Fractures in people happen quite often. Limbs are usually injured. Such fractures do not pose a threat to life. In most cases, their treatment and subsequent recovery period are successful.
One of the most common types of injury is a fracture of the navicular bone. The ICD of the 10th revision assigned the code S62.0 to this damage. Its peculiarity is that such a fracture is very difficult to identify. Inexperienced doctors often take damage for a banal bruise, so the treatment is prescribed incorrectly. In today's article, we will tell you what symptoms accompany a fracture of the navicular bone. Also, the main methods of its treatment will be presented to your attention.
Anatomical reference
The navicular bone is considered one of the most traumatic elements of the wrist. It is located on the side of the thumb. The boat-shaped formation owes its name to the shape resembling a boat. The wrist is represented by eight small bones that form two rows. Each of them contains four elements. The navicular bone can be palpated independently in the "anatomical snuffbox" area. This point is located between the tendons of the thumb and the abductor muscle.
The anatomy of the joints and bones of the wrist is one of the most complex in the entire body. These structures allow for various movements in several planes. On the other hand, ligaments provide strength to the joints. The navicular bone is responsible for the coordination of movements and the location of other nearby structures. Therefore, when it is broken, the work of the entire wrist is disrupted.
Causes and mechanism of damage development
Fracture of the navicular bone most often occurs due to a fall on the arm. In this case, overextension occurs in the area of the wrist joint. Therefore, the main part of the load falls on the navicular bone. In rare cases, traumatic injury is the result of a direct impact on this structure.
The vast majority of victims are diagnosed with a closed fracture of the navicular bone. The presence of breaks in the skin may be due to the characteristics of the injury. For example, when falling onto a rocky surface.
Injuries to the scaphoid appear in several ways. Among them, the following are the main ones:
- Transverse split, which entails the formation of two fragments of the same size.
- Tear off the bone along the edge.
- Fracture, accompanied by the formation of a large number of fragments and displacement of the bone. Otherwise, it is called multi-splintered.
If we talk about the main causes of such injuries, most often they occur whenplaying sports or as a result of a car accident.
Clinical picture
A scaphoid fracture is difficult to diagnose. This is due to the weak clinical picture. Therefore, it is so important to seek medical help immediately after an injury and undergo a comprehensive examination. This will help avoid complications in the future.
The main manifestations of a scaphoid fracture include:
- Appearance of puffiness on the affected area. Over time, it may spread to larger areas.
- The presence of pain on the back of the wrist. Discomfort usually increases with joint extension or pressure on the affected area.
- Violation of the full functioning of the hand.
- Presence of bruises and hematomas due to ruptured vessels.
Symptoms that characterize a fracture of the navicular bone of the hand are diverse. With the right diagnosis and proper physical examination, it is not difficult to suspect a problem.
First Aid
After an injury, the victim needs urgent first aid. First, you should try to immobilize your hand. Extension or reflex muscle tension will provoke displacement of bone fragments. They, in turn, can additionally injure soft tissues. It is necessary to hang your hand in a free position on a scarf or piece of cloth. It is not recommended to fix the brush on your own with a splint and bandages. Any treatment options without consulting a doctor are categorically contraindicated. Otherwise, you can only harm the victim, provoke the development of quite serious complications.
What can be done to relieve pain?
- Apply an ice pack to the affected area. Keep the cooling bandage for no more than 15 minutes to avoid frostbite. As a compress, you can use ice cubes, a bottle of cold water, or a piece of frozen meat. Between it and the surface of the skin you need to lay a fabric. Do not allow non-sterile condensate to get on an open wound.
- Take a non-narcotic pain reliever pill. In this case, you must follow the attached instructions and avoid overdosing. Otherwise, the medicine may cause poisoning.
Transportation of the victim, as a rule, is carried out on their own. If necessary, you can call a team of medical workers. In no case should a person who suspects a fracture of the navicular bone be allowed to independently move by car. Severe pain syndrome causes a decrease in concentration.
Diagnostic features
If one or more of the symptoms of trauma appear, which were described just above, you should immediately seek qualified help. It is better to consult with a traumatologist or surgeon.
The first step in the diagnosis is to take an anamnesis. The patient should describe what precededdamage to the navicular bone. It can be a fall, intense sports or a domestic fight. Also, the doctor needs to know about previous diseases of the musculoskeletal system, injuries of the wrist joint.
After that, the specialist usually proceeds to a physical examination. With a fracture, swelling is found in the affected area, pain discomfort after palpation. Sometimes the patient is asked to flex the wrist joint, while paying attention to the peculiarities of movement in this area.
If the doctor suspected a fracture of the navicular bone of the hand, the patient is sent for x-rays. The procedure must be carried out in three projections. The absence of obvious pathologies in the picture does not mean at all that they do not exist in reality. In this case, the patient is put in a cast, which cannot be removed for two weeks.
After this period, a second x-ray is taken. In 14 days, the bone will have time to go through the process of rarefaction, and the gap between the fragments will noticeably increase. Such a fracture can be seen on an x-ray. Based on the results of the diagnostics, the doctor will already be able to make an accurate diagnosis and give recommendations for treatment.
Conservative therapies
Treatment of a scaphoid fracture depends on the severity of the injury and the level of activity of the victim. Not the last role in this matter is played by the desire of the patient to recover as soon as possible.
In case of a fracture without displacement, conservative methods of influence are used. For treatment on the wrist jointand the first finger is put in plaster. The bandage is worn for about two months until the fracture is completely healed. Sometimes patients insist on surgical intervention in order to reduce the period of immobilization and restore the efficiency of the hand faster. This method of treatment is still controversial among surgeons.
Fracture of the lower third of the navicular bone grows together in 4-6 weeks. This part of the hand has a good blood supply, so there are practically no problems with recovery.
Fracture in the middle third or proximal pole requires longer treatment. These areas of the scaphoid have a poor blood supply. The fusion time largely depends on the age of the patient, metabolism. Periodically, you need to visit a doctor for an examination. In severe cases, milestone x-rays and CT scans may be required to assess progress in recovery.
Regardless of the specific area of injury, plaster is applied to all patients with a fracture of the navicular bone. While wearing a bandage, doctors recommend:
- limit wrist mobility;
- give up from sports;
- keep a balanced diet;
- follow the regime of work and rest.
If the above recommendations are followed, the recovery process will go much faster.
Surgery
Surgical treatment is recommended for patients with marked displacement of fragments or a high risk of aseptic necrosis. Its main goal is to stabilize the affected limb. This approach contributes to the speedy restoration of blood supply in the affected area, the healing of the fracture.
Surgery is usually performed on an outpatient basis using regional or local anesthesia. During the operation, the doctor eliminates the displacement of bone fragments, fixes them with a screw (implant). To evaluate the result, use a radiograph.
The incision is made on the back or palmar side of the wrist. Its size and specific localization depend on which part of the navicular bone has been traumatized. Displacement is eliminated quite easily. A fresh fracture of the navicular carpus is usually fixed with a screw through an incision of about 3-5 mm.
If the damage has grown together incorrectly, a more serious approach is required. The surgeon first makes a large incision to allow for an osteotomy. After that, he proceeds to recreate the correct anatomy, and then fixes the bone with screws.
When multiple lesions are present, a special graft is used during the operation. It is a synthetic version of bone tissue. It is placed around the lesion. The graft is used to stimulate the healing process of tissues.
Recovery period
When diagnosed with a fracture of the navicular bone of the hand, the terms of treatment largely depend on well-organized rehabilitation. Recovery procedures begin with a course of exercise therapy. All exercisesselected by a specialist. Their main goal is to eliminate stiffness and contracture. The rehabilitation period can be divided into 3 conditional stages.
At the initial stage, exercise therapy pursues the following tasks:
- muscle relaxation in the affected area;
- eliminate pain;
- elimination of hemorrhage;
- normalization of the circulation of lymphatic fluid;
- restoration of metabolic processes.
The listed goals allow you to choose the most effective exercises. As a rule, flexion and extension of the fingers, circular and pendulum movements with the brush are used. This recovery phase lasts about 14 days.
From the third week, the exercises are somewhat modified. Now exercise therapy is aimed at restoring the functions of the limb and the range of motion of the joint. For this purpose, various complexes with a gymnastic ball and on the machine are recommended.
At the third stage, the tasks of exercise therapy are reduced to increasing the tone of the whole organism, improving the mood of the victim. Complicated exercises are allowed for patients: push-ups, pull-ups, etc.
After a fracture of the navicular bone and removal of the plaster cast, physiotherapy (UHF, massage, paraffin applications) is mandatory. Properly selected rehabilitation methods allow you to fully restore the mobility and performance of the damaged limb.
Possible consequences
Proper diagnosis of injury is very important because it helps to prevent the development of negativeconsequences. In addition, a fracture of the navicular bone should not be left without therapy. Treatment carried out untimely, threatens the appearance of complications. Among them, the following are considered the most dangerous:
- Arthrosis of the wrist joint. This pathology is accompanied by excruciating pain and limited mobility in the limb. In especially serious cases, it leads to disability.
- Incorrect bone fusion. In rare cases, damaged fragments grow together at a slight angle. The patient experiences severe pain discomfort. A similar problem can only be solved with a new operation. During the surgical intervention, repeated bone fracture is performed, the alignment of all elements. After that, bone transplantation begins.
- Necrosis. Against the background of poor blood supply, bone tissue begins to gradually die off. As a result, an inflammatory process develops, and in advanced situations, gangrene may occur. To eliminate this pathology, a complete amputation of the hand is often required. The aseptic form of necrosis develops gradually. In the initial stages, it cannot be seen even on a radiograph. 2-3 months after the injury, pronounced symptoms of the disorder appear. Very often, it is no longer possible to save bone tissue.
Summarize
According to statistical information, a fracture of the navicular bone of the hand quite often goes unnoticed. Therefore, this pathology is characterized by the appearance of various complications. Timely diagnosis and competent therapy are the key to successfulconvalescence. At the same time, with the help of a properly performed rehabilitation, it is possible to fully restore the functionality of the limb.
Doctors warn that a fracture of the scaphoid (ICD 10 - S62.0) is a very serious disease. It should not be ignored or ignored. Injury to one small bone often results in dysfunction of the entire wrist.
