Bones, muscles, ligaments

Dislocation of the radius bone. Fracture of the radius in a typical location. The structure of the radius

A common injury to the forearm is a fracture of the radius. Diagnosed in 16% of all bone lesions or 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 exposure to 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 violation bone integrity 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 avulsion 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 a direct injury to a limb occurs, then most likely there will be a transverse injury, in in rare cases A comminuted fracture may occur, resulting in more than three comminuted fragments.

If the hand is squeezed from two different sides, they talk about a compression fracture. Under versatile strong pressure The radius bone disintegrates into small fragments that affect the soft tissue around. 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 in case of injury and intense pain that persists 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 skin at the site of damage;
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 difficult situations It is better to call an ambulance to the scene.

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 actions enough to provide first aid, further treatment 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 the x-ray examination, without which it is impossible to deliver 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), 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 carrying out one or another therapy is determined only by a doctor based on the results of the examination, the nature of the damage and individual characteristics 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 rod apparatus or the Ilizarov apparatus;
bone - when there is a need to use plates with angular stability.

External fixation devices (screws, plates) are rarely used. In the treatment of children, doctors give preference to the conservative method and resort to operations in the most 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 therapeutic massage, physiotherapy, exercise therapy, aquatic therapy or the use of an orthosis.

We should not forget about proper 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 for 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 (providing 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.

Compliance with the attending physician's instructions and course rehabilitation measures will help you recover faster and return to your normal pace of life.

Violation of the integrity of the radial bone after mechanical impact involving surrounding soft tissues in the pathological process is a common injury. Deformation of the anatomical structure of the beam takes 2nd place among traumatic pathologies of the hands. The radius bone is thin in structure, age-related changes or metabolic imbalance lead to osteoporosis, so patients are more often treated with this injury old age. Children are also on the list of risk factors, as they constantly fall from their body height onto their wrists, which leads to bone destruction and constant complaints of pain.

Factors leading to fractures of the radius of one or both limbs can be divided into two categories: exogenous (trauma after a blow) and endogenous (trauma due to chronic somatic pathologies). These categories are united by mechanical impact, after which the integrity of the bone is disrupted in the form of a crack, open or closed fracture.

List causal factors leading to beam fractures:

injury after an unsuccessful jump, fall, run, collision with some object, compression of the hands of the upper limbs;
hand injuries after an accident;
intensive sports training with frequent falls plus blows;
menopause with increased leaching of calcium and depletion of cartilage plates in women (during male menopause, osteoporosis develops more slowly);
increased mobility of children;
pathology of the development of the bone skeleton and cartilage tissue;
improper movements in old age;
wrist injuries at work;
diabetes mellitus plus ray strokes;
cachexia in oncological pathologies;
endocrine diseases;
urolithiasis disease;
diseases with metabolic disorders.

Attention! If a patient, after a blow or fall, feels a sharp pain, a specific crunch in the wrist area, the formation of a dent or lump, as well as the appearance of a hematoma, redness with temperature over this area - this is obvious signs fracture of the radius. In this case, immediate consultation with a traumatologist or surgeon is recommended.

There are many incidents when numbness, tingling, biomechanical disturbances + temporary absence reflex function limbs can be confused with residual effects after compression of the hands during an accident, earthquake, or any mechanical pinching of the limbs.

Types of beam damage

Violation of the anatomical structure of the radial bones (fractures of the wrist of one limb or both hands) after any external impact are divided into 2 types, which depend on the mechanism of displacement of the radial bone: flexion fracture ( Smith's fracture) when the fragments are directed towards the palm and extensor ( Wheel fracture) - fragments of the wrist bone are shifted to the back.

Fractures of the radius of the arm are classified into:

Injuries inside the joints (intra-articular): some parts of the bone are affected, such as the styloid process, the intra-articular components (bursa, ligaments, cartilaginous plates) are slightly affected, and the soft tissues are completely healthy.
Fractures outside the joint zone (extra-articular): the bone structure is disrupted, the articular structure (synovial bursa, reinforcing connective tissue elements) is not affected.
Fractures of the closed type, in which the bone is partially or completely broken, and the muscular-ligamentous corset is healthy (except for the formation of small hematomas).
Destruction of bones, soft tissues, blood vessels and nerves are open fractures.
Comminuted type of bone fracture (the fracture can occur in several places of the bone or bones at the same time).
Impacted type: remnants of inert tissue are embedded in each other. This type occurs in isolated cases.

A combined type of fracture can be added to this classification, when several bones are broken at once, plus joints and soft tissues are affected. This type of damage occurs after an accident, a fall from a height, or severe blows from blunt objects.

Symptoms of a fracture

After any mechanical impact on the upper limbs, including the wrist area, the first thing felt is pain + numbness in the hand. The severity of these symptoms varies depending on individual pain tolerance. That is, some patients do not react so acutely to severe pain, while others may faint with the same blow.

Clinical picture of a wrist fracture:

Symptoms	Short description
Pain syndrome	Nature of pain - acute type. When you try to move your fingers or bend or straighten your arm, the pain intensifies. This reaction occurs when the muscular-ligamentous corset is tense. The pain with an open and splintered type of fracture of the arm bones can be unbearable.
Swelling of the fracture area	After bone damage, a disruption of the innervation and blood supply to the joint occurs. Fluid stasis plus hematoma results in swelling of the fracture area. Tisular fluid accumulates in muscle tissue, fatty tissue. The clinical picture is a violation of the anatomical parameters of the hand plus a change in the shade of the skin (bluish-purple color).
Inappropriate limb movements	A fractured arm has inadequate biomechanics, which indicates a violation of the integrity of the bones. To ensure the safety of complications, especially for open injuries, it is recommended that only a doctor check for a fracture. IN otherwise fragments will be able to damage larger areas, and will also be able to affect central nerves and larger vessels.
The arm or both arms are shortened in size	The limb becomes shorter after the fragments are displaced or impaled. This symptom visible to the naked eye regardless of the type of fracture.
Crepitation symptom	Crepitus is a specific sign of a radius fracture. This symptom is checked exclusively by a traumatologist. Independent attempts testing the fracture will result in greater displacement of the fragments.

Open fracture, except specified symptoms, is characterized by torn skin, torn muscle fibers, remnants of ligaments, constant bleeding (especially when trying to move the arm), and exposed bones. In this case, first aid is provided to stop the bleeding, administer pain-relieving injections with analgesic drugs, and disinfect the wound (with a solution of potassium permanganate, furatsilin or iodine). It is recommended not to move your hand until the doctor arrives to avoid complications.

Diagnostic methods

The degree of damage to the radius after a mechanical shock, as well as clarification of the diagnosis, is performed through instrumental examination.

The list of diagnostic procedures includes:

X-ray of the hand in three positions: this is the fastest method to determine the extent of damage and accurate diagnosis finding fragments.
MRI: This method is performed for combined fractures plus comminuted types of injuries. Using MRI, you can determine the extent of damage to the nerves and central vessels supplying the limb.
Computed tomography It is recommended to use it as a last resort, when it is clinically impossible to clarify the nature of the fracture; this applies to the intra-articular type.

To carry out the operation CT scan is the most important factor that specifies the location of bone fragments.

First aid for a fracture

Immobilization, disinfection, anesthesia are the main points for bone fractures. The immobility of the locomotor organ is achieved by applying a splint made of a wooden plank, strengthening it with an elastic or simple bandage. If there is an open fracture, you need to place a tourniquet above the wound, then treat the area with disinfectants, and apply a sterile bandage from your home first aid kit.

Eliminate unbearable pain, it is recommended intramuscular or intravenous injection solution of Analgin, Baralgin or Ketanov. A cold ice compress is placed locally over the fracture area. The patient should be sent to the hospital, and not try to treat with traditional methods.

Healing procedures

In the trauma department, the patient undergoes radiography in three projections, which determines the exact location and depth of the fracture zone, as well as the radius of the pathology. The procedure of reduction + comparison of damaged bones is performed only after anesthesia. The accuracy of the matched fragments is the success of fast and correct fusion of bones.

Therapeutic measures are divided into:

Fixation of damaged bone fragments plus osteocyte regeneration.
Rehabilitation processes to restore hand functionality. The rehabilitation period goes faster when using physiotherapeutic procedures + the use of special exercises.

Comparison (reposition) of fragments of a radial bone fracture is performed in several ways, such as applying a plaster cast (conservative method) and inserting metal pins. The first method is widely used in traumatology, having a high effectiveness rating. The second treatment option is more risky, because fixing bone fragments with metal plates + bolts can cause rejection as if they were foreign bodies or there may be a risk of microbial infection. This method has its advantages - it accurately collects bone fragments, giving them the opportunity to grow together into their previous anatomical configuration.

Non-surgical treatment

Non-surgical interventions for radius fractures include minor fractures, non-displaced fractures, and articular fractures. Such cases are treated only with plaster casts. The hand should be immobile for about 1-1.5 months, depending on accompanying pathologies. After an X-ray examination, the plaster is removed, and the patient is prescribed massage, diet, and physical therapy.

Attention! If you do not respond to this injury in time, the hand will lose full functionality, undergoing early arthrosis.

If the process is started, the patient needs to consult a traumatologist; surgery with subsequent rehabilitation period plus the appointment of conservative treatment in an inpatient setting.

Surgical treatment

Incorrect reduction of radial bone chips or complex reduction of broken bones is a direct indication for surgical intervention. These two types of trauma are difficult to correct using plaster fixation; after regeneration, some complications are possible in the form of improper fusion. Therefore, doctors resort to the method of fixation with knitting needles. It involves manually adjusting the fragments and inserting metal spokes. This method has its disadvantages and advantages, namely: suppuration of the fracture zone with fistula formations, a long procedure of wearing a cast, long period paralysis of arm movement, which leads to long-term rehabilitation of the limb.

Bone fragments are inserted into place using the open method or external fixation devices. The first option for repositioning the fragments is carried out by incising the muscles, pushing back the tendons, plus repositioning the bones. The restoration structure is fixed with metal plates without the need for a plaster cast. If there is a risk of rejection of plates, wires, screws, external fixation devices are recommended . Open fractures are an indication for surgical interventions. The wound is treated, sutured, and then a fixation device is attached around the damaged area.

Diet for a radius fracture

TO dietary dishes includes foods rich in vitamins of group B, as well as C, D, A, E. They are contained in large quantities in fish, beef, eggs and milk. Cottage cheese is a must for fractures of skeletal bones; it has a sufficient amount of calcium to eliminate osteoporosis, plus it is effective for the rapid healing of the damaged area. Vegetables, fruits + berries contain all vitamin complex, which is necessary to strengthen bones and soft tissues. Fish products rich in phosphorus, this element is part of bone tissue.

Advice! People who constantly consume fresh cottage cheese in their diet, olive oil, fish and seafood, are very rarely subject to fractures of the radius, so it is recommended to include these products in your menu every day.

Features of a fracture of the radius in a child

The physiological data of the child’s bones have their own characteristics, namely the elasticity of the periosteal tissue and the bone itself. The areas of osteocyte growth are provided with abundant blood supply + innervation. With any impact, except for severe mechanical damage, the periosteum can only crack, even after strong bending. There are practically no fragments during fractures, so the bones heal quickly without the formation of bone growths. A child's bone is compared to a green twig, that is, after an injury, the periosteum is intact, but the bone is cracked. Such fractures are rehabilitated much faster than in adults.

Important! If parents do not seek help in time, for some reason or due to their own oversight, the damaged limbs in children will heal incorrectly, which will lead to a violation of their anatomical shape plus a violation of the full function of the locomotor organ. These hand dysfunctions will remain for life.

Recovery after a fracture

The healing period of broken bones depends on the type of fracture or on individual physiological qualities human body, as well as from concomitant diseases. Ordinary fractures heal after 1.5 - 2 months, open or combined injuries of the radius heal after 2.5 months, depending on the cleanliness of the wound, the compatibility of the metal elements securing the bones with human tissue, as well as on effective conservative + surgical treatment.

Pain and numbness may be present for a long time after injury, these symptoms will completely disappear only after 1-2 years. Permanent procedures like massage + exercises, will bring the hand to a healthy phase of functionality much faster.

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

Staying a limb in one position for a long time disrupts the motor function of the hand, muscles, ligaments, and finger motility, so it is necessary to rehabilitate the locomotor organ. It is recommended that after applying the plaster (if the plaster does not cover the entire hand), carefully and slowly stretch your fingers 10-15 times a day for 5 minutes. After 5 days, you need to try to straighten + bend your fingers. These exercises will help quickly rehabilitate an injured arm. If severe pain or swelling occurs, warm-up exercises should be stopped. After removing the fixing bandages, patients undergo massage, physiotherapy, and exercise therapy.

Massage

Through massage movements plus medication based on non-steroidal anti-inflammatory drugs and chondroprotectors, blood supply and innervation of the hand improves. Metabolism increases, which promotes effective healing broken bones. The massage starts with shoulder girdle, slowly moving down the muscles of the arm to the fracture zone. Time spending massage treatments exactly 15-20 minutes. If there is pain, ointments or gels based on analgesic drugs are prescribed.

Physiotherapy methods

Physiotherapeutic procedures help relieve pain syndrome and development of osteocytes. The list of procedures includes UHF, iontophoresis, electrophoresis, mud and paraffin pads. These physiotherapeutic procedures accelerate the accumulation of vitamin D and calcium, which are part of bone tissue.

Exercise therapy classes

Therapeutic exercise consists of several effective exercises for developing the fingers and bones of the hand, especially the radius. First exercise: you need to place the injured hand, palms down, on the table. Slowly and carefully perform flexion-extension movements 50-60 times in one session. During extension, the wrist joint is developed. The second exercise consists of rotating the open palm along the surface of the table. The edges of the palm should alternately touch the surface tightly. It is recommended to repeat this exercise 50-55 times.

After these movements, the elbow and shoulder joints are developed, this will improve blood flow + innervation of the arm. You can develop your fingers, as well as hand motor skills in general, by sorting through small objects such as beans, peas, and balls. Collecting puzzles, drawing, working with plasticine, as well as “drumming” with your fingers on the table will quickly restore impaired hand function. A set of exercises with a rubber ball or “donut” will strengthen the joints, muscles and connective tissue cuff of the limb. The frequency of exercise will speed up the recovery process and give full functionality.

Complications and possible consequences

Complications of hand injuries include rupture of the nerves, which are responsible for the reaction to heat, movement, sensitivity to cold + sensation of objects. Violation of the integrity of the tendons responsible for the process of flexion/extension and the grasping reflex. If the injury with a fracture was open, there is a risk of poor blood supply due to the destruction of blood vessels.

After muscle rupture, strictures + contractures appear, and the muscles themselves shorten in size. The wound can become infected, leading to osteomyelitis. Severe fragmentation of the bone is the source of improper healing of the fracture, with a further change in the configuration of the hand. After being hit or falling, sharp pain, swelling, and impairment appear on the hands. motor function and bone crepitus. These signs are direct evidence of damage to the radius bone, so you need to call immediately ambulance . If you do not respond in time, there can be a variety of complications that will lead to disability. Fractures of the radius - serious injury

, which leads to decreased hand function and loss of prestigious work. To avoid such incidents, you need to know everything about a fracture of the radius of the arm - symptoms, treatment and recovery. Contents of the article:

classList.toggle()">toggle

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:
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 in elbow joint at an angle of 90 degrees and bring it to the body, turning the hand upward.

To minimize painful sensations, 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 points. First of all, there is the risk of wound infection. Therefore, after the operation it is necessary to take a course of antibiotics. wide range actions. The second disadvantage of surgical treatment of fractures is the long rehabilitation period.

Recovery time

Duration recovery period depends on the complexity of the injury and lasts, 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 your arm swells after removing the cast, this is 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 start restoring 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 comes down to the slow directed movement of particles medicinal product deep into the tissues. 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 ultraviolet radiation Vitamin D is produced, which is necessary for better absorption 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 from the very simple 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 nerve bundle(for example, a gap). 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 break muscles;
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 features 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.

As you know, evolution placed man upright, left his legs for support, and adapted his arms for labor. And traumatology (if it existed in those ancient times) would immediately be enriched with the following facts: a fracture of the radius in a typical location is the most common fracture: 12% of all injuries associated with fractures isolated bones, falls specifically on him.

A radial fracture in a typical location - what is it?

If we look through a textbook of traumatology and orthopedics of any year, we will be convinced that for no other fracture there is such a localization, which is called a “typical place”. Only the radius bone received such an “honorary nomination.” And this fact immediately gives rise to mysteries. For example, why we're talking about only about the fracture of this bone? It would seem more logical and simpler when two forearm bones break at once in a “typical place”.

In fact, of course, the forearm is often broken along two bones at once, and an isolated fracture is, in principle, more difficult to recognize. After all, the supporting function does not suffer (due to the intact bone), and if there is no open fracture, then this injury is often not recognized. But the radius breaks even more often, and in the “favorite place.”

The arrow in the photo indicates a typical fracture site.

In this case, we are talking about an isolated fracture of the lower part of the radius. A bone can be broken here either by flexion or extension. Extension plays a much larger role in the pathogenesis of injury than flexion.

A fracture of the ray in a typical place, accordingly, is of two types:

Extensor or extension version (Collis). It occurs when falling on an outstretched arm with an attempt to fall on the palm, although it is also possible during a fight and combat sports. With this type of injury, the bone fragment is displaced towards the back of the hand;
Flexion or flexion fracture (Smith). It occurs if you fall not on an extended palm, but on a bent one. Of course, this happens less often, since a person instinctively, when falling, tries to fall on the palm of his hand, and not on the back of it. Therefore, the bone fragment here is shifted towards the palm.

Most often, in adults, the bone breaks 2–3 cm higher than the gap of the wrist joint, and in children the “weak spot” falls on the bone growth zone.

Despite the fact that in general men are more likely to be injured, this type of fracture is more common in the female population, perhaps simply because when women fall, due to their “graceful” skeleton and often greater body weight, the corresponding risk of fracture is higher.

An interesting fact that has become a thing of history: it is known that old cars in the USSR could often be started with a crank. When the engine started, the handle would “break out” and begin to rotate furiously if its fastening did not provide for free exit. And in this case, inexperienced drivers received a beam fracture in “that very place.” Experienced drivers warned that when holding the handle, you should not put your thumb against the rest - all fingers should be on one side of the handle, this will allow the hand to slip out without injury.

The radius is a rather long formation. It connects the elbow and wrist joints, and can break in the following places:

the head and neck of the radius near the elbow joint.

Most often, this is the result of a sharp hyperextension of the elbow, or a jerk of the forearm outward or inward around the elbow joint. Swelling occurs in the elbow area, along the front and outer surface of the forearm. After this, movement of the elbow, especially rotation and extension, causes severe pain;

diaphyseal fracture of the radius (in its middle part).

Quite often, a fracture of the diaphysis is combined with a fracture of the ulna. A single fracture of the radius is more hidden, since there is no deformation of the forearm, and there are no signs of gross dysfunction.

However, there is pain and swelling at the fracture site. The range of motion (rotation of the forearm) is reduced, and when moving, you can hear the crunching of fragments, or crepitus. A characteristic symptom The fracture of the radius is a “silent” and non-rotating head of the radius, when the forearm is rotated.

fracture-dislocations of Monteggia and Galeazzi.

This is the name for combined injuries, in which one bone breaks and the second is dislocated. In a Monteggia injury, the ulna bone is broken (in upper third, closer to the elbow), and the head of the radius is dislocated, but remains intact. But Galeazzi’s fracture-dislocation leads to the radius breaking in the lower third, and the ulna dislocating its head.

A Monteggia injury occurs when the upper third of the forearm receives a blow. Arises sharp violation movement in the elbow, the forearm shortens slightly, and it swells near the elbow.

With a Galeazzi injury, swelling and pain occur in the area of the wrist joint, and deformation of the radial bone contours occurs at a certain angle.

All these types of injuries can be treated conservatively or surgically, depending on the severity of the injury, the presence of displacement, tissue interposition and other factors.

Symptoms of a radius fracture

The most likely symptoms for this location of injury are:

Pain occurs in the area of the wrist joint;
Swelling appears;
If a bone fragment is displaced, it can be felt on the dorsum or palmar side of the forearm;
If there is no displacement, then there is no deformation, but only a hematoma occurs;
When you try to palpate the wrist joint, severe pain appears, especially on the back side;
When trying to create an axial load (for example, when resting with the palm of your hand), sharp pain occurs in the wrist area;
If branches are damaged during a fracture radial nerve, then symptoms of radial nerve damage may occur. They will be written about when we'll talk about complications.

About displacement, open and closed fracture

Displacement of bones is always an unfavorable fact. It is said that the “traumatologist’s dream” is a crack in the bone, which is often called a non-displaced fracture. Displacement always complicates and prolongs the rehabilitation period after a fracture of the radius.

Several types of displacement can occur in the forearm area:

In width - bone fragments diverge under the influence of traumatic force;
The fragments stretch along and do not touch each other. Contraction of the forearm muscles is to blame for this;
The displacement can also be angular - the fragment rotates due to uneven traction of one of the muscle groups.

But displacement is not the only trouble that can happen. Still, we are dealing with two fragments. But in the event that there is a comminuted fracture, and even against the background of osteoporosis, in which there is a significant displacement of fragments, with tissue interposition, this is always an indication for surgical treatment. Similarly, if an impacted axial fracture occurs, then surgery is required, otherwise shortening of the bone and disruption of the joint will occur.

As for open fractures, if we talk about the “typical location”, they are quite rare.

Diagnosis of fractures

Naturally, the basis for accurate diagnosis is qualified x-ray examination. In any case, irrefutable evidence of a fracture will be the detection of both the fracture line and individual displaced fragments. In children, a fracture with the beautiful name “green twig” often occurs when the young and flexible periosteum remains intact.

In this case, as well as in impacted fractures, identifying the fracture line presents certain difficulties. But, “fortunately”, for a beam injury in a typical place, an impacted mechanism is not typical, and yet variants are very rare.

The radiologist then determines the position of the fragments. Sometimes the distal fragment is not whole, but fragmented. In some cases, a fracture of the styloid process of the ulna is detected. This “surprise” is noted in 70% of all cases.

It is very important to determine the type of fracture - what mechanism caused the injury, and specifically on a lateral X-ray. When repositioning, you need to put the fragment in place so that it does not stand anteriorly or posteriorly. If this is not done, then after the bone heals, either flexion or extension of the hand may be limited.

It is important to remember that healing of a radius fracture requires the following conditions:

Accurately bring the fragments together along the fracture line;
Squeeze them tightly until the gap disappears;
Immobilize fragments as much as possible for at least 2/3 of the immobilization period.

Of course, these are ideal conditions, and both the quality and the period of fusion depend on them. What do doctors usually do for uncomplicated types of radial fractures?

With an extension fracture

First, the traumatologist anesthetizes the fracture site. For this, 20 ml of a 1% novocaine solution is sufficient, and manual closed reposition of the fragments is performed. To do this, the forearm is bent and a counter-thrust is created towards the elbow along the longitudinal axis of the hand. This position must be maintained for 10 - 15 minutes. This is necessary so that the desired muscle group relaxes and does not interfere with reposition. After this, the fragment usually easily moves towards the palm and elbow.

In order for the angular deformation to disappear, the hand and the fragment are bent in the palmar direction, usually at the edge of the table. After this, with palmar flexion and slight abduction to the elbow, a plaster splint is applied to the back of the hand. It should cover the space from the upper third of the forearm to the metacarpophalangeal joints, leaving only the fingers free.

If the injury is flexion

The difference is that here the force and direction are created by moving the fragment to the back side, and not to the palmar side. To prevent angular displacement, everything is done in the opposite way, that is, the hand is extended at an angle of 30 °, and a plaster splint is also applied.

After the reposition is carried out, you need to make sure that everything is matched correctly. To do this, an x-ray is taken, and difficult cases(for example, with a helical fracture line), the reduction itself is carried out under X-ray control.

Possible complications

Fortunately, an infrequent but unpleasant complication is injury or rupture of the radial nerve. This is an indication for urgent surgery. Symptoms of damage are:

dorsal numbness of the hand and the first three fingers (from the thumb);
causalgia (burning pain on the back of the hand).

Then surgical treatment should be carried out, sometimes with the involvement of a neurosurgeon, if the use of operating microscopes and microsurgical intervention is planned.

When is surgery needed?

Most often, it is possible to restore the integrity of the radius without any incisions, osteosynthesis or other types of operations. But there are cases when surgical care is indispensable, and then urgent hospitalization in the trauma department is necessary. After all, if you miss several weeks, then the ability of the ends of the bone to consolidate sharply decreases, and either improper fusion or the formation of a false joint is possible. There are the following absolute readings for surgery for any type of fracture:

Open fracture. Naturally, primary surgical treatment is required, removal of necrotic tissue, fragments, and prevention of secondary infection;
Interposition of soft tissues. This is the name for the situation when soft tissues get between bone fragments, along the line of future fusion: muscles, fascia, fatty tissue. Under such conditions, no fusion will occur, but a false joint. It is necessary to get rid of any traces of foreign tissue in the fusion zone;
Injuries to the vascular and nerve bundles;
Difficulties during reposition, a significant number of fragments;
“Uncontrollable” fragments. This is the name given to pieces of bone to which nothing is attached and which can move freely.

How to treat a radial fracture while wearing a splint and after removal?

It is important to follow a diet with plenty of proteins, microelements and vitamins. The patient must receive cottage cheese, fish, eggs, and meat. It is possible to take vitamin and mineral complexes. From 10 to 15 days after injury, the use of calcium supplements is recommended - in the form of chloride or gluconate.

Recovery period and its duration

Typically, a splint for uncomplicated fractures is applied for a month, at a normal rate of bone healing. You can “move your fingers” from the second day, you can use physiotherapy from the third day (UHF, which has a decongestant effect). Usually after a month the plaster is removed and a course of restorative treatment begins.

Typically, ability to work returns a month after the cast is removed, or 6 to 8 weeks after the injury.

The healing time for a displaced fracture of the radius of the arm depends not only on the treatment option, but also on age. So, after repositioning a displaced fracture at a young age, a full recovery is possible after 8 weeks. But with postmenopausal osteoporosis, a twice as long healing period is possible.

About physiotherapy and rehabilitation

You should not think that nothing can be done while wearing a plaster splint. This is wrong. Already in early period after injury, UHF sessions are used. It is for this type of physiotherapy that plaster is not an obstacle. The goal of physical therapy is to reduce swelling and pain. 6–8 sessions are carried out using a low heat regime from 3–4 days after the injury. The duration of each session is about 10 minutes.

Diadynamic currents are also shown. The splint is not a continuous bandage, and there is space for electrodes to be attached. In combination with UHF, diadynamic therapy provides good pain relief.

If the lognet has a window, then electrophoresis with local anesthetics, magnetic therapy sessions are shown.

On average, 3–5 weeks after injury, it is necessary to ensure the “transport” of calcium and phosphorus compounds to the fracture zone for the “construction” of bone tissue. Good help This is achieved by electrophoresis of 2% calcium chloride and 5% sodium phosphate, in an amount of 10 - 20 procedures.

Therapeutic gymnastics is indicated even when the plaster is not removed: after all, the fingers are free. From day 10, you can slightly strain the muscles under the splint (static or isometric exercises).

It is important for the patient to understand that the period of complete immobility should end with the formation of a soft callus, and during its ossification (ossification), both longitudinal load and development exercises are needed, regardless of whether there was a fracture of the radius with or without displacement.

You need to be careful not to allow a feeling of “flushing”, distension in the bandage, or numbness. If your fingers turn white, blue and lose sensitivity, you should definitely consult a doctor.

After removing the plaster, it is very important to eliminate muscle wasting, normalize blood circulation in the fracture area and surrounding tissues, and begin to use the wrist joint. Helps with this physiotherapy. It cannot be replaced by any other means of physiotherapy, since movement is life.

First, passive movements are performed, when the other hand helps, and then active ones. Then electrophoresis techniques are used again, for example, with dibazole, vitamins, lidase. This helps improve nerve trophism and prevent scars and adhesions, especially after operations. Phonophoresis, heat and phototherapy, ozokerite therapy, and paraffin applications are used.

Damage to the forearm is the most common injury of the entire musculoskeletal system. A fracture of the radius can vary depending on where the deforming force was applied. With such fractures, subluxation of the elbow joint is observed with shortening of the bone and displacement of the head of the bone forward.

In addition to the place where the bone most often breaks there is great amount fractures that occur anywhere.

You can go straight to the section you need

Types of damage

Among the main fractures, consider the following:

Necks and heads. Such injuries usually occur when they occur at arm's length.

Diaphysis isolated. It is quite rare and occurs after a blow to the radial side of the forearm. The danger is that the musculoskeletal functions hands.

Damage to the diaphysis of both bones. Occurs with a direct blow. A fracture appears on both bones at the same level. When falling, both bones break at the thinnest point. Such injuries are very serious.

Damage to Galleation. This displaced fracture of the radius is characterized by a fracture of its upper third part, displacement of the lower fragment and dislocation of the head in the wrist. The causes of such injuries can be either a blow or a fall on the hand.

The distal section is the most typical fracture for the radius. It is most common in the weaker half of humanity and occurs when falling on the hand.

Observable signs

The main symptoms of a fracture of the neck and head of the radius are the appearance of swelling, pain in the elbow joint, which greatly intensifies when bending the arm, and it is difficult for the victim to touch the elbow. The diagnosis can be confirmed using x-rays.

An isolated fracture of the diaphysis does not have such a rich clinical picture; a small tumor can be visually observed, the patient reports pain during rotation or upon contact with the arm. An accurate diagnosis, as in the first case, can only be made by x-rays.

In case of a fracture of both bones of the forearm at once, a bright clinical picture, due to the fact that the fracture is quite severe. You can visually observe the appearance of swelling, visible deformation and visual shortening of the forearm. The patient experiences severe pain and when trying to turn, you can hear a characteristic crunch.

Damage to Galeazzia is accompanied by severe swelling, deformity and pain. It becomes impossible to rotate not only the forearm, but also the hand.

The distal part is characterized by the appearance of unbearable pain and swelling, and deformation of the hand. To establish an accurate diagnosis, an x-ray in two projections is required.

First aid in action

It is worth noting that the first thing that needs to be done for any shoulder fracture is carry out general pain relief measures. 1 ml of a one percent solution of promedol is perfect for this. It is worth calming the victim by giving him valerian or tazepam.

If conditions permit, it is necessary to apply a special splint, but do it correctly. First of all, the arm is pulled to the side at the shoulder joint and bent at the elbow at a right angle. The forearm should be in a mid-position between pronation and supination. To place a cotton ball or bandage into your hand, bend it towards the back and bend your fingers slightly. You cannot fix your fingers with outstretched fingers.

A cloth roller is placed in the armpit, which must be secured through the healthy shoulder girdle.

The splint is applied starting from the healthy shoulder joint, onto the back through the suprascapular region, then tied around the posterior outer shoulder surface, forearm, and so on to the base of the fingers. The hand should be suspended on a scarf or bandage.

If there are no special means intended for first aid, use available materials, which can be planks. It is worth transporting the victim only in a sitting position.

Treatment period

Depending on the nature of the radius fracture, the doctor chooses the appropriate treatment for the patient.

The most conservative treatment for a radial fracture is typical for neck and head injuries that occur without displacement. In this case, a plaster of two splints is applied to the damaged area. The hand must be immobilized for a week and a half.

If the fracture still involves displacement of the fragments, mandatory anesthesia and reposition of the inert fragments in their place are necessary. Only after this the arm is fixed using plaster splints, and then a control radiograph is taken. If the expected results are not obtained, repositioning and fixation of the bone with a wire is necessary, which will be removed after a few weeks, but the cast will remain on the arm for a month.

If the bones are completely crushed, surgical intervention and the use of endoprosthetics are necessary.

In case of an isolated fracture of the diaphysis, it is mandatory to apply a circular plaster cast for up to ten weeks, which completely covers the entire damaged area and fixes the hand from the beginning of the fingers to the middle third of the hand.

In case of displacement, it is carried out by repositioning through regular x-ray monitoring.

If the reposition is unsuccessful, surgical intervention by a surgeon is required.

One of the most severe injuries is damage to both bones of the forearm at once. If the displacement has not been confirmed, conservative treatment in the form of splints can be applied.

Unfortunately, such a displaced fracture of the arm often forces the doctor to resort to reduction with the help of fixing structures. Most often, such operations are performed immediately after the swelling has subsided, in order to reduce the time to restore mobility in the injured arm, a plate is placed on the radius bone, and an intraosseous pin is placed on the ulnar bone.

Damage to the Galeatia is corrected by reducing the resulting dislocation and fixing the bone using two knitting needles. The plaster cast is removed only after ten weeks. If treatment does not work desired result, osteosynthesis is used.

If the lesions are old and have not healed properly, the distraction method is used.
Distal fractures are treated conservative methods, if there is no displacement of the fragments, if there are any, they are fixed using two knitting needles. If there is a large number of fragments, a distraction method is used using a lightweight apparatus.

Subsequent rehabilitation

Immediately after the patient has been injured, UHF and ultrasound are used to reduce swelling in the damaged area and pain, as well as improve blood circulation and prevent muscle wasting.

After the immobilization stage is completed, the patient is prescribed massage and physical exercise. After removing the plaster, it is recommended to take warm coniferous and salt baths that contribute complete rehabilitation after the injury.