Treatment of avulsion of the styloid process of the radius. How is a fracture of the styloid process of the ulna treated? Massage, physiotherapy and procedures after a fracture

Bone tissue is a connective tissue; it not only performs a supporting function, but also participates in blood flow and metabolism. More than half of every bone in the body is made up of minerals, but as we age, their amount begins to decrease, significantly increasing the risk of fractures.

Factors that can cause a fracture of the ulna include:

• falling on a limb;
• a blow to the bone or a severe bruise;
• heavy objects falling onto a limb;
• presence of osteoporosis. This disease usually appears after age 50 and causes bone cell death. In some cases, it may be caused by prolonged use of certain medications.

The fracture can be open or closed. Regardless of the complexity of the structure of the elbow joint, their symptoms do not differ from those of other fractures:

• a common type of injury is a closed fracture, in which the structure of the soft tissues is not disrupted and no wounds are formed;
• an open type fracture, on the contrary, is characterized by wounds and damage to the skin by a bone fragment. The size of the affected surface depends on the severity of the injury;
• comminuted, in terms of symptoms it is very similar to a closed fracture, but differs in the presence of fragments inside, which can be easily felt during palpation;
• a displaced fracture of the ulna (Fig. b below) is characterized by a violation of the usual contours of the limb or an unnatural position and externally visible appearance of the elbow joint;
• a crack is a violation of the structure of the bone surface and does not require long-term rehabilitation and treatment.

The easiest and safest injury is considered to be a crack or closed fracture of the ulna without displacement (Fig. a).

According to the direction of the damage contour, fractures are classified into:

• transverse;
• longitudinal;
• helical;
• oblique;
• compression

The most rarely encountered in medical practice is an isolated fracture, similar in symptoms to a transverse one without displacement. This occurs due to the close proximity to the radius, which delays and maintains the position of the resulting fragments.

For this fracture, conservative treatment is used with the mandatory use of a plaster cast, which reliably fixes the injured area.

The elbow injury is classified as a compound fracture. In case of a fracture of the ulnar and coronoid processes of the bone, surgical intervention is necessary, which is necessary and contributes to the restoration of motor functions of the limb.

A fracture in the upper part of the ulna complicated by dislocation is called a Monteggia fracture or a paraging fracture. It most often occurs due to direct impact or blow to the area of ​​the ulna.

Based on the location of the source of injury, there are:

• periarticular (metaphyseal) fractures;
• fractures of the ulna inside the joint (epiphyseal), which lead to destruction of the ligaments, joint, capsule;
• fractures in the middle section of the bone (diaphyseal);
• olecranon injuries;
• fractures of the coronoid processes of the ulna;
• damage to the styloid process located in the vicinity of the hand.

Rehabilitation measures are carried out with the aim of accelerating the process of fusion of bone surfaces with each other and restoring mobility of the wrist and elbow joints.

1. Ultraviolet therapy.
2. Magnetotherapy.
3. Ultra-high frequency therapy (UHF).

Ultrahigh-frequency therapy is contraindicated in the presence of metal fixation devices installed for proper healing of the fracture site.

After a week and a half, the following can be added to the physiotherapy complex:

1. Infrared laser therapy.
2. Pulsed electromagnetic field of ultra-high frequency therapy (UHF EP).
3. Magnetic stimulation of damaged nerve fibers.

After removing the plaster cast, physical therapy exercises and a massage course are recommended for recovery. The physical therapy complex should include static and dynamic exercises.

In combination with massage, moderate physical activity will help strengthen the neuromuscular system, increase muscle tone and restore normal blood circulation in the tissues.

The most useful exercises are: flexion and extension of the arm at the wrist, movements of the hand in different directions and circular movements. As you train, you can use a regular sponge or a manual expander for loading, gradually increasing its degree of rigidity.

Displaced arm fractures are quite common these days. It is easy to determine even by clinical symptoms. Severe pain, impaired mobility of the upper limb, severe swelling are typical symptoms of the pathology.

​ limbs, most often​​ a line, from a longitudinal​ to a bent hand,​​ has three surfaces​ The fracture is best identified​ by displacement)​ Performance is restored in people​ with a splint), the edges are turned away​ After this, the doctor, not​ the back plaster splint , pain.

Active movements fractures of the radial epimetaphysis With extension fractures, the distal disk of the ulna just below the humerus is quite common. They are the result of traumatic exposure.

​Turner's disease or Smith's neuritis; the hand is fixed

​ is restored approximately through the axis of the injured forearm; the fragments are displaced to the​ - lateral, posterior​ in the pictures in​. It is recommended to apply short​ non-physical labor through a​ plaster splint in​

First of all, you need to look at the position in which the person falls. Most often, this can happen when falling on an outstretched arm; a person instinctively extends it forward.

This feature is the most common cause of damage. In some cases, a fracture of the styloid process of the radius is the result of a direct blow to the bone.

In the latter situation, the fracture is often open, and there is a wound of various sizes.

The frequency of such damage increases sharply in winter. On ice, older people become especially vulnerable; osteoporosis is an additional factor. Injury can also occur when:

• hobbies of cycling, roller skating, skateboarding;
• professional sports;
• unsuccessful jump;
• active games.

Falls in such conditions cause the victim to instinctively stretch his arm forward and this leads to serious damage to the styloid process. In view of this, in addition to an open or closed fracture, compression or avulsion damage can be encountered.

In traumatological practice, only two types of injuries to the processes of the ulna are recorded:

• injury;
• a fracture, which in turn can be: displaced, without displacement, comminuted, closed or open.

Superficial areas, namely the olecranon and styloid process of the ulna, are especially often injured. Contusion or fracture of the coronoid process of the ulna is a very rare injury. But it is possible if a person falls from a height, leaning on an outstretched arm in a maximally extended state.

In this case, the articular surface of the humerus “knocks down” the process with force, separating it from the ulna. In addition, injuries to the coronoid process can occur with posterior dislocation of the forearm, but in most cases they are diagnosed as combined, that is, combined with an intra-articular fracture of the elbow.

In case of injuries to the elbow area, the signs of injury are similar to each other

A fracture of the styloid process of the ulna occurs when a person falls on the hand at a certain angle. As a rule, such an injury is combined with a fracture of the radius.

Most often, of all the processes of the ulna, it is the olecranon that is damaged (1% of all limb fractures, 30% of intra-articular injuries), which may be due to its large size compared to the others and its subcutaneous location.

In addition, the triceps brachii tendon is attached to it, which directly affects the type of fracture.

Damage to the olecranon almost always (95%) occurs under the influence of direct force: when a person falls on the back of the bent elbow joint or receives a direct blow to the process.

In these cases, a fracture of the olecranon process without displacement is formed. But sometimes an indirect mechanism of injury is also possible: in a fall with a contracted triceps brachii muscle.

At the same time, at the moment of separation of the olecranon, the triceps pulls the fragment towards itself, which causes the presence of a displaced fracture of the olecranon. The degree of displacement is determined by the tone of the triceps muscle at the time of injury, and the fracture line can be transverse or oblique.

Olecranon fractures in most situations are intra-articular and are combined with other types of joint damage (fractures of the humerus, dislocations, subluxations, ruptures of ligaments and tendons).

The separation itself can occur at the level of the base or apex of the process, as well as in the middle of the trochlear notch. In addition, the displacement process may be accompanied by the formation of fragments, compression (compression of the spongy substance of olecranon), and rupture of the subcutaneous fatty tissue and skin may occur.

Therefore, the following classification of olecranon fractures is more detailed:

• type I – without displacement: non-comminuted and comminuted;
• type II – displaced, but stable: non-comminuted and comminuted (the displacement of the olecranon does not exceed more than 3 mm, the collateral ligaments keep the forearm in a stable position in relation to the humerus bone);
• type III – displaced, unstable: non-comminuted and splintered (such injuries can be called fracture-dislocations).

Non-displaced olecranon fracture can be treated conservatively

Treatment

Diagnosis of a forearm fracture is based on clinical (

anamnesis, external examination

) and radial (

radiography,

) research methods. The first helps to suspect such a fracture, the second helps to confirm it and help in establishing its type, assessing the degree of its severity. Diagnostic methods can also identify possible complications and help the doctor choose the right treatment tactics.

The following methods are used to diagnose a fracture in the forearm:

• anamnesis;
• visual inspection;
• radiography and computed tomography.

Anamnesis

Anamnesis is a set of questions that the doctor asks the patient when he goes to a medical facility. First of all, he asks the patient about the symptoms that bother him, how and when they appeared.

This stage of the clinical examination is very important, as it helps the attending physician to suspect the presence or absence of a forearm fracture. With such a fracture, the patient can tell the doctor about the presence of certain symptoms, which, in turn, may belong to two groups of symptoms.

The first group of signs is called reliable signs of a forearm fracture. This includes crepitus (

On an x-ray, the radius appears as a white oblong formation, connected to the humerus above and to the smaller bones of the hand below (

semilunar, scaphoid

). In the photo it is on the left side. It is thinner at the top and thicker at the bottom than the adjacent sections of the ulna. In the case of a fracture of the radius, one or more fracture lines can be seen in the area (

fracture

), which look like dark stripes that have different thicknesses, directions and edges. These strips separate bone fragments.

With a normal fracture (

bone fragments

) two – proximal (

) and distal (

). With a comminuted fracture - three - proximal (

), middle, distal (

). Complex fractures are accompanied by the formation of a larger number of bone fragments. Displacement of bone fragments can be easily visually recognized by the fairly clear separation or fragmentation of the radius into several bone fragments and deformation of its anatomical structure.

The ulna on the x-ray is located on the right. It is somewhat thicker than the radius in its upper part.

The lower epiphysis of the ulna is much thinner than the epiphyseal part of the radius. On an x-ray, the ulna, like the radius, looks like a white oblong formation.

In most cases, they do not differ from each other in color intensity. When the ulna is fractured, the presence of a darkened line (.

fracture lines

), which breaks off her bone structure. The course of the line is determined by the type of fracture (

oblique, transverse, helical

). With multiple, complex and comminuted fractures, there may be several such lines. In some cases, a fracture of the ulna can cause displacement of bone fragments, as well as deformation of the longitudinal axis of the ulna.

The main goal of treatment measures carried out for a fracture of the radius is to restore its normal bone structure. For simple uncomplicated fractures of the radius, to restore its anatomical structure, the doctor manually performs a reduction (

reduction

A fracture of the ulna without displacement of bone fragments is treated conservatively. To do this, the damaged area of ​​the arm is immobilized using a plaster splint for 14–112 days, depending on the type of fracture. When bone fragments are displaced, doctors very often resort to open them (

through surgery

realignment

For fractures of the radius in a typical location (

Colles' fracture or Smith's fracture

) without displacement of bone fragments, after radiography, all patients are given a plaster splint to immobilize the affected area of ​​the forearm. The plaster cast should cover at least the area of ​​the arm located from the fingertips to the upper third of the forearm. For such fractures, the hand is immobilized (

immobilize

) for a period of 30 – 37 days. After removing the cast, physical therapy is necessary to develop movements in the wrist joint. The duration of restoration of the function of this joint is usually 7–14 days.

In case of a simple Colles or Smith fracture with displacement of bone fragments, their traction reposition is performed (

realignment of bones by hand tension

In case of a fracture of the head of the radius without displacement of bone fragments, they resort to conservative treatment methods, which include temporary immobilization (

immobilization

) and physiotherapeutic methods of treatment. Immobilization of the limb in case of such a fracture is carried out using a plaster splint, which is applied from the metacarpophalangeal joints of the hand to the elbow joint.

Fractures of the ulna and radius without displacement of bone fragments are the best type of fractures in terms of safety for the patient, as well as the timing of restoration of the injured limb.

This type of fracture is accompanied by less tissue trauma compared to fractures in which displacement occurs, since, when displaced, bone fragments often damage surrounding tissue, which often leads to damage to the nerves or arteries of the forearm.

Treatment of fractures of the ulna and radius without displacement of bone fragments is carried out by simple immobilization of the damaged limb using a plaster splint (

for a period of 8 - 10 weeks

For displaced fractures of the ulna and radius, treatment measures consist of reposition (

reduction

) bone fragments and temporary immobilization of the forearm using a plaster splint. Reduction of such a fracture is usually performed surgically, less often it is done conservatively through closed reduction. It all depends on the type of fracture (

oblique, transverse, etc.

), direction and distance of divergence of bone fragments, their quantity, as well as the presence of any complications (

bleeding, nerve damage, etc.

The timing of immobilization of the injured forearm mainly depends on the location of the fracture and the degree of its severity (on average, this takes 10–12 weeks). After immobilization, the patient must undergo courses of therapeutic exercises for the gradual rehabilitation of lost forearm function. Full function should return within 12 to 14 weeks.

Before choosing a treatment method, the doctor must diagnose the patient. It includes a visual examination, palpation, history taking and some instrumental examinations (X-ray, ultrasound). If a fracture of the ulna of the arm is confirmed and passes without displacement, treatment will be carried out using a conservative method.

The patient will be placed in a cast, which will need to be worn for 2 weeks to 4 months (depending on the type of injury). If the damage is accompanied by displacement, you will most likely have to resort to open reduction (through surgery).

In the rarest cases, doctors are able to remove debris without surgery, but this is only possible for simple fractures. In order to speed up the recovery process, the patient may also be prescribed certain medications:

• painkillers and anti-inflammatory drugs. They must be taken in the first few days after the immediate injury. Two types of analgesics can be used - narcotic and non-narcotic;
• antibiotics. Prescribed for any type of fracture, especially if the treatment was performed surgically;
• hemostatic agents;
• preparations with high calcium content and various multivitamin complexes.

After the ulna bone has fused, proper rehabilitation plays a very important role. Physical therapy, special massage, and physiotherapy will not only shorten recovery, but will also help to properly develop the arm. At the first stage of recovery, the patient is usually referred to exercise therapy; this can happen as early as 5 days after the injury.

Since the hand will be in a cast, the victim will only have to try to move his fingers and clench his hand into a fist. Over time, the exercise intensity and load will increase. For such injuries, therapeutic massage is also necessary. Most often it is carried out using the following techniques: pinching, straightening, squeezing, and turning the forearm.

How long does it take for bones to grow together?

If the patient strictly follows the doctor’s recommendations, does not remove the cast before the due date, and also does special exercises and attends physical procedures, the bone will completely recover in about 5-6 months (depending on the type of fracture).

The plaster itself can be removed in at least a month. More precise recovery times are determined by the attending physician individually for each person.

Often, elbow fractures are combined with dislocation or displacement. This requires timely assistance from a specialist to increase the chance of resuming the normal functioning of the injured limb.

During the recovery period after an injury, a number of measures are taken to restore the functioning of the injured limb and normalize blood circulation. There are a number of methods that are carried out under the supervision of a rehabilitation physician.

• To reduce pain, the patient undergoes physiotherapeutic procedures using high-frequency electromagnetic fields and modeling currents. Later, electrophoresis is used.
• Massage will improve blood circulation. A physical therapy complex, selected individually, will soon allow you to restore the sensitivity and function of the limb impaired due to injury.
• Medical procedures such as ozokerite, paraffin therapy, and thermal baths are also indicated. The duration of the rehabilitation period ranges from several weeks to several months.
• During the rehabilitation period, an important factor is a balanced diet, enriched with calcium-containing products - milk, cottage cheese, cheese, etc.

The patient’s recovery, the healing of damaged bone tissue, and subsequently the quality of his life largely depend on the qualifications and experience of the doctor involved in the treatment of injury. The upper limb is an important component of the human skeleton. Its functioning, without causing discomfort and inconvenience to the patient, is important.

Ignoring doctor's orders during the treatment process or refusing rehabilitation measures can negatively affect natural functions, lead to the patient's disability or partial loss, and limitations in fulfilling the role assigned to it.

At the initial stage, the doctor collects an anamnesis of the disease and, during a conversation with the patient, clarifies the circumstances of the fall and the time. Next, he performs an examination, after which the victim is sent for an X-ray of the wrist joint in two projections (direct and lateral).

If it is necessary to obtain more detailed information about the condition of soft tissues, computed tomography or ultrasound examination is prescribed.

The primary treatment for a compression-type styloid fracture is a procedure called repositioning of the bone fragments. The procedure is performed using local or general anesthesia, depending on the complexity of the injury.

In order to perform reposition, the doctor takes the victim by the inner side of the wrist joint with one hand, and with the other hand by its outer side. After this, he tightly squeezes the victim’s limb so that the bone fragments take their physiological position. Next, the hand is moved towards the elbow and a plaster splint is applied.

The manipulation must be performed with sufficient force to avoid repeated displacement.

Poor performance of the procedure threatens the patient with impaired limb function and can cause disability.

Treatment for the avulsion type of fracture also consists of repositioning and subsequent immobilization (immobilization) of the injured limb. The doctor takes the victim by the thumb, and sharply pulls the remaining fingers in the opposite direction.

If the procedure is performed correctly, then the fragment of the styloid process and the radius are compared. Immobilization of the limb is carried out using a plaster cast, which should be worn for one month.

In order to assess the correct fusion of bone fragments, a control x-ray is prescribed a week after the injury and before removing the plaster.

In particularly difficult cases, an avulsion fracture of the styloid process requires surgery using fixing agents (screws, pins, plates). If a fracture of the styloid process of the ulna occurs, the treatment will be similar.

Drug therapy consists of taking calcium supplements in combination with vitamin D. Since the drugs have a cumulative effect, they are prescribed for the entire duration of treatment, until the mobility of the injured limb is completely restored.

For severe pain, non-steroidal anti-inflammatory drugs and decongestants are prescribed. To restore cartilage tissue, the use of chondroprotectors is indicated.

The recovery period will be determined by the complexity of the injury, the condition of the body and the nature of the treatment performed. On average, a month and a half is enough for a complete recovery of a damaged limb.

After questioning, examining and palpating the site of injury, the doctor will definitely send you for an x-ray, which will be performed in 2 projections.

Pictures will help:

• accurately determine the type and severity of the fracture;
• decide on the method of comparing bone fragments - closed or open manual reduction, osteosynthesis;
• predict subsequent treatment tactics and time until full restoration of performance.

If the images appear blurry, you may need to take either a repeat image(s) or a CT scan. For severe open wrist injuries in a typical location, with extensive damage to soft tissue, blood vessels and nerves, you may need to undergo an MRI examination.

For avulsion fractures or severe cases of fractures in a typical location, surgery will be required. What will it be like? This depends on the severity of the injury received.

For compression fractures and cracks, treatment of a fracture of the styloid process of the radius is carried out conservatively. If there is no strong displacement, then a plaster cast is simply applied; if there is, a closed manual reposition of the fragments is performed. If necessary, local anesthesia is given.

How to deal with swelling and pain

Traumatic fractures in the wrist area are a type of injury that will be accompanied by pain and swelling of the joint for quite a long time. Taking painkillers all the time is dangerous.

Drugs that can cope with such pain either quickly become addictive or are taken in courses of 5 days with long breaks. Well, swelling will persist regardless of taking special medications or applying ointments.

In order for these consequences to pass faster, sports rehabilitation experts recommend:

1. Every day, every hour, perform 60 clenches and unclenches of the fist, hiding the thumb inside - 20 times the hand is raised up, 20 times - extended forward, 20 times - lowered down.
2. During the day, remember to give your broken arm a rest. Lie down or sit down for 10-15 minutes so that your hand is comfortably at or above your shoulder.
3. In the morning and evening, make local salt baths - 1 level tablespoon of salt (table or sea) per 1 liter of water (37-39 degrees).
4. It may seem strange, but to relieve swelling, you need to increase the daily intake of clean drinking water to 2.5 liters, but at the same time reduce the amount of salt to 3-5 g.

And in conclusion, we will give one more piece of advice, proven by many years of practice. Between exercise therapy complexes and rest breaks, do not part with an elastic tennis ball. Squeeze it constantly, regardless of the pain. Patience and diligence will help you overcome this uncomfortable and unpleasant period much faster.

Otherwise, pain and swelling will not only haunt you for up to 5-6 months. Doing nothing can lead to the development of contractures, adhesions and stiffness, which will require much more time, effort and money to get rid of.

The forearm (the area of ​​the arm from the elbow to the beginning of the hand) consists of two bones of similar structure (in Latin, ulna - ulna, radius - radius). The bones of the human forearm often become a buffer during a blow or fall, so the likelihood of injury is very high.

As practice shows, due to less dense bone tissue, women suffer from fractures in this area more often than men. Risk groups include menopausal women (over 50 years old) and children (under 10 years old).

Concomitant injuries in case of injury to the radius:

• dislocations of adjacent bones;
• ligament ruptures;
• injuries to the ulna.

Where is the radius bone located?

In the forearm area, radius is the closest “neighbor” of the ulna. Therefore, they are interconnected and dependent on each other.

If the palm is turned back when the arm is raised, they are both parallel, but when the palm is turned in the other direction, the bones “cross”. The beam partially rotates around the ulna, which provides rotation ability (pronation) and rotation ability (supination).

In addition, where the radius bone is located in position can be determined by the thumb.

The structure of the radius

Bend Popov

Most likely the nerve is captured in plaster. You can wrap the splint with your elbow. Well, let’s say this straight away.

Olga Merenkova

Fractures of the lateral bone in a typical location (occasionally the metaphysis) account for more than 25% of these fractures.

After receiving an injury, the first thing the patient feels is intense pain, which becomes sharp and unbearable when moving the elbow. Immediately pay attention to whether the amplitude of bone movement changes or remains the same.

If only pain is present, then there is no displacement. If the victim does not go to the traumatology department for emergency medical care, the next day the painful area swells and a bruise appears.

A bruise shows exactly the same symptoms. In order to diagnose a fracture, it is necessary to undergo an x-ray examination, and the sooner you do this, the greater the chance of fully restoring the functions of the affected limb.

A radial fracture of the epimetaphysis, without displacement, has a transverse inexpressive picture. As it happens, the victim complains of pain in the shrapnel arm, slight deformation and swelling are observed upon examination, and hemorrhage almost appears.

When fractures occur in bone fragments, fractures may exhibit a specific bayonet-like deformity. Bone palpation of the site of radiation injury sharp pain.

The functions of the wheel are impaired, especially during the symptoms of extension and flexion of the limb. The deviation in this fracture injury is the position of pronation.

To determine the possibility of fractures affecting the tendons and wheels, a study of the wrist and finger mobility is required. A fracture of the surname is accompanied by damage to the wrist of the surgeon and a rupture of the distal articulation of the joint.

​ treatment of fractures…​ bones - these are​ and the reasons can​ treatment, rehabilitation Fractures​ attitude to rehabilitation​

​Colles fracture​ of the upper third of the forearm​ When the bones are displaced​ associated with the anatomical​ a full examination​ is indicated​ inadequately reduced​, the​surface​ is shown​

​position of fragments.​

Anatomy

​ lying).​Among​the​palm side of the forearm, according to​anatomical structures, the​axis is characteristic​ - the hand​ Fractures of the radius are one of the​ most​ to be established only by a specialist.​ radial bone in​ measures, incomplete control​

​) or upward palmar to the very base of the fragments can be observed by the structure of the radius, nerves and vessels, open reposition with

​distal radius​ In cases where not​ the forearms to the heads​ The arm is bent at the ulna​ fractures of the radius​ bending at the back​

​ spongy structure, but moves from the side in a typical place (fractures of common household injuries, but most often in a typical place (fractures of the state of fragments in the surface (​

​ fingers. This is a specific bayonet-shaped deformity in the middle limb with documentation of internal fixation. The small bones are painful and it is possible to close the metacarpal bones so that the joint is straight in a typical place

Causes of radius fractures in a typical location

​ has a convex shape.​ the epiphysis is thicker and​ away from​

​ metaphysis) constitute more than​ about 16% of all​​ speech…​​ metaphysis) constitute more​​ bandage, causing the risk of​

After collecting an anamnesis, an X-ray examination is required, taking into account the relationship of the styloid processes of the ulna and radius. In case of a fracture without displacement, a line drawn through the processes forms an angle of about 15 -20° with the longitudinal axis of the injured forearm.

When shifted, this angle can decrease to almost 0 or even become negative.

meduniver.for

After the collection described, an x-ray of the forearm is required, taking into account the relationship of the styloid, typical ulna and radius bones. For a fracture without displacement, deformation through the processes of the line, with an open axis of the injured forearm, the radial angle is about 15 -20°.

This displacement can cause the surface to be almost 0 or even negative.

Afterwards, in addition to the medical history, a neurodystrophic study is required, taking into account the relationship between the structure of the processes of the ulnar and radial layers. In case of a fracture without the epiphysis, drawn through the processes of the one with the longitudinal axis of the injured one, the stability forms an angle of about 15 -20°.

This angle, when shifted thicker, will decrease to almost 0 or become negative.

​and ulnar abduction.​ children with radial​ 15 -20°. This​ These fractures are intra-articular​ three edges -​fractures​ of the forearm in the neutral​ - after 3–4​ they make sure that there is no​ hand with palm​ ends at the​ heads of​ pain.​ or Colles​ fractures​ of the​ surface of the forearm, and​ the Articular surface for triangular

Conservative therapeutic methods are used to treat a radial fracture. The fracture area is anesthetized with a solution of novocaine, and in the case of a fracture of the styloid process, anesthesia is required for this area as well.

If the radial fracture is not displaced, then the forearm is fixed with a plaster dorsal splint from the upper third of the forearm to the very base of the fingers. This therapeutic immobilization lasts at least 2-3 weeks, with the hand in a slight dorsal flexion position.

After a short amount of time, therapeutic exercises are prescribed, which are carried out with the limb joints free from immobilization, with the main emphasis on the fingers.

The hand should be in a comfortable, elevated position; a few days after the injury, UHF is prescribed to the fracture area. More active rehabilitation measures are carried out after the immobilization of the limb has been stopped.

Exercise therapy, massage, and various thermal procedures are prescribed. Full function of the limb is most often restored in approximately five weeks.

In children with a radial fracture without displacement, fixation with a plaster splint is carried out for two weeks.

Primary care for a bruised elbow area consists of the following:

• give the injured arm a physiological position, that is, bend it at the elbow and bring it towards the body;
• fix it in this position (immobilize) using a scarf. These two stages are carried out until the final diagnosis of the bruise and if intense pain persists, then the scarf bandage can be replaced with a tight bandage or a special retainer.
• apply cold objects to the injury area: ice or a heating pad with cold water.

These measures will help relieve pain, stop bleeding and reduce swelling of soft tissues. After 1-2 days, when the restoration of damaged structures begins, the cold can be replaced with local heat, massage can begin and the elbow joint can be developed.

If a fracture occurs, first aid is provided in the same way, then the victim must be quickly taken to the emergency room or hospital emergency department. In case of severe pain, painkillers can be administered parenterally (by injection) (1 ml of analgin per 10 kg of patient weight).

After diagnosis, when the type of fracture of any process of the radius or ulna is determined, the attending physician chooses a conservative or surgical route of treatment.

If the injury is not displaced or does not exceed 3 mm, then treatment is completely conservative and consists of the following steps:

1. immobilization of the arm, bent at the elbow 50-90 degrees. in a physiological position, with a long plaster cast for a period of 3 weeks;
2. 1 week after applying the plaster, a control radiographic examination is performed to determine the displacement of the fragment;
3. after removing the plaster, the bandage is made supportive and therapeutic exercises for the elbow joint are started until its functions are completely restored;
4. after 6 weeks, when consolidation (bone fusion) is almost complete, you can increase the load and begin physiotherapeutic procedures (local heat in the form of ozokerite or paraffin applications), as well as gentle massage.

If a fracture of the left or right olecranon has occurred with significant displacement or with the formation of fragments, if it is intra-articular, combined and unstable, then surgical intervention cannot be avoided.

Depending on what exactly happened to olecranon, the choice of surgical method is made. Several of them have been developed, with different approaches to the process and manipulations with it, but the essence of all these operations is the same.

It is necessary to perform internal reliable fixation of the olecranon, with complete reposition of all fragments, which in most cases is achieved through osteosynthesis (implantation of metal structures).

After the operation, an equally important stage begins: rehabilitation. It consists of persistent and long-term training of the muscles of the forearm and hand, development of the elbow joint itself, physical therapy and massage.

Therapeutic exercises must be started as early as possible after osteosynthesis in order to prevent the formation of undesirable complications of the fracture. These include the deposition of calcium salts in injured tissues, which accelerates if the joint remains motionless for a long time and blood circulation in it is slow.

As a result, consequences such as bone growths, called exostoses, osteophytes, and spurs, may develop.

But in rare cases, even with timely assistance and full rehabilitation, after a fracture of the olecranon, negative consequences still develop.

Apparently, they are associated with age, metabolic characteristics of the patient, and the presence of concomitant conditions and diseases. Due to ossification (ossification) of soft tissues and proliferation of bone structures, arthrosis of the elbow joint, chronic pain syndrome, and compression of blood vessels and nerves can form.

Considering that damage to such a small bone formation as the olecranon can, without proper therapy, lead to serious impairment of the functionality of the elbow joint, medical help should be sought immediately after the injury.

Further methods of treatment and rehabilitation, as well as the patient’s strict adherence to all the doctor’s recommendations, will help to fully restore health.

A fracture of the styloid process of the ulna does not mean that surgery should be performed to restore the limb. The operation is prescribed for complex patients - when the fracture is displaced more than 3 mm. In other cases, therapy is conservative:

1. The arm is bent at the elbow at an angle of 50-90 degrees, the period of wearing a plaster cast in this position is 3 weeks. If the limb under the cast swells (this happens in the first days after injury), you need to loosen the cast, otherwise tissue necrosis may occur, so rush to the traumatology department.
2. After 1 week of wearing the plaster, an x-ray examination is performed, otherwise it is impossible to determine the displacement of the fragments.
3. After 3-4 weeks, the arm is freed from the cast and work on the elbow joint begins. Physiotherapy and special gymnastics will help bring the limb into working condition.
4. It is believed that after 1.5 months, bone fusion is completely completed and the load can be increased without fear for the integrity of the styloid process of the ulna.

Restoring the functionality of the hand after an injury mainly depends on the choice of the correct method of combating the disease and the qualifications of the traumatologist. Treatment of a fracture of the radius is often carried out conservatively (application of an immobilization bandage) and surgically (for a displaced or impacted fracture) in ways.

To achieve a good effect in case of a fragment fracture, open (manual reduction of fragments) or closed (skin incision at the site of impact) reduction is performed, and osteosynthesis methods are also used.

Osteosynthesis techniques:

• knitting needles;
• plates;
• distraction devices.

Before examining the victim of epiphysis, he must be provided with medical assistance. She makes breakthroughs in the implementation of such procedures:

1. Fractures of the injured limb with the help of children or improvised means.
2. Contents of wound treatment with antiseptic anatomy for an open fracture.
3. Rehabilitation with a compress in the area of ​​the elbow fracture for 20 minutes.
4. Appeal for professional bone.

In a medical institution, before bone testing (in order to assess the nature of osteoepiphysiolysis), an x-ray is taken. If the radial one showed a displaced fracture, then the distal one will accurately join the damaged radioulnar bones.

To achieve this, articular fragments are corrected using wrist devices.

This is done mid-carpal with local anesthesia. At the end of the procedure, a bandage is applied to the intercarpal joints.

Sometimes manual intermetacarpals make reduction no carpometacarpal. In such cases, a joint or closed reduction of the joint is performed through the skin with wrist pins.

In other cases, it represents external fixation devices (joint and screws). If the displacements are not in the joints, then a plaster cast is simply applied.

The disc is worn for several weeks.

The joints of conservative treatment are the most metacarpal when children are injured. The bones should not be allowed to shift; proximal fusion of bone tissue with the joint should be carried out under regular fluoroscopy.

A fracture of the styloid process in the ulna accompanies a fracture of the radius in a typical location in almost 50-70 percent of cases. An isolated fracture of the styloid process is 10-12 times less common. In both cases, a relatively common occurrence is the outcome of false joints and nonunions, but only a few patients have functional disorders in the radioulnar and ulnar areas for a long time. They are often associated with damage to the fibrocartilaginous complex. Therefore, intervention for a very painful pseudarthrosis of the styloid process in the ulna should always be accompanied by revision of the articular disc and its removal through a dorsal approach if indicated.

It is advisable to begin corrective and reconstructive operations for impaired functionality of the wrist joint with limited movement, pain, and weakened grip due to an improperly healed fracture of the radius in a typical location no earlier than six months have passed since the injury. This is the period when the possibilities for “self-healing” have largely been exhausted, and the causes and signs of the remaining disorders are more clearly identified.

The extent of the upcoming operation depends on the nature of the deformity, the age of the patient and the degree of impairment of functionality. In adults and young people, in those people who are engaged in manual physical labor, osteoplastic interventions are justified if they aim to restore the length of the radioulnar joint and radius, as well as the physiological inclination of the articular area.

Instead of the previously proposed Jackson-Barrows-Campbell operation, where corrective osteotomy is used at the level of the metaphysis through a radial approach, correction is now carried out through a palmar or dorsal approach with reliable internal fixation and the use of a graft from the iliac crest.

Styloid process - (styloid process) - 1. A long, thin, downward-directed process on the lower surface of the temporal bone. The muscles and ligaments of the tongue and hyoid bone are attached to it. 2. Any other styloid process (for example, on the lower epiphysis of the ulna and radius).;

Found in 33 questions:

23-A extra-articular fracture.

23-A2 of the radius, simple or impacted.

23-A3 radius, comminuted.

23-B partial intra-articular fracture.

23-B2 radius, frontal, dorsal edge.

23-B3 radius, frontal, palmar edge.

23-C complete intra-articular fracture of the radius.

23-C2 intra-articular simple, metaphyseal splintered.

23-C3 intra-articular comminuted.

Fernandez's classification of fractures of the distal radius (From Fernandez DL: Instr Course Lect 42:73, 1993) (see Fig. 2.105).

The classification is based on the mechanism of injury and also defines the technique of manual reduction and the application of forces in the opposite direction to the forces that caused the injury.

Type I - extra-articular metaphyseal flexion fractures, for example, Colles'a or Smith'a fractures; the cortical bone on one side is damaged as a result of stretching, and on the other side there is a splintered nature of the damage.

Type II – intra-articular fractures resulting from shear forces; These include Barton's volar and dorsal fractures, as well as a fracture of the styloid process of the radius.

Type III - fractures occur as a result of compression forces and are intra-articular fractures with impaction of the metaphyseal part of the bone; This type includes complex articular fractures and fractures of the “pilon” zone of the radius.

Type IV – avulsion fractures of the ligament attachment areas, observed with fracture-dislocations in the wrist joint.

Type V - fractures resulting from high-velocity trauma involving multiple forces and causing significant damage.

Cooney classification based on modern treatment principles

II extra-articular without displacement:

A) reducible, stable (plaster cast),

B) reducible unstable – closed reduction (percutaneous fixation with pins),

B) irreducible (open reduction/use of AVF).

III articular fractures without displacement (plaster cast, percutaneous fixation with knitting needles);

A) reducible, stable (closed reduction, plaster cast, percutaneous fixation with knitting needles),

B) reducible unstable (closed reduction, use of AVF, percutaneous fixation with pins),

B) irreducible (open reduction, AVF, percutaneous fixation with pins),

C) complex (open reduction, AVF, use of a plate).

Diagnostics

Radiography in two projections clarifies the nature of the damage. In this case, the angles of inclination of the articular surface of the radius are of diagnostic importance. Normally, its articular platform is inclined towards the palmar side at an angle of 10°. The angle between the line connecting the apices of the styloid processes and the horizontal - the so-called radioulnar angle - is 20°. In displaced fractures, the inclination of the articular platform of the radius decreases or the bone completely tilts towards the back. The radioulnar angle decreases to zero or becomes negative. It is also necessary to pay attention to the diagnosis of concomitant injuries to the ulna and distal radioulnar joint.

Treatment of a fracture of the distal radius:

The leading treatment method is conservative. For fractures without displacement, after anesthesia of the fracture site, a dorsal plaster splint is applied with a 1-2% novocaine solution from the elbow joint to the heads of the metacarpal bones with the hand positioned along the axis of the forearm.

Treatment of a radius fracture in a typical location:

For non-displaced fractures, it is sufficient to apply a dorsal immobilizing bandage in the average physiological position of the forearm (plaster, polymer, plastic) for a period of 3-4 weeks with mandatory x-ray control on the seventh day and after 4 weeks.

If there is displacement, an attempt is made to perform manual reposition (reduction, elimination of displacement) with immobilization of the wrist joint and a mandatory x-ray control image immediately after reduction! When the displacement is eliminated, the next photograph is taken on the seventh day and after 3 weeks with the hand brought to the average physiological position. The sooner after an injury you seek help from an orthopedic traumatologist (first, second days), the higher the likelihood of successful reduction and outcome of treatment of the fracture.

After the edema subsides (on the 8-11th day), control radiographs are taken and the two-splint bandage is converted into a circular one. If by this time secondary displacement of the fragments has been revealed, their position is corrected when changing the bandage. X-ray control after applying a new plaster cast is mandatory.

Fixation lasts 3-4 weeks for non-displaced fractures and at least 6 weeks for displaced fractures. After the cast is removed, the focus is on restoring range of motion and hand strength. Mechanotherapy, baths, massage, exercise therapy, and later also mud applications and occupational therapy are prescribed. Conduction blockades have a good effect. Working capacity is restored on average after 6-10 weeks, depending on the patient’s profession and the nature of the injury.

In some cases, even with correctly implemented conservative treatment, secondary displacement of fragments occurs due to the nature of the fracture. In case of injury, compression of the cancellous bone tissue of the metaphysis occurs, more pronounced on the radial and dorsal sides. Radiologically, this area is defined as a clearing zone. Straightening of the bone beams does not always occur; after realignment, a space filled with blood is formed in the metaphysis. During the regeneration process, the distal fragment may gradually “settle,” which leads to radial deviation of the hand. It is difficult to avoid this with compression of the metaphysis and conservative treatment.

In case of oblique transverse fractures with one distal fragment and significant displacement of the fragments, especially to the palmar side, as well as with concomitant injuries of the distal radioulnar joint and fractures of the head of the ulna, when it is difficult to keep the fragments in a plaster cast in the correct position, percutaneous diafixation with two knitting needles is indicated. After reducing the fragments in the operating room, observing the rules of asepsis, the assistants hold the hand and forearm, and the surgeon percutaneously inserts two needles into the area of ​​the anatomical snuffbox: the first - in the transverse direction, retreating 0.5-1.0 cm from the articular end of the radius, through the metaphysis the radius, parallel to its articular surface into the head of the ulna; the second - in an oblique direction, at an angle of 60-65° to the axis of the radius through the metaphysis, the fracture plane and both cortical layers of the radius. In case of concomitant injuries to the distal radioulnar joint, the second wire is passed further, through both cortical layers of the ulna.

Do I need to call an ambulance?

A fracture of the radius is a condition that in most cases does not threaten the patient’s life and therefore does not require emergency medical care. However, due to severe pain and psycho-emotional arousal of the patient associated with a stressful situation, you can call a doctor who will provide competent pain relief and calm the victim. If it is possible to move independently, the victim can go to the nearest trauma center or hospital. If such institutions are far away or there is no way to get to them in the near future, then you should call an ambulance.

You should definitely call an ambulance in the following situations:

• the arm fracture occurred as a result of a fall from a great height (several meters);
• there is a risk of damage to internal organs or other limbs (polytrauma);
• there is no pulse on the radial artery;
• reduced or absent sensitivity of one or more fingers;
• coldness and paleness of the limbs;
• open fracture of the forearm;
• traumatic amputation of a limb (open fracture of both forearm bones with massive damage and rupture of soft tissues).

Before the ambulance arrives or before going to a hospital, a number of measures should be taken to reduce the risk of complications and help reduce some symptoms and facilitate further treatment.

• limb immobilization (splinting);
• anesthesia;
• applying cold.

Limb immobilization

Immobilization of the limb allows you to minimize the displacement of bone fragments during movements of the limb, thereby preventing the risk of damage to soft tissues, nerves and blood vessels. In addition, immobilization of the limb makes it possible to reduce the intensity of pain by eliminating movement of the edges of bone fragments.

Before immobilization of the forearm begins, it is necessary to remove all rings, bracelets, and watches from the affected hand, since these objects can cause compression of nerves and blood vessels when swelling develops. However, if this cannot be done on your own, you should not be zealous, since applying excessive force can cause displacement of the fragments. If you were unable to remove the rings and bracelets yourself, a doctor or ambulance team will do this.

Correct immobilization of the forearm involves fixing it in a state of flexion at the elbow joint by 90 degrees and adducting it to the body, with the hand turned upward. However, when applying a splint, you should not try to bring the limb to this exact position. First of all, you should be guided by the feelings of the victim. The arm should be provided with maximum rest and should not be bent or brought towards the body if this position provokes pain or is difficult. Often, when the radius is fractured in a typical location, the most painless position of the hand is observed when it is turned with the palmar surface downwards.

During the immobilization process, you should never try to reset displaced bone fragments yourself, since, firstly, it is almost impossible to do this correctly without radiological control and special skills, and secondly, this is associated with a high risk of damage to nerves and blood vessels.

Immobilization is carried out using a special Kramer splint or any other sufficiently rigid and long object - a board, stick, branch, hard cardboard. When immobilizing a limb, try to cover the distal and proximal joints (

), eliminating movements in them, as this allows you to create the most complete rest for the limb. The tire should not be pulled too tight, but it should be installed (

Barton's dislocation. a) palmar Barton; b) back Barton.

Fixation of a fracture of the distal metaepiphysis of the radius with a volar support plate

The fracture site is opened using a volar approach, as described above. Reduction is accomplished by traction and dorsiflexion of the wrist. A thick plate is applied as a support, i.e. fix the plate with proximal screws, with the end resting on the fragments, providing pressure on them. Fixing the fragments with screws is not required, as this would interfere with support. The wound is sutured and a splint is applied to secure the wrist. Rehabilitation can begin after the sutures are removed.

Styloid process of the radius

A fracture of the styloid process of the radius occurs with dorsiflexion and ulnar deviation at the wrist. This may be the first stage of perilunate fracture-dislocation, described below. Fractures without displacement are subject to conservative treatment in a plaster cast, but as intra-articular injuries with the slightest displacement they are subject to reposition and fixation to restore congruence. In addition, the wrist ligaments are attached to the styloid process, therefore, nonunion or malunion of its fracture leads to instability of the wrist. Surgical treatment may involve percutaneous cannulated screw fixation, facilitated by arthroscopic visualization of the articular surface during reduction. These fractures are characterized by a high percentage of post-traumatic arthrosis.

Restorative treatment for malunion of fractures of the distal metaepiphysis of the radius

In cases of malunion of fractures of the distal metaepiphysis of the radius, which manifest themselves clinically, osteotomy is indicated. It is better to perform this operation no earlier than six months after the injury, but no later than 18 months. A dorsal or palmar approach can be used. The operation involves cutting the radius at the site of the malunion using a cooled saw. The distal fragment after distraction is bent, trying to obtain the position of the fragments as close as possible to the anatomical parameters described above. A corticocancellous graft from the iliac crest is used to fill cavities, and in the absence of the required quality of iliac bone - with bone replacement materials. The fixing structure is applied over the dorsal or palmar surface; according to modern standards, lockable plates are used. If satisfactory restoration of the radius is not achieved, a shortening osteotomy may be required at a later date. However, these two operations should never be performed simultaneously to avoid synostosis.

The limb is placed with the palmar surface down (for a Colles fracture) or up (for a Smith fracture) so that the fracture site is above the edge of the table. The elbow joint is bent at a right angle. The traumatologist's assistant performs counter-traction by the shoulder, and the traumatologist holds the patient's hand by the 2nd, 3rd, 4th fingers with one hand, and by the 1st finger with the other, and performs lengthwise traction. Then, in case of Colles fractures, the traumatologist bends the hand to the palmar side and deflects it in the direction of the ulna, and additionally, with the fingers of the other hand, displaces the peripheral fragment to the palmar-ulnar side. In Smith fractures, after stretching along the length, the peripheral fragment is displaced to the dorsal-ulnar side. Correct reposition can only be achieved with complete anesthesia and gradual relaxation (as a result of muscle fatigue from slowly increasing effort). When applying a plaster cast, it is necessary to once again check that the alignment of the bone fragments is maintained. For Colles's fractures, the hand is fixed in a position of slight palmar flexion and ulnar abduction; for Smith's fractures, the hand is placed in a position of extension and ulnar abduction within the same limits. When post-traumatic swelling of the forearm subsides, it is necessary to constantly bandage the splint. The immobilization period ranges from 4 to 6 weeks, depending on the nature of the fracture (weeks for children). Working capacity is restored within a week. Treatment of a fracture of the radius in a typical location may be accompanied by such errors as:

• Incomplete reduction.
• Lack of control over the condition of fragments in a plaster cast (risk of secondary displacements).
• Insufficient time and volume of immobilization.
• Neglect of rehabilitation measures.

Between exercises, you can do short warm-ups in warm water. When performing exercises, you must ensure that the feeling of slight discomfort does not turn into pain. If your hand is tired, then you need to give it a rest. The amplitude of movements can be increased gradually (every three days). If the patient performs exercises regularly, then recovery after a fracture of the radius will occur much faster due to the activation of muscle function and increased blood circulation in the damaged area.

Symptoms and treatment of a fracture of the styloid process of the radius

A fracture of the styloid process of the radius (ulna) with and without displacement is an injury that is characterized by seasonality. The greatest number of fractures occurs in the autumn-winter period, when black ice sets in.

Damage occurs not due to the direct impact of a mechanical factor, but as a result of impact recoil. It should be noted that women are more susceptible to this injury than men.

In the article you will learn everything about the fracture and avulsion of the styloid process of the ulna, treatment of the injury and consequences.

Common Causes of Injury

As mentioned above, the most common cause of a styloid process fracture is a fall on ice. However, other factors can also trigger injury:

• Road traffic accident;
• Falling on your hand while riding a bicycle or moped;
• Active participation in outdoor games;
• Sports activities (skates, rollers, skateboard, etc.);
• Unsuccessful completion of sports stunts. This happens especially often among acrobats.

In the vast majority of cases, a fracture occurs when a person falls on an arm extended at the elbow joint, as a result of which it experiences a colossal load at the time of the fall. It must be said that many people unconsciously (reflexively) fall on their outstretched arms.

Diagnosis of a fracture

To diagnose an injury, the doctor must first talk with the patient and collect complaints. Then you need to collect an anamnesis (history of the incident). The following points are clarified:

• Time of injury;
• The circumstances under which the fracture occurred;
• How did the fall happen?

After the conversation, the doctor sends the patient for an X-ray examination. A photograph of the injured arm is taken in frontal and lateral projections. X-ray examination is considered the “gold standard” in the diagnosis of fractures.

Compression fracture

A compression fracture occurs when the wrist hits the radius bone. In this case, the main force of the impact is transmitted to the scaphoid bone, with which the styloid process of the ulna is in direct contact.

A compression fracture is characterized by the absence of displacement of bone fragments, and the damage itself has the appearance of a small crack.

Symptoms of a compression fracture are as follows:

• Swelling at the site of injury, affecting the underlying tissue. This creates a feeling that the skin at the site of injury is stretched.
• Pain;
• Inability to make any movements with the affected limb. Sometimes when you try to move your hand, a characteristic crunching sound occurs, which experts call crepitus.
• Hyperemia (redness) of the skin at the fracture site. In some cases, hematomas may form.

To diagnose a fracture of the styloid process, the doctor must take a thorough history. It is important to find out all the circumstances under which the injury occurred.

Then the patient needs to undergo an X-ray examination of the injured arm in several projections to assess the nature of the fracture, the presence of complications, etc.

A fracture of the styloid process, like any other fracture, is accompanied by pain and a gradual increase in soft tissue swelling. Therefore, in the first minutes after the incident, it is necessary to apply a heating pad with ice or any other object to your hand.

Cold in this case will have a double effect. Firstly, it will prevent the formation of edema, and secondly, it will have a slight analgesic effect. You need to act carefully so as not to cause further harm to the victim.

Treatment of a compression fracture of the styloid process is reduced to closed reduction (comparison) of bone fragments and immobilization of the limb. Reposition is carried out under local anesthesia. The doctor needs to squeeze the bone very tightly on both sides: one hand squeezes the wrist joint from the inner surface, and the other from the outer surface.

There is no need to be afraid that such a strong impact on the bones will cause additional damage to health. On the contrary, if the compression is not strong enough, the reposition will be performed poorly. And this, in turn, can lead to loss of limb function and even disability.

Avulsion fracture of the styloid process

Avulsion of the styloid process of the ulna is quite rare in clinical practice. As the name implies, during an injury, the integrity of the radius bone is damaged. If in the case of a compression fracture the violation of integrity is an ordinary crack, then in this situation a real separation of the bone occurs.

In the vast majority of cases, avulsion fractures of the styloid process occur after an unsuccessful fall on an outstretched arm.

In this case, the wrist sharply shifts inward, the styloid process of the radius is, as it were, “pulled” from the radius, and, if the impact force is significant, it breaks off. Sometimes an avulsion fracture is accompanied by complete dislocation of the wrist joint.

The most characteristic symptom of an avulsion fracture of the styloid process is a sharp pain that intensifies with the slightest attempt to move the hand. That is why the victim tries to give his hand the most gentle position possible. After some time, swelling forms at the site of injury, and in some cases, a hematoma.

A very characteristic symptom of an avulsion fracture is crepitus of bone fragments. It lies in the fact that when you try to move the bones at the fracture site, you will feel a characteristic creaking sound of bones rubbing against each other. Only an experienced specialist can check the symptom of crepitus. Otherwise, you can cause even more harm to the victim.

To diagnose an avulsion fracture, it is important for the traumatologist to determine the mechanism of injury. Afterwards, the doctor examines the injured limb and checks for a number of symptoms that may indirectly indicate the presence of a fracture. Then the patient is sent for an X-ray examination of the wrist joint in 2 projections.

As a rule, the listed manipulations are sufficient to diagnose an injury. Occasionally, in complex clinical cases, additional research methods are used to diagnose injuries (for example, ultrasound of soft tissues, etc.).

To eliminate an avulsion fracture, a specialist needs to reposition the bone fragments. The arm is then immobilized in a plaster cast, which must be worn for 1 month. After this time, the patient undergoes a control x-ray to ensure the correctness of the treatment.

For faster bone healing during the rehabilitation period, you need to take vitamin D and give preference to foods rich in calcium (cottage cheese, milk, sour cream, etc.).

First aid for such fractures

Unfortunately, it is not always possible to immediately deliver the victim to a medical facility where he will receive assistance. Therefore, every person must have basic skills in providing pre-hospital medical care.

First of all, the injured limb must be immobilized, that is, immobilized. This is a very important stage in providing care, as it prevents the development of complications (bleeding, displacement, etc.). In addition, proper immobilization reduces pain.

The second stage of first aid is sanitary treatment of the wound (if there is an open fracture). To do this, you can use a solution of any antiseptic (for example, an alcohol solution of iodine or hydrogen peroxide) and a clean cloth (handkerchief, napkin, cotton pad, etc.). Skillful treatment of the wound surface will protect the victim from infection.

After this, pain relief must be performed. For this purpose, any tableted drugs from the NSAID group (non-steroidal anti-inflammatory drugs) are suitable. The most effective are diclofenac, ibuprofen and ketoprofen. In parallel with pain relief, cold must be applied to the wound to prevent the spread of swelling.

Rehabilitation after injury

Rehabilitation is an integral component of complex fracture treatment. It includes a number of activities that accelerate bone healing and promote a speedy recovery. These include physical therapy, massage, physiotherapeutic treatment methods, as well as special nutrition. Let's look at each method in more detail.

On the 3rd day from the moment of fracture, traumatologists recommend attending physiotherapy sessions. The most useful and effective for fractures are courses of ultraviolet irradiation (ultraviolet irradiation), magnetic therapy and UHF therapy. The latter method is not used if the fracture was treated with the implantation of a metal structure.

One and a half weeks after the injury, infrared laser therapy, pulsed UHF EP, and magnetic stimulation of the affected nerves can be used.

You can learn more about recovery from radius fractures here.

After removing the plaster cast, the patient is prescribed physical therapy and massage. These two methods are aimed at restoring the hand as quickly as possible. During physical therapy sessions, various static and dynamic exercises will be performed to strengthen muscles and improve the transmission of nerve impulses.

As for nutrition, during the rehabilitation period it is important to give preference to foods that contain a lot of calcium and vitamin D. These are seafood, cottage cheese, milk, sour cream, hard cheeses, legumes, greens, dried apricots, figs, etc. The leader in vitamin content D is known to be fish oil.

Recovery time and whether there may be complications

Complete recovery of a hand with a fracture of the styloid process occurs, on average, in one and a half months. This period may increase or shorten depending on the complexity of the injury, the chosen method of treatment, as well as the individual characteristics of the body.

• Purulent-septic complications. They occur if the wound surface has not been treated with an antiseptic well enough. Sometimes this is fraught with the development of sepsis - blood poisoning.
• Damage to blood vessels and nerves. Nerve injury can cause contracture - restriction of mobility in the joint.
• Incorrect fusion of bone fragments, limb deformation.
• Osteomyelitis is a purulent disease of the bone marrow and bones.

To avoid the complications listed above, you must promptly seek medical help and diligently follow all medical recommendations.

Fractures of the radius in a typical location

Fractures of the radius in a typical location (metaphyseal fractures) account for more than 25% of all fractures.

It is in this place that fractures of the radius most often occur in adults, and in children and adolescents - epiphysiolysis and osteoepiphysiolysis.

Anatomy

1. ulna; 2. radius; 3. distal radioulnar joint; 4. articular disc; 5. wrist joint; 6. midcarpal joint; 7. intercarpal joints; 8. carpometacarpal joints; 9. intermetacarpal joints; 10. metacarpal bones.

The wrist joint is the connection of the lower epiphysis of the radius and the articular disc of the ulna with the bones of the proximal row of the wrist.

The articular surface for the triquetral bone is formed by cartilage, which occupies the free space between the carpal bones and the head of the ulna.

The articular surface of the radius, together with the distal surface of the disc, forms the articular fossa of the radiocarpal joint, and the triquetral, lunate and scaphoid bones of the wrist are its head.

Movements in the wrist joint occur around two axes - the hand moves from side to side from the radius to the ulna, and also bends and bends relative to the frontal axis of the joint.

Causes of radius fractures in a typical location

The mechanism of injury is always indirect - a fall with emphasis on the hand.

In this case, two types of fractures occur: extension (Colles fracture) and bending (Smith fracture).

Extensor fractures most often occur because a person, when falling, rests on the palmar surface of the hand. Much less often, when falling, the emphasis falls on the dorsum of the hand when it is in palmar flexion.

In extension fractures, the distal fragment (epiphysis) is displaced towards the dorsum of the forearm, and the proximal fragment towards the palmar surface. In flexion fractures, the distal fragment is displaced to the palmar side, and the proximal fragment to the dorsal side.

The reason for frequent fractures of the radius in a typical location lies in anatomical and biomechanical conditions.

The radius in the area of ​​the metaphysis and epiphysis does not have a pronounced cortical layer. In addition, these anatomical structures are characterized by a spongy structure, but the epiphysis is thicker and, moreover, the capsule and connections give it greater stability. Therefore, all the mechanical force acting during a fall with a pronated forearm and emphasis on the hand is concentrated in the metaphysis area.

The strong palmar ligament, which never breaks, when suddenly overstretched at its attachment site, breaks the outer layer of the bone, and the traumatic force of the fall completes the bone fracture with a corresponding displacement of the fragments. The fracture plane in these cases is almost always transverse.

Splinter intra-articular fractures of the epimetaphysis of the radius also occur.

Symptoms

For Colles fractures

On the dorsum of the forearm above the wrist joint under the skin there is a clear bony protrusion, a deformity with an angle open to the rear.

The palmar side of the forearm, according to the bend on the back, has a convex shape. The fingers of the hand are in a semi-bent position and active movements of them, as well as movements of the hand, are significantly limited and aggravate the pain. The victim cannot clench his fingers into a fist.

For Smith's fractures

The distal fragment is displaced to the palmar side, and the proximal fragment to the dorsal side; a deformity is formed with an angle open to the palmar side of the hand in the position of palmar flexion.

The fingers are half-bent; the victim cannot clench them into a fist due to pain. Active movements in the wrist joint are impossible due to worsening pain.

With a fracture of the styloid process of the ulna

With fractures of the radius, a fracture of the styloid process of the ulna often occurs in a typical location, which is clinically manifested by deformation of the contours of the distal end of the ulna and local pain on palpation.

Diagnostics

X-ray examination confirms the diagnosis and characterizes the characteristics of the fracture.

Urgent Care

Emergency care consists of pain relief and transport immobilization.

Complications

Its cause is considered to be damage to the interosseous dorsal branch of the radial nerve, which lies in the area of ​​the epimetaphysis on the radial bone itself.

Clinically: swelling of the fingers, hand, lower third of the forearm increases, constant pain.

The skin becomes bluish, the swelling is hard, active movements of the fingers are very limited, hyposthesia, local osteoporosis, and contractures of the fingers appear.

Neurodystrophic Turner syndrome has a torpid long-term course, mostly with loss of ability to work for victims.

Treatment

No offset

It is treated by immobilization with a deep dorsal plaster splint, starting from the upper third of the forearm and ending at the heads of the metacarpal bones.

With offset

Fractures with displacement of fragments are subject, after anesthesia (injection of a 1% solution of novocaine or lidocaine into the hematoma), to a closed simultaneous comparison of fragments.

The victim is sitting, the injured hand is placed on the table so that the end of the table corresponds to the level of the radiocarpal joint (if the victim cannot sit, then the comparison is carried out in a lying position).

The arm is bent at the elbow joint to a right angle, the assistant grabs the shoulder above the elbow joint for counterweight. The doctor grabs the first finger with his right hand, and the second – third – fourth fingers with his left hand and, without jerking, with increasing strength, performs traction along the axis of the forearm (eliminates displacement in length and impacted fragments). Having achieved stretching of the fragments, the doctor vigorously moves the hand to the position of palmar flexion. In this case, the epimetaphysis should not be pressed against the edge of the table. The fragments are compared, and the hand is given a position of moderate ulnar deviation.

After this, the doctor, without reducing the traction along the axis of the forearm, moves the hand out of palmar flexion and passes it to the second assistant, maintaining the position of lengthwise extension. At this time, with his thumb he presses the epiphysis from top to bottom, and with three fingers from below he pushes the proximal end of the fragment from the palmar surface in the dorsal direction until the deformity is completely eliminated.

A deep plaster splint is applied from the upper third of the forearm to the heads of the metacarpal bones so that the edge of the splint on the radial side extends to the middle of the forearm along the palmar surface, carefully modulating the plaster cast along the contours of the wrist joint and forearm, preventing excessive compression.

They carry out X-ray control through the plaster, make sure that the displacement is completely eliminated and send the victim for outpatient treatment with mandatory monitoring for a day.

Pay attention to the severity of swelling, the color of the skin of the fingers, their sensitivity, the possibility of active movements, and identify the presence of depression of the edges of the plaster splint.

They bandage the splint (without removing the splint), turn away the edges of the plaster splint in the places where it is pressed, make sure that there is no compression of the vessels, and tighten the splint with a bandage without squeezing the soft tissues.

On the 7th–9th day, the traumatic swelling subsides and the victim should see a doctor, who should tighten the splint so that it fits tightly to the forearm, preventing secondary displacement of the fragments. After this, X-ray control (through plaster) of the position of the fragments is carried out.

In cases where it is not possible to closedly renew the congruence of the articular surface of the radius, surgical treatment, open reduction with synthesis of fragments, is indicated.

Rehabilitation

As soon as the patient feels that the plaster cast has become looser, it is necessary to consult a doctor in order to tighten it in a timely manner.

The duration of immobilization is 4-5 weeks.

After the immobilization is removed, X-ray control is done and, depending on the quality of bone fusion, physical therapy, calcium electrophoresis, alternating with novocaine, magnetic therapy, and from the 6th week, massage are prescribed.

Efficiency is restored in people who do non-physical work after 2 months, and in people who do physical work - after 3–4 months.

Fractures of the radius in a typical location: symptoms, first aid, treatment, rehabilitation

Fractures of the radius in a typical location (metaphyseal fractures) account for more than 25% of all fractures.

It is in this place that fractures of the radius most often occur in adults, and in children and adolescents - epiphysiolysis and osteoepiphysiolysis.

• Rehabilitation

Anatomy

1. ulna; 2. radius; 3. distal radioulnar joint; 4. articular disc; 5. wrist joint; 6. midcarpal joint; 7. intercarpal joints; 8. carpometacarpal joints; 9. intermetacarpal joints; 10. metacarpal bones.

The wrist joint is the connection of the lower epiphysis of the radius and the articular disc of the ulna with the bones of the proximal row of the wrist.

The articular surface for the triquetral bone is formed by cartilage, which occupies the free space between the carpal bones and the head of the ulna.

The articular surface of the radius, together with the distal surface of the disc, forms the articular fossa of the radiocarpal joint, and the triquetral, lunate and scaphoid bones of the wrist are its head.

Movements in the wrist joint occur around two axes - the hand moves from side to side from the radius to the ulna, and also bends and bends relative to the frontal axis of the joint.

Causes of radius fractures in a typical location

The mechanism of injury is always indirect - a fall with emphasis on the hand.

In this case, two types of fractures occur: extension (Colles fracture) and bending (Smith fracture).

Extensor fractures most often occur because a person, when falling, rests on the palmar surface of the hand. Much less often, when falling, the emphasis falls on the dorsum of the hand when it is in palmar flexion.

In extension fractures, the distal fragment (epiphysis) is displaced towards the dorsum of the forearm, and the proximal fragment towards the palmar surface. In flexion fractures, the distal fragment is displaced to the palmar side, and the proximal fragment to the dorsal side.

The reason for frequent fractures of the radius in a typical location lies in anatomical and biomechanical conditions.

The radius in the area of ​​the metaphysis and epiphysis does not have a pronounced cortical layer. In addition, these anatomical structures are characterized by a spongy structure, but the epiphysis is thicker and, moreover, the capsule and connections give it greater stability. Therefore, all the mechanical force acting during a fall with a pronated forearm and emphasis on the hand is concentrated in the metaphysis area.

The strong palmar ligament, which never breaks, when suddenly overstretched at its attachment site, breaks the outer layer of the bone, and the traumatic force of the fall completes the bone fracture with a corresponding displacement of the fragments. The fracture plane in these cases is almost always transverse.

Splinter intra-articular fractures of the epimetaphysis of the radius also occur.

Symptoms

For Colles fractures

For extensor fractures, or Colles fractures (after the name of the surgeon who first described them in 1814), pain and deformation of the lower third of the forearm like a bayonet or fork with deviation of the hand to the radial side are typical.

On the dorsum of the forearm above the wrist joint under the skin there is a clear bony protrusion, a deformity with an angle open to the rear.

The palmar side of the forearm, according to the bend on the back, has a convex shape. The fingers of the hand are in a semi-bent position and active movements of them, as well as movements of the hand, are significantly limited and aggravate the pain. The victim cannot clench his fingers into a fist.

For Smith's fractures

With flexion fractures, which Smith described, the deformation is of the opposite nature.

The distal fragment is displaced to the palmar side, and the proximal fragment to the dorsal side; a deformity is formed with an angle open to the palmar side of the hand in the position of palmar flexion.

The fingers are half-bent; the victim cannot clench them into a fist due to pain. Active movements in the wrist joint are impossible due to worsening pain.

With a fracture of the styloid process of the ulna

With fractures of the radius, a fracture of the styloid process of the ulna often occurs in a typical location, which is clinically manifested by deformation of the contours of the distal end of the ulna and local pain on palpation.

Diagnostics

X-ray examination confirms the diagnosis and characterizes the characteristics of the fracture.

Urgent Care

Emergency care consists of pain relief and transport immobilization.

Complications

Among the complications of fractures of the radius in a typical location, Turner's neurodystrophic syndrome is severe.

Its cause is considered to be damage to the interosseous dorsal branch of the radial nerve, which lies in the area of ​​the epimetaphysis on the radial bone itself.

Clinically: swelling of the fingers, hand, lower third of the forearm increases, constant pain.

The skin becomes bluish, the swelling is hard, active movements of the fingers are very limited, hyposthesia, local osteoporosis, and contractures of the fingers appear.

Neurodystrophic Turner syndrome has a torpid long-term course, mostly with loss of ability to work for victims.

Treatment

No offset

It is treated by immobilization with a deep dorsal plaster splint, starting from the upper third of the forearm and ending at the heads of the metacarpal bones.

With offset

Fractures with displacement of fragments are subject, after anesthesia (injection of a 1% solution of novocaine or lidocaine into the hematoma), to a closed simultaneous comparison of fragments.

The victim is sitting, the injured hand is placed on the table so that the end of the table corresponds to the level of the radiocarpal joint (if the victim cannot sit, then the comparison is carried out in a lying position).

The arm is bent at the elbow joint to a right angle, the assistant grabs the shoulder above the elbow joint for counterweight. The doctor grabs the first finger with his right hand, and the second – third – fourth fingers with his left hand and, without jerking, with increasing strength, performs traction along the axis of the forearm (eliminates displacement in length and impacted fragments). Having achieved stretching of the fragments, the doctor vigorously moves the hand to the position of palmar flexion. In this case, the epimetaphysis should not be pressed against the edge of the table. The fragments are compared, and the hand is given a position of moderate ulnar deviation.

After this, the doctor, without reducing the traction along the axis of the forearm, moves the hand out of palmar flexion and passes it to the second assistant, maintaining the position of lengthwise extension. At this time, with his thumb he presses the epiphysis from top to bottom, and with three fingers from below he pushes the proximal end of the fragment from the palmar surface in the dorsal direction until the deformity is completely eliminated.

A deep plaster splint is applied from the upper third of the forearm to the heads of the metacarpal bones so that the edge of the splint on the radial side extends to the middle of the forearm along the palmar surface, carefully modulating the plaster cast along the contours of the wrist joint and forearm, preventing excessive compression.

They carry out X-ray control through the plaster, make sure that the displacement is completely eliminated and send the victim for outpatient treatment with mandatory monitoring for a day.

Pay attention to the severity of swelling, the color of the skin of the fingers, their sensitivity, the possibility of active movements, and identify the presence of depression of the edges of the plaster splint.

They bandage the splint (without removing the splint), turn away the edges of the plaster splint in the places where it is pressed, make sure that there is no compression of the vessels, and tighten the splint with a bandage without squeezing the soft tissues.

On the 7th–9th day, the traumatic swelling subsides and the victim should see a doctor, who should tighten the splint so that it fits tightly to the forearm, preventing secondary displacement of the fragments. After this, X-ray control (through plaster) of the position of the fragments is carried out.

In cases where it is not possible to closedly renew the congruence of the articular surface of the radius, surgical treatment, open reduction with synthesis of fragments, is indicated.

Rehabilitation

As soon as the patient feels that the plaster cast has become looser, it is necessary to consult a doctor in order to tighten it in a timely manner.

The duration of immobilization is 4-5 weeks.

After the immobilization is removed, X-ray control is done and, depending on the quality of bone fusion, physical therapy, calcium electrophoresis, alternating with novocaine, magnetic therapy, and from the 6th week, massage are prescribed.

Efficiency is restored in people who do non-physical work after 2 months, and in people who do physical work - after 3–4 months.

The symptoms of an injury in a typical location are similar to a wrist injury. When the pathology appears:

• sudden intense pain at the time of injury and immediately after it;
• a kind of crunch;
• in case of a fracture with a large displacement, a bulge or dent appears in the wrist area;
• if a bone fragment damages a vessel, a hematoma develops;
• redness of the skin in the affected area;
• numbness, tingling, feeling of cold, impaired mobility and sensitivity if nerve endings are injured;
• pain when trying to move your arm or hand;

The absence of pain some time after the injury does not mean that the hand is not damaged.

First aid and treatment

Before the victim is examined by specialists, he must be given first aid. It consists of carrying out the following procedures:

1. Fixing the injured limb using a splint or improvised means.
2. Mandatory treatment of the wound with an antiseptic solution for an open fracture.
3. Apply a cold compress to the fracture area for 20 minutes.
4. Seeking professional help.

In a medical institution, before treatment (to assess the nature of the damage), an x-ray is taken. If the image shows a displaced fracture, then the damaged bone fragments should be accurately joined. To carry out reposition, the fragments are corrected using special devices.

This must be done under local anesthesia. At the end of the procedure, a splint bandage is applied to the forearm.

Sometimes it is not possible to perform a reduction manually. In such cases, surgery or closed reposition of the fragments through the skin using needles is performed. In other cases, external fixation devices (plates and screws) are used. If no displacement has occurred, then simply apply plaster. They wear it for several weeks.

Conservative treatment methods are most appropriate when children are injured. To prevent displacement, it is necessary to monitor the fusion of bone tissue using regular fluoroscopy.

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How is recovery after injury going?

After removing the plaster, the patient needs to normalize the mobility of the upper limb. Rehabilitation after a fracture of the radius should take place under the constant supervision of a doctor. This is due to the fact that injury can give rise to quite serious complications, including loss of motor ability.

The recovery period takes at least 21 days. It includes physical exercise, massage, physiotherapeutic procedures, and diet.

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Features of physical therapy

For a fracture in a typical location, exercise therapy is prescribed immediately after release from the plaster. Experts advise doing a short warm-up (bending and straightening your arm) a few days before starting a course of physical therapy. This will make it possible to prepare atrophied muscles for greater load.

To restore motor function of the hand, a specially selected set of exercises is used.

The hand is lowered to the elbow into a container of water. In this case, the hand is rotated plastically using the wrist joint and moves it up and down. This kind of water gymnastics is good for developing an injured limb. Its use brings faster results. Physical therapy is performed independently at home or in exercise therapy classes under the guidance of an instructor.

Be sure to perform exercises aimed at restoring fine motor skills. Experts recommend collecting matches, mosaics, puzzles, and stringing beads.

Exercises are performed in such a way that the load on the injured joint is uniform. It is impossible to restore normal motor function of the hand in a short time. This must be done by gradually increasing the strength and duration of the load. Otherwise, the consequences may be negative.

It is better that the exercises take place under the supervision of a specialist who will explain how to do the exercises correctly and monitor their safe implementation. For greater effect, gymnastics must be done systematically. Occupational therapy and active games will be a good help in restoring motor function of the upper limb.

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Massage, physiotherapy and procedures after a fracture

In order to increase blood circulation and relieve pain in the bruised area, a therapeutic massage is prescribed. In this case, pain-relieving gels and essential oils are used.

The massage begins from the shoulder, then goes down to the muscles of the elbow joint. And only after that they carefully begin to rub the area near the injury. Massage procedures should only be performed by a specialist.

Physiotherapeutic procedures are prescribed by the treating doctor in accordance with the type and degree of injury.

At first, electromagnetic therapy is recommended to restore lymph and blood circulation and relieve swelling. She is able to quickly restore sensitivity and the ability to perform difficult actions to the injured hand. Warm compresses and mud packs are also useful for hand rehabilitation.

Drug treatment promotes rapid recovery of the injured arm. Shilajit is usually used. It can be taken in tablet form. Shilajit-based ointments work great.

It should be realized that delayed and incorrect therapy leads to dire consequences in the future, which include limited mobility and the appearance of pain.

Among all traumatic injuries, a radial fracture is quite severe. This is due to the fact that the functions of the forearm with such an injury are disrupted to a very high degree, and it is with the direct participation of the radius that pronation and supination of the limb are carried out (rotational movements).

The radius is located next to the ulna and is a paired bone in the forearm. It has a body and lower and upper ends. In cross-section, the body of the radius is triangular. The bone has three surfaces - lateral, posterior and anterior and three edges - interosseous, posterior and anterior. The interosseous edge is pointed and turned towards the ulna bone, and the other two edges are rounded.

A fracture occurs due to direct or indirect trauma and may be accompanied by displacement of fragments or be functionally correctable. Often this type of fracture is accompanied by rotational and angular displacement of the radial bone fragments.

The epidemiology of a radial fracture is directly related to the anatomical structure of the radius, which in the middle third flattens, widens, and has a certain curvature facing the ulna. The distal third is covered with a thicker muscle layer and is therefore less susceptible to traumatic effects.

Causes of radial fracture

The leading factor in the occurrence of a radial fracture is a fall on outstretched arms. It is the position of the hand during injury that determines the direction of pathological displacement of fragments. Most often, there are two types of radial fractures - a Colles fracture, in which the fragments are displaced to the back of the hand, and a Smith fracture, which occurs when falling on a bent hand, the fragments are displaced towards the palm.

These fractures are intra-articular and are accompanied by injuries such as avulsion of the styloid process, fracture of the carpal bones, fracture of the head of the ulna, and damage to the distal radioulnar joint.

Symptoms of a radial fracture

An isolated radial fracture, without displacement, has a rather inexpressive picture. As a rule, the victim complains of pain in the injured arm, there is slight swelling and edema upon examination, and hemorrhage may occur. When bone fragments are displaced, a specific bayonet-like deformity may be observed. When palpating the injury site, sharp pain occurs. The functions of the joint are impaired, especially during active extension and flexion of the limb. With this injury, the forearm is in a pronated position. To exclude the possibility of damage to the tendons and nerves, a study of the sensitivity and mobility of the fingers is required. The fracture may be accompanied by damage to the carpal bones and rupture of the distal articulation of the elbow joint.

Diagnosis of a radius fracture

After collecting an anamnesis, an X-ray examination is required, taking into account the relationship of the styloid processes of the ulna and radius. In case of a fracture without displacement, a line drawn through the processes forms an angle of about 15 -20° with the longitudinal axis of the injured forearm. When shifted, this angle can decrease to almost 0 or even become negative.

Treatment of a radius fracture

Conservative therapeutic methods are used to treat a radial fracture. The fracture area is anesthetized with a solution of novocaine, and in the case of a fracture of the styloid process, anesthesia is required for this area as well. If the radial fracture is not displaced, then the forearm is fixed with a plaster dorsal splint from the upper third of the forearm to the very base of the fingers. This therapeutic immobilization lasts at least 2-3 weeks, with the hand in a slight dorsal flexion position. After a short amount of time, therapeutic exercises are prescribed, which are carried out with the limb joints free from immobilization, with the main emphasis on the fingers.

The hand should be in a comfortable, elevated position; a few days after the injury, UHF is prescribed to the fracture area. More active rehabilitation measures are carried out after the immobilization of the limb has been stopped. Exercise therapy, massage, and various thermal procedures are prescribed. Full function of the limb is most often restored in approximately five weeks. In children with a radial fracture without displacement, fixation with a plaster splint is carried out for two weeks.

In case of radial fractures with displaced bone fragments, reposition of the fragments is carried out immediately. The basic principle of reduction is thrust and countertraction. Complete reposition should be as early as possible, instantaneous, atraumatic and painless. The limb is placed palmar down (Colles fracture) or palmar up (Smith fracture) so that the fracture site is located above the edge of the table. The elbow joint is bent at a right angle, and the traumatologist, holding the patient’s hand, performs lengthwise traction, and his assistant immediately applies countertraction to the shoulder.

Correct reposition is carried out only with the help of pain relief and gradual muscle relaxation. When applying a plaster cast, you must once again make sure that the bone fragments are aligned correctly. With a Colles fracture, the hand is placed in a position of palmar slight flexion and ulnar abduction, and with a Smith fracture, the hand is fixed in a position of extension and ulnar abduction. The applied plaster splint will need to be constantly bandaged after the post-traumatic swelling subsides. Depending on the nature and severity of the fracture, the time of limb immobilization can last from four to six weeks.

Treatment of a radial fracture may be associated with errors such as insufficient immobilization in terms of volume and time, incomplete reduction, neglect of rehabilitation measures, and incomplete control of the condition of the fragments in the bandage, causing the risk of re-displacement.

Complications of a radius fracture

Patients with radial fractures may experience complications such as Sudeck's trophoneurotic bone atrophy and Turner's disease.

Bone atrophy, or post-traumatic patchy osteoporosis, is characterized by tension in the tissues of the fingers and hand and the development of edema. The skin of the limb becomes purple, shiny and cold to the touch, the fingers are straightened and swollen, and joint movements are limited and very painful. The disease is long-term, treatment is conservative - novocaine blockades, physiotherapy, exercise therapy.

Turner's disease, or median nerve neuritis, can occur when the nerve is damaged by trauma or pinched by scar tissue. It manifests itself as constant pain and atrophy of the muscles of the interdigital spaces and tenor. Etiopathogenetic treatment methods are used - vitamins, analgesics, exercise therapy, physiotherapy, massage. If conservative treatment does not bring results, surgical intervention is indicated.

Fractures are classified based on the number of bones affected:

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

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 coming out into the wound, the presence of deformation in the area of ​​the fracture with intact skin, etc.

The diagnosis is made on the basis of a survey, examination, palpation, the presence of pathological syndromes (crepitus, pathological mobility), as well as a set of instrumental diagnostic results.

Principles of treatment of radial fractures

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 treatment for fractures: operative 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 the individual characteristics of the patient’s body.

Let's look at some of them below.

A fracture without displacement of fragments is most favorable for the patient, does not require surgical intervention and allows the patient to recover quickly. Occurs at different heights of the radius. With an isolated fracture (with the integrity of the ulna), its diagnosis can be difficult. Treatment consists of fixing the fracture site with a two-split plaster cast and then replacing it with a circular plaster cast.

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

In the presence of extra-articular non-comminuted fractures, manual reposition of the fragments is performed under local anesthesia and a two-split plaster cast is applied. After the swelling subsides, it is changed 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 repositioning the fragments, it is necessary to realign the head of the ulna.

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

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

• without displacement of bone fragments;
• comminuted fracture with displacement;
• intra-articular fracture.

First of all, it is necessary to diagnose a fracture and find out whether there is displacement of bone fragments. After this, treatment tactics are developed. If there is no displacement of the fragments, conservative treatment is prescribed, consisting of anesthesia and application of a plaster cast. If there is displacement of fragments or fragmentation of the bone head, surgical treatment is necessary, consisting of osteosynthesis.

If the head of the radial bone is crushed or comminuted, it may be removed. However, such measures are not practiced in children, so as not to affect the bone growth area.

One of the most common injuries to the forearm 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 arm with the wrist joint bent or extended.

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

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

Post-immobilization period: exercises are performed in front of a table with a smooth surface to facilitate sliding of the hand. Exercises in warm water, as well as everyday activities, in particular self-care, are useful. It is necessary to avoid carrying heavy objects and hanging. Massage of the affected limb is very useful.

Very often, a fracture of the radius in a typical location is combined with avulsion of the styloid process. The diagnosis is made based on a survey, examination, palpation (fragment crepitation syndrome), as well as the results of an X-ray examination.

Displacement of the styloid process during a fracture can be not only in the dorsal or palmar region, but also at various angles. Treatment tactics are selected strictly individually in each specific 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 the 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 forearm bone fractures for different types of fractures in a given anatomical region varies slightly. It is important to know the general directions of restoration measures and vary techniques 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 at the elbow joint at an angle of 90 degrees and supported by a scarf. Immobilization time: for an isolated fracture of the radius - 1 month, for multiple fractures (radius and ulna) - 2 months.

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

Physiotherapeutic measures from the third day after injury: UHF therapy on the fracture area, magnetic therapy and ultraviolet irradiation. It must be taken into account that UHF therapy is contraindicated in the presence of metal structures in the area of ​​treatment. This factor is not a contraindication for magnetic therapy.

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

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 the occurrence of contracture in the joints: all joints are worked out sequentially from the fingers to the shoulder. Occupational therapy is added: restoration of self-care skills. During this period, the following are very useful: massage, thermal physiotherapy, therapeutic exercises in warm water (hydrokinesitherapy), mechanotherapy.

The thermal regime when exercising in water should be soft. Water temperature: from 34 to 36 °C. Gymnastics is performed with the arm (forearm, hand) completely immersed in water. Hydrokinesitherapy is prescribed after 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 exercises with his healthy arm. All movements should be performed before the pain syndrome, and not through it.

The exercises begin with flexion and extension of the joints, then adduction and abduction, pronation and supination are done.

It is quite possible to supplement exercises in water with exercises 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 fish out.

Physical factors used in the post-immobilization period: paraffin baths, electrophoresis of lidase, potassium, ultraphonophoresis of lidase, electrical stimulation of muscles, 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 a complex of physical therapy, additional equipment for weights is used, as well as hanging and resistance exercises. During this period, the emphasis is on complete restoration of the limb and elimination of residual effects of the fracture.

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

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

Therapeutic physical education is supplemented with occupational therapy (restoration of everyday skills and self-care functions).

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

Shock wave therapy

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

Complications

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

Early complications:

• Attachment of infection with the development of a purulent process in an open fracture.
• Sudeck's syndrome.
• 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).
• Turner's neuritis.

Fracture of the styloid process of the radius without displacement. Pain. Plaster splint. But why did the thumb become numb???

Alexander Popov

The nerve is touched.

Most likely the nerve was compressed by the plaster. You can wrap the splint looser. Well, tell the doctor about it.

Olga Merenkova

I have the same fracture and the doctor warned me about this in advance. If you wear your hand with the hand down and not in a bandage in the first days, swelling may occur. this swelling is also the reason for the numbness of the finger, because the nerves were pinched. You MUST consult a doctor

The human elbow is formed by three bones. The humeroulnar girdle also contains the styloid process of the ulna, which is responsible for the normal functioning of the entire joint. The styloid area often suffers from falls and impacts. As a result, a fracture is diagnosed.

Location and purpose

The ulna of the forearm consists of two sections: proximal and distal. The styloid zone is located in the lower, distal region and can be easily palpated.

The purpose of the styloid process is to fix the brachioradialis muscle.

A fracture of the styloid process of the ulna is a common type of injury that occurs during a fall on an outstretched arm. Women are more likely to suffer from a fracture when they are in menopause. Due to hormonal changes, the structure of bone tissue changes, osteoporosis develops, which leads to mechanical damage.

Other, most common causes of fracture of the process of the styloid zone:

• road accidents;
• falling during icy conditions in the cold season;
• falling on your hand from a height, a bicycle, while roller skating;
• extreme sports;
• active games.

Damage to the styloid process in the elbow joint accounts for about half of the total number of fractures. This is explained by its large size and close location to the subcutaneous layers.

Types of injuries

In traumatology, there are two types of styloid process injury:

• injury;
• fracture

The fracture can be with or without displacement, closed or open, comminuted. A compression and avulsion type of fracture is diagnosed when the bone of the right or left forearm is displaced. The type of fracture is influenced by the triceps brachii tendon attached to the styloid process.

Fracture

The photo shows a compression type of fracture or fissure of the styloid process, when the radius bone protrudes without displacement. This type of injury usually occurs when there is a blow to the wrist area. The impact force extends more to the radial process and is pushed outward and backward.

Injury to the styloid process is often combined with complete damage to the scaphoid bone.

The compression type of fracture is accompanied by the following symptoms:

1. Severe pain in the damaged area of ​​the radius process.
2. A characteristic crunch of fragments is heard.
3. Due to severe pain, joint mobility is sharply limited.
4. Severe swelling forms at the site of injury.
5. A subcutaneous hematoma occurs.
6. With the development of a hematoma, tension occurs in the skin during flexion on the damaged area of ​​the patient's elbow joint. But this sign does not always appear.

The type of fracture can be determined by an x-ray taken in two projections. To study cartilaginous tissues and confirm the clinical diagnosis, the doctor prescribes an MRI study.

Displaced fracture

Displaced fractures of the styloid process are of two types:

• extensor type. Fragments of bone tissue are displaced to the radial region and to the back side;
• flexion type of fracture. The injury is characterized by displacement of bone tissue towards the palm and occurs when the bone is in a flexed position.

Symptoms of a displaced fracture:

• visible deformation of the hand;
• swelling of the damaged area;
• pain that increases with any type of movement of the injured limb;
• limited movement of the elbow joint.

The type of fracture is determined after receiving the X-ray results.

Breakaway

Severance of the styloid process of the ulna occurs during an unsuccessful fall on an arm extended for support, and is less common than the compression type of injury. Ruptures can be combined with dislocation of the wrist bone.

At the moment of injury, the wrist moves inward, the radius bone may be damaged and the styloid process may be torn off at the same time.

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Avulsion of the styloid process can be diagnosed by the following symptoms:

1. Vivid pain at the site of injury.
2. The pain intensifies when trying to move.
3. The wrist area of ​​the joint is deformed.
4. The crunch of broken bone tissue can be heard.
5. Fingers go numb.
6. If you tap on the base of your palm, severe pain occurs.
7. The pain intensifies when walking and with any type of movement of the injured limb.
8. A hematoma forms at the site of injury.

To diagnose avulsion of the styloid process, the following diagnostic measures are carried out:

• taking an anamnesis, including examination and questioning of the victim;
• an x-ray is prescribed in two projections;
• If there is any doubt after an X-ray examination, computed tomography is indicated as an additional diagnosis.

Before applying a plaster cast, the styloid process is repositioned. The cast must be worn for about a month or more, depending on the severity of the injury. A second, control X-ray is taken 5 days after casting, and another one two weeks after the injury.

The styloid process protrudes

After a fracture of the elbow joint in the area of ​​the styloid zone, complications may develop, manifested as follows:

1. The outgrowth of the styloid process protrudes under the skin. This side effect can occur due to improper fusion of damaged tissues, causing them to become bulging.
2. The deviation is explained by incorrect reposition of the bone, as a result of which the bone tissue is deformed. After the healing of the connective tissue with the ligaments and subsequent fusion of the surface, pain remains in the area of ​​damage.
3. Deforming osteoarthritis of post-traumatic type.
4. Neurotrophic disorders. There is a constant discomfort in the shoulder and forearm area.
5. If the plaster cast is removed earlier, secondary displacement of the styloid process may occur.
6. Vascular disorders develop in the damaged area.
7. With an open fracture of the ulna, a purulent-inflammatory process may begin in the styloid zone.

Protrusion of the styloid process cannot be eliminated in all cases, even with the help of surgery. The main reason for protrusion of the appendix is ​​the displacement of bone fragments after early removal of the plaster splint.

Another reason for malunion of the styloid process is the high load on the injured arm during the healing process of the injury. Bone protrusion can also occur when seeking medical help late after a fracture, when the integrity of the bone tissue is disrupted during the process of independent pre-medical care.

Treatment

As an emergency treatment for a styloid compression fracture, it is recommended to apply ice to the injured area. Under the influence of cold, blood vessels narrow, which prevents the development of swelling. Cold also has a mild pain-relieving effect. The first steps are especially important, and correctly provided assistance will avoid complications.

In a medical facility, a plaster cast is applied to the damaged area.

Therapeutic methods for restoring the styloid process with a displaced fracture begin with reposition. Reposition refers to the correction and realignment of bone tissue. The procedure is performed under local anesthesia.

After reposition, a plaster splint is applied to the damaged area. When applying a bandage, the hand is bent and slightly moved to the side. The duration of wearing the splint is from 1 to 1.5 months.
After the swelling subsides, the splint is fixed with soft bandages.

To control the fusion of bone tissue, after a week has passed from the moment of applying the plaster, a repeat x-ray is taken.

Surgical intervention, with a protruding type of fracture and fusion of the styloid process, consists of performing an osteotomy. This is an orthopedic operation during which an artificial fracture is performed. The damaged bone is re-cut and the damaged part is removed. Then artificial materials are installed in this place.

What the operated joint looks like can be seen in the photo. After surgery, the damaged area is fixed with a special plate.

Rehabilitation

Complications after a fracture can be avoided if you follow medical recommendations during the recovery period. Rehabilitation procedures are indicated immediately after relieving pain after a fracture and applying a plaster cast, and include the following:

• On the 3rd day after applying the plaster splint, you must carefully develop your fingers. Therefore, light loads during self-care are allowed;
• the next stage in restoring the damaged joint consists of sessions of physiotherapy, massage and special gymnastic exercises.

Exercise therapy after a fracture of the styloid process on the ulna consists of exercises aimed at developing the fingers and plaster-free areas of the joint, which are at a right angle due to the bandage.

To avoid stress on the injured ulna, exercises can be performed in water. To bring joint functions back to normal, it is necessary to endure a recovery period of 1.5 to 2 months.

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