fractures

Wrist fracture. Fractures of the bones of the wrist. Classification, diagnosis Causes of a fracture in the wrist

Fractures of the trapezius, firmly fixed and well covered, are rare. Since they arise mainly as a result of direct trauma, they are most often combined with other injuries of the wrist joint, including dislocations of the trapezius bone itself.

Both clinical and radiological recognition of these fractures is not easy.

Usually, conservative treatment is carried out with immobilization for 3-6 weeks. After comminuted, crushed fractures due to the development of deforming arthrosis, arthrodesis of the trapezoid-metacarpal joint (and even the trapezio-trapezoid joint) may be required.

Dislocations of the hand

Dislocations of the hand are about 5%. Mechanism-forced violence with extension or flexion of the hand, occasionally displacements to the ulnar or radial side occur.

Reposition must be urgent. The reduction mechanism is a prolonged stretching of the joint, culminating in mild pressure on the base of the hand with its flexion (with dorsal displacements) or extension (with palmar ones). At the same time, dislocations of the hand can be reduced up to 4-5 days from the moment of injury.

Surgical treatment of stale and chronic dislocations should be accompanied at the first stage by the application of the traffic police apparatus. Two accesses are almost always required: dorsal and palmar. Their sequence depends on the type of displacement: with a dorsal dislocation of the hand, first the palmar and then the dorsal, and vice versa with palmar dislocations.

With an old true dislocation of the hand, arthrodesis of the wrist joint according to Brockmann is performed with resection of the articular surface of the radius, head of the ulna and economical resection of the articular surfaces of the scaphoid, lunate, and, if necessary, triangular bones. The hand is set in the extension position at an angle of 20-30 degrees. The prognosis is favorable.

Approximately one percent of all types of fractures occur precisely in the fracture of the bones of the wrist. The most common fracture is the navicular bone, a little less often the lunate, and other bones of the wrist are extremely rarely injured, which occurs as a result of a significant number of inactive joints, which are strengthened from the back of the palm by highly stretched ligaments.

It is as a result of this that a fracture of the trihedral, pisiform, capitate, hook-shaped, small, and also large trapezius bone is extremely rare.

In order to be able to prevent the formation of fractures of the bones of the wrist, it is necessary to become more familiar with the causes that can provoke the formation of this type of injury.

The appearance of a fracture of the navicular bone is possible if a person falls directly on an outstretched arm and tries to focus on the hand. In almost all cases, the bone breaks into two approximately equal parts. However, in the event that a tubercle fracture has formed, then one bone fragment is much smaller than the other.

In the event that the fall occurs directly on the hand, which will be retracted to the ulnar side, then a fracture of the lunate bone is formed.

The formation of a Bennett fracture occurs if a fairly strong and sharp blow was received, the direction of which is along the axis of the first finger. At the same time, a dislocation will also occur directly in the carpometacarpal joint, with a parallel fracture of the base of the first finger of the metacarpal bone. Then the metacarpal bone will move upward and a small fragment of a triangular shape will break off from the edge of its base. It is as a result of this that the mechanism in which this type of fracture occurs can be called “fracture dislocation”.

The formation of a flexion fracture of the first metacarpal bone can be formed as a result of a rather sharp flexion of the first metacarpal bone directly to the palmar-ulnar side. This can happen in the case of a fairly strong impact on some hard object. The main difference from obtaining a similar Bennett fracture is that in this case the fracture line will extend further by about one or one and a half centimeters, and the fragments themselves are displaced at a certain angle, the opening of which occurs in the palmar side.

Fracture of the second-fifth metacarpal bones is most often formed as a result of receiving a strong blow to the hand, as well as when hitting some hard object, and sometimes in case of receiving a rather strong load directly on the joint axis, in case of twisting or bending of the hand .

Most often, the formation of a fracture of the fingers occurs as a result of any industrial or domestic injury. The formation of a fracture occurs as a result of the impact of the brush on some hard object, and sometimes the object on the brush itself. As a result of the impact of the deep, superficial flexors of the fingers, and of course, the interosseous, as well as the worm-like muscles, in the event of a fracture of the phalanges of the fingers, a characteristic displacement of the fragments that appear will form, which occurs at a certain angle, the opening of which will be strictly to the back.

The formation of a fracture of the remaining bones of the wrist occurs in very rare cases, which is characterized by stiffness of the joints, since they are additionally strengthened on the back of the hand due to highly stretched ligaments.

Additional factors that explain the low rates of injury will include the location of the bones themselves in the form of a vault, which is slightly convex towards the back. It is thanks to this that excellent conditions are created for depreciation.

Symptoms

In the event that a fracture of the lunate, as well as the navicular bone occurs, the victim himself begins to experience quite severe pain, which worries directly in the area of the wrist joint, while there will be a significant limitation of the natural mobility of the joint. However, at the same time, no more characteristic signs appear.

If the formation of a flexion fracture of the first finger occurs, in this case the clinical picture and the main signs appear, which are similar to the symptoms of Bennett's fracture. However, the only exception is the presence of a characteristic deformation.

With the formation of a Bennett fracture, deformations will appear directly in the area of traumatization of the bone and a rather strong edema will form, while there is a strong limitation of the natural function of the damaged hand, the patient experiences severe pain.

In the event of a Bennett fracture, the contours of the injured joint will be smoothed out, during palpation, as well as in the case of axial load on the first metacarpal joint, there is a significant increase in pain. There is a sharp restriction of all active movements, passive movements become very difficult.

If a fracture of the second to fifth fingers of the hand has occurred, then in this case the natural functions of the injured limb will be severely limited, and a feeling of sharp pain appears. In the case of the formation of fractures of the fingers, the appearance of a characteristic deformation will be observed, since the resulting fragments of the damaged bone are displaced.

With this type of fracture, a characteristic edema will appear, which is accompanied by bruising. There is also the possibility of the formation of a characteristic crunch (crepitus), and sometimes pathological mobility. All active movements with a damaged hand become completely impossible, while passive movements will be very difficult, and sometimes completely absent.

If there is a fracture of other bones of the wrist, then such an injury is accompanied by the appearance of a rather strong edema of the hand itself, the appearance of local pain is observed. If pressure is applied along the axis of the injured finger or metacarpal bone, a positive sign of axial load will appear, which is a rather pronounced symptom of a fracture.

Diagnostics

It is possible to diagnose the presence of a fracture of the bones of the wrist during a thorough examination of the patient, while taking into account the complaints of the patient himself. In some cases, in order to make a more accurate diagnosis, there is a need for additional clinical studies. However, in all cases, without fail, an x-ray examination will be done, thanks to which it becomes possible to determine the severity of bone damage.

Prevention

Prevention of wrist fractures is based on avoiding injuries that can lead to them. In the case of active sports, it is necessary not to forget about the methods of personal protection.

Also, special attention should be paid to your diet, you need to diversify your daily diet with calcium-rich foods, which will make it possible to strengthen the bones and avoid their increased trauma.

Treatment

If a navicular fracture has occurred, conservative treatment methods will be used in almost all cases. As soon as a local anesthetic is injected, by stretching the fingers of the injured hand, as well as bending the hand towards the palm, the resulting fragments are compared.

In this case, a fixing plaster bandage is also applied up to the elbow area, capturing the fingertips, and left for about three months. After a few days, the patient is prescribed special physical methods. Approximately six months after the injury, there is a full recovery.

In the event that, due to certain circumstances, in some cases it becomes completely impossible to carry out conservative treatment, then surgical treatment is performed. The operation is used in the presence of nonunion fractures, as well as false joints. Such an operation is carried out by conducting an open reposition, and of course, fastening the resulting fragments.

When a lunate fracture is formed, conservative treatment is performed, which is very similar to the treatment of a scaphoid fracture. A fixing plaster bandage is also applied, which is left for about ten weeks, while full working capacity is restored after about three months.

The same method as a fracture of the navicular bone will treat a fracture of the lunate bone. In this case, the period of immobilization lasts about three weeks, after four months, recovery is observed.

Bennett's fracture is also amenable to conservative treatment - anesthesia is performed with local anesthetics, and then the fragments are reduced. In the event that it is not possible to carry out reduction, then there is a need for surgical treatment, using skeletal traction.

With the formation of a flexion fracture of the first finger, conservative treatment is carried out, in which the technique of closed reposition is used. If it is not possible to carry out reposition, then the patient is prescribed surgical treatment or skeletal traction. Within seven weeks from the moment of injury, full recovery occurs. Treatment can only be carried out by an experienced doctor.

The degree of damage to bone and muscle tissues, as well as the intensity of pain, fully depend on the specifics of the fracture of the radius. Against the background of an open fracture, wound surfaces are observed, bone fragments are visible directly, severe bleeding appears.

The pain syndrome with such damage is strongly expressed, even loss of consciousness by the patient or pain shock is possible.

The reasons

As a rule, such injuries are received by people who are actively involved in sports or extreme entertainment. Nevertheless, ordinary citizens often injure their hands by slipping during a leisurely walk.

Older people over the age of 60 often suffer from osteoporosis. This disease greatly affects the strength of the bones, and as a result, even weak loads lead to the damage in question.

And most often, a fracture of the wrist joint is noted in women of age. The thing is that after menopause, they have a hormonal imbalance, accompanied by the excretion of calcium from the body.

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

Let's take a closer look at the two types of wrist fractures and the symptoms by which you can determine the type of fracture.

Types of fractures

Damage in such a typical place has long been known to physicians and is contained in the International Classification of Diseases (ICD). The most common injuries are even named after famous doctors. So:

extensor is called Colles' fracture;
flexion - Smith.

The first option happens if a person fell on the palm of his hand. Here, the bone fragment is always shifted to the area of the thumb finger and closer to the back. As a result, a bump appears on the hand, called the "bayonet".

Compared to the one described above, Smith's fracture is much less common. In this situation, a person falls on the back of the hand (this happens if they land on their backs). In this case, the wrist becomes like a fork, while the bone usually moves towards the palm.

Often, by the way, an open fracture also occurs, that is, soft tissues are destroyed, which leads to rather severe bleeding.

Comminuted injuries are accompanied by fragmentation of the bone into several fragments.

Fractures can be classified according to the direction of the line, the presence of confusion, or depending on the location. Allocate damage:

In the navicular bone, the fracture line runs:

in the proximal part;
in the middle part;
in the distal part.

The wrist is a small segment of the arm between the hand and forearm, or rather, between the bones of the metacarpus (palmar part of the hand) and the radius. That is why it is called so, because it is located “behind the metacarpus” towards the forearm.

Its formation involves 2 rows of small irregularly shaped bones located in different planes. Thanks to this, the wrist has a somewhat curly shape, referred to as an "anatomical snuffbox", with a bulge on the back and a groove on the palmar surface.

Displacement of bone fragments during a fracture significantly deforms the wrist

Each row of carpal bones, proximal (closer to the forearm) and distal (bordering on the metacarpus), consists of 4 formations interconnected by cartilage layers, which, however, do not give mobility to the joints.

With injuries, a fracture of each of the 8 bones can occur, but in most cases the navicular bone of the wrist, which is located in the proximal row and is involved in the formation of the wrist joint, is damaged.

Often, with injuries of the wrist region, a combined fracture is recorded, affecting both the joint and the bones of the wrist.

Fractures of this zone can occur if a person put his arm under him when falling, if he got into a traffic accident, or an external force acted on the wrist and hand. Depending on in which plane and with what intensity this action occurred, fractures can be of several types:

along the line of the split of the bone structure - transverse (bone fragments have even chips) and comminuted (the presence of small fragments).
according to the integrity of the skin - open and closed.
unilateral (injury to one hand) and bilateral.
with or without displacement of bone fragments.
combined (combined with injury to the wrist joint, damage to the tendons or blood vessels) or isolated.

Separately, a fracture of the navicular bone stands out as the most common type of injury, in turn, it is subdivided as follows:

fracture in the middle part of the navicular bone;
in the distal part;
in the proximal part.

The most common fracture in the wrist is the navicular bone.

This classification is necessary in order to correctly formulate the diagnosis, develop treatment tactics and predict the prognosis for the health and working capacity of the patient.

For example, a displaced fracture of the wrist will require assistance only in stationary conditions in order to properly reposition (combine) bone fragments.

This type of injury is more severe, it takes a long time to heal, and it will also take a lot of time and effort to restore the functionality of the hand.

Symptoms

After a fall on the wrist, a person usually feels quite a lot of pain. However, it can equally indicate not only a fracture, but also about:

True, in such cases, the injured arm retains at least partial mobility. Only x-rays can accurately confirm the diagnosis in this situation.

There are, however, a number of obvious signs indicating a fracture:

bones are deformed or displaced;
the pain is greatly aggravated when the victim tries to move his wrist;
swelling appears;
the damaged area becomes numb;
a bruise appears;
shrapnel is heard.

A fracture of each bone is characterized by its own clinical symptoms, despite the fact that they are located in sufficient proximity. Based on the symptoms, it is not always possible to make a correct diagnosis, but they can lead to an understanding of the essence of the issue. So, the navicular bone is characterized by:

pain in the area of \u200b\u200bthe "anatomical snuffbox", it appears at the base of the first finger, between the tendons, if you lift it up;
pain when tapping on the first and second fingers;
soreness with dorsal extension of the hand;
swelling and subcutaneous hemorrhages at the site of injury;
supplemented by signs of a fracture of the arm in the wrist with pain when trying to clench into a fist;
in case of a fracture with a displacement, the injury site is deformed;
fragments can crepitate, pathological mobility is observed;
limited active and passive movements of the hand.

Symptoms of damage to the semilunar bone:

pain at the site of injury;
painful dorsal extension of the hand;
swelling and bruising in the projection of the bone;
soreness with a load on the third and fourth fingers.

Symptoms of a fracture of the trapezoid, trihedral, trapezoid, pisiform, capitate and hamate bone:

pain and swelling on palpation of the damaged area;
soreness with a load on the finger, the axis of which passes through the damaged bone.

In trauma practice, a fracture of the wrist with or without displacement may look almost identical, and only with the help of additional instrumental examination it will be possible to clarify which bone is affected.

Symptoms of a fracture of the wrist, as a rule, are always bright, the clinical picture of the pathology develops rapidly and immediately after the injury.

Signs of a fracture of the bones of the carpal zone can be determined as follows:

development of pain syndrome;
limitation of mobility or its absence;
edema formation;
formation of a hematoma (bruise);
deformity of the carpal region;
an audible crunch (or crepitus).

These symptoms of a wrist fracture are formed almost simultaneously, but first of all, the victim feels a sharp pain. The pain syndrome is often pronounced significantly, it can radiate (give) to the hand or forearm (if the nerve trunks are affected).

When you try to clench your hand into a fist or straighten it to the back, the pain intensifies, and its exact localization is most often noted on the axis of the thumb and forefinger, that is, in the place where the navicular bone is located.

Damage to soft tissues and capillaries leads to the release of fluid into the interstitial space and the formation of edema. If there is a massive rupture of the walls of capillaries and larger vessels, then a hematoma is formed, or an accumulation of blood under the skin, often of an extensive size.

Edema, hematoma and severe pain syndrome lead to the fact that the injured person spares the injured hand and tries to keep it in a position that reduces pain.

With closed fractures and in the presence of bone fragments, if you move your wrist, you can hear a crunch, or crepitus, which is formed when the fragments rub against each other.

Displaced parts of the bones also cause deformation of the carpal region. If a severe injury occurs, with a rupture of the skin and displacement of bone fragments, then the patient has bleeding, and the wound has torn edges and quickly becomes infected.

The X-ray clearly shows the fracture line.

All these features of injuries must be clarified as quickly as possible, since the effectiveness of therapy, the timing of recovery and the restoration of all functions of the hand depend on it.

Complex diagnostic measures carried out in a trauma center or in a hospital will help determine the type of fracture of the wrist region.

Diagnosis of a fracture of the radius

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

This angle can decrease almost to 0 or even become negative during displacement.

When an injured person seeks help, the doctor first of all clarifies the history of the pathology, that is, finds out the fact of the injury and the circumstances of its receipt.

Other symptoms, such as pain and swelling, may accompany this type of injury, such as a severe bruise.

Therefore, for the differential diagnosis of fractures of the wrist region with other injuries, it is necessary to carry out an x-ray examination, which remains the most accessible in all medical institutions. If possible, computed tomography is performed instead.

But even on several x-rays taken in different projections, it is not always possible to clearly determine the line of a bone fracture if it is not comminuted.

In these cases, the diagnosis will be based only on the patient's complaints and examination data, and the treatment of a fracture of the navicular bone or other bone of the wrist will begin with plaster fixation.

After 3 weeks, when the consolidation (fusion) of the fragments begins, the x-ray examination is repeated. As a rule, the fracture line becomes more distinct, which will confirm both the correctness of the previously made diagnosis and the literacy of therapy.

Cold at fracture reduces pain

Treatment

The treatment process is divided into several stages:

first aid;
examination by a doctor;
pain relief with medications;
examination of a damaged hand;
basic therapeutic measures;
rehabilitation.

The method of therapy is chosen by the doctor, based on:

radiographic data;
the patient's condition;
the nature of the damage.

When the fracture is not complex and no displacement has occurred, immobilization with a plaster cast will suffice. The shift of fragments requires reduction.

This procedure is performed under local anesthesia. The bone is fixed, and the arm is plastered.

When an open fracture occurs, the patient is put on the Elizarov apparatus, which allows the bone to be immobilized from the outside. If everything goes well, then after 2 weeks this device is replaced with a standard plaster.

The condition is monitored by X-ray.

For the treatment of a radial fracture, conservative therapeutic methods are used. The area of the fracture is anesthetized with a solution of novocaine, and in case of a fracture of the styloid process, anesthesia in this area is also mandatory.

If the radial fracture is without displacement, then the forearm is fixed with a plaster dorsal splint from the upper third of the forearm to the very base of the fingers. Such therapeutic immobilization lasts at least 2-3 weeks, while the hand takes the position of a slight dorsiflexion.

After a short amount of time, therapeutic exercises are prescribed, which are carried out with the joints of the limb 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 for the fracture area. More active rehabilitation measures are carried out after the immobilization of the limb has been terminated.

Exercise therapy, massage, various thermal procedures are prescribed. Full working capacity of the limb is most often restored after about five weeks.

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

The goal of any treatment is to return the impaired functionality to the organ.

If the bone is damaged without fragments, a deep plaster splint is applied for a period of 4 to 6 weeks. The control of the correct fusion of the hand is carried out using a radiograph.

A fracture of the wrist joint with displacement of fragments is treated under general or local anesthesia using closed reduction and fixation with a plaster cast.

The brush must be given a slight dorsiflexion.

For comminuted injuries, percutaneous transarticular fixation is used for up to 6 weeks to prevent displacement of debris.

In any case, a medical examination should take place every 24 hours. The control X-ray is carried out in a week.

Fixation of Colles' fracture

With an extensor fracture, stretching is carried out along the axis of the forearm by the hand, while stretching is carried out in the opposite direction behind the shoulder. After completion of the traction procedure, a dorsal plaster splint is applied, and the hand is placed with the palmar surface down.

Smith's fracture fixation

When establishing the diagnosis of a flexion fracture, the joint is reduced in a similar way, however, the displacement of the distal fragment is carried out to the back of the hand. The place of damage is fixed with a palmar dorsal bandage, laying the hand with the palm up.

Medications

Regardless of the chosen method of treatment, the appointment of drugs that accelerate the healing of damage is indicated. Calcium preparations are of paramount importance, preferably in combination with vitamin D, which increases its absorption. Shown drugs:

Help with folk remedies

A fracture of the wrist joint, as noted earlier, is accompanied by quite severe pain. Often they torment patients at the stage of rehabilitation. To alleviate the condition, it is worth using one proven drug. This ointment requires:

2 teaspoons chopped onion;
one each of eucalyptus and rose essential oils;
15 tablespoons of vaseline.

All products are heated in a water bath with constant stirring. The resulting composition is rubbed on the skin in the area of the healing fracture. To enhance the effect, still worn horseradish is applied over the ointment and the hand is wrapped with a film and a warm scarf.

Complications of injury

In the middle part, the blood supply is poor, which leads to the development of a false joint. Also, the cause of the development of complications may be an incorrectly applied bandage.

Complications can occur in a situation where a person does not go to see a doctor, taking the injury for a bruise. In such a situation, a fracture of the arm with a displacement in the wrist may heal incorrectly, sometimes the neurovascular bundle is damaged.

The hand is deformed, a chronic pain syndrome develops, leading to dysfunction of the hand.

With improper and inattentive treatment of a fracture of the wrist, the following complications can be observed:

Unfortunately, in some clinical cases, there may be a violation of the consolidation of the radius or a slowdown or suspension of the natural process of bone tissue repair.

This can happen due to a number of negative factors, such as the patient's tendency to malnutrition, alcohol consumption, smoking, old age, diabetes or other diseases that reduce the body's regenerative abilities.

Depending on the symptoms, the complications of consolidation are divided into three main types:

A fracture that does not heal properly. As a rule, this happens due to incorrect or insufficient fixation of fragments, as well as against the background of existing diseases that slow down regenerative processes.
Delayed fusion. The processes of tissue repair take a long time. The causes of this pathology are diverse, among the factors include, for example, the advanced age of the patient.
Nonunion fracture. There are no signs of bone tissue restoration even after a long period of recovery and the use of the necessary therapeutic measures.
False joint. It is characterized by a violation of the functional features of the radius and its excessive mobility.

To prevent pathologies, the medical instruction recommends the use of not only standard, but also a number of additional methods in the process of tissue consolidation, including physiotherapy exercises, physiotherapy, and taking drugs, the price of which is often quite high, that stimulate the body's regenerative abilities.

Advice! To prevent possible complications in the treatment of fractures of the radius, it is required to give up bad habits and unhealthy diet, eat only healthy foods and lead a proper lifestyle.

megan92 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!

Daria 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things

megan92 13 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why the Internet sell ah?

Yulek26 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official site. Be healthy!

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then, it's OK! Everything is in order - exactly, if payment upon receipt. Thank you so much!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman has been suffering from pain for many years ...

Andrew a week ago

What kind of folk remedies I have not tried, nothing helped, it only got worse ...

Ekaterina a week ago

I tried to drink a decoction of bay leaves, to no avail, only ruined my stomach !! I no longer believe in these folk methods - complete nonsense !!

Maria 5 days ago

Recently I watched a program on the first channel, there is also about this Federal program for the fight against diseases of the joints spoke. It is also headed by some well-known Chinese professor. They say they have found a way to permanently cure the joints and back, and the state fully finances the treatment for each patient

A fairly common injury is fracture of the bones of the wrist and it occurs in people who lead an active lifestyle or are professionally involved in sports. Also, trauma is not uncommon in the elderly and postmenopausal women. This is due to the development of osteoporosis, in which the bone is damaged even after a small impact. Due to the small size and close location of the bones of the wrist, the symptoms are similar. However, in some cases there are characteristic signs that allow diagnosing damage to a particular bone. It is necessary to take into account the anatomical structure.

Wrist - part of the skeleton of the hand, located between the radius and ulna, as well as metacarpal bones. Any person in the area of \u200b\u200bthe wrist has eight small bones arranged in two rows.

The reasons

Each bone has its own factors that lead to damage. So,wrist fracture, namely the navicular bone occurs when falling on an outstretched arm. Often, road traffic accidents lead to damage. Another reason is punching a hard object or during a fight. Damage occurs as a result of a blow to the palm. Bilateral damage occurs less frequently, its cause is a fall on both upper limbs at once. In parallel, with a fracture of the navicular bone, a dislocation of the lunate can also be observed.

Injuries to the semilunar bone are rare, mostly from a fall on an outstretched arm or from a direct blow. Injuries to the trapezium, trihedral, trapezius, pisiform, hamate and capitate bones are rare in the practice of a traumatologist and are the result of a direct blow.

Classification

Fractures can be classified according to the direction of the line, the presence of confusion, or depending on the location. Allocate damage:

transverse;
splintered.

In the navicular bone, the fracture line runs:

in the proximal part;
in the middle part;
in the distal part.

Symptoms

pain in the area of \u200b\u200bthe "anatomical snuffbox", it appears at the base of the first finger, between the tendons, if you lift it up;
pain when tapping on the first and second fingers;
soreness with dorsal extension of the hand;
swelling and subcutaneous hemorrhages at the site of injury;
supplemented by signs of a fracture of the arm in the wrist with pain when trying to clench into a fist;
in case of a fracture with a displacement, the injury site is deformed;
fragments can crepitate, pathological mobility is observed;
limited active and passive movements of the hand.

Symptoms of damage to the semilunar bone:

pain at the site of injury;
painful dorsal extension of the hand;
swelling and bruising in the projection of the bone;
soreness with a load on the third and fourth fingers.

Symptoms of a fracture of the trapezoid, trihedral, trapezoid, pisiform, capitate and hamate bone:

pain and swelling on palpation of the damaged area;
soreness with a load on the finger, the axis of which passes through the damaged bone.

First aid after injury

In a situation where, after an injury, it is suspectedfracture of the bones of the wristproper first aid must be provided. Immediately after the injury, cold is applied to the injury site, wrapped in a cloth. Any item from the freezer or refrigerator will come in handy. Cold is applied for 20 minutes, after which it is removed for 10, otherwise frostbite cannot be avoided. You can repeat the procedure about three times, the cold will reduce pain and swelling.

Additionally, the victim can be given analgesics, most often non-steroidal anti-inflammatory drugs. Before delivering the victim to a medical institution, a transport tire is applied to the injury site. It can be standard or made from any material at hand, most often a board wrapped in cloth. A tissue roller is placed under the brush, thanks to which it acquires a physiological position. If a displaced fracture of the wrist is visually visible, mandatory hospitalization is indicated.

Diagnostic criteria

If a person is suspectedwrist fractureit needs to be examined. Of great importance are complaints and how a person was injured. An examination by a doctor is of no small importance; on its basis, an x-ray is prescribed. Since there are many different bones in the wrist area, the x-ray is taken not in two, but in three projections (direct, lateral and 3/4).

Since the navicular bone is often damaged, its damage can be seen on the image as a line. When the fracture is not visible in the picture immediately after the injury, a plaster is applied for a period of 3-5 days. During this period, the damage begins to grow together and the symptoms of a wrist fracture are complemented by the expansion of the fracture line in the picture.

If difficulties arise in the diagnosis, computed tomography (CT) is indicated. The technique allows you to show the doctor the state of the bone tissue, especially when it comes to the navicular bone. If damage to ligaments, cartilage, or other soft tissue structures is suspected, an MRI is indicated.

Therapeutic measures

When diagnosed after examinationdisplaced wrist fracture, surgery is indicated. If there is no displacement, the injury can be treated conservatively by applying a plaster cast. Additionally, in order to accelerate the fusion, the use of medications, physiotherapeutic methods is shown.

The technique is shown, if available.non-displaced wrist fracturewhen the body is able to repair the damage. A circular plaster bandage is applied to the victim for an average of 4-6 months. The bandage is applied from the heads of the metacarpal bones to the upper third of the forearm. Without fail, the first finger must be abducted at a right angle to the hand. After 2 or 3 months, the bandage is removed and a control x-ray is taken. If the fracture has not healed and there are signs of a wrist fracture on the x-ray, then the bandage is applied again for a period of 2-3 months. In total, and goes up to 6 months.

In the event that the x-ray shows that the fracture has not yet healed, the patient must again apply an immobilizing plaster bandage for 2-3 months. Thus, with a fracture of the wrist, a cast is worn for up to 6 months.

In case of a fracture of the bones of the wrist, except for the scaphoid, treatment is carried out by conservative methods. A plaster bandage is applied to the victim, which is required to be worn for a month.

Surgical treatment

The main indication for surgery is a displaced fracture of the hand at the wrist. During the intervention, anesthesia is general, and the essence of the operation is to fix the fragments with a needle or screw. This leads to tight compression of the scaphoid fragments and reliable fixation. The doctor may use an external fixation device. The fusion process takes from one to two months, the activity of the wrist joint is restored. Surgical intervention for a fracture of the remaining bones is not performed, only if there is a significant displacement.

Medications

Calcium D3 nycomed;
Structum;
Calcemin;
Osteogenon.

With the development of pain syndrome, a person is prescribed non-steroidal anti-inflammatory drugs. Their doctor prescribes them in a strictly defined dose, otherwise there is a high risk of developing complications, primarily from the digestive system. Means shown:

Nise;
Naizilat;
Xefocam;
Nimesil;
Movalis;
Revmoxicam;
Aertal.

Since the blood supply to the navicular bone in the middle part is poor, the doctor prescribes agents that enhance microcirculation. These are drugs: Latren, Tivortin, Pentoxifylline. Medications are not prescribed for high blood pressure.

There are a large number of joints in this area of the bone brush, and prolonged immobilization can cause the development of post-traumatic deforming arthrosis. Chondroprotectors contribute to the restoration of cartilage tissue in the hand and the rest of the body. These are the drugs:

Mukosat;
Protecon;
Hyalual;
Chondroitin complex.

Locally, especially after removing the plaster cast, anti-inflammatory and analgesic ointments and gels are used. Use drugs: "Ketorol gel", "Voltaren", "Dip-relief", "Fastum gel", "Flamides gel". You can use them after doing gymnastic exercises.

Complications of injury

Most often, with a fracture of the navicular bone, a false joint develops, which is associated with the peculiarities of the blood supply. Fractures of the proximal and distal sections grow together perfectly. In the middle part, the blood supply is poor, which leads to the development of a false joint. Also, the cause of the development of complications may be an incorrectly applied bandage.

Complications can occur in a situation where a person does not go to see a doctor, taking the injury for a bruise. In such a situation, a fracture of the arm with a displacement in the wrist may heal incorrectly, sometimes the neurovascular bundle is damaged. The hand is deformed, a chronic pain syndrome develops, leading to dysfunction of the hand.

Rehabilitation activities

After removedplaster for broken wristthe rehabilitation process begins, however, some methods are used even before that. The patient is shown:

physiotherapy;
massage;
physiotherapy;
food.

It starts from the second day after the injury and the imposition of a plaster cast. To perform all exercises, you need to start with gymnastics for the fingers, the elbow and wrist joints are additionally worked out. The second stage is performed after the plaster is removed under the guidance of an experienced rehabilitation therapist.

Active and passive movements are performed, however, with a reduced range of motion and passive exercises. Paraffin applications, gymnastics, better in water and massage are carried out. The third period begins no earlier than a month after the injury. Sports training after there was a fracture of the wrist of the radius is allowed no earlier than 2 months after the fracture.

The diet should be dominated by foods high in calcium and vitamins.

Immediately after removing the cast, you can do something with your hand, but it is optimal to choose a set of exercises for yourself together with a rehabilitation specialist. You can start by raising your hand and shrugging your shoulders. Both hands are raised up and to the sides, and then forward and up. The arm can be rotated clockwise and counterclockwise at the wrist and elbow joints. It is useful to comb the head with a damaged brush, to pat in front of you and behind your back.

It is useful to perform gymnastics in water, as the load is reduced and the intensity of pain decreases. The water should be warm, a small amount of sea salt is added to it. Such procedures help relieve muscle spasm, relax. You will need to take a large basin, the water temperature should be about 36 degrees, it can be a little higher.

In water, the palm is actively compressed and unclenched, to increase the load, you can use a soft cloth or sponge, the brush also bends and unbends, it is useful to rotate it. Each movement must be performed at least six times. Then the palm should be laid on the bottom of the pelvis, after which the fingers rise in turn, each from 5 to 15 times. The palm should roll up and down, the back surface should touch the bottom. Gymnastics should be performed at least once a day, and more often.

You can also use the surface of the table for gymnastics in a sitting position. The palm is placed on the surface of the tabletop, the hand is clenched into a fist, after which it relaxes, the load should increase every day. In the position of the hand on the tabletop, it is useful to raise the fingers until a slight pain is felt (a similar exercise can be performed in water). For each finger, at least 6 repetitions are required, the exercise allows you to remove swelling of the fingers and hands, which may bother you after removing the plaster cast.

Also, the brush fits tightly on the surface of the table, after which the fingers are spread and brought together until a slight soreness appears. With your thumb, you can rub the rest, conduct a light massage. It is useful to develop finger motor skills by playing a virtual piano on the surface of the table. The hand is placed with the elbow on the surface of the table, after which the thumb needs to touch the tips of the rest, perform clicks, straining the finger as far as possible. Without changing position, thumb movements are performed along the rest from the palm to the tips.

In the position of the hand on the elbow, the thumb is pressed on the pads of the rest for 1-2 seconds. Without changing position, the palms are pressed against each other tightly and slowly turn from side to side. The palm rises up in the position on the elbow and with the pad of the thumb you need to touch the rest, you need to go through several “rows”.

On the first day after doing gymnastics, pain will bother you, which must be taken into account, fatigue comes quickly. It is impossible to rush things, it is categorically contraindicated to overstrain the limb, but being lazy will not be the best way out. For faster recovery, gymnastics is performed 2-3 times a day, starting with six times for each movement, increasing the amplitude as you feel.

Gymnastics for wrist joints

Since the wrist has many joints, gymnastics is also shown for this anatomical region. You can start the complex by connecting the palms, pressing one on the other, without separating them, after which the wrists are bent in one direction and then in the other direction. Further, the hands are located vertically, on the edge of the palm, carefully and slowly the palm turns to the surface of the table, it is worth touching it only with the fingertips.

The palm is placed on the surface of the table, the brush turns up and down until a slight soreness appears. The hand is placed on the elbow, the brush is raised up and the fist is clenched. The wrist of the healthy hand is wrapped around the wrist, and the patient smoothly bends back and forth. Each deviation is delayed by 3-4 seconds. The hand in the position of the hand on the elbow rotates in one direction and the other, the wrist is held by a healthy hand.

The duration of classes is at least half an hour to get the expected effect. For each movement, it is shown to carry out three cycles with a repetition of 5-6 times.

Damage to the bones of the wrist is a serious injury, since a person cannot fully use the brush or attend work for several months. Such damage is dangerous for professional athletes or students. The main thing is to consult a doctor in a timely manner and undergo an examination in order to minimize the risk of developing various complications.

The bones of the wrist form a collection of 8 small spongy bones, which are arranged in two rows, each of which contains 4 bones.

The first or proximal row, located closer to the forearm, consists of the following bones, presented in order, starting with the thumb:

navicular or os scaphoideum;
semilunar or os lunatum;
trihedral or os triquetrum;
pisiform or os pisiforme.

The connection of the first three bones forms an elliptical articular surface that articulates the wrist and the distal end of the radius. The pisiform bone of the wrist, which is commonly referred to as the sesamoid bone, is in turn attached to the triquetral bone.

The second row of carpal bones - distal - is formed by the following bones:

trapezium or os trapezium;
trapezoid or os trapezoideum;
capitate or os capitation;
hook-shaped or os hamatum.

The surface of each bone is equipped with special articular facets that help the bones connect with nearby bones. Also on the palmar surfaces of a number of bones of the wrist are tubercles, to which ligaments and muscles are attached. These bones include: scaphoid, trapezoid, hamate.

The general view of the bones of the wrist has the shape of a vault, the convex part of which is located on the back of the hand, the concave part is on the palmar.

Almost all 8 bones of the wrist have six surfaces (except for the pisiform). At the same time, all bones, without exception, belong to the articular: their lower surface forms the articular fossae, and the upper surface forms the articular heads. Between the lateral surfaces of the bones there are also joints that connect the bones of the wrist to each other.

Wrist bone injuries

Among the most common injuries of the wrist are dislocations and fractures:

Dislocations of the bones of the wrist. Dislocations come in many varieties, depending on the bones involved in the injury. Most often there are dislocations of the lunate bone, a little less often - the scaphoid, rarely - the pisiform. Dislocation of the semilunar bone is difficult to recognize even with the help of x-rays. However, the main symptoms are the following: the presence of a protrusion in the center of the palmar side of the wrist and a retraction on the back, a feeling of pain when straightening the fingers, which are often motionless or take the form of a half-bent. In addition, the wrist joint swells from the side of the palm, movements are painful. The dislocation is reduced by counter-traction, traction or pushing according to the Behler method. Dislocation of the navicular bone is often accompanied by a fracture. It can be diagnosed only with the help of X-ray examination. Such a dislocation is reduced under anesthesia or local anesthesia by traction, after which a bandage is applied, special gymnastics, physiotherapy are prescribed. A dislocation of the pisiform bone of the wrist usually does not adversely affect the functioning of the hand and wrist. Operative treatment is prescribed, in which the bone is sutured into place, and sutures are applied to the ligamentous apparatus;
Fractures of the bones of the wrist are quite rare, but the navicular bone is the most susceptible to fractures. In more rare cases (as with dislocations), fractures of the lunate and pisiform bones are possible. Fractures of other bones of the wrist are exceptional cases. Fracture of the navicular bone is possible in situations associated with a fall on a bent arm, a fist on a hard surface, or a direct blow to the palm. In most cases, the navicular bone breaks into two pieces when it is fractured. The symptoms of a fracture are as follows: soreness of the wrist joint, aggravated by a load on fingers I or II, the impossibility of squeezing the hand into a fist due to pain. Diagnosis is carried out using X-ray examination, treatment includes immobilization for a period of 1 to 6 months. If the fracture of the wrist bone is not accompanied by displacement, then it is recommended to apply a plaster cast for approximately 3 months. In the presence of displacement, osteosynthesis of bone fragments is carried out with screws. In this case, the immobilization period is increased to 2 months. A fracture of the lunate bone occurs when falling on the hand or as a result of a direct blow. After damage, swelling of the joint is noted, pain, which increases when the hand is extended to the back. Treatment involves the imposition of a plaster splint, the wearing period of which is from 1.5 to 2 months. As a rule, complications during bone fusion are not noted. The rarest type of fractures of the bones of the wrist is a fracture of the pisiform bone, which is caused by blows to the area of damage or a blow with the edge of the hand on a hard surface. Symptoms are pain in the area of the wrist joint from the side of the little finger, which intensifies when clenching the hand into a fist or trying to bend the little finger. Treatment involves immobilization lasting at least 1 month.