Radial fracture with offset and without - rehabilitation and treatment
What is a fracture of the radius?
Fracture of radius is one of the most common domestic injuries, about 16% of all recorded acute pathologies of the bone system are such damages. With this type of fracture, mankind has experienced throughout its history, in burial places over 5 thousand years old, archaeologists find bones with traces of such traumas, and the first known ancient, Egyptian, Chinese treatises already contain recommendations for the treatment of such victims. This pathology is so widespread, as a result of the mechanism of its occurrence, the injured person receives a trauma, falling on the arm extended forward, or with a strong blow by an elongated hand about something hard enough.
More often this trauma occurs in women after menopause, more than half of such injuries are received by them. This is due to the fact that during this period they have reduced calcium content in the bones, and they become more fragile, and even a small load can lead to injury. Further, we will consider in more detail how such a lesion arises, what symptoms it has, how to be treated, and how dangerous the fracture of the radius can be.
Radial fracture with bias
A fracture of the radius of the radial bone develops if the parts of the fractured bone move relative to each other. The types of such fractures are very diverse, and differ in the direction and type of movement of damaged bone fragments, their localization, and the integrity of the skin.
There are several groups of such fractures:
Closed - all fragments of the broken bone are under the skin, they are most favorable for the patient, the area of the injury is sterile, the risk of possible complications is minimal, among fractures of this type.
Open - in which fragments of broken bone tear the skin, and the area of injury is in contact with the external environment, such a wound is not sterile due to microorganisms entering into it from the external environment, such traumas are dangerous due to possible infectious complications.
Intraarticular - the fracture line is completely or partially in the joint cavity, as a result, blood from the broken bone gets into it, hemarthrosis develops, there is a significant risk of disruption of the normal operation of the damaged joint.
A change in the proportion of bones in the area of trauma may be the result of the injury itself, for example, when the bone is fragmented into fragments, or may be a consequence of muscle work. This happens when they pull one end of the bone in their direction, and it mixes with the other part of the bone, to which this muscle is no longer attached. As a rule, with fractures with displacement, both variants of the pathological process are observed simultaneously, which makes it difficult to ensure an adequate restoration of the function of the limb.
A characteristic outward sign of a fracture with mixing, this change in the appearance of the limb, visible in the eye, there is a characteristic deformation, however, one must understand that the outwardly visible changes in this trauma occur only with strong destruction of bone tissue, and are relatively rare.
The transverse and longitudinal displacement of bone fragments is widespread. With this type of injury, a transverse or oblique fracture occurs first, which divides the radius of the bone into 2 parts. As a result, one part of the bone under the action of the contracted muscles goes to the side, in this case a transverse fracture with displacement is observed. If the fracture was longitudinal, then part of the bone fragments, under the influence of traumatic action, moves up the arm, and they seem to glide relative to each other. In most cases, we have experienced simultaneous transversal and longitudinal displacement of bone fragments.
Somewhat less common is a fracture with a displacement, called punctured. It looks like this, the patient falls on the arm, and one part of the radius bone is jammed into the other, the bone in this case is a bit like a telescopic antenna in which one part of the bone enters the other.
Since the mid-20th century, among fractures of the radius, the proportion of compression fractures has been increasing. This is directly related to the spread of road transport, and industrial equipment, and as a consequence with the increase in the number of victims in accidents involving equipment. The mechanism of injury, in such situations, differs from the typical for this pathology, the damage to the bones arises not as a consequence of a fall or a blow by the hand, but as a result of infringement of the limb between two metal surfaces, as a result of which the bone is crushed as if it were in a vice. Such injuries are characterized by extensive damage to soft tissues, and many small bone fragments at the site of injury.
The main method of diagnosis, this type of fracture, in modern medicine - is an X-ray examination. A radiograph made in two projections allows the doctor to assess the position of the bones relative to each other, and the severity of the resulting injury.
Radial fracture without bias
At least half of the fractures of the radial bone occur without bias, since the muscular mass of the forearm is significantly smaller than on the lower limb or on the shoulder, then with incomplete fractures, the muscle strength is insufficient to move the fragments of the bone relative to each other. In some cases, even a complete transverse fracture of the radius, there is no displacement of the bone fragments.
The most common variant of a fracture of a radius without displacement is a crack in a bone tissue. A fissure in traumatology is usually called not a complete fracture, when there are damages only to some part of the bone, but they do not extend to its entire thickness. As a rule, cracks result from domestic and sports injuries in relatively young people. Their bones are elastic enough and strong to withstand serious loads, and a complete fracture when falling from a low altitude or bumps occurs rarely.
Externally, such a fracture manifests itself in the form of edema and pain at the site of the injury, in contrast to the fracture with an offset and an open fracture of the radius, only the edema and possibly the hematoma will be in place of the lesion. On the roentgenogram with this type of pathology, a full-fledged fracture line can not be observed, but only damage to the periosteum, and compaction of the bone tissue at the site of injury.
Fracture of radius in a typical place
Fracture of the ray in a typical place is the most common trauma of the radius, the destruction of bone tissue in this area is due to the anatomical features of the structure. In the region of the wrist joint, 3-4 cm from its articular surface, when falling on the arm, the maximum load occurs, and as a result the bone does not stand up and collapses.
There are two main types of fracture of the radius in a typical place:
Collapse of the - is an over-extension of the wrist joint, in which a fracture of the radius in a typical place occurs. In this type of injury, the distal( located further along the limb) bone fragment is mixed towards the rear surface of the forearm. Approximately two-thirds of fractures of the radius in a typical place are of this type. For the first time such a variant of the fracture was described in 1814 by Abraham Kolles, a famous surgeon and anatomist who lived in Ireland.
Fracture of Smith - represents a flexural fracture of the radius, the injured in this case falls on the arm, the brush of which is bent towards the rear surface of the forearm. Thus, the distal bone fragment moves to the outer surface of the forearm. This type of typical trauma of the radius was first described by Robert Smith in 1847.In fact, a ray fracture in a typical place is a two mirror-like type of fracture.
Currently, a significant proportion of victims with a fractured ray in a typical place are women after 45 years of age. This is due to the effects of menopause, which adversely affects not the strength of bone tissue, and as a consequence of not the stability of bones to shock loads. The impact that at the age of 20 would only lead to a bruise, for a woman of 50 years, can easily end in a fracture.
The peak of treatment with similar injuries in countries with a cold climate occurs in the spring and autumn, it is associated with ice, and the risk of falling, the number of injured people increases, and the number of fractures increases.
Complications after fracture of radial bone
Complications of fractures of the radius can be divided into two large groups:
Immediate complications of trauma are complications arising from the influence of injuries resulting from bone fracture on the normal functioning of the limb.
Long-term consequences of trauma - complications resulting from improper treatment, or disruption of normal healing after trauma.
Direct complications include:
Nerve tears and injuries that provide sensitivity or limb mobility. Bone fragments can damage or tear large nerve trunks with their sharp edges, depriving the site lying below the trauma site of signals from the brain. As a result, the ability to arbitrarily move the affected area partially or completely disappears, sensitivity is lost.
Injuries to flexor tendons of the flexor, bone fragments displacing the sternum of the dorsum of the forearm can damage the bundle of tendons going to the wrist, and as a result the victim completely or partially loses the ability to move with the fingers of the hand.
Tough swelling of the Turner brush, as a result of it, the reflexive immobility of the fingers develops, the patient can not perform any voluntary movements, but if he tries to move them, he experiences severe pain. A strong osteoporosis develops to the bones of the wrist and cyst.
Injury of large main vessels, followed by intracavitary hemorrhage, such damage can lead to the development of long-term complications.
Complete or partial muscle rupture, or muscle detachment from the attachment points to the bone tissue, leads to the impossibility of subsequent arbitrary movements by that part of the limb, the movement of which was performed by the affected muscle.
Acute infectious complications, with open fractures, an infection can enter the wound, which in turn can lead to the formation of acute osteomyelitis. This pathological condition is manifested in the form of purulent melting with a bone tissue with a high temperature and intoxication.
The long-term consequences of the injury include:
Ischemic contracture - impaired mobility of the joints of the affected limb due to an incorrectly imposed cast bandage that compresses soft tissues disrupting the blood supply, and as a result, spikes are formed, which disrupt the mobility of the involved joints. Distortions of the bone structure due to inadequate repositioning, an incorrectly imposed plaster bandage can hold the bone fragments not well enough, and during the time necessary for healing they will assume the wrong position and in this position they will be fixed with a proliferating bone tissue.
Distant infectious complications, as a rule, are manifested in the form of chronic osteomyelitis. This chronic purulent-septic disease develops as a result of penetration into the bone tissue of an infectious agent, which in the course of its life begins to gradually destroy the bone tissue forming purulent cavities in the bone. The presence of these cavities causes intoxication, pain in the affected bone, and can lead to a pathological fracture, due to a decrease in the strength of bone tissue in the affected area.
The long-term consequences of hemarthrosis, if there is a radial bone inside the joint fracture, blood is inevitably entering the joint cavity. Blood in the joint leads to the formation of a fibrin clot, and this protein aggregation adheres the joint surfaces from the inside, and the person can no longer freely, fully bend the affected joint.
Edema after fracture of radius
Edema at the site of injury is a typical sign of bone fracture, and trauma of the radius is no exception. Let's consider more detailed, than it can be dangerous at such fracture, and what with it to do. In most cases, swelling is not a significant hazard, but you do not need to treat it lightly.
If we do not take into account the magnitude of the growing edema when the cast is applied, then its increase in the enclosed space of the gypsum lingeta will lead to squeezing and tissue ischemia, which, in turn, can cause the formation of ischemic contracture.
No less dangerous complication, a tight Turner swelling, as a result of which the patient loses the ability to move the brush, and without timely medical assistance, this can lead to a prolonged loss of mobility in the affected joints.
Related: How to relieve swelling at home?
It should be closely monitored for the condition of the brush and tissues visible from the gypsum langettes, since the presence of edema, under the bandage, is difficult to detect, and its continued existence is dangerous not only for ischemic but also for thromboembolic complications. That is, in the region of the edema, because of the slowing of the blood flow, blood clots can be formed, which can later move along the vessels, and lead to serious health problems.
Treatment of a fracture of a radial bone
Treatment of a fracture of a radius, as well as any other fracture develops of following stages:
the First help, can turn out to be any person, even without medical education. The purpose of first aid is to reduce pain, ensure rest of the affected limb, prevent damage to the soft tissues surrounding the fracture site. If the fracture is closed, then it is necessary to fix the limb in a safe position, if a fracture open, it is necessary to stop the bleeding and put a protective bandage on the site of the injury. After that, measures should be taken to transport the patient to a medical facility.
The first medical assistance is provided by a doctor or other specialist with a medical background. It is performed directly at the injury site or in the emergency room. The task of assistance, at this stage, is to assess the condition of the victim in order to determine the extent of further treatment and to prevent the development of further complications. To do this, you should evaluate whether the patient has a fracture of the radius, to differentiate it from dislocation and stretching. After confirming the fact of the fracture, the patient is immobilized limb, the task of this procedure is to prevent the displacement of fragments of the injured bone. If the patient is in the emergency room, then a decision is made about the necessity of his hospitalization in a hospital or treatment at home.
Qualified medical assistance is provided by a physician as a traumatologist, the task of this type of care is to restore the anatomical and functional integrity of the injured limb.
It is necessary not only to properly join the bone, but also to ensure the mobility of all fingers and brushes, to preserve their sensitivity. This goal can be achieved in three ways:
Therapeutic treatment of fracture of the radius. This technique refers to the most ancient, but still effective. We received information that about 5 thousand years ago people knew the methods of conservative treatment of fractures, and they actively used them. This is also evidenced by archaeological finds, where on the bones of skeletons we see traces of the professionally restored fracture sites.
The essence of this method of treatment is as follows: bone fragments by the hands of a traumatologist are exposed in such a way that their position coincides with the structure of the bone as far as the moment of trauma. Then, the bones in this position are fixed with a gypsum or polymeric bandage, and the limb is in it, until the callus is formed, and the bones will not again be a single whole.
The method is the safest, but in about 20% of cases the fractures grow unevenly and the curvature of the broken bone is observed, often it is invisible to the patient, but in some cases leads to serious problems.
Closed or open reposition, followed by fixation with knitting needles. This method of treatment, compared with the therapeutic treatment of fractures, is relatively young, and actively began to be used only in the late 19th century. The essence of the method is as follows: through bone fragments through the skin or by making an incision through the needles, or by applying a plate, and fixing the parts of the bone with the bolts in the same position.
Advantage of the method is its highest reliability, bolt fixation, metal needles, all this is done under the visual control of the surgeon, the bones are always fixed in the correct position. However, this technique is not without drawbacks, firstly, it is still an operation, and it has all the typical risks for the operation, secondly, the metalware is a foreign object, and sometimes they are rejected by the body, which leads to serious complications.
With external fixation device. This method of treatment of fractures is the youngest, for the first time such a device was patented in the USSR in 1952.At its core, the technique is a setting on the limb of a patient of the percutaneous apparatus of compression-distraction osteosynthesis.
Simply put, spokes are inserted through the skin of the patient into the fragments of broken bones, then these spokes are fixed on a special cylindrical frame into which the limb of the victim is placed, the fastening of the spokes on the frame is mixed so that the parts of the broken bone are in a position repeating the structure of the healthy bone,then all this is fixed, and the formation of a callus that will connect the damaged areas is expected.
This technique allows to completely restore the bone structure even after the most complex fracture fractures, but there is a risk of infectious complications that penetrate the patient's body along the spokes passing through the skin.
By topic: 12 folk methods for home treatment
Rehabilitation after fracture of radius
Complete recovery after fracture of the radius, is not only to restore the structure of the bone, but also in the complete restoration of limb function, in particular mobility and sensitivity.
Even with fully adequate treatment, prolonged preservation of immobility in the joints and muscles of the upper limb leads to the fact that it is difficult for a patient to make movements, in joints that were previously easily accessible to him. The process of recovery from trauma takes a long time, and requires the patient to work and patience. Let's look more closely at what needs to be done for a complete recovery.
How to develop a fracture of the radius? Exercises
To develop joints and muscles in the fracture of the radius should start as early as possible, the timing of the beginning of these activities depends heavily on what your fracture is, and what method of treatment was used by the doctor in its treatment. If the fracture is treated conservatively, then after 3-5 days, after the edema subsides, you should start to practice the fingers of the hand.
Begin the exercises with passive movements, take a healthy finger on the broken arm and gently begin to bend it in all the joints, knead this way for 5-7 minutes 3 times a day, all fingers except the big one. After a week of such training, you can move to active movements, the patient can start on his own, without the help of the second hand to bend fingers. It is very important to correctly distribute the load, if pain develops during the exercise, or the swelling recurs, exercise should be stopped.
If after a week the swelling does not subside, and the exercises with the fingers cause pain, then you should consult a doctor, such a problem is a sure sign that the plaster cast applied to you does not provide a reliable fixation of bone fragments.
Simultaneously with the beginning of passive movements in the fingers of the hand, it is necessary to start active movements in the elbow and shoulder joint, raise and lower the arm, bend it at the elbow, do these exercises for 3-5 minutes at least twice a day. Gradually increase the load.
After 3-4 weeks, if active movements of the fingers of the hand do not cause pain, begin to increase the load on these joints, take a clot of plasticine and start kneading it in the fist, do this as often as possible, within a week. After you have removed the cast, you can proceed to exercises with a carpal expander, deal with it no less than 3 times a day, for 5-7 minutes.
It is very important to perform exercises on fine motor skills, by the end of 4 weeks, start painting or writing with the affected hand, if you could not do it earlier, then try to sort through one grain of rice or buckwheat, this will allow you to save not only strength and mobilityjoints, but also the coordination of finger movements. You can print the text on the computer keyboard as an exercise for coordination.
If you, while you have a gypsum board installed, will perform all these exercises, then after its removal, the rehabilitation period will be significantly reduced.
LFK with fracture of radius
In the process of recovery the thermal procedures play a role, heating can be performed in many different ways, but the temperature should not exceed 39-40 degrees Celsius. You can do it at home without any difficulty, put in a plastic bottle of 1 liter of water with a temperature of 39 degrees, take it into a healthy arm, and gently roll it along the affected forearm, do similar movements for the back and face, repeat them while the water is inThe bottle will not take body temperature.
If possible, it is highly desirable to add regular massage of the affected limb to the main exercises of exercise therapy.
Physiotherapy can significantly alleviate the unpleasant manifestations of the disease experienced by the victim.
For treatment in this case, the following procedures are used:
Exposure to the ultra-high frequency electromagnetic field. During the procedure, the patient's tissues begin to warm up, the patient feels heat, regeneration accelerates, the pain weakens.
Exposure to the electromagnetic field of low frequency. During the procedure, the edema decreases, the discomfort and pain decrease.
Irradiation of the site of fracture by ultraviolet, UV irradiation provokes an increase in the synthesis of vitamin D, which is necessary for absorption of calcium from food in the digestive tract.
Calcium electrophoresis on the area of trauma. Under the influence of the magnetic field, the charged positive calcium ions penetrate through the skin into the patient's tissues, the increase in the calcium concentration promotes the acceleration of the construction of bone tissue, and as a consequence facilitates the restoration of damaged bone tissue.
It should be remembered that although physiotherapy techniques seem harmless, they should not be used without prescribing a physician, uncontrolled prescription of physiotherapy can lead to serious problems and significantly slow down the recovery process after a fracture of the radius.
The diet plays an important role in the recovery process after fracture, it should include a sufficient amount of protein food, it is highly desirable to add calcium supplements to the usual diet.
Calcium preparations can be replaced with conventional products, make up for the deficit, which is important for the construction of bones, the material you can with the help of fish and cottage cheese. If you prefer fish, then use small fish that you can eat with bones.
Learn more: What can and can not be eaten with a fracture?
It is very important to remember that calcium is poorly absorbed from the intestine if the body lacks vitamin D. Observing all these not difficult recommendations, you will restore your health completely without problems.
Author of the article: Aleksandr Sergeevich Kaplan, Trauma Physician, orthopedist
LFK after fracture of radius
In fractures of the arm, the radius of the arm suffers most often. First, it has a thin lower part, located near the wrist. Secondly, when a person falls, he instinctively puts forward his arm for insurance, and the main burden is on it.
Completely working capacity of the hand is restored after 1-1.5 months after the removal of gypsum, but you need a rehabilitation period. It includes the provision of therapeutic massage and physiotherapy procedures that improve blood circulation and reduce muscle atrophy. These same tasks are performed and therapeutic exercises, which can be done already 3-4 days after the removal of plaster from a sick hand.
Gymnastics in water after a fracture of a radial bone
It will help to remove a pain and an edema, during water exercises the load on an arm or a hand is reduced to a minimum. To complete the complex, fill the pelvis with water and immerse the hand in it with the palm of the hand down. Bend and unbend the palms, then lower them to the bottom of the pelvis and turn up and down.
If you do not use the elbow joint, lean your palms on the bottom of the pelvis, lift up and lower down the hands, make them circular motions. A healthy hand should wrap the patient around the wrist joint for insurance.
Exercises repeat 4-6 times, it will be enough to do them 2 times a day.
When this complex is mastered, it's time to move on to the next stage.
Exercises LFK at the table
- Sit at the table, place your elbows on it, place a small flat litter under the brush. Brushes bend and unbend, then lead and remove, perform a circular rotation.
- Place the hand on the table with the edge, gradually tilt the arm outward so that the first finger first lay on the table, then the unnamed one, then all the next fingers of the
- . The starting position is the same - the edge is on the table with the edge. Turn it inward until all the fingers are on a flat surface.
- The elbows rest against the table, the palms are in tight contact with each other, tilt them first to the left, then to the right( movements go to the right wrist, then to the left one).
Warm-up of fingers after fracture of radial bone
It allows you to include the muscles of the forearm. Put your palms on the table and alternately lift each finger of the hand 5-10 times. Then remove the brush from the table( 5-10 times).
Spread your fingers without lifting them from the surface of the
The back of your hands touches the table, and your fingers are clenched into a fist.
Hands have an edge, wipe in a circular motion of the thumb about everyone else( as if sprinkling a dish with salt).
Turn the hand with your palm upward. Simulate your fingers playing the piano, it looks like this: squeeze the hands of a pencil and, in turn, tear off each finger from it, if it's hard to do, help yourself with a healthy hand.
The good news is that the radius can quickly recover from injury. You just have to be patient, and do exercises every day for half an hour. They should be done gently so as not to injure the hand.
Exercises after a fracture of a radial bone
Bone fractures occur in people of different ages. The most risky people of the older generation. Due to age-related changes, calcium in the body becomes inadequate, and bones acquire increased brittleness. Particularly affected by frequent fractures are patients with osteoporosis.
- How to prevent fractures
Fracture of arm radial
Fractures of the radius can be formed in a typical and atypical location. The fracture in the wrist area is typical. It can be with or without bias.
If a fracture occurs, you must immediately contact the emergency department. The patient must make an x-ray - a picture. The doctor on the basis of the picture will lay down the broken bone and fix it in the gypsum. After a certain time( about a month), the gypsum is removed. A second X-ray is taken at the fracture site to make sure that the bone has grown properly, and no displacement has occurred.
Exercises for wrist in water
After removing the plaster, it is necessary to develop a broken and newly matched wrist. We must be prepared for the process of recovery to be painful. A warm bath will help to remove the pain.
Pour water into a basin or other container, where not only the hand can be placed, but also the forearm. The temperature of the water should not be below 35 C. You can do the following exercises:
- Immerse the hand to the middle of the forearm into the water, put the palm to the bottom. How can you more vigorously bend and unbend your arm in the area of your wrist. Repeat this exercise should be at least six times.
- Place your hand to the elbow on the bottom of the container with your palm facing down. Alternately, turn your hand up with your palm, then palm down so that it touches the bottom. Repeat the exercise at least six times.
It is enough to do such exercises once a day.
Exercises help to normalize blood circulation in a traumatized place and quickly restore muscle fibers.
Wrist exercises at the table
Restorative procedures can be done at the table during the execution of some work, alternating the occupation and physical movements by hand. A few simple exercises will help to quickly restore the full functions of a broken arm. Here are some of them:
- put your hand on the surface of the table. Do flexing and unbending movements with a brush, turning the hand up and down;
- position the brush with the edge on the table surface, slowly turning the palm, touch the fingertips of the table on both sides of the palm;
- elbow hands put on the table and fold the palms backwards. Alternately, without opening the palms of your hands, bend your hands in the area of the wrist in one direction, then the other;The
- hand is on the table in the palm-down position. You should not only develop your wrist, you can lift each finger individually and lower it. Since after a fracture often there are swelling on the fingers and palms, this exercise will help strengthen the phalanges and reduce swelling;
- put on the table hand down the palm. Push and slide your fingers, sliding them on the surface of the table. Repeat such movements to a feeling of easy fatigue;
- elbow to put on the table, palm raised up. With the thumb of the hand, consistently touch the other fingers, reaching the little finger - and back;
- hand put your palm up. Straining his arm, squeezing his fingers into a fist and unclenching. Repeat until the hand is tired.
After a while, you should increase the load, complicating the exercises and increasing the number of movements. At this stage of rehabilitation, it is advisable to do additional work for the hands. For example, it helps to develop fingers and wrist crochet. Do not be afraid of unnecessary burden on the hand and feel sorry for yourself, feeling the pain. Physical exercises will only help to restore the motor activity of the hand more quickly.
If you repeat the exercises every day, then recovery from a fracture of the radius will be promoted more actively by accelerating blood circulation and activating the muscles of the arm. So you can quickly return to the normal life course.
How to prevent fractures
In order to avoid fractures, simple rules should be observed. Here are some of these rules:
- walk where there is good lighting;
- you need everyday shoes to choose with a non-slip sole and preferably without a heel;
- in winter on a slippery road try to go slowly;
- before crossing the roadway, see if moving vehicles are approaching;
- ensure the constant replenishment of calcium in the body to strengthen the bones. At a certain rate, calcium is especially needed by children;
- sometimes exercise feasible physical loads, allowing to strengthen the skeleton and muscles of the limbs;
- to lead an active and healthy lifestyle.
Any trauma, especially fracture, disrupts the normal rhythm of a person's life. As they say, knocked out of the rut. To prevent this, you need to be more attentive and have a certain sense of caution.Topic: Published by Belka on Fri, 01 /24/ 2014 - 00:41.
Re: Exercises after a fracture of a radial bone
Since the removal of gypsum my mother has already passed six months, and the hand still makes itself felt. As it turned out, fracture of the radius is not so simple, and the rehabilitation period can be quite long. The procedures that are prescribed in the polyclinic: paraffin, massage and exercises. At home, as exercises, you can still squeeze a small rubber ball, toss it and catch it with one hand. If there is fitball, then you can press on it with your hand, as far as possible.
In terms of the number of affected bones, fractures are distinguished:
- isolated - one bone is injured;
- multiple - several bones affected;
- combined - damaged bones and internal organs.
Fractures of the radial bone sharply reduce the capacity of patients and are manifested by sharp pain in the forearm and edema. Depending on the type of fracture, the symptomatology can be supplemented by the presence of a hematoma, tissue rupture with the exit of bone to the wound, the presence of deformation in the fracture area with intact skin, etc.
Diagnosis is based on questioning, examination, palpation, the presence of pathological syndromes( crepitus,pathological mobility), as well as a complex of instrumental-diagnostic results.
Principles of treatment of fractures of a radial bone
The purpose of treatment is restoration of anatomic integrity of a bone and function of the damaged department.
There are two types of fracture treatment: operative and conservative. To surgical interventions try to resort in extreme cases and in the presence of certain indications for this method of treatment.
Radial fractures are classified according to the traumatic factor and individual characteristics of the patient's body.
Below are some of them.
Fracture without displacement of fragments is most favorable for the patient, does not require surgical intervention and allows the patient to recover quickly. Occurs at different radial bone heights. With an isolated fracture( with the integrity of the ulna), its diagnosis is difficult. Treatment consists in fixing the place of fracture with a double-lingual cast strip and then replacing it with a circular gypsum dressing.
Fracture with displacement of fragments in certain cases requires osteosynthesis( bony, transosseous or intraosseous) with plates, screws, screws or wire seams.
In the presence of extra-vertebral fractures without fractures under local anesthesia, a manual reposition of the fragments is performed and a double-lingual gypsum dressing is applied. After the fall of the edema, it changes to a circular gypsum bandage until the end of the immobilization period.
In some situations, fractures of the radius are combined with a dislocation of the ulna. In this case, in addition to repositioning the fragments, the ulnar bone must be inserted.
Immobilization: fixation with a plaster bandage from the base of the fingers to the upper third of the shoulder in the physiological position.
Radial fractures in the neck and head are of the following types:
- without displacement of bone fragments;
- comminuted fracture with displacement;
- intraarticular fracture.
First of all, you need to diagnose a fracture and find out if there is a displacement of bone fragments. After that, tactics of treatment is built. If there is no displacement of the fragments, a conservative treatment is prescribed, consisting in anesthetizing and applying a plaster bandage. If there is a displacement of the fragments or fragmentation of the head of the bone, surgical treatment is necessary, consisting in carrying out osteosynthesis.
When crushed or fractured fracture of the radial head, it can be removed. However, such measures are not practiced in children, so as not to affect the area of bone growth.
One of the most common injuries of the forearm is fracture of the radius in a typical place. Then the fracture region is localized in the lower part of the ray. This damage is obtained by falling on an elongated arm with a bent or straightened wrist joint.
Immobilization: from the metacarpophalangeal joint to the upper third of the forearm. Term: from 1 month( fracture without displacement of bone fragments) to 1.5-2 months( with displacement of fragments).
Therapeutic gymnastics: breathing exercises, gymnastic complexes for joints free from plaster bandages with obligatory involvement of fingers.
Postimmobilization period: exercises are performed in front of a table with a smooth surface to facilitate the sliding of the hand. Useful exercises in warm water, as well as household loads, in particular self-service. It is necessary to exclude the use of weights and vises. Very useful massage of the affected limb.
Very often the fracture of the radius in a typical place is combined with the detachment of the styloid process. The diagnosis is made according to a survey, examination, palpation( crepitation syndrome fragments), as well as the results of an x-ray study.
The dislocation of the styloid process in the fracture can be not only in the back or palmar region, but also at different angles. The tactics of treatment are selected strictly individually in each specific case after the X-ray study, and in some cases - computed tomography.
One of the treatments for this fracture is the manual reposition of fragments under local anesthesia followed by gypsum immobilization of the limb. However, this approach can lead to a secondary displacement of bone fragments, which will complicate further treatment of the fracture.
General methods of rehabilitation after fracture of radius
Rehabilitation of forearm fracture with various types of fractures in this anatomical area varies slightly. It is important to know the general directions of recovery measures and to vary the methods depending on the characteristics of a particular fracture.
First period: immobilization of
In case of a fracture of the radius after comparison of the bone fragments, a plaster bandage is applied from the base of the fingers to the upper third of the shoulder. The hand should be bent at the elbow joint at an angle of 90 degrees and be supported by a scarf. Time immobilization: with an isolated fracture of the radius - 1 month, with multiple fracture( radial and ulnar bone) - 2 months.
During this period, exercises of therapeutic gymnastics for the joints free from gypsum bandages are performed: active, passive and static, as well as imaginary movements( ideomotor) in the elbow joint.
Physiotherapeutic measures from the third day after the injury: UHF-therapy on the fracture area, magnetotherapy and ultraviolet irradiation. It should be taken into account that UHF-therapy is contraindicated in the presence of metal structures in the area of exposure. For magnetotherapy, this factor is not a contraindication.
After 1.5 weeks after fracture, magnetic stimulation of muscles and affected nerves, pulsed EP UHF, infrared laser therapy( directly through the gypsum dressing) or red laser therapy( in the gypsum cut out the holes for the radiator) is applied.
Massage of the collar area, general ultraviolet irradiation.
Second period: removable orthosis
After the plaster bandage was replaced with a removable gypsum orthosis, the gymnastics should be aimed at preventing the occurrence of contracture in the joints: all joints are consistently worked from the fingers to the shoulder. Added ergotherapy: restoration of self-service skills. During this period, very useful: massage, thermal physiotherapy, therapeutic gymnastics in warm water( hydrokinesotherapy), mechanotherapy.
The thermal regime in water exercises should be gentle. Water temperature: 34 to 36 ° C.Gymnastics is performed with a completely immersed hand in the water( forearm, hand).Hydrocinesitherapy is prescribed after removal of the plaster bandage.
Attention is paid to all joints from fingers to elbows. At the initial stages the patient helps himself to do exercises with a healthy hand. All movements must be performed before the pain syndrome, and not through it.
The exercises begin with flexion and extension in the joints, then the reduction and withdrawal, pronation and supination are done.
It is possible to supplement exercises in water with exercises with soft sponges and balls, then the size of objects should decrease. To train fine motor skills, the buttons that the patient must grab and catch in the water drop into the water.
Physical factors used in the postimmobilization period: paraffin applications, electrolysis of lidase, potassium, lymphase phonophoresis, muscle electrostimulation, salt baths.
Third period: without fixation
In the third stage, when fixation is not required, the load on the affected limb is not limited. When performing a complex of exercise therapy, additional equipment for burdening, as well as vises and resistance exercises, is used. In this period, emphasis is placed on the complete restoration of the limb and the elimination of residual fracture phenomena.
Therapeutic physical training includes complexes of gymnastics, mechanotherapy and hydrokinesotherapy.
Hydrocinesitherapy: the exercise is conducted as at the last stage, but is supplemented by the implementation of household manipulations. They are designed to increase the amplitude of movement in the joints and allow the patient to expand the scope of exercises: imitation of washing hands and dishes, washing and squeezing, etc.
Physiotherapy is complemented by ergotherapy( restoration of household skills and self-service functions).
Complete restoration of the limb occurs in 4-5 months with an isolated fracture and after 6-7 months with multiple fractures.
Shock wave therapy
With badly growing fractures and the formation of false joints, shockwave therapy is prescribed. This method is based on the pointwise action of an ultrasonic wave in the fracture region to stimulate the processes of tissue regeneration and accelerate the formation of bone callus. This type of therapy allows you to speed up the rehabilitation time and in certain cases is an excellent alternative to surgical treatment.
Complications after fractures of the radius are triggered by the very nature of the fracture, the wrong treatment tactics, or the patient's actions. They are divided into early and late.
- Attachment of infection with development of purulent process with open fracture.
- Syndrome of Zudeck.
- Circulatory disturbance.
- Secondary displacement of bone fragments with improper application of a cast bandage or incorrect reposition of fragments.
- Damage of tendons, ligaments with the formation of diastase between bones or adhesions between tendons( the cause of stiffness in the joints).
- Turner's neuritis.