Identify the real problems with a radius fracture. Symptoms and signs of a non-displaced radius fracture: how long to wear a cast and how to develop your arm after an injury

Date of: 17.10.2023

Injuries to the distal metaepiphysis (DME) of the radius account for over 16% of all pathologies of the skeletal system. Fractures of the radius are common in all age groups, but women over 45 years of age are common victims of injury. Doctors attribute this to a weakening of the skeletal system and hormonal changes. A fracture of the radius in a typical location is not a dangerous disorder, but the speed of recovery is determined by the individual characteristics of the body and the age of the victim.

A fracture of the distal metaepiphysis is often accompanied by complications. These include the presence of many fragments and their displacement relative to each other, damage to the muscles of the nerve fibers. A comminuted fracture of the radius is aggravated by muscle activity - arm movement is accompanied by muscle tension. Each pulls the fragments in its own direction, the functions of the limb are impaired. Damage to the lower third of the radius is often accompanied by dislocation.

The most common fracture is the radial head. It occurs when a fall occurs with simultaneous movement of the forearm. Trauma is typical for the distal head. This type of damage can be regional or central. Among fractures of the radius in a typical location, a special place is occupied by injuries that split the bone in half. Another group of injuries includes fractures of the neck of the radius, and in childhood, injuries to the periosteum with pathology of the growth plates are observed.

Among displaced fractures, the impacted fracture stands apart. It occurs due to a fall on the hands, when one bone seems to enter another. The two elements form a single bone with a connection at the bend. Often this is a closed fracture of the radius without significant soft tissue contusion.

Injuries to the left hand account for fewer injuries, and intra-articular fractures of the right bone are observed more often due to the fact that the hand is the leading one, that is, the supporting one. With reverse recoil, a fracture of the styloid process occurs.

According to the specifics of injuries, they are distinguished:

oblique injuries - occur when falling on a bent palm;
spiral - characterized by displacement as a result of bone movement;
longitudinal - are the result of compression effects;
transverse - occur due to a direct blow.

A closed fracture of the radius without displacement is characterized by bruises, but without tissue rupture. An open fracture is quite common and is accompanied by displacement of fragments.

Trauma code according to ICD 10

In the international classifier, such injuries are assigned code S52. For a fracture of the radial head, S52.1 is assigned. If there is an injury to the diaphysis of the ulna or radius, then codes S52.2 and S52.3 are assigned, respectively. Other types of unspecified damage are designated S52.9.

Causes

Injuries can occur due to accidents, failure to comply with safety regulations at work, or due to negligence. The majority of fractures occur as a result of falls. If there was a fall with support on the palms, then they arise. In the event of a direct blow, a fracture of the radius bone of the arm in the middle is guaranteed. Among the most common causes of injury:

falling of a heavy object onto an outstretched arm;
gunshot wounds;
osteoporosis and bone diseases;
extreme sport;
calcium deficiency in the body.

Pathological injuries occur as a result of exposure to minor forces. In such cases, the bones are destroyed even with slight compression. Endocrine disorders, oncology, and osteomyelitis can cause weakening of bones. Fractures of the styloid process of the radius and damage to part of the hand are observed due to some resistance upon impact. A driven fracture occurs as a result of significant force or a fall from a great height.

The causes and types of fracture determine the symptoms and first aid. with displaced fragments are accompanied by severe pain and are more difficult to treat. These fractures occur as a result of serious accidents or while working with heavy equipment.

Symptoms

Hand injuries are often combined with dislocations, bruises, and hemorrhages. One of the most characteristic signs of destruction of the integrity of bone tissue is deformation of the limb. In some cases, cracks in the bone diaphysis occur. In this case, the anatomical shape of the hand is preserved. Signs of a fracture include:

swelling and swelling at the site of injury;
pain on palpation and movement;
hematomas;
decrease in blood pressure.

If the arm is swollen, this is not always a symptom of a fracture. This is how a bruise or... When numbness is added to the swelling of the arm after a fracture of the radius, damage to nerve fibers and muscle tissue is possible. The symptoms of an open fracture are more pronounced. Rupture of blood vessels and skin increases the risk of infection. In this case, the fingers also become numb and the bone is severely deformed.

A fracture of the radial head leads to pathological mobility and crepitus. Swelling in the area of the injury may spread to the entire arm. The functioning of the limb is severely limited. If accompanied by rupture of blood vessels, then it is not possible to feel the pulse in the artery.

Due to a violation of the outflow of venous blood, the hand may turn blue. This condition is especially dangerous as soft tissues and blood vessels begin to die.

Symptoms largely depend on the location of the fracture. With an impaction injury, the injured limb becomes shorter. The functions of the entire arm are impaired, the patient cannot move his fingers, or efforts are difficult for him and result in unbearable pain. The situation is aggravated with fragmented trauma. Thus, fragments destroy internal tissues and damage blood vessels. It is necessary to minimize the negative effect of the traumatic factor on the bone and provide adequate assistance to the victim.

First aid

With minimal trauma, the patient can be transported to a medical aid station independently. In case of serious injury, an ambulance is called. Before the arrival of specialists, the injured arm is immobilized. Basic care and rehabilitation are carried out in a hospital setting. You can give the victim painkillers on the spot and apply ice to reduce swelling.

First aid for suspected fractures involves fixing the elbow. All jewelry should be removed from the hand; the hand should be held at an angle, unless we are talking about an impacted fracture of the radius and ulna. Select a suitable splint, apply it from the elbow to and bandage it. In case of damage to the hand, a splint will help out.

If a fracture of the head of the radial bone is accompanied by a rupture of the skin, then antiseptic treatment is carried out, which avoids infection. In case of an open injury, protruding fragments stick out, but no manipulations can be performed with them, otherwise the fragments will move.

To prevent complications from arising after a fracture of the radius, it is necessary to provide rest to the limbs. When the vessels and nerves of the forearm are damaged, arterial or venous bleeding may occur. In the first case, you cannot do without applying a tourniquet. For a thief, a pressure bandage is enough. To avoid possible consequences, the victim is urgently taken to the hospital. The tourniquet is not left on the limb for long, since necrosis begins after 2 hours of bleeding.

Diagnostics

The main method of instrumental diagnosis for a fracture of the radius in a typical location is radiography. In the photographs in two projections it is possible to see the localization of the damage and associated injuries. X-ray diagnosis of radial bone fractures is considered an informative method, on the basis of which the optimal treatment is selected.

The traumatologist palpates the arm, assesses the condition of the muscular and vascular systems, and feels the pulse. MRI is recommended for suspected distal epimetaphyseal fractures with extensive damage to the radius. Ultrasound is prescribed for hematomas and edema to detect blood accumulation.

CT and radioscopy are considered informative methods. With their help, it is possible to see accompanying disorders and the smallest defects, which eliminates diagnostic errors.

Treatment

Only a traumatologist can tell you how to cure a fracture in a specific situation. You should not rely on folk remedies to treat a fracture. Due to the lack of qualified assistance, complications arise. A consolidated fracture is a typical manifestation of inadequate therapy. As a result, the fragments splice on their own, but not always correctly, which is why. It reduces the functionality of the hand and makes the bone tissue vulnerable. Due to improper fusion, contracture occurs - stiffness or complete immobility.

For uncomplicated wounds, closed reduction of the fragments is performed, followed by the application of plaster. This is the most common treatment for radius fractures. The fragments are compared under radiological control, which eliminates errors and improper fusion. Plaster application is carried out after reposition. The arm is bent at the elbow and brought towards the body. Further treatment takes place at home.

An avulsion-type fracture of the styloid process requires precision in matching the fragments. Fracture reduction may be open if the injury passes through the joint. The main treatment method is long-term immobilization with X-ray control. During surgical reduction, an orthosis rather than a cast is used.

Surgical treatment

It is injuries to the styloid process of the radius that often require surgical treatment. The operation involves fixing the fragments with screws or plates. With severe fragmentation, not all the fragments can be collected. In this case, part of the bone is artificially grown.

Indications for the operation are:

associated damage to blood vessels, muscles, nerves;
comminuted fracture of the radius with significant displacement;
fracture of the radial head with dislocation;
improperly healed fracture.

One of the methods of surgical treatment is restoration of the radius using the Ilizarov apparatus. After the operation, the needles remain in the hand. They are removed after the fragments have fused. Repeated surgery is required if the reduction is incorrect. In this case, the healing time of the displaced fracture of the radial bone of the arm will be longer, but the arm will still retain a certain vulnerability.

Long-term immobilization for a fracture of the head of the radial bone of the elbow joint is not required. In the case of a fracture of the ulna and radius, the healing period will take 2-3 times longer. The general terms of treatment, as well as accompanying procedures for recovery, are determined by the doctor based on the clinical picture.

How long to treat and wear a cast

The healing time for a fracture of the radius of the arm with conservative treatment takes from 4 to 10 weeks. How quickly the hand can be restored to health is determined by the specifics of the injury, the patient’s age and the individual characteristics of his body. In young people, the healing time of a radial bone fracture is always shorter, as are the negative consequences. In old age, tissues recover more slowly, and in the presence of diseases of the skeletal system or increased fragility, problems arise.

The plaster can be removed when the bone has completely healed. If the radius is damaged, it takes 8-10 weeks. In case of simultaneous dislocation and complicated wounds, the plaster is left for 2 months. If the radius bone is not displaced during an arm fracture, 6 weeks of immobilization is sufficient.

How long to wear a cast for an open fracture of the radius depends on the treatment method. Surgical reduction does not require long-term immobilization. Traditionally used, which limits movement mainly in the hand.

If your arm hurts after a fracture, then analgesics are prescribed, but obsessive pain indicates problems in therapy. If your broken arm hurt after the operation, then after a few days the discomfort should go away. Pain can be caused by inflammation. That is why antibiotics and immunity drugs are prescribed for open reduction.

Rehabilitation

In the case of surgery, rehabilitation after a multiple fracture of the radius with displacement takes 6-8 weeks. Not least important are the scale of damage and the complexity of surgical procedures. Fractures heal more easily after falls. The recovery period after road accidents and disasters is more difficult. Rehabilitation methods influence hand recovery. Patients are recommended to develop the limb under the supervision of a specialist.

At the first stage of rehabilitation after a fracture of the radius bone of the arm, minor loads are given. Forcing the process leads to repeated injuries, because the bone remains vulnerable to external influences. . Correct nutrition.

At this time, the body needs protein foods, vitamins and minerals. It is especially useful to consume aspic, fermented milk and seafood after a fracture of the radius. The best source of vitamin D for humans remains fish oil.

Physiotherapy, balneotherapy, and gentle massage will help speed up recovery after a complicated fracture of the radius. If the radial nerve is damaged, the rehabilitation period increases. How long it takes to fully recover depends on many factors. But immediately after removing the cast, you should develop your hand, restore blood circulation, and train weakened muscles.

Physiotherapy

Physical factors are fundamental at the rehabilitation stage. Physical therapy for an uncomplicated fracture of the radius is mandatory. But physical therapy techniques for fractures are so diverse that they deserve special attention.

Hardware therapy gives excellent results during the recovery phase. Physiotherapy after a broken arm includes:

low frequency magnetic therapy– activates molecular and cellular restoration. Anesthetizes, soothes, relieves inflammation and prevents swelling. Indicated after removal of the plaster. Conducted in a 10-day course of 30 minutes;
UHF exposure– treatment with a high-frequency electromagnetic field promotes the fusion of bones. The method is indicated on the 3rd day after the fracture. 10 sessions are enough for recovery. During the procedure, the tissues warm up, blood circulation improves, and atrophic processes are inhibited. Regeneration increases, bones grow together faster and without complications;
electrophoresis– calcium is traditionally used to increase the effectiveness of the main treatment. If radial bone fractures are caused by weakening of the musculoskeletal system, then this method is indispensable. The procedure is carried out from the second week after injury. Minimum duration of exposure – 20 minutes;
UV therapy– physiotherapeutic irradiation enhances capillary blood circulation, activates the production of vitamin D, prevents swelling and inflammation. Only 3-4 sessions are performed with an interval of 3 days.

Deserves special attention mechanotherapy. It helps develop the hand and restore its functionality. Exercise machines are selected taking into account the permissible load and the desired result. Hydrokinesitherapy has a similar effect, but it is not carried out in all institutions. Therapeutic gymnastics in the first days after injury is excluded, but therapeutic physical training techniques do not exclude passive gymnastics, which helps maintain finger activity and normalize blood supply to the injured limb.

How to develop an arm after a fracture of the radius

Gymnastics is aimed at developing muscles that have been immobilized for a long time. All techniques are available to patients. If it is better to do the exercises for the first time with a specialist, then during subsequent training sessions the help of a doctor is not required. It is important to follow a work and rest schedule so that the hand recovers gradually.

A set of exercises after a fracture of the radius includes:

clenching your hand into a fist - after removing the cast, this exercise will be the most useful. It allows you to disperse the blood, use muscles that were at rest, and without harming the joint. Working with a small ball or plasticine will help increase the effectiveness of classes;
fingering objects - it would seem that this is a simple exercise, but how many benefits it brings! Firstly, the accuracy of movements is honed. After the cast, the fingers, and the hand as a whole, do not want to obey. Fine motor skills training eliminates this problem. Secondly, the load on the joint is minimal, and the muscles work very well. As a result, blood supply improves and strength appears in the hands;
circular rotations - they help restore hand mobility. But you should rotate your hand smoothly and slowly. There should be no pain, but a slight crunch may accompany the workout. He will subsequently leave;
Raising and lowering the shoulders - this exercise can be done synchronously and alternately. The shoulder girdle is not directly related to the site of injury, but working it out will increase the motor activity of the limbs and relieve stiffness;
flexion at the elbow - you should alternately bend and straighten your arm, but this exercise is done after the limbs are functioning well. Such training is necessary to increase the functionality of the joint and relieve muscle tension during prolonged immobilization of the arm in a bent position.

When the first stage of recovery is completed, it is worth incorporating exercises such as clapping in front and behind you, raising your arms to the sides and up, interlocking your fingers behind your back. The load, like the training time, increases gradually. There should be no pain or discomfort during training.

Massage

If the radius bone is damaged, massage becomes the main element of training immediately after the injury. It is aimed at stimulating blood circulation, preventing atrophy, increasing muscle tone and relieving pain. Due to immobilization, tissues do not receive enough oxygen, which has a bad effect on bone healing and skin condition. In case of a fracture of the radius in a typical place, it is advisable to perform a gentle massage:

The injured hand is stroked with gentle movements up and down. There is no pressure. The fingertips gently run over the surface of the skin. This technique allows you to maintain sensitivity, improve capillary blood circulation and activate nerve receptors;
rubbing – involves more intense movements along the arm. We do not deprive attention of the side of the dorsal surface of the forearm. After the procedure, the hand turns slightly pink, which indicates improved blood supply to the tissues. There should be no aggressive movements;
pinching and pressing - they are best carried out using special massagers, for example, needle rollers. Since the cast eliminates the movement of internal and external rotation of the hand, there is no need to worry about possible damage to the hand during the massage. It will remain lying on a flat surface, and applicators and rollers with “bumps” will intensively affect the surface tissues, preventing stagnation;
at the final stage of the massage they return to stroking. They calm and relax. You can use special oils for massage, which will make skin care more effective and make it easier to glide during the procedure.

Massage can be done in case of a fracture of the radius in a typical place already on the 3rd day. But the doctor will tell you about all the necessary manipulations after the patient is discharged home. The main development of the arm will begin as soon as the plaster is removed, although the recovery period can be accelerated at the immobilization stage.

Complications and consequences

Due to improperly healed fracture of the radius, the majority of negative consequences occur. The functionality of the limb decreases sharply. Often the problem cannot be solved either by physiotherapy or intensive gymnastics. The injury has to be re-opened and repositioned. Secondary displacement occurs after restoration of bone fragments. An accidental movement of the patient's hand or a muscle spasm can cause fragments to come off. In the case of open reduction, such manifestations are excluded, because the fragments are fixed with metal structures.

The consequences of a displaced radius fracture also include stiffness. For example, the hand is not able to make a full rotation or there are problems with clenching the fingers into a fist. Damage to muscles and nerves are responsible for this. Post-traumatic dystrophy in medicine is called Sudeck syndrome. Most often it appears precisely after a trauma to the radius (more than 60% of cases). Early removal of the cast, application of a too tight bandage, or intensive exercise immediately after the immobilization regime can lead to such a complication.

This syndrome after a fracture of the radius in a typical place causes severe pain and causes immobilization of the joint. Bone structures and nerve tissues are involved in the pathological process. Severe swelling is observed, the skin changes color from red to bluish, and the bone becomes brittle. Drug therapy allows you to cope with the complication.

Negative manifestations of fractures of the radius in a typical location include: If healing does not heal properly after a fracture, a bone callus is formed. Bone fragments are smoothed out by friction, forming a false joint or pseudarthrosis after a fracture. The disorder is detected using radiography. The image shows pathological tissue and the gap between the fragments. Traditionally, the problem is solved surgically.

Among the complications after a fracture of the radius, synostosis is rare, but still occurs - fusion of the ulna and radius bones. Post-traumatic synostosis limits mobility. It is treated primarily surgically.

In the case of an open injury, infection cannot be ruled out. Pathogenic microorganisms multiply rapidly in soft tissues. Microbes can cause purulent inflammation and bone destruction. Osteomyelitis is considered a particularly dangerous complication of a fracture. That is why they try not to resort to open reduction in case of injury unless there is an urgent need for it. The vast majority of episodes of post-traumatic osteomyelitis are associated with surgical treatment.

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

A common injury to the forearm is a fracture of the radius. Diagnosed in 16% of cases of all bone lesions or in 40% of arm fractures. The radius is the most mobile part of the upper limb and is very thin, so it is easy to break. Damage to the area located near the hand (distal metaepiphysis) often occurs. In medical circles, such an injury is diagnosed as a fracture in a typical location.

Anatomical certificate

One of the two bones that make up the human forearm is called the radius. The ulna is located on the side of the little finger, and the radius is located on the outside of the arm, in front of the ulna. In its structure, it can be distinguished: the epiphyses (upper and lower), the bone body itself, which has a triangular shape. The surfaces are conventionally divided into posterior, anterior, lateral (side), and its edges are classified as interosseous, posterior and anterior.

The multifaceted motor function of the hand is possible thanks to the coordinated work of the joints. The forearm is crowned with joints at both ends. Where the radius and ulna meet together is the elbow joint. It is responsible for the process of extension and flexion of the arm, turning the forearm down and up. Where the bones adjoin the wrist, there is another joint - the wrist.

The bones of the proximal (remote from the body) row of the wrist (triquetral, lunate and scaphoid), as well as the radius, participate in the formation of this joint, and the ulna does not reach it, being supplemented by the articular disc. In its shape, it resembles an ellipse and provides extension and flexion of the hand, abduction and adduction. Rotational movements occur in conjunction with the bones of the forearm.

Causes leading to injuries

Due to the influence of external or internal factors, a fracture of the radius bone of the arm occurs with or without displacement. The most common causes leading to injury are:

work injury;
traffic accident;
sports injury;
falling from a height onto an outstretched arm;
osteoporosis.

Partial or complete disruption of the integrity of the bone is called a fracture. If the impact force exceeds its strength, the structure is damaged. This is due to excessive stress, a blow, a fall, or human diseases, due to which the bones become brittle or thin.

Important! Trauma to the beam also provokes a fracture of the wrist joint with or without displacement.

Classification of fractures

Like any other injuries, these fractures are classified depending on the degree of damage, the nature of the injury and its location.

There are closed fractures of the radius (in which the skin retains its integrity) and open (when, along with the bone structure, soft tissues are also damaged, and fragments come out).

If the injury did not cause displacement of the fragments, the fracture is classified as “without displacement.” When, under the influence of the force of an impact, the fragments separate, forming a gap of more than two millimeters between themselves, it is called a displaced fracture of the radius. The broken fragment will move under the influence of the muscles.

Based on the position of the injured person’s hand, fractures of the ray in the wrist joint can be:

extensor, which are also called Wheel fractures, when bone fragments are displaced towards the beam and to the rear;
flexion, better known as Smith fractures, when the blow falls on the bent hand, its back side, and the fragments move away towards the surface of the palm.

Often this injury is defined as intra-articular and is complicated by the separation of the styloid process (in more than half of the cases), which often entails a fracture of the wrist bone. In the case where the joint remains intact, they speak of extra-articular injuries.

A bone fracture occurs in a transverse or oblique direction. If there is a direct injury to the limb, then, most likely, a transverse injury will appear; in rare cases, a comminuted fracture may occur, in which more than three splinter fragments are obtained.

If the arm is compressed on two different sides, it is called a compression fracture. Under varied, strong pressure, the radius bone breaks into small fragments that affect the soft tissue around it. This type of damage has recently become more common. This is primarily due to technological progress, the emergence of vehicles, and automation of production.

A rare type of injury in this area is an impacted fracture, when one part of a bone fragment, under the force of impact, enters another fragment.

Main symptoms of injury

You can determine the presence of a fracture by knowing the main symptoms:

a characteristic crunching sound of bone fragments is heard (crepitus);
sharp pain upon injury and intense painful sensations that persist for a long time;
hematoma due to disruption of the integrity of blood vessels;
hyperthermia (increased temperature) of the affected area;
swelling;
if the bone fragments have shifted significantly, a bump or dent is visible in the wrist area;
redness of the skin at the site of injury;
in the case where the nerve endings have been affected, there is a loss of sensitivity in the fingers (numbness, tingling, feeling of cold) and their mobility;
increased pain with any attempt to move the arm or hand.

It is important to remember that even if after some time the painful sensations dull or disappear altogether, this does not mean that the damage is not serious. Do not forget that a displaced fracture of the forearm is a serious injury, and the treatment and recovery processes can take a long time, regardless of its severity.

First aid and diagnostics

In case of any damage, it is necessary to obtain qualified assistance from medical personnel. Injuries are not always as simple and insignificant as they seem at first glance. The victim must be taken to the nearest emergency room, and in difficult situations it is better to call an ambulance to the scene of the incident.

First you need to examine the injured limb. If clothing prevents you from doing this, you should not take it off. Any movements will provoke an attack of pain and can lead to displacement of bone fragments. It is better to carefully roll up or cut the sleeve. If there is damage to the skin, the wound is washed and treated with an antiseptic. A three percent solution of hydrogen peroxide will help stop the bleeding. The wound must be covered with a sterile bandage, which is applied very carefully and not too tightly.

A cold compress will help reduce pain and swelling of the injured limb. It is best to use ice. For convenience, it is first poured into a bag, and the bag is wrapped in a cloth or towel. Do not allow bare skin to come into contact with ice, as this will lead to negative consequences. If you don't have ice on hand, any food from the freezer or refrigerator will do. You can pour chilled water into a bottle and apply it to the damaged area. You should not keep the lotion for too long; after fifteen minutes you need to remove it for a while and after a while use the cold again.

Before transporting the victim to the hospital, it is necessary to fix the limb, immobilizing it as much as possible. Immobilization is carried out using a special transport ladder splint. If you don’t have one at hand, use suitable materials at hand: sticks, boards, pipes, thick strips of cardboard. You can attach the injured limb to an improvised splint using bandages, belts, or strips of fabric.

If the victim complains of unbearable pain, give him any non-narcotic painkiller (Ketanov, Tempalgin, Celebrex, Analgin, Brustan). These simple steps are enough to provide first aid; further treatment is carried out in the trauma department.

Diagnostics

The correct diagnosis can only be made by a traumatologist based on a thorough examination. First, an anamnesis is collected, which shows the mechanism of injury and the patient’s complaints about general health. Then the doctor examines the injured limb and checks its functional abilities by palpation. An important point in diagnosis is an x-ray examination, without which it is impossible to make an accurate diagnosis.

The image is taken in two projections for detailed visualization. Additionally, computed tomography or magnetic resonance imaging is prescribed. If neurological symptoms are detected, a neurologist (neurosurgeon or vascular surgeon) is invited for consultation, who will treat along with a traumatologist.

What you need to know about treatment

There are several directions in the treatment of radial bone fractures: conservative and surgical. The advisability of this or that therapy is determined only by the doctor based on the examination results, the nature of the injury and the individual characteristics of the patient (age, concomitant diseases).

Typically, non-displaced fractures are treated conservatively by applying a bandage (polymer or plaster). Fixation is carried out until the bone has completely fused to prevent displacement of the broken fragments.

If a displaced fracture is diagnosed, all fragments must be returned to their natural physiological position (reduced). Only after this the limb is fixed with plaster. Reposition is carried out under local anesthesia manually or using special devices (Sokolovsky, Edelstein and the like). The plaster cast is removed after about a month to a month and a half; during the entire period of treatment, several radiographic studies are performed to monitor.

In the event that it is not possible to carry out a closed reduction, the displacement of bone fragments is unstable and critical, or has occurred repeatedly, it is recommended to carry out surgical intervention, which is a closed reduction using special metal pins, or osteosynthesis. In modern medicine, there are two ways of performing osteosynthesis of the wrist joint:

transosseous - using a rod apparatus or an Ilizarov apparatus;
bone - when there is a need to use plates with angular stability.

External fixation devices (screws, plates) are rarely used. When treating children, doctors prefer the conservative method and resort to surgery as a last resort.

Rehabilitation

At the final stage of therapy, it is necessary to perform a number of rehabilitation procedures. If necessary, the attending physician prescribes a course of therapeutic massage, physiotherapy, physical therapy, water therapy or the use of an orthosis.

We should not forget about the correct diet. For a speedy recovery, the patient needs to include foods rich in vitamins and calcium in his diet. These include: dairy products, fresh fruits and vegetables, fish, honey, nuts.

Complete recovery after a displaced fracture of the radius occurs after at least two months in the case when healing proceeded without medical errors (incorrect or incomplete alignment of fragments, improper immobilization of the arm, lack of control over the recovery process) and complications.

Negative consequences of a fracture

A lack of calcium or other substances in the body will cause poor bone tissue regeneration. Prolonged inactivity of a fixed limb will cause muscle flaccidity, especially if the patient did not pay attention to physical training before surgery.

May be observed:

repeated displacement of broken fragments under plaster;
bone deformation;
neurotrophic abnormalities of the limb;
development of purulent-inflammatory processes (typical of open fractures);
disorder of innervation (supply of nerve cells) in the affected area;
vascular disorders under plaster.

Rotting of tissues in the area of installed metal structures is rarely observed. The plaster cast deserves special attention, as it should not dangle and at the same time compress soft tissues.

Following your doctor's instructions and taking a course of rehabilitation measures will help you recover faster and return to your normal pace of life.

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A fracture of the radius of the arm is considered one of the most common injuries.

It accounts for almost 16% of all injuries sustained at home. It is especially common in women during menopause.

The first mentions of fracture can be found in ancient medical treatises of Egypt and China. Even then, ancient healers paid attention to this type of injury and made recommendations for the treatment and rehabilitation of victims.

Fracture of the radius in a typical location

Traumatologists have such a concept as “fracture of the ray in a typical place.” This is because the vast majority of fractures (almost 75%) occur in the distal part of the bone (closer to the hand).

Fracture of the middle and proximal (located closer to the elbow) part of the radius occurs in only 5% of cases.

There are two types:

Smith, or flexor. It happens when a person falls on a hand bent towards the back of the forearm. As a result, the bone fragment of the radius is displaced to the outer surface of the forearm;
Wheels, or extensor. Occurs when the victim falls on the palmar surface of the hand. As a result, hyperextension occurs in the wrist joint, and the bone fragment is displaced towards the dorsum of the forearm.

As can be seen from the description, Smith's fracture and Wheel's are mirror images of each other.

Classification of injury

Depending on the nature of occurrence:

Pathological - occur not so much under the influence of mechanical force, but as a result of a decrease in bone mineral density. The disease, a clear manifestation of which is pathological fractures, is called osteoporosis;
Traumatic. They arise as a result of the impact of any mechanical factor on the bone: impact, fall, twisting, excessive physical activity, etc.

Depending on the violation of the integrity of the skin:

Closed fracture of the radius of the arm, when the skin over the injury site is not damaged;
Open. In this case, the integrity of the skin is broken, and bone fragments come out.

Depending on the fault line:

Any type of fracture can be with or without displacement of bone fragments.

There is also an anatomical classification:

Fracture of the diaphysis (body) of the bone;
Intra-articular fracture of the head and neck of the radius;
Fracture of the styloid process.

Symptoms

The injury is accompanied by a fairly clear clinical picture. The main signs and symptoms of a broken arm are as follows:

First aid for a fracture of the radius of the arm

There are three fundamental steps that must be carried out when providing first aid. These include:

Early immobilization (immobilization) of the injured limb;
Adequate pain relief;
Local exposure to cold;

Immobilization of an injured limb is the first step in first aid. Correct fixation of a limb performs several tasks at once:

Minimizes additional bone displacement;
Reduces the risk of soft tissue damage from fragments;
Reduces pain.

Before immobilization, it is important to free your hand from rings, watches, bracelets, etc. Otherwise, they can cause compression of blood vessels and nerves. To give a fixed limb a physiological position, it must be bent at the elbow joint at an angle of 90 degrees and brought to the body, turning the hand upward.

To minimize pain, you can use drugs from the NSAID group.(non-steroidal anti-inflammatory drugs). These include diclofenac, ibuprofen, ketonal, dexalgin, Celebrex, etc. The listed drugs can be taken in tablet form or as intravenous and intramuscular injections.

Local application of cold also reduces pain. In addition, under the influence of low temperature, vasoconstriction occurs and tissue swelling decreases.

Use cold for pain relief with caution so as not to cause frostbite. To do this, wrap heating pads or ice packs in a towel before use.

Diagnostics

Radiation diagnostic methods are the “gold standard” in the diagnosis of fractures. Most often in routine practice, radiography of the limb in two projections is used.

An X-ray will show not only the presence of a fracture, but also its nature, the presence of fragments, the type of displacement, etc. These data play a key role in choosing treatment tactics.

Sometimes traumatologists use computed tomography to diagnose complex injuries.

Treatment of radius fractures

Treatment tactics directly depend on the nature of the damage and are selected individually in each specific case.

In the case of a bone fracture in a typical location, treatment consists of closed reduction (“reassembly”) of the bone fragments and application of a plaster cast to prevent displacement. Typically the plaster cast covers the hand, forearm and lower third of the shoulder.

How long to wear a cast for a fracture of the radius of the arm? Immobilization lasts on average 4-5 weeks. Before removing the plaster cast, a control x-ray is required. This is necessary to assess the fusion of inert fragments.

Sometimes it may not be possible to treat an injury with a cast alone. Then resort to the following methods:

Percutaneous fixation of fragments with knitting needles. The advantage of the method is its speed and low trauma. However, with this treatment it is impossible to begin early development of the wrist joint;
Open reduction of bone fragments using metal structures. In this case, the surgeon makes an incision in the soft tissue, compares bone fragments and fixes them with a metal plate and screws.

Unfortunately, surgical methods have a number of negative aspects. First of all, there is the risk of wound infection. Therefore, after the operation it is necessary to take a course of broad-spectrum antibiotics. The second disadvantage of surgical treatment of fractures is the long rehabilitation period.

Recovery time

The duration of the recovery period depends on the complexity of the injury and is, on average, 6-8 weeks. The duration of recovery is influenced by factors such as the scale of the operation, the speed of wound healing, the state of the immune system, the presence of bone diseases, etc.

Often, the recovery process after a fracture of the radius is delayed due to the fact that patients neglect doctors’ recommendations, in particular, they independently remove plaster casts ahead of schedule. This is fraught with a number of complications, which will be discussed below.

If, after removing the cast, your arm swells, this is a normal process; you can find out how to get rid of swelling after a broken arm.

Rehabilitation and how to develop an arm after a fracture of the radius

Rehabilitation after a fracture should be carried out comprehensively and include massage, physiotherapy, as well as physical therapy. The success of treatment largely depends on how responsibly a person approaches each of the listed activities.

Massage

You can begin the restoration of a limb with a massage. Correctly performed massage after a fracture of the radius has an analgesic effect, improves recovery processes, and also prevents muscle wasting.

They start with a shoulder massage, then work with the elbow joint, and only after that they move on to massage the areas around the injury. Finally, a hand massage is performed. The duration of the massage session is about 15 minutes.

Physiotherapy methods

Physiotherapy plays an important role in rehabilitation. The following procedures are used:

Electrophoresis with calcium preparations. The essence of electrophoresis is the slow directed movement of drug particles deep into the tissue. Calcium increases bone mineral density and accelerates the healing of bone fragments;
Low frequency magnetic therapy. Has an analgesic and anti-inflammatory effect;
UHF method. This technique is aimed at warming up soft tissues. As a result, local metabolism improves, which accelerates regeneration;
Ultraviolet radiation. Under the influence of ultraviolet radiation, vitamin D is produced, which is necessary for better absorption of calcium.

Exercise therapy classes

As a result of prolonged immobilization, muscles lose tone, which is fraught with the development of malnutrition. This is why timely initiation of exercise therapy for a fracture of the radius is so important. Classes should begin with the simplest exercises, for example, with alternate bending of fingers. The doctor will write out an exercise regimen on how to develop your arm after a fracture of the radius.

Exercises after a fracture of the radius should be performed carefully, without sudden movements.

It is important to carry out exercise therapy under the guidance of a specialist who will select a set of exercises in accordance with the patient’s physical capabilities and ensure that they are performed correctly.

Complications and possible consequences

They can be divided into two groups: immediate complications of injury and its long-term consequences.

Immediate complications of injury include:

Damage to the nerve bundle (for example, rupture). It entails a violation of sensitivity (thermal, tactile, motor, etc.);
Damage to the finger tendons, as a result of which the function of flexion or extension of the hand may be impaired;
Damage to blood vessels with the formation of a hematoma;
Partial or complete muscle rupture;
Infectious complications (for example, infection joining the wound surface).

Long-term complications are not as common. These include osteomyelitis (purulent melting of bone), limb deformation due to improper fusion of bone fragments, and the formation of contractures.

Features of a fracture of the radius in a child

The structure of a child's bones is different from that of an adult. This is due to the presence of bone growth zones, better blood supply, as well as the characteristics of the periosteum - the membrane that covers the bones from the outside.

The formation of “green branch” type fractures is very common in childhood., or subperiosteal fracture. Due to the fact that the periosteum in children is very flexible, it does not lose its integrity during injury.

When a bone falls or is hit, it bends, the convex side breaks, and the concave side remains intact. Thus, the fracture is incomplete and heals much faster.

Despite these features, fractures in children should be taken seriously. There are often cases when improper fusion of bones in childhood leaves an imprint in the form of impaired hand function for life.

If you find out at the doctor's office after injuring your arm that you have suffered a direct fracture of the radius, don't panic. Having all the necessary information about it, you will not only understand the mechanism of damage and methods of its treatment, but will also be able to contribute to a better and faster return to normal of all physiological functions of your hand.

A little about anatomy

The radius bone is located in the forearm. This is the part of the arm between the elbow and wrist. The lower part of the radius is quite vulnerable. It is thinner and its outer (cortical) layer is also less durable.

Causes of injury

Based on the above characteristics of the physiological structure of the radius, one can understand why it is so often injured. A fracture of the radius of the arm often occurs from landing on an arm extended forward for protection or from a crushing blow to a hard surface. Situations in which a person can receive such damage:

car accident;
with insufficient compliance with safety regulations at work;
adverse weather conditions;
passion for extreme sports.

Anyone can cripple their hand. But still, doctors identify the following categories of people whose risk of getting a fracture of the upper limb is higher than others. At-risk groups:

women over 45 years old;
children from 5 to 15 years old;
people doing heavy physical labor;
athletes.

Types of injury

In adults and children, ray fractures have a general classification:

Intra-articular. An injury that directly damages the wrist joint.
Extra-articular. The joint remains unharmed;
. The breakdown is hidden under the skin. There is no visible rupture, the integrity of the muscles and ligaments is not compromised. A closed fracture of the radius is the safest type of fracture of the hand for the victim.
Open. A very dangerous type of injury. The danger is that the skin and soft tissues are torn; contamination can enter the wound at any time, and as a result cause serious infection.
Comminuted fracture. The radius is damaged in more than two places. It often occurs when there is strong compression of a limb on both sides. Ultimately, the bone breaks into many small fragments, which in turn severely damage nearby tissue.
Fracture with and without displacement (crack).

Let's look at this type of fracture in more detail. Depending on the fracture line, the displacement can be horizontal or vertical. With a horizontal fracture, the bone is broken into two parts and displaced to the side. A longitudinal fracture occurs when one of the fragments has moved above and along another part of the bone. The displacement can also be complete (the connection between the fragments is severely disrupted) and incomplete (the integrity of the bone is almost preserved or bone fragments are supported).

Breaking the beam in its lower part (lower third) is . Depending on the position of the hand at the moment of injury, there are two main types of this fracture:

Extensor (wheel fracture). This is the most common type of beam fracture in traumatology. With this injury, one of the bone fragments is displaced towards the dorsum of the hand.
Flexion (Smith's fracture). The main impact falls on the inside of the wrist. The fracture plane is from front to back to the outside of the palm and from bottom to top.

Symptoms

When damaged, a crunching sound is clearly heard - this is a 100% fracture. A clear signal that the resulting injury will be displaced is an externally visible deformation of the shape of the hand, accompanied by swelling or bruising. The arm hurts a lot, and with the slightest attempt to change its position, the pain intensifies significantly.

First aid

The very first thing to do in a fracture situation is to completely immobilize the arm. This is done to prevent further displacement of bone fragments and to avoid damage to nearby tissues, nerves and tendons. Every person can do this, even if he does not have a medical education. The main thing is not to be afraid.

If the injury is closed, the limb should be well fixed by applying a splint. Any flat and hard object can act as a fixation splint. If it occurs and is accompanied by heavy blood loss, then first it should be eliminated using a tourniquet, tightly rolled cloth, belt or rope. Only after this we fix the hand with a splint. It should be applied from the middle of the shoulder to the base of the fingers.

Modern alternative to plaster and splints

Many people wonder how to hold their hand when the radius is fractured with displacement? The correct and safe position is above the waist, in a position bent at a right angle at the elbow, independently or by tying a wide scarf.

To reduce pain, you can apply something cooling for a short time. Having received such an injury, you should not hesitate to go to the emergency room. It is best to seek qualified help within one to two hours after the incident. With an open fracture, you will most likely have to go to the hospital for some time. A closed injury can be treated at home. The basic rule remains the same - impeccably follow all the instructions of the attending physician.

Treatment

For a displaced arm injury, doctors often choose one of two time-tested treatment options: repositioning the bone with the hands of a specialist or open reduction followed by fixation of the fragments with knitting needles. X-rays of the hand help them make the right choice. It is important not only to heal the bone correctly, but it is also extremely necessary to maintain the same sensitivity and maneuverability of the fingers. The healing time for a displaced radius fracture largely depends on the treatment chosen.

The displacement is corrected manually after local anesthesia. After this, not a circular plaster cast, but plaster plates (splints) are applied to the back of the forearm and hand. They will immobilize the arm for the first 3-5 days until the swelling subsides. Otherwise, blood circulation in the injured arm may be significantly impaired. When the swelling subsides, a second photograph is taken, after which the splint is strengthened with bandages or replaced with a circular plaster cast.

An open reduction is a minor surgery in which an incision is made over the site of the injury. Having gained open access to the broken bone, the displacement is eliminated. The restored structure is secured with knitting needles, plates or other special structures and plaster is applied.

The interest in how long to wear a cast for a fracture of the radius is understandable. All patients really want to quickly return to their normal course of life.

The answer to this will be determined by a number of factors:

severity of injury;
the age of the patient (in a child the bone heals faster, in older people it takes longer);
type of treatment (joining the fragments during surgery significantly reduces the risk of improper bone fusion).

Taking into account the above factors, the period of wearing a cast for a fracture of the radius can vary from three weeks to one and a half months. The average fusion time is 5 weeks.

Recovery

When the cast is removed, do not expect the arm to be able to immediately withstand the same loads. The forced downtime caused the muscles to weaken significantly. To regain the previous mobility of the hand, you should go through a full rehabilitation cycle. It includes warm-up exercises and fine motor skills exercises, massage with special ointments and various physiotherapeutic procedures. You should train your arm carefully and increase the load gradually.

Various water procedures, swimming or baths with sea salt will help restore your hand to its former strength. The water temperature should not exceed 36-37 degrees.

Nutrition also plays an important role. The body needs calcium more than usual. It is especially abundant in various dairy products. But there are also products that can slow down fusion. This includes alcohol, strong tea and coffee with a high level of caffeine, and any carbonated drinks.

Fracture of the distal metaepiphysis of the radius (“radius in a typical place”)

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

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

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

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

The duration of sick leave for a fracture of the distal metaepiphysis of the radius depends on the type of activity of the patient. For example, for office workers the average period of disability is 1.5 months. For professions involving physical activity, the period of incapacity for work may be increased.

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

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

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

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

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

Osteosynthesis of the radius with a plate

If the fragments are significantly displaced, osteosynthesis of the radius is used with a metal plate specially made for this segment. After matching the fragments, the plate is fixed with screws to the damaged bone. After installation, the plates are applied to the skin, sutures are applied for 2 weeks, and a plaster splint is applied for approximately the same period. After the operation, drug therapy is prescribed: painkillers, calcium supplements for faster bone healing, and, if necessary, topical medications to reduce swelling. The average length of hospital stay is 7 days. Sutures are removed on an outpatient basis after 2 weeks. The hand is worn in an elevated position on a scarf. There is no need to remove the plate.

External fixation device

In some cases - in old age, with severe swelling of the hand and wrist joint, it is undesirable to make access to install the plate due to various factors (swelling, skin condition). In such cases, an external fixation device is installed - it fixes the fragments using knitting needles that pass through the skin into the bone. The device protrudes above the skin as a small block (about 12 cm long and 3 cm high). The advantage of this type of osteosynthesis is that there is no need to make large incisions, but you need to take care of the device - make dressings so that the needles do not become inflamed.

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

The external fixation device is removed after approximately 6 weeks, after X-ray control, in a hospital setting. The operation of removing the external fixation device does not take much time and is quite easily tolerated by the patient. The average length of hospitalization is 5-7 days, the duration of sick leave is about 1.5 months. Dressings should be done every other day, on an outpatient basis. The hand is worn in an elevated position on a scarf.

Fixation with knitting needles or screws

If the fragments are slightly displaced, the radius bone is fixed with knitting needles or screws through small punctures in the skin. A plaster splint is applied for about 2 weeks, then the person begins to develop the arm. After 6-8 weeks, the needles are removed.

In some cases, it is possible to use self-resorbable implants, which do not need to be removed.

Old, malunited fractures of the radius

With old, improperly healed fractures, pain may occur, there may be restrictions on movement - joint stiffness, and other unpleasant consequences (numbness and swelling of the fingers). In such cases, surgical treatment is recommended, most often with plate fixation. The bone is separated, placed in the correct position and fixed. If there is an area of bone defect - for example, if the bone has fused with shortening, this defect is filled either with the person’s own bone (the graft is taken, as a rule, from the iliac crest), or with artificial bone, which is rebuilt into its own bone tissue in 2 years.

Further postoperative and restorative treatment for old and improperly healed fractures of the distal metaepiphysis of the radius are similar to those described above. However, given the long-standing nature of the injury, longer rehabilitation may be required.

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

To carry out all the above operations, as a rule, conduction anesthesia is used - an anesthetic solution is injected into the brachial plexus area, where the nerves that innervate the entire upper limb (responsible for its sensitivity and movements) pass, and the arm becomes completely numb. Such anesthesia is quite easily tolerated and lasts 4-6 hours. In fact, it is a type of local anesthesia. In addition, premedication is given - a sedative injection, and during the operation the person sleeps normally. General anesthesia may be used. The final choice of anesthesia method is determined by the anesthesiologist on the eve of the operation.