The wrist joint is the radius and carpal bones, they are movably connected. An expanded concave articular surface, which is turned towards the wrist, is adjacent to the distal surface of the triangular cartilaginous disc. It, in turn, is connected to the convex proximal surface of the wrist bones of the first row of the joint: scaphoid, lunate and trihedral. These bones form the joint. The wrist is the distance between the forearm and the hand. Its name is due to the fact that it is located "behind the metacarpus", in the proximal side of the forearm.
The wrist joint is formed by bones arranged in 2 rows, which have an irregular shape and are in different planes. Therefore, it has such a curly shape. Its other name is anatomical snuffbox or radial fossa.
In fact, this is a triangular depression on the back of the hand at the base of the thumb, between the tendons of its short and long extensorand long abductor muscle. This name has been given since ancient times, because this area was used for placing and sniffing tobacco.
The radial artery passes here and you can feel the pulse. Two rows of carpal bones (distal and proximal) have 4 bones each, between which there is a cartilaginous layer.
By the number of forming bones, the wrist joint is classified as complex (more than two bones) and complex (there is a cartilaginous disc), and in the shape of the articular surfaces it belongs to ellipsoid and has two axes of rotation - sagittal and frontal.
The composition of the first row of the wrist joint is as follows:
- navicular, lunate, triangular (or triangular) and pisiform;
- second row - hook-shaped, capitate, large and small polygonal.
The human wrist joint can perform such movements as abduction and adduction of the hand - along the sagittal axis; flexion and extension - along the frontal axis; the elliptical shape of the joint allows for circular rotations of the hand.
The wrist bones are surrounded by ligaments - collateral radius and ulna. Which are attached to the styloid process of the ulna at one end, and to the pisiform bone at the other. There are 2 more smaller ligaments of the wrist - dorsal and palmar.
The junction of the wrist bones can make movements due to the muscles around. All muscles of the articulation are combined into 4 groups:
- Group 1 - responsible for the flexion of the wrist and little finger.
- Group 2 - extends the wrist and adducts the hand.
- Group 3 - takes awayhand and is involved in flexion of the wrist.
- Group 4 - involved in adduction and extension of the wrist.
The blood supply to the wrist comes from the radial, ulnar and interosseous arteries. The outflow of blood through the veins is carried out by two radial, ulnar and interosseous veins, as well as the palmar venous arch of the wrist.
One of the interesting features of the wrist is that there is practically no fat on it, and under the thin skin, the anatomy of the joint, i.e. the bones that form the wrist joint, is easy to feel.
Causes of fractures
The most common cause of fractures of the radius (beam) is a fall of a person on an outstretched arm with an emphasis on the palm. Such injuries are possible when falling from a height of their height, for example, in ice, in an accident, riding a bicycle or motorcycle.
Promote beam fracture and osteoporosis. In this case, the bones become brittle due to a lack of calcium, and even with a slight blow they break easily. Pathology is especially characteristic of the elderly after 60 years. Injuries and fractures of the wrist bones should be treated very carefully, otherwise they lead to contractures.
Classification of fractures
A fracture in the victim must not only be established, but classified. This is extremely important for the choice of treatment tactics and assistance. Therefore, we propose to study how fractures of the radius of the wrist joint are subdivided:
- Extra-articular and intra-articular; in the latter case, the fracture with its line is in the veryjoint.
- Comminuted - the bone breaks into more than three fragments;
- Open and closed fracture, depending on the presence of skin damage.
The fracture may involve the radius or the wrist bones. In the joint, the radial bone most often breaks, followed by the frequency of the navicular.
Also, fractures are divided into flexion and extensor. Colles' fracture is extensor. With it, the point of impact falls on the palm, that is, the person fell on the palm. The radius bone breaks from the distal end higher, closer to the forearm. Bone fragments are usually displaced proximally upward from the palm, i.e. in the area of the thumb and closer to the back. Such a fracture is characterized by the appearance of a bump called a bayonet. Consolidation is quite fast due to good blood circulation in this area of the beam.
Smith's fracture is a flexion or reverse Colles fracture. It occurs much less frequently. The destructive force is directed to the back surface of the wrist. This is possible if in a crash a person landed on his back and fell on the back of his hand. With such an injury, the wrist becomes like a fork, the fragments of the beam are shifted towards the palm. Often such a fracture is open, with heavy bleeding.
Among the carpal bones, the scaphoid is the most likely to break, followed by the lunate. But any of the eight others can also break.
Such injuries can be divided along the fracture line, the presence of mixing or depending on the location. Displacement of the wrist bones (their fragments) during a fracture always causes deformity of the carpalareas. Unfortunately, sometimes the hand remains mutated forever.
In the navicular bone, the fracture line can pass in the proximal, middle and distal parts. Quite often there is a combined, or combined fracture of the wrist bones, in which the joint and the bones of the wrist themselves suffer. This happens when a person, falling, tucks his arm under him or an external force acts on his hand. For example, in a fight.
Depending on the strength of the action, fractures can be transverse and comminuted. The transverse has even chips.
Common symptoms of wrist fractures
If, as a result of a fall, a person landed on his hand, and he immediately experienced a sharp pain in the wrist, limited mobility, swelling, hematoma or bruise, wrist deformity, crepitus or crunch, numbness of the fingers, this indicates a fracture. In this case, you should immediately consult a doctor.
After a fracture of the wrist bones of the hand, the symptoms are usually always bright, the clinic develops rapidly and immediately. Manifestations occur almost simultaneously, but the first of them is pain. It can radiate to the hand and forearm. Always aggravated when trying to clench the hand into a fist or unbend. The pain axis runs along the navicular bone, i.e. on the axis of the thumb and forefinger.
Hematomas and bruises occur when capillaries break and fluid escapes into the interstitial space. This is the mechanism of edema. With massive injuries, bleeding or hematomas of the extensivecharacter.
All this leads to a forced position of the hand to reduce pain. The man holds her still. In open fractures, the wound almost always has lacerations that can become infected.
On the x-ray, the fracture line is always clearly visible. However, pain can equally indicate not only a fracture of the bones of the wrist joint, but also a dislocation, arthrosis, inflammation, osteoporosis. The difference is that the affected arm retains full or partial mobility. Each bone at a fracture has its own signs.
Symptoms of individual bone fractures
So, the nature of pain and symptoms depend on which joint bone is broken:
- For the scaphoid pain is characteristic in the radial fossa, at the base of the thumb. If you lift it up, pain occurs with percussion of 1 and 2 fingers. It hurts to unbend the hand, as well as to clench it into a fist. There is swelling and bruising at the site of injury. In the presence of displacement, the joint is deformed, fragments can crepitate and be pathologically mobile. Active and passive voluntary movements of the hand are limited.
- Fracture of the lunate bone is manifested by pain at the fracture site and in the region of 3 and 4 fingers; swelling and bruising appear. Wrist extension causes severe pain.
- Symptoms of a fracture of other radiocarpal bones - pain in the wrist and swelling on palpation of the injury site, pain when the finger is loaded, the axis of which passes through the damaged bone.
Diagnosis
Since the symptoms in the case of bruises, sprains and dislocations are largely similar, x-rays are taken in two projections for reliable diagnosis. This will help to make an accurate diagnosis.
Complications of injury
Complications can be caused by an incorrect plaster splint or fixation, as well as a late visit to a doctor when a person considered his fracture a simple bruise.
With a false joint of the navicular bone, there is a violation of the functionality of the wrist and its increased mobility. This is especially common in the elderly.
When treated late, a fracture of the arm with a displaced wrist may heal incorrectly, with damage to the neurovascular bundle. Then the pain syndrome becomes chronic, the functions of the hand are disturbed, and it is deformed. It is also possible delayed union and nonunion fracture of the bones of the wrist.
Treatment process
The process of treating a wrist fracture is divided into several stages:
- first aid;
- doctor's examination;
- drug relief of pain syndrome;
- main treatment;
- rehab.
When the fracture is not complex and there is no displacement, immobilization with plaster will suffice.
When fragments are displaced, their correct anatomical location should be restored, i.e., set - this is the initial procedure.
Otherwise arthrosis will develop. Due to the pain of the procedure, it is performed with local anesthesia with novocaine solution. Fixation of the bone is achieved due to the applied plaster.
With an open fracture, the patient is put on the Ilizarov compression-distraction apparatus, i.e., this is immobilization of the bone from the outside. With a normal fusion process, after two weeks it is removed and replaced with a plaster splint.
Condition control is carried out by x-ray. For the treatment of a fracture of the radius of the wrist joint, conservative treatment is used. If the radial fracture is without displacement, then a plaster back splint is applied from the upper third of the forearm to the base of the fingers for 2-3 weeks. The brush is slightly bent.
After this period, therapeutic exercises are prescribed, the emphasis of which is on the fingers. At this time, it is possible to use UHF on the fracture area. Active development of the joint begins after the removal of the cast. Exercise therapy, massage, physiotherapy are prescribed.
If the bone is damaged without fragments, plaster is applied for a period of 4 to 6 weeks.
In comminuted injuries, percutaneous transarticular fixation is used for up to 6 weeks to immobilize debris and avoid dislocation. The control X-ray is carried out in a week. The doctor examines the patient daily and without fail.
In case of a fracture with a displacement, in which the fragments were repositioned, control shots are taken every 10 days for a month. Control allows you to make sure that the bones are immobile after fixation. In the first days after the fracture, it is necessary to pay attention to the fingers, the possibility of their movements. Excessive compression of the plaster cast can lead to edema and neuritis of the peripheral nerves. In such cases, the surgeon can cut the soft bandage, and slightly bend the edges of the splint.
Active finger movements should be done from the second day of applying the splint. And after removing the swelling and pain, you need to carry out movements with the wrist joint - pronation and supination.
From drug treatment prescribed:
- calcium preparations in combination with vitamin D, "Osteogenon", "Ostemax", mummy, multivitamin complexes with minerals;
- reparative drugs;
- analgesics in the early days to eliminate pain.
Infection requires antibiotic therapy. During the healing period, diet, herbal medicine become important.
Colles fracture fixation
In case of an extensor fracture, the doctor must perform traction (stretching) along the axis of the forearm by the hand and at the same time reverse traction in the opposite direction behind the shoulder. After stretching is completed, a dorsal plaster splint is applied, and the hand is placed with the palmar surface down.
Smith fracture fixation
With a flexion fracture, the reposition is similar, but the distal fragment is moved to the back of the hand. Fixation of the fracture is also carried out with a palmar back bandage, the hand is placed palm up.
Surgery
The operation is performed in cases where the displaced fragments are in critical condition, they do not holdafter repositioning to the correct position.
In this case, the trauma surgeon is bonding together with knitting needles, screws or titanium plates.
Reduction surgeons produce open and closed methods, depending on the type of fracture itself. Closed surgery takes less time and is non-traumatic. It is performed without skin incisions. The disadvantage of the method is in the protruding ends of the spokes through which the wound can become infected. This also delays the rehabilitation process for such fractures.
Open reposition of the hand is performed with a classic incision and elimination of displacement using the above staples. The development of the joint occurs in such cases ahead of schedule, and wearing a cast is not necessary.
Rehabilitation period
This period is final and important, the further work of the brush depends on it. It includes:
- exercise therapy (physiotherapy exercises);
- massage and development of the joint with active and passive movements.
The development program is selected individually by a rehabilitation doctor and is carried out under his supervision. According to the nature of the fracture, he develops individual exercises that will help to fully restore the functionality of the hand.
In conclusion, we can say that wrist injuries are not life-threatening, but bring a lot of unpleasant moments in their treatment and rehabilitation. To avoid dangerous consequences, it is important to follow all the doctor's instructions.
