Spinal nerves briefly. How are spinal nerves formed? Anterior branches of the spinal nerves, rr

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

To clarify the nature of the fracture and the choice of further treatment tactics, radiography is used, in some cases - CT scan. Sometimes an ultrasound of the wrist (wrist) joint is required.

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

Duration sick leave fracture of the distal metaepiphysis radius depends on the type of activity of the patient. For example, for office workers, the average period of disability is 1.5 months. For professions related to physical activity, the period of incapacity for work may be longer.

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

Can be used for non-displaced fractures conservative treatment– in a plaster cast or use plastic plaster which is more comfortable and not afraid of water. The average stay in plaster is about 6 weeks. However, this method of treatment has its drawbacks - after conservative treatment, the joint requires the development of movements, rehabilitation. In the treatment of a fracture, even with a slight displacement of fragments, a secondary displacement of fragments may occur in the cast due to the anatomy of the radius.

Surgical treatment of a fracture of the radius (osteosynthesis)

Almost all fractures of the radius with displacement require surgical treatment - comparison and fixation of bone fragments - osteosynthesis. It is this method that allows you to restore the function of the hand most fully and achieve good functional results.

The radius initially fuses in about 6–8 weeks, but complete remodeling of the bone continues up to 2 years after the fracture. After this period, the patient can begin to fully use the hand. But it is possible to develop a hand with the help of certain exercises recommended by a doctor, thanks to the use of fixators, already on the first day after the intervention. Light sports physical exercise You can start about 3 months after the operation.

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

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

Osteosynthesis of the radius with a plate

With a significant displacement of fragments, osteosynthesis of the radius is used with a metal plate specially designed for this area. After comparing the fragments, the plate is fixed with screws to the damaged bone. After installing the plate, sutures are applied to the skin, and a plaster splint is also used. After the operation is given drug therapy: painkillers, calcium preparations to stimulate bone fusion, if necessary - drugs local action to reduce swelling. The average length of stay in the hospital is 7 days. The sutures are removed after 2 weeks, at a follow-up appointment with a traumatologist, at the same time the patient refuses a plaster cast. The hand is in an elevated position on scarf. There is usually no need to remove the plate.

External fixation device

In some cases, in the elderly, with severe swelling of the hand and wrist joint, it is undesirable to make access to install the plate due to various factors (edema, skin condition). In such cases, an external fixation device is installed - it fixes the fragments with the help of spokes that pass through the skin into the bone. The device protrudes above the skin in a small block (about 12 cm long and 3 cm high). The advantage of this type of osteosynthesis is that there is no need to make large skin incisions, but the apparatus must be monitored for the entire period of its wearing - dressings must be made so that the needles do not become inflamed.

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

The external fixation device is removed after about 6 weeks, after X-ray control, in a hospital. Dressings should be done every other day, on an outpatient basis. The hand is worn in an elevated position on a kerchief bandage.

Fixation with spokes or screws

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

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

Chronic, malunion fractures of the radius

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

a) Indications for osteosynthesis with a plate for distal fracture of the radius:
- Planned: fractures during flexion, fractures of the dorsal or palmar articular margin.
- Contraindications: open fractures with soft tissue damage.
- Alternative procedures: external fixation.

b) Preoperative preparation. Preoperative examination: exclude damage to vessels and nerves (especially the median nerve!).

in) Specific risks, informed consent of the patient:
- Infection
- Damage to blood vessels and nerves
- Possibility of harvesting and use of cancellous bone
- Violation of reposition (less than 10% of cases)
- Reduced range of motion
- Removing the retainer

G) Anesthesia. Brachial plexus block, general anesthesia.

e) Patient position. Lying on the back, armrest, turnstile, image intensifier.

e) Online access . Palmar incision, in the ulnar side of the tendon of the radial flexor of the wrist.

and) Operation steps:
- site of fracture
- Skin incision
- Access
- Crossing of the quadrate pronator
- Identification of the fracture site
- T-plate contouring
- Muscle recovery

h) Anatomical features, serious risks, operational methods:
- Warning: avoid intense and repeated repositioning actions: reflex sympathetic dystrophy (Sudek's syndrome).
- Retract the radial artery and its accompanying veins radially, leaving the median nerve and flexor tendons on the ulnar side.
- Completely separate the pronator quadrate from its insertion on the radius.
- If the median nerve is compressed, the transverse carpal ligament may be severed.

and) Measures for specific complications. Fill in the defects in the area of metaphyseal fragmentation with spongy bone.

to) Postoperative care after surgery for a distal fracture of the radius:
- medical care: remove active drainage on day 2; remove the plate after 6-9 months.
- Physiotherapy: early range of motion exercises if fixation of the fracture is stable.
- Period of incapacity for work: 2-8 weeks, depending on the type of activity and the side of the injury.

l) Stages and technique of osteosynthesis with a plate for distal fracture of the radius:
1. Location of the fracture
2. Skin incision
3. Access
4. Crossing the square pronator
5. Identification of the fracture site
6. T-plate contouring
7. Muscle recovery

1. Fracture site. Indications for surgery are unstable fractures, which usually occur with excessive flexion. The close location of the superficial branch of the radial nerve often leads to impaired sensitivity. Palmar marginal fracture is not amenable to conservative treatment. This situation is the main indication for fixation of a fracture of the radius with a plate.

2. skin incision. The skin incision for palmar access should be oriented to the course of the median nerve, which is in close proximity to the long palmar muscle, which is the best structure for orientation. The nerve passes between the long palmar muscle and the radial flexor of the wrist. The skin incision deviates slightly radially from the palpable tendon of the long palmar muscle and continues through deeper layers. Here it is necessary to avoid damage to the superficial branch of the radial nerve.

3. Access. Once the intermuscular space is exposed, it is recommended to develop a layer between the easily palpable tendon of the radial flexor of the wrist on one side and the tendon of the long palmar muscle, together with the median nerve, on the other. Depending on the extent of the fracture, the development of the layer may be extended to a flexor tendon strain to fully expose the styloid process of the radius.

4. Crossing the quadrate pronator. Once found, the pronator quadratus is transected along the radius. The median nerve and flexor digitorum are abducted with a blunt hook to the ulnar side, while the radial artery and flexor carpi radialis are abducted radially.

5. Fracture site identification. After complete abduction of the quadratus pronator muscle, a fracture site is found in depth. To this end, the flexor tendon strain is separated as distally as possible.

6. T-Plate Contouring. After the fracture is exposed, a small T-shaped plate is fitted. The plate is superimposed and set in such a way as to hold all the fragments. After fixation to the styloid process of the radius, the position of the plate can be corrected using the oval hole and fixed in the correct position with the remaining screws.

7. Muscle recovery. After radiological confirmation of the position of the plate in two planes, the square pronator is repaired with separate sutures (3-0 PGA). Active drainage is then established and the tendons are returned to their original position. This is accompanied by the restoration of the flexor tendon stretch with separate sutures. The operation ends with subcutaneous and skin sutures, and the application of a dorsal splint below the elbow.

Video lesson on normal anatomy of the radius

Other video tutorials on this topic are:

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

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

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

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

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

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

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

For fractures without displacement, conservative treatment can be offered - in a plaster cast. The average stay in plaster is 6-8 weeks. This rarely passes without a trace for the limb - after conservative treatment, the joint requires the development of movements, rehabilitation. In the treatment of a fracture, even with a slight displacement in the cast, secondary displacement of the fragments can occur.

Surgical treatment of a fracture of the radius in a typical location (osteosynthesis)

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

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

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

Osteosynthesis of the radius with a plate

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

External fixation device

In some cases, in the elderly, with severe swelling of the hand and wrist joint, it is undesirable to make access to install the plate due to various factors (edema, skin condition). In such cases, an external fixation device is installed - it fixes the fragments with the help of spokes that pass through the skin into the bone. The device protrudes above the skin in a small block (about 12 cm long and 3 cm high). The advantage of this type of osteosynthesis is that there is no need to make large incisions, but the apparatus needs to be monitored - dressings should be done so that the pins do not become inflamed.

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

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

Fixation with knitting needles or screws

With a slight displacement of fragments, the radius is fixed with knitting needles or screws through small skin punctures. A plaster splint is applied for about 2 weeks, then the person begins to develop the arm. After 6-8 weeks, the needles are removed.

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

Chronic, malunion fractures of the radius

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

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

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

For all the above operations, as a rule, conduction anesthesia is used - an anesthetic solution is injected into the brachial plexus area, where the nerves that innervate the entire upper limb(responsible for her sensitivity and movements), and the hand becomes completely numb. Such anesthesia is quite easily tolerated, lasts 4-6 hours. In fact, this is a kind of local anesthesia. In addition, premedication is done - a soothing injection, and during the operation the person sleeps with his sleep. Application possible general anesthesia. The final choice of anesthesia method is determined by the anesthesiologist on the eve of the operation.

Vilmos Vechey , Prof., Traumatology and Surgery Clinic, Vienna medical University, Austria

It would seem that the conservative treatment of these fractures using a plaster cast should be guaranteed to provide excellent treatment results (preserve range of motion and relieve the patient of pain) and there is no need to use other methods of treatment. But is this statement always true?

On fig. 1 shows that very often with distal fractures of the radius there is some change in angles, shortening of the radius and relative lengthening of the ulna. The result of this is the loss by the patient of a large part of the range of motion: flexion / extension, radial and ulnar abduction, rotation.

Distal radius fractures account for about 16% of all human fractures. In men under 40 years of age, their frequency is 9 cases per 10,000 population, and after 40 years - 10 cases per 10,000 population. These fractures are much more common in women: up to 40 years 36/10,000 of the population, after 60 years 115/10,000 of the population. In men, these fractures can be classified as "traumatic", and most cases of fractures in women - as "osteoporotic".

A study we conducted in 2008 (157 cases) showed (Fig. 2):

male to female ratio is 1:4
This injury is more common between October and March
left hand break a little more often than the right.

Is it possible to be sure that with closed reposition and conservative treatment such small fragments will be correctly set and fixed?

As early as 1961, Chanli expressed the opinion that a complete restoration of range of motion with these fractures is possible. only when using internal fixators.

pledge right choice The method of treatment is to determine the type of fracture according to the AO classification (Fig. 3):

in cases of type A fractures, conservative treatment is preferred (plaster cast)

For type B fractures, it is better to use surgical treatment

In cases of severe type C fractures, it is better to use less invasive external fixation devices or full-fledged osteosynthesis with plates.

Rice. 3. Classification of AO distal fractures of the radius.

The final choice of treatment method depends on three main factors:

bone quality
patient quality
surgeon qualifications

Indications for surgical treatment are:

1. Fractures types

2. Unstable fractures. Instability criteria (Fig. 4):

Fragmentation of the dorsal articular facet by more than 50%

Crushing of the palmar metaphyseal articular surface

Back deflection greater than 20°

Displacement of fragments more than 1 cm

Articular surface incongruity

Existing concomitant fracture of the radius

Severe osteoporosis

Rice. 4. Criteria of instability.

Surgical treatment allows to perform anatomical reposition, stable fixation of fragments and obtain the best clinical result.

What can be said about fixation?

An analysis of 677 patients who were treated in 2006 at the University Hospital of Vienna, Austria showed that

Ø In 10% of cases, a high shoulder cast was placed to prevent rotation of the forearm

Ø in 70% a cast was used on the forearm and hand

Ø in 20% of cases, patients underwent surgical treatment

1% using Kirschner wires

5% using an external fixator

14% osteosynthesis with plates

The advantages of fixation with Kirschner wires are simplicity, speed and low invasiveness. However, the indications for the use of pins are very limited, requiring the application of a plaster cast and quite frequent cases of loss of reposition.

The application of an external fixation device is good method treatment of comminuted fractures, as it allows to achieve a good self-reduction of fragments and avoid damage to soft tissues. To disadvantages this method include a complex technique of reposition, a significant number of cases of loss of reposition after removal of the apparatus, the likelihood of developing such formidable complications as rod osteomyelitis, Sudeck's syndrome.

The advantages of osteosynthesis with plates is the possibility of achieving anatomical reposition, as a rule, there is no need to apply a plaster cast. Best results can be achieved with inserts with lockable screws. Disadvantages: the possibility of damage to the tendons, the development of nerve compression, errors in screw insertion.

There are several types of surgical approaches used for osteosynthesis:

Palmar approaches (Fig. 5)
1. transcarpal
2. access by henry
Dorsal access (Fig. 6) in the gap between the tendons.

Rice. 6. Dorsal access.

In type B fractures, the inserted plate should press the fragment against the radius so that it cannot move to the side (Fig. 7). In this case, there is no need to insert screws into the fragment, since the plate will hold it anyway. On fig. 8 shows a clinical example of a type B fracture and the result of osteosynthesis of this fracture with a plate.

Rice. 7. Reposition and fixation of a type B fracture with a plate.

In type C fractures, it is often necessary to place a plate on a small distal fragment and then reposition using the plate (Fig. 9). As a result, a gap appears along the dorsal surface of the radius (Fig. 10).

On fig. Figure 11 shows a clinical example and the result of osteosynthesis of a distal fracture of the radius of type C. Reliable fixation of fragments was achieved using a plate and the correct installation of only two screws, respectively, of the anterior and posterior parts of the articular surface of the radius.

Rice. 11. Osteosynthesis with a type C fracture plate.

A clinical example of a type C fracture with massive destruction of the articular surface (Fig. 12). As a result of closed reposition, it was possible to achieve a good comparison of the fragments, after which a plaster cast was applied (Fig. 13). However, later an attempt was made to fix the position of the fragments with Kirschner wires, which led to the displacement of the fragments (Fig. 14).

Rice. 12. Distal radius fracture type C.

Rice. 13. X-ray control after closed reduction and immobilization with a plaster cast.

Rice. 14. Attempt to fix with Kirschner's wires, displacement of fragments.

What to do in this situation?

We performed an open reduction and fixed it all with a plate through the palmar approach. This is just the rare case when, after installing the plate, it is better to apply a plaster cast or an external fixation device to reduce the load on the destroyed articular surface. In this case, one of the first locking plates proposed for distal radius fractures (Peter's plate) was used and an excellent result was obtained (Fig. 15).

Rice. 15. Osteosynthesis with a plate with the application of an external fixation device, consolidation before and after removal of the plate.

In the next clinical sign of a type C fracture, an unsuccessful attempt was made to install an external fixation device, after which they switched to installing a plate from the dorsal approach. The scaphoid fracture was fixed with a separate screw (Fig. 17). Unfortunately, the situation was complicated by damage to the extensor tendons and synovitis, which is not uncommon in the dorsal approach.

When using a dorsal approach, it is very difficult to place the plate without irritating the tendons. If a plate or screw, due to loosening or incomplete screwing, protrudes more above the bone surface, synovitis and tendon damage may develop. The functional result after removal of the plate and reconstruction of the tendons is shown in Fig. 18. On the basis of such cases, we made an important conclusion for ourselves: if it is possible to install a plate from the palmar access, it is better not to use the dorsal one. If the situation requires the use of a dorsal approach, we make sure to cover the plate under the tendons with a flap cut from the tendon retainer.

Rice. 18. Consequences of damage to the extensor tendons.

Below is a case of dorsal and volar plate placement (Fig. 19) with an excellent functional result (Fig. 20).

Fig.19. Installation of two plates from the dorsal and palmar access for distal fracture of the radius.

Rice. 20. Functional result after surgery.

Let's take a closer look at the complications of surgical treatment of distal radius fractures.

A 50-year-old woman was admitted on October 17, 2004 2 days after the injury, type C2 fracture.

This type of fracture can be treated using a cast or external fixator, but we last years nevertheless, we tend to anatomical reposition (Fig. 21). During X-ray control after 8 days of surgery, we saw a secondary displacement, which increased (Fig. 22).

What is the reason for this? Upon closer examination of the image, it turned out that the plate had broken (Fig. 24). After 4 weeks, due to secondary displacement, we lost 15 degrees of reduction (Fig. 23).

Case 2

A 96-year-old woman, fracture type C 2 (Fig. 25), osteosynthesis with a plate was made 2.5 years ago. A week after the operation, some movement of fragments was already observed. On the radiograph 2.5 weeks after the operation, a secondary displacement of fragments is seen (Fig. 26). The plate broke 37 days after the operation (Fig. 27).

Rice. 27. 37 days after surgery. The plate is broken.

I removed the patient's plate, applied an external fixator, and fixed the styloid process with Kirschner wires (Fig. 28). Result after removal of the spokes (Fig. 29).

I want to draw attention to the need to restore 3 columns (Fig. 30) in case of comminuted distal fractures of the radius. Otherwise, after osteosynthesis, the wrist joint will remain unstable. The radiograph clearly shows damage to all 3 columns (Fig. 31), which requires surgical treatment. The use of modern anatomical plates allows successful reconstruction (Fig. 32).

The results of treatment of distal radius fractures can be assessed using the Lidström scale (Fig. 33), which takes into account the degree of shortening of the radius according to radiography and dorsal deviation. The functional result is evaluated according to the Sarmiento scale (Fig. 34), which takes into account both objective and subjective data.

Performance analysis various methods treatment of distal radius fractures according to our clinic is shown in Fig. 35.

The report was presented at a scientific and practical conference with international participation"Minimally invasive technologies in traumatology and orthopedics" (Kyiv, November 11-12, 2010.

Fractures of the radius are caused by a traumatic factor and the individual characteristics of the patient's body. However, rehabilitation measures with various injuries in this anatomical region, they are approximately the same.

What is a fracture, types of fractures

A fracture is a violation of the integrity of the bone, caused by mechanical action from the outside with deformation of the surrounding tissues and impaired function of the damaged section. Fractures are:

open, if the integrity of the skin is broken;
closed;
splintered, including fragmented during the formation a large number fragments;
without splinters.

In addition, fractures are classified in relation to the axis:

transverse,
longitudinal,
oblique,
fragmented,
from bending
hammered,
helical.

By the nature of the mixing of fragments:

in width
by lenght,
at an angle
along the periphery.

Fractures resulting from a tumor, osteomyelitis and other diseases are called pathological.

According to localization, they distinguish:

metaphyseal,
diaphyseal,
epiphyseal,
intraarticular.

According to the number of affected bones, fractures are distinguished:

isolated - one bone is injured;
multiple - several bones are affected;
combined - damaged bones and internal organs.

Fractures of the radius sharply reduce the ability of patients to work and are manifested by severe pain in the forearm and swelling. Depending on the type of fracture, the symptoms may be supplemented by the presence of a hematoma, tissue rupture with bone entering the wound, the presence of deformation in the fracture area with intact skin etc.

Diagnosis is based on questioning, examination, palpation, presence pathological syndromes(crepitus, pathological mobility), as well as a complex of instrumental and diagnostic results.

Principles of treatment of fractures of the radius

The goal of treatment is to restore the anatomical integrity of the bone and the function of the damaged section.

There are two types of fracture treatment: surgical and conservative. They try to resort to surgical interventions in extreme cases and in the presence of certain indications for this method of treatment.

Fractures of the radius are classified depending on the traumatic factor and individual features the patient's body.

Let's look at some of them below.

Fracture without displacement of fragments is the most favorable for the patient, does not require surgical intervention and allows the patient to recover quickly. Occurs at different heights of the radius. With an isolated fracture (with the integrity of the ulna), its diagnosis can be difficult. Treatment consists in fixing the fracture site with a double-long plaster bandage, followed by its replacement with a circular plaster bandage.

Fracture with displacement of fragments in certain cases requires osteosynthesis (extraosseous, transosseous or intraosseous) with plates, screws, screws or wire sutures.

In the presence of extra-articular non-comminuted fractures under local anesthesia manual reposition of fragments is carried out and a two-long plaster cast is applied. After the edema subsides, it changes to a circular plaster cast until the end of the immobilization period.

In some situations, fractures of the radius are combined with dislocation of the head of the ulna. In this case, in addition to the reposition of fragments, it is necessary to set the head of the ulna.

Immobilization: fixation with a plaster bandage from the base of the fingers to the upper third of the shoulder in a physiological position.

Fractures of the radius in the region of the neck and head are of the following types:

without displacement of bone fragments;
with displacement of bone fragments;
comminuted fracture with displacement;
intraarticular fracture.

First of all, it is necessary to diagnose a fracture and find out if there is a displacement of bone fragments. After that, a treatment strategy is built. In the absence of displacement of fragments, conservative treatment is prescribed, which consists in anesthesia and the application of a plaster cast. If there is a displacement of fragments or crushing of the head of the bone, surgical treatment is necessary, which consists in osteosynthesis.

With crushing or comminuted fracture of the head of the radius, it can be removed. However, such measures are not practiced in children, so as not to affect the bone growth zone.

One of the most common forearm injuries is a fracture of the radius in a typical location. Then the fracture area is localized in the lower part of the beam. This injury occurs as a result of a fall on an outstretched hand with a bent or extended wrist joint.

Immobilization: from the metacarpophalangeal joint to the upper third of the forearm. Term: from 1 month (fracture without displacement of bone fragments) to 1.5-2 months (with displacement of fragments).

Therapeutic gymnastics: breathing exercises, gymnastics complexes for joints free from a plaster cast with the obligatory involvement of the fingers.

Post-immobilization period: exercises are performed in front of a table with a smooth surface to facilitate the sliding of the hand. Exercises in warm water are useful, as well as household loads, in particular self-service. It is necessary to exclude the carrying of weights and visas. Very useful massage of the affected limb.

Very often, a fracture of the radius in a typical place is combined with a detachment of the styloid process. The diagnosis is made according to the survey, examination, palpation (crepitus fragments syndrome), as well as the results of X-ray examination.

The displacement of the styloid process during a fracture can be not only in the dorsal or palmar region, but also at different angles. The tactics of treatment is selected strictly individually in each case after an X-ray examination, and in some cases - computed tomography.

One of the types of treatment for this fracture is manual reposition of fragments under local anesthesia, followed by plaster immobilization of the limb. However, this approach may result in secondary displacement of bone fragments, which will complicate further treatment of the fracture.

General methods of rehabilitation after a fracture of the radius

Rehabilitation of a fracture of the bones of the forearm with various types fractures in this anatomical region differs slightly. It is important to know the general directions of restorative measures and vary the methods depending on the characteristics of a particular fracture.

First period: immobilization

In case of a fracture of the radius, after comparing the bone fragments, a plaster cast is applied from the base of the fingers to the upper third of the shoulder. The arm should be bent in elbow joint at an angle of 90 degrees and supported by a scarf. Immobilization time: with an isolated fracture of the radius - 1 month, with a multiple fracture (radius and ulna) - 2 months.

During this period, exercises of therapeutic gymnastics are performed for joints free from a plaster cast: active, passive and static, as well as imaginary movements (ideomotor) in the elbow joint.

1.5 weeks after the fracture, magnetic stimulation of the muscles and affected nerves, pulsed UHF EP, (exposure directly through the plaster cast) or red (holes for the emitter are cut out in the plaster) are applied.

Massage of the collar area, general ultraviolet irradiation.

Second period: removable orthosis

After the plaster cast has been replaced with a removable plaster orthosis, gymnastics should be aimed at preventing contractures in the joints: all joints are worked out sequentially from the fingers to the shoulder. Ergotherapy is added: restoration of self-care skills. During this period, the following are very useful: thermal physiotherapy, therapeutic exercises in warm water (hydrokinesitherapy), mechanotherapy.

The thermal regime when exercising in the water should be soft. Water temperature: from 34 to 36 °C. Gymnastics is carried out with the arm (forearm, hand) completely submerged in water. Hydrokinesitherapy is prescribed after the removal of the plaster cast.

Attention is paid to all joints from fingers to elbows. In the initial stages, the patient helps himself to do the exercises with a healthy hand. All movements should be performed before the pain syndrome, and not through it.

Exercises begin with flexion and extension in the joints, then adduction and abduction, pronation and supination are done.

It is quite possible to supplement exercises in the water with soft sponges and balls, subsequently the size of the objects should decrease. To train fine motor skills, buttons are lowered into the water, which the patient must grab and catch.

Physical factors used in the postimmobilization period: , lidases, potassium, phonophoresis of lidases, salt baths.

Third period: no fixation

At the third stage, when fixation is not required, the load on the affected limb is not limited. When performing the complex physiotherapy exercises additional equipment for weights is used, as well as hangs and resistance exercises. In this period, emphasis is placed on the complete restoration of the limb and the elimination of residual fracture phenomena.

Therapeutic physical training includes complexes of gymnastics, mechanotherapy and hydrokinesitherapy.

Hydrokinesitherapy: the lesson is carried out as at the previous stage, but is supplemented by household manipulations. They are designed to increase the range of motion in the joints and allow the patient to expand the amount of exercise: imitation of washing hands and dishes, washing and squeezing, etc.

Physiotherapy exercises are supplemented with ergotherapy (restoration of household skills and self-service functions).

Complete recovery of the limb occurs after 4-5 months with an isolated fracture and after 6-7 months with a multiple fracture.

shock wave therapy

With poorly fused fractures and the formation of false joints, it is prescribed. This method is based on the point impact of an ultrasonic wave on the fracture area to stimulate the processes of tissue regeneration and accelerate the formation of callus. This type therapy allows you to speed up the rehabilitation time and in certain cases is an excellent alternative to surgical treatment.

Complications

Complications after fractures of the radius are provoked by the very nature of the fracture, incorrect treatment tactics or the actions of the patient. They are divided into early and late.

Early complications:

Accession of infection with development purulent process with an open fracture.
Syndrome Zudek.
Circulatory disorders.
Secondary displacement of bone fragments due to incorrect application of a plaster cast or incorrect reposition of fragments.
Damage to tendons, ligaments with the formation of diastasis between bones or adhesions between tendons (the cause of stiffness in the joints).
Neuritis Turner.

Late complications:

trophic disorders;
ischemic contracture;
malunion of the fracture.

Fractures in the region of the radius have varying degrees of severity. In this regard, their treatment will be different. But the rehabilitation procedures are the same. The attending physician can combine restorative techniques depending on the patient's condition and the characteristics of his fracture.

Video on the topic "Exercise therapy after a broken arm":

TV channel "Belarus-1", program "Health" on the topic "Fracture of the radius and other injuries of the hand: is it possible to neglect rehabilitation?":