has a curved shape and completely repeats the normal anatomy of the bone. If it is necessary to give a certain curvature, the plate is bent at the discretion of the doctor. When there is damage to the ligaments of the acromioclavicular joint, then plates with special protrusions are selected. They enter in one part into the acromial process of the scapula, and the second is fixed with screws to the collarbone.

Plates used for damage to the acromioclavicular joint.

Pelvis and lower limbs

Injuries to the pelvis and lower extremities are classified as severe and sometimes require immediate surgical intervention. After the examination, a specialist will help you choose which one is better, since the price (in dollars) can reach several thousand.

For displaced pelvic fractures, various modifications are used. The wings of the ilium, acetabulum, and pubic bones are most often operated on. It is these bones and components that provide the supporting function of the pelvis. The plates are used not only for fractures, but also for rupture of the pubic symphysis, including after childbirth. Surgical intervention requires tears larger than a centimeter.

Hip injuries also require the placement of various plates. Very often, operations require fractures in the femoral neck and transtrochanteric region. The last version shows the use of the DHS construction, which consists of a plate, from which a screw departs at a certain angle, which is fixed in the thickness of the neck. The plate is fixed to the body of the femur with screws.

In the area of ​​the body of the bone, plates with full or partial contact are used. Quite often, lockable plates are used, in which the holes are angled or threaded. The head of the screw in such plates is tightly fixed in the hole or clamped with a thread. Also, when the screw is tightened, the plates contribute to the compression of the fracture site, due to which the fusion occurs faster.

In the lower part of the thigh, damage affects the region of the condyles. In this section, it is very important to restore the articular surfaces of the femoral condyles. To achieve anatomical integrity, special curved plates are used, as well as screws. When fixing any screw into the bone, it is important that the terminal section protrudes slightly from the opposite edge of the bone. Under this condition, the most durable fixation of the screw in the bone is achieved.

In the shin area, fractures occur in the upper, middle or lower sections. For each section, the use of its own plate is shown, of course, the articular surfaces in the upper and lower sections require special attention. The plate in the leg with a fracture should stand for about a year, after which it can be removed.

In the area of ​​the condyles, the use of plates with angular stability is shown. It allows not only to fix the fracture, but also to keep damage to the articular site. In case of a fracture of the middle third of the leg, the use of simple plates with partial or complete contact with the bone surface is indicated.

The lower third of the bones of the lower leg requires a separate approach, when it is necessary to restore not only the articular site, but also fix the damaged ligament, which is called syndesmosis. Before installation, the titanium implant is given an individual shape that repeats the bending of the bone.

Plates are also used for damage to the bones of the foot, especially the metatarsal. For this, microplates are used, which are used for comminuted or oblique injuries. Plates are widely used for heel fractures, in this case the plate allows you to restore the anatomical integrity of the bone. Such plates cannot provide support, but with their help the bone fuses correctly. When the fracture has consolidated, the support on the bone is carried out in full, pain does not bother when walking, flat feet do not develop.

Recovery

It is not enough just to put a plate and compare the fracture, it is important that then a person can fully live and work. Held rehabilitation only under the supervision of an experienced specialist. The approximate period required for a full recovery is approximately a month, and a longer period of time may continue. If the fracture is aligned correctly, the desire of the patient himself is required and the result will not be long in coming.

Simple movements in the joints are shown after the wound has healed, but on the condition that the displacement does not threaten. As the fracture consolidates, the load on the limb is shown, first with the use of crutches, then with a cane or walker. After surgery on the upper limbs, the load on the operated segment is performed using expanders, weights, and dumbbells. The use of therapeutic exercises in the supine or sitting position is shown.

Each type of fracture requires its own set of exercises. A rehabilitation doctor or traumatologist will help you choose them. After each operation, its own complex is shown. After some operations, recovery is carried out only in the form of movements in the joints without relying on the limb. If you neglect such a rule, then the result will be lost, and the fracture will shift.

Removal of plates after fracture

Many people who have undergone surgery are interested in the question of whether it is necessary to remove the plate after a fracture. In general, implants are designed for lifelong use. You can remove it when there is a good callus or the implant interferes with normal movements. It is also possible to remove the plate if a cyst develops at the site of the screw placement. In general, the issue of removing the plate is decided in each individual case jointly by the traumatologist and the patient.

Delete or not?

Today we will talk about indications and contraindications for the removal of metal structures.

Last year, or maybe even earlier, you or your loved one underwent osteosynthesis for a broken bone, a metal structure was placed, and now the question arose: “Should I remove it or not?” This article will help you take a more balanced approach to this issue.

On the one hand, this is another operation, and on the other hand, a foreign body that causes certain reactions in the body.
So, consider the necessary conditions and indications for the removal of metal structures:

- Fracture healing for which surgery was performed.

If the union of the fracture has not occurred, of course, the metal structure should not be removed. An x-ray examination, which is mandatory for everyone before the operation, will help answer this question. Non-union of a fracture for 6 months or more is called a false joint and requires an appeal to an orthopedic traumatologist. In most cases, the formation of a false joint requires a second operation with the removal of the old one and the installation of a new metal structure.

- Limited mobility of the joint, next to which the metal structure is installed.

Metal construction can interfere with articular structures, limiting movement in the joint. Also, an intense cicatricial process caused by primary trauma, surgery and metal structures (which is a foreign body) can cause the formation of joint contracture. In such a situation, when removing a metal structure, it is possible to mobilize (release) the muscles and tendons, which, with proper subsequent rehabilitation, will significantly improve the function of the joint.

- Low quality metalwork installed.

The plate and screws must be made of special alloys and have the same chemical composition to reduce the likelihood of metallosis. This process is the corrosion of metal retainers. In the surrounding tissues, the concentration of iron, chromium, nickel, titanium increases. The combination of different grades of steel in the design enhances the metallosis process, the combination of chromium and cobalt, vanadium and titanium in metal alloys, high concentrations of nickel in stainless steel is very unfavorable.

The dependence of the degree of corrosion of metal implants under conditions of a decrease in the pH environment, which is typical for purulent-inflammatory complications, osteomyelitis, as well as for a long stay in the body, has been established. Electrochemical corrosion in metal implants occurs due to the presence of dissolved metal salts (Fe, Na, K, Cb, etc.) in tissue fluids, which are electrolytes.

A certificate from a medical institution and an implant passport, which is issued upon discharge, help determine the quality of the implant.

- Migration, fracture of the implant or its elements.

If during the control radiographs it turned out that the metal structure began to migrate or its fracture occurred, contact the doctor who performed the operation for you to agree on the treatment tactics. This situation is possible with non-union of the bone and / or an infectious process.

- Infectious process in the postoperative period.

If after the operation there were problems with wound healing, fistulas and purulent discharge, the doctor prescribed you an additional course of antibiotic therapy. Despite the fact that now nothing may bother you - remove the metal structure in a planned manner. Scars in such a situation are a source of chronic infection. A decrease in the immune status and trauma to this area can provoke an inflammatory process, which will require the removal of the structure on an emergency basis.

- The need for cosmetic correction of the scar.

A hypertrophic, keloid scar can be located on a part of the body subject to mechanical stress. Constant traumatization causes discomfort and limitations. For example, after osteosynthesis of the clavicle with a plate, the backpack strap puts pressure on the postoperative scar and a person cannot engage in any hobby - tourism.

Removal of a metal structure, in contrast to the primary operation, is a planned intervention, in which a full-fledged aesthetic correction of the scar is also possible.

- It is mandatory to carry out a staged removal of the metal structure, which is included in the treatment technique.

The most common situations are: dynamization of a fracture of the leg bones after intramedullary osteosynthesis with a pin with blocking and removal of the position screw after an ankle fracture. Fracture dynamization allows you to give the necessary load on the callus, accelerating the healing of the fracture and reducing the risk of false joint formation. Removal of the position screw 6-8 weeks after osteosynthesis of a fracture of the ankles of the lower leg with damage to the distal tibiofibular syndesmosis (ligament stabilizing the joint) makes it easier to restore the full range of motion in the ankle joint, reduce the likelihood of developing deforming osteoarthritis of the ankle joint and the formation of tibiofibular synostosis (bone fusion of the tibial fibula) among themselves, disrupting the physiological work of the joint).

- Remove hardware if you play sports or plan to start doing so.

In particular, this applies to game, contact and extreme sports. With repeated trauma, the probability of a fracture along the edge of the plate is higher and the presence of an old implant will create technical difficulties during the operation, especially if the fixator is installed for more than 2 years.

- Consult with an orthopedic traumatologist if the metal structure is located near the joint.

Any joint that has been injured is at risk for the earlier development of deforming arthrosis. The presence of a plate or a pin during arthroplasty (replacement of a joint with an artificial one) will significantly complicate the surgical intervention, especially if the metal structure was installed 5 years ago or more.

- Osteoporosis (decrease in bone mineral density) and the presence of a retainer on the lower limb.

Patients with osteoporosis require a special approach in the choice of metal structures, rehabilitation and deciding on the removal of the fixator. The installed plate after the fracture union interferes with the plastic deformation of the bone during movement, during which there is an increase in blood flow in the bone. The load is also splinted through the plate and stress concentration is created at the bone-implant interface, which also increases the likelihood of a re-fracture. This situation requires a balanced approach and a comprehensive examination of the patient.

Now let's look at contraindications.

In addition to general contraindications to elective surgeries and anesthesia allowance, which are determined by the therapist, a specialist in your profile pathology (if any), the anesthesiologist should note the following points:

When the metal structure is located in the immediate vicinity of the neurovascular bundle, the cicatricial process caused by trauma and the primary operation makes it difficult to identify it during surgical access. In such a situation, the possible risks may outweigh the benefits of removing the metal structure, and surgery should be refrained from.

In the presence of neurological disorders, such as a decrease or disappearance of skin sensitivity, muscle weakness or lack of active movements, may be an indication for neurolysis (release of the nerve from scars) and removal of the implant, of course, subject to fracture healing. In such a situation, it is optimal to carry out the operation by an orthopedic traumatologist together with a microsurgeon.

A properly installed, modern fixator that does not cause subjective complaints and is installed on the upper limb in a patient with low motor demands in most cases does not require removal. In other cases, the decision to remove the plate, pin, wires and other implants is made jointly with an orthopedic traumatologist at a face-to-face consultation with a mandatory X-ray examination.

If for some reason you do not have the opportunity or desire to have the metal structure removed by the doctor who performed the primary operation, we suggest that you perform this operation at the XXI century clinic.

In most cases, the removal of a metal structure is a less traumatic intervention than the primary operation, and it can be performed without hospitalization. clinic "XXI century" is equipped with the necessary modern equipment for safe anesthesia, solving possible non-standard situations with implants of unknown origin. It is possible to carry out the operation by a multidisciplinary team together with a microsurgeon or a plastic surgeon.

The cost of removing metal structures in our center is 12,000 rubles. + the cost of anesthesia from 3500 rubles per hour, depending on the type of anesthesia.

Memo for patients "Preparation for anesthesia" - , . You can print and fill out at home, or preview the questions and complete them at the clinic prior to surgery.

IMPORTANT! When asking a question in this thread, please write:

- Age of the patient
- Date of injury and/or surgery
- What is the diagnosis in the statement
- What kind of treatment did you receive?

A “beam in typical location” fracture usually occurs with a direct fall on an outstretched arm. In addition to a sharp pain in the arm, a bayonet deformity, 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 clamped 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 (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 only conservatively, 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 fully unbend - joint stiffness (contracture) formed, pain remained. 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 longer.

Conservative treatment of a fracture of the radius (plaster or plastic bandage)

For fractures without displacement, conservative treatment can be applied - in a plaster cast or use plastic plaster which is more comfortable and not afraid of water. The average stay in plaster is about 6 weeks. However, this method of treatment has its drawbacks - after conservative treatment, the joint requires the development of movements, rehabilitation. In the treatment of a fracture, even with a slight displacement of fragments, a secondary displacement of fragments may occur in the cast due to the anatomy of the radius.

Surgical treatment of a fracture of the radius (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 initially fuses in about 6–8 weeks, but complete remodeling of the bone continues up to 2 years after the fracture. 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 on the first day 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 by screws ; external fixation device; screws or spokes.

In some cases, with severe edema, an external fixation device is first applied to the hand, 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 designed for this area. After comparing the fragments, the plate is fixed with screws to the damaged bone. After installing the plate, sutures are applied to the skin, and a plaster splint is also used. After the operation, drug therapy is prescribed: painkillers, calcium preparations to stimulate bone fusion, if necessary, topical preparations to reduce swelling. The average length of stay in the hospital is 7 days. The sutures are removed after 2 weeks, at a follow-up appointment with a traumatologist, at the same time the patient refuses a plaster cast. The hand is in an elevated position on a kerchief bandage. There is usually 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 apparatus 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 skin incisions, but the apparatus must be monitored for the entire period of its wearing - dressings must be made so that the needles do not become inflamed.

After the operation, the arm is in a plaster 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 about 6 weeks, after X-ray control, in a hospital. 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 spokes or screws

With a slight displacement of fragments, the radius is fixed with knitting needles or screws through small skin punctures. According to the standard protocol, a plaster splint is applied for 2 weeks, then the patient begins to develop the arm. The pins are removed after 6 weeks.

In some cases it is possible to use absorbable implants(screws, spokes), which do not need to be removed.

Chronic, malunion fractures of the radius

In case of chronic improperly fused fractures, patients may be disturbed by pain, 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, then it is filled either with the person's own bone: a bone is transplanted, which is usually taken from the iliac (pelvic) bone crest, or an artificial bone, which is rebuilt in about 2 years into own bone tissue.

Many people have broken bones at least once in their lives, and they will naturally agree that the recovery period was not the most pleasant in their life.

The human skeletal system, although not fragile, is still prone to fractures. With such injuries, doctors most often apply plaster (although there are more modern solutions), prescribe a course of painkillers and complete rest. For most patients, this is enough. Unfortunately, there are more severe cases.

People with severe fractures need metal plates or screws to restore the integrity of the bone. However, this process is painful and lengthy. First, foreign elements are introduced into the body during a surgical operation under general anesthesia, and then removed during a second operation.

The results of X-ray studies have shown how a ceramic implant is literally. It is noted that the implant is as strong as natural bone.

To date, these are all the details that are known. The results of the work have not yet been published in a peer-reviewed journal.

What are the research prospects for medicine? Although rabbits and sheep are not the same as humans, they are not that far removed from us biologically. And if the work led by Zrykat eventually brings the expected result in clinical trials, then after a while the world will be able to reap the benefits, and patients will receive an excellent alternative to the traditional method of treating fractures (which, by the way, has not changed for several decades).

In fact, the new technique will potentially lead to faster healing of injuries, patients will experience less pain and - the boldest assumption - will increase the life expectancy of patients.

By the way, since the early 2010s, scientists around the world have been experimenting with 3D printing technology,