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Osteosynthesis of the radius in a typical place with a plate. Technique of plate osteosynthesis surgery for distal radius fracture

Among all arm fractures, the radius fracture is the most common. This is due to the anatomical features of the hand and the characteristic manner in which people fall. When we land unexpectedly, we instinctively extend our arms forward to protect our body from the impact of the fall. If a person is overweight or has a weak skeleton, then the load on the arm in the area of the radius exceeds the maximum permissible and it breaks.

A fracture of the radius according to ICD-10 refers to fractures of the forearm and has code S52.

When the distal part of the radius is fractured, in some victims the fragment splits into several parts and the fracture line is displaced into the joint.

At-risk groups

Women over 40 years of age with symptoms of osteoporosis (leaching of calcium from the skeleton, resulting in bone fragility);
Women and men with large body weight;
Children and teenagers who are fond of extreme sports with a lot of falls (skateboarding, snowboarding);
Women and men of any age with poor body coordination (clumsy, clumsy).

According to statistics, most injuries to the radius occur in the winter season, when there is ice outside. Most often, a fall causes a fracture of the right radius.

Classification

The radius bone in the area of articulation with the carpal joint has the thinnest cortical layer. Almost always, it breaks only in this area, which is why such injuries began to be called “radial fracture in a typical location” (ICD-10 code - S52.5). Depending on how the arm was twisted during the fall, the injury is classified into two categories:

Smith's or flexion fracture (when the blow fell on the back of the hand);
Colles' or extensor fracture (when the blow falls on the open palm).

When falling onto an outstretched arm in a position of dorsiflexion of the bone, adults usually experience an impacted fracture of the radius without obvious displacement of bone fragments.

The general classification of bone fractures also applies to this type of injury, so damage to the radius can be: open (when the skin and soft tissues are ruptured) or closed (when the integrity of the integument is not broken); with displacement of bones or their fragments or without displacement.

Symptoms

The clinical picture of such injuries does not present any particular difficulties in diagnosis. Usually the fracture is accompanied by a bayonet-shaped deformity of the wrist. There is swelling in the distal arm, a hematoma is possible, but not necessary.

Of course - pain. Functional mobility of the hand does not disappear, but is greatly reduced due to pain. Movement in the wrist joint is usually limited.

The victim is practically unable to perform flexion and extension of the hand, adduction and abduction, as well as circular movements. If a displaced fracture of the radius occurs, then among other symptoms, crepitus (crunching) of the fragments upon palpation will be observed. When examining the injured hand, you will notice that it is pale and cold to the touch. If blood vessels and nerve endings are damaged as a result of the injury, the victim may experience numbness in the fingers.

Diagnostics

Anamnesis;
Complaints from the victim;
Objective examination data;
Additional research methods
- X-ray examination;
- Computed tomography;
- Nuclear resonance imaging.

First aid

First of all, any medical care involves stop bleeding. Minor bleeding from a fracture of the radius of the arm is prevented by applying a thick, clean cloth or bandage. If large arteries are damaged, you can stop the bleeding by applying a tourniquet to the arm above the elbow. In the absence of a tourniquet, any available means are used (leather belt, cord, nylon tights).

If a closed fracture of the radius with displacement occurs, then you can immediately begin to immobilize the injured arm. Using available objects (a ruler, a straight stick), you need to apply a fixing splint to your hand. The arm is bent at an angle of 90° and secured with a scarf that is worn around the neck. It is advisable to apply ice to the site of bone damage. If the medicine cabinet contains painkillers (spray, ointment, tablets), then the patient can take a dose for anesthesia.

When immobilizing an injured upper limb, the physician should pay attention to changes in the color of the fingers. The patient is hospitalized on a stretcher by an ambulance to the trauma department of the hospital.

Treatment for a fracture of the radius

The nature of the injury determines the treatment strategy for the fracture. To put it simply, mild closed fractures without displacement are subject to conservative treatment: bandage - plaster - go home. A comminuted fracture of the radius with displacement, damage to the wrist joint or a combined fracture with the ulna - all this is a direct indication for surgical intervention.

After the final diagnosis is made using radiography, the trauma surgeon begins to collect the bone in parts. Comparison of fragments can occur both under local anesthesia and general anesthesia. Reduction can be open (with an open fracture) or closed (blind). In case of a Colles fracture, the victim’s hand is placed with the palmar surface down. If a patient is diagnosed with a Smith fracture, then the palmar surface is located upward.

Immediately after the bone is assembled, a control x-ray is taken to check the complete alignment of the bone tissue fragments. Then, for one month, a circular plaster cast is applied from the beginning of the heads of the metacarpal bones to the upper third of the forearm.

When diagnosed with a “displaced fracture of the radius,” the operation is performed with several goals at once: it is necessary to compare the bone fragments in one step and fix them for healing.

The fixation of bone tissue consists of a complex of different methods, united by one common name - osteosynthesis.

Osteosynthesis

The type of fixator is selected depending on the complexity and nature of the fracture.

Methods of osteosynthesis for a fracture of the radius in a typical location:

Overbone osteosynthesis using a plate with angular stability;
Transosseous osteosynthesis using an Ilizarov apparatus or a rod apparatus.

Kirschner spokes. The essence of the method is that fixation occurs by fastening with several knitting needles inside the bone. The advantages are simplicity, low invasiveness, and quick installation. Disadvantages include the need to wear a plaster cast and frequent cases of secondary displacement of bone fragments. In addition, this method is indicated only under certain conditions and in many cases is not suitable for the patient.

Osteosynthesis with metal plates (when the fixator is attached directly to the bone using screws). This technique allows for good anatomical reduction of bones, especially when using fixators. On the other hand, there are certain disadvantages: frequent errors in screw installation, high trauma to bones and tendons, and complications such as compression of the nerve of the arm.

Treatment of a displaced radius fracture is possible with the help of a external fixation devices . A highly effective technique in the treatment of multiple comminuted fractures. In this case, the microcirculation of the injured area is not disrupted, and the soft tissue remains intact. Difficulties arise during the installation of the device; often the fragments are re-displaced after the fixator is removed. The most unpleasant complication is the possibility of core osteomyelitis.

Rehabilitation

If the arm bones heal successfully, after 3–4 weeks all fixing devices are removed. The period of restoration of hand functions begins.

The complex of rehabilitation measures for a fracture of the radius bone in the arm includes:

Therapeutic gymnastics;
Massage;
Physiotherapy;
Good nutrition;
Water procedures;
Wearing an orthosis;
Sanatorium-resort treatment.

The healing period for a fracture of the radius bone of the arm is at least one month (the period of callus formation).

Physiotherapeutic treatment

Paraffin therapy;
Magnetotherapy;
Ultraviolet irradiation;
Calcium and phosphorus electrophoresis on the fracture area;
Electric field UHF;
Mud therapy.

If the doctor prescribed 15 sessions of physiotherapy, then you need to visit everything and on time. This will be the key to final recovery without any complications.

All therapeutic gymnastics exercises are performed slowly and simultaneously with both hands, with a small amplitude, until a sensation of “moderate pain” is felt. It is very good to combine physical exercises with thermal treatments and massage during the rehabilitation period. Billiards restores the functioning of the wrist joint very well.

If the patient has laboratory proven osteoporosis, tablet forms of calcium supplements and multivitamins (Kalcemin, Miacalcic, Calcium-D3-Nycomed, Vitrum) are prescribed.

Orthosis with a pneumatic fixation system for distal radius fractures

Advantages:

The orthosis has built-in air cushions that evenly distribute pressure and provide reliable fixation;
The orthosis has a special manual balloon. It is equipped with a pressure sensor and serves to pump air;
The patient retains complete freedom of movement of the thumb due to the fact that the palmar part of the orthosis body is located at an angle;
The product is very well treated with an antiseptic;
The orthosis is used for fractures of the distal metaepiphysis of the radius;
The orthopedic product has a durable and lightweight plastic case that transmits x-rays, so the patient does not need to remove the orthosis during additional examinations.

Titanium plates can have a wide variety of shapes, sizes and modifications.

Functions of titanium plates:

Restore the anatomical integrity of the bone;
Allow bones to perform their function in the shortest possible time.

In orthopedics and surgery, entire methods for using titanium plates have been developed.

Each section of the skeleton has its own options, as well as methods for their placement during surgery.

There are also a lot of special devices and tools that facilitate and optimize the process of installing and fastening titanium plates. The type of plate that is placed on the patient depends on the location of the fracture and what function it should perform.

Plate classification

Protective (or neutralizing);
Supporting (or supporting);
Compression;
Plates for tightening fractures.

The process of applying a plate to a bone is called metal osteosynthesis.

There are certain medical indications for osteosynthesis surgery:

As a result of the injury, significant displacement of bone fragments occurred;
X-ray examination revealed several bone fragments;
The victim does not have severe concomitant diseases that are a contraindication for surgical intervention;
Return of lost physiological functions of the injured limb;
The patient has no contraindications for giving anesthesia.

For bone fractures in elderly people and with signs of early osteoporosis, as a rule, titanium plates are not removed after the fracture has healed.

Self-resorbable osteosynthesis

If there are no indications for removing metal structures, they do not need to be removed.

Metal plates should be removed 8-12 months after osteosynthesis. Indications for the operation to remove the structure are as follows:

purulent process in the area of the plate;
unsatisfactory fixation;
patient intolerance to the metal from which it is made;
damage to ligaments and muscles by the structure during movement of the limb;
inability to fully carry out movements in the joint;
breakage of a screw or plate;
formation of osteophytes in the area of damage;
likelihood of re-fracture;
the need for the absence of foreign bodies due to the type of activity;
psychological intolerance to the presence of the plate in the body;
location of the structure on the tibia of the leg;
discomfort while wearing shoes.

As a rule, the metal structure is easily separated from the bone. But due to the presence of stitches, when the operation to remove the osteosynthesis plate is performed, the patient needs to stay in the hospital for about 2 weeks until the postoperative scar gets stronger.

At the same time, pain is weakly expressed during this period. After removing the plate, plaster immobilization of a previously injured area on the leg or arm is not required, as are specific rehabilitation techniques.

But you will still need to stop putting loads on the injured bone for a while.

The use of specific biosoluble materials minimizes side effects from the use of plates.

The most acceptable and harmless method of osteosynthesis is to carry it out using special materials that, over time, can completely dissolve and be removed from the human body.

Most often, this technique is used for fractures of the tibia of the leg. The main advantage of such an operation is the elimination of repeated intervention, which reduces the degree of trauma to soft tissues, avoids temporary disability and the need for dressings.

Gymnastics

Conscientious implementation of exercises in the interests of the patient himself

Before starting therapeutic exercises (physical therapy), a person must independently learn to bend and straighten his arm. Simple exercises will help normalize blood flow and nutrition to the joint, accustom the muscles to work and prepare them for more complex movements and loads.

Exercises done in water, preferably warm, have a good effect. A set of exercises is developed by a specialist for each specific case and patient. At first, constant control over the implementation is necessary, after which the person can do everything independently.

There are many sets of exercises, but before giving preference to one or another, you need the advice of your doctor or rehabilitation specialist. The proposed complex can also be used, but only after consultation.

In the first stages of rehabilitation, assistance with a healthy hand is allowed

You can start with flexion-extension movements. The sore arm is placed on the table, and the healthy one raises and lowers the hand; you can also make movements to the sides. The repetition rate can be up to 10 times, after which you can begin to stretch your fingers.

The hand also remains on the table, only now you need to move your fingers together and spread them apart. The fingers slide along the surface of the table, and the multiplicity of execution ranges from 6 to 12 times. The hand is placed palm up and in this position the fingers are clenched into a fist, and then unclenched. The multiplicity of execution ranges from 5 to 10 times.

Small objects, balls, cylinders, jars - all this can help during rehabilitation

You can use your fingers to finger small objects or perform crawling movements on the surface of the table. Crawling movements can be done not only on the surface of the table, but also while lying on the surface of a wall or bed, at any convenient time.

Afterwards, you can make movements that resemble the salting process. Everything resembles an attempt to add salt to a dish while preparing it.

The repetition rate is up to 10 times.

Afterwards, the hand is turned palm down again and imitates playing a string instrument or piano. For greater pleasure, you can do this exercise with music, but this is strictly at the request of the person.

Exercises can take about half an hour, it is better to repeat them several times a day

There is an exercise for which you will need a cylinder with a diameter of approximately 4 cm. Such a cylinder can replace a jar of glue. It is clasped with all fingers, each finger is straightened in turn, after which it is returned to its original position.

The duration of the gymnastics is approximately 25 minutes; you can perform from two to three cycles of therapeutic exercises per day. Over time, it is necessary to increase the amplitude of movements; do this every two days.

If you perform exercises regularly and correctly and strictly follow the recommendations, the rehabilitation period is reduced and recovery is much faster.

Physiotherapeutic procedures

This is an important stage in the rehabilitation process and is aimed at eliminating muscle spasm, resolving hematoma and edema.

When the radius is fractured, the function of the forearm is significantly impaired, so such an injury is considered a relatively severe injury.

A fracture of the radius is not in all cases eliminated by immediate reduction. Then the patients are transferred to the hospital for surgical treatment.

The cause of a fracture of the radius in a typical location in 90% of cases is a fall on an outstretched arm. In this case, most often the styloid process of the ulna, scaphoid, and lunate bones are simultaneously affected, and ruptures of the radiocarpal and radioulnar ligaments occur.

To restore full function of the forearm, it is first necessary to reconstruct the distal radioulnar articular surfaces.

Symptoms of a fracture

Symptoms of a radius fracture in a typical location:

pain,
edema,
bayonet-shaped deformity of the forearm.

An x-ray of the wrist joint is required in two projections. The severity of the fracture is characterized by the degree of displacement of fragments, the number of fragments and associated acquired injuries.

Fracture of the radius and treatment is anatomical reposition and stable fixation of fragments, in order to restore painless and precise movements of the hand and fingers.

Usually, when there is no displacement of fragments for a month, a plaster splint is made, and the ability to work returns after a month and a half.

Treatment of a radius fracture

If displacement of the fragments is determined, anesthetic measures are carried out and manual reposition is performed, and immobilization is carried out using a plaster cast. Mandatory radiography helps ensure the correct position of the fragments after correction.

Analysis of the clinical picture and radiographs allows us to determine the final treatment plan. The duration of immobilization ranges from a month to one and a half.

During this period, usually every week, a control X-ray examination is required.

Recovery after a fracture

Upon completion of immobilization, health-improving exercises and recovery after a fracture of the radius are prescribed, including movements in warm water, as well as massage.

Moreover, the most painless transition from immobility to constantly increasing load is provided by physical exercise in warm water.

Movements in water are carried out in a large basin, into which both the hand and forearm should easily fit. The temperature should not exceed 350C.

The hand is immersed in water up to the middle of the shoulder, the hand should lie on the bottom with its edge. Bend and extend the hand up to six times. Touch the bottom with your palms, turning them up and down.

The elbow rests the sore arm on the bottom of the pelvis. Use your healthy hand to clasp the affected joint. With the help of such support, circular movements are carried out.

Among the therapeutic exercises there are exercises at the table. Placing the painful hand on a flat soft pad, abduct and adduct, bend and straighten the hand and make turns with the palm.

It is very useful to do handicrafts during the recovery period. Winding threads onto a ball, knitting and crocheting, sewing and embroidering, gluing envelopes, drawing and drawing.

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.

Skull bones

Damage to the bones of the brain part of the skull most often occurs when a direct force is applied to the bone, usually a blow to the head with a heavy object. In this case, the victim is diagnosed with open, comminuted or depressed fractures.

During the operation, it is necessary to remove fragments of the skull bones from the victim, otherwise this can lead to injury to the membranes and substance of the brain and the development of severe neurological symptoms and disruption of the vital functions of the body, including death.

When the bones of the skull are damaged, titanium plates close the bone defects and protect the patient’s brain. When titanium plates are placed, they are not removed; they remain for the rest of your life. Usually such people with titanium plates can be seen on the street with small scars on the scalp.

When the bones of the facial skull are damaged, surgeons do not install titanium plates. In this case, a special cerclage wire is used.

How is it carried out?

Lower limbs and pelvic bones

For fractures of the bones of the upper extremities, titanium plates of various shapes and sizes are widely used.

If the palmar part of the hand is damaged, plates are not placed on its outer surface. This part of the arm contains many nerve endings, ligaments and muscles that can be easily damaged by the plate. Usually in these cases the dorsum of the hand is used; here the bones are close to the skin, there are fewer nerves and blood vessels.

There are special fixators for bone damage in the area of the elbow or wrist joints. The traumatologist fastens the bones together using titanium plates, and attaches the damaged ligaments to the bone formations using anchors.

The titanium plate, which is located on the bones of the upper limb, can remain in place for about 1 year, and then it is removed during a second operation. Before removing the plate, the doctor must make sure that callus has formed and the bone no longer needs fixing elements.

Titanium inert plates are used for fractures of the femur and knee joint. The plate is inserted into the leg by the surgeon during surgery.

The main indications for the application of titanium plates for fractures of the lower extremities are:

Incorrectly healed fracture;
Long-term non-healing bone injuries.

Bonding of bones to each other occurs only after removal of fragments or damaged areas of bone and soft tissue. For complex hip fractures and long-term non-healing fractures, an external fixation device (Ilizarov) is used.

If the body of the femur is damaged, a special pin is inserted into the canal of the patient’s bone, which is fixed with screws. The pin is inserted into the bone from the middle of the tibia, knee or hip joint.

The location of the pin insertion depends on the location of the fracture. During the operation, traumatologists use a special device called a navigator for proper insertion and fixation.

For fractures of the lower leg bones, direct fixators are used, which are often made of titanium. The choice of the type of fixator depends on the location and nature of the bone damage, whether it is the area near the knee joint or the middle of the tibia.

If improper fusion of the leg bones occurs, then in this case, the Elizarov apparatus or titanium inert plates are used for external fixation.

If the victim has a fracture of the metatarsal bones as a result of the injury, then small titanium plates are used to fix the fragments. Such small plates can be placed during orthopedic operations for curvature of the big toe.

Removing titanium plates

Some patients are interested in the question: “Why remove the titanium plate?”

If there are no contraindications for repeated surgery and a good callus has formed, then it is best to remove the titanium plate, because it is a foreign body for the human body and can be rejected over time.

In some patients, bone growths - cysts - form in place of the plate around the screws. The issue of when to remove titanium plates should be decided by the traumatologist individually with each patient.

Fracture of the radial bone of the arm - symptoms, treatment for a fracture of the neck and head of the radial bone

At what age do people most often break bones? This is not typical for children, although, of course, it happens. Their bones are still elastic and flexible, and therefore suffer less. But old people are always at risk.

As we age, not only does our appearance change, but our bones also wear out, and calcium loss increases in old age. Our skeleton becomes fragile, and if you just fall lightly and lean on your outstretched arm, the radius bone will immediately crack.

But we put it forward mechanically, as if trying to protect ourselves from harm. But, alas, it turns out the other way around.

The upper extremities are often injured, and among this mass of injuries, more than a quarter are fractures of the radius.

Moreover, most often it breaks in a typical place, mainly in elderly women. This bone itself is quite thin, and its distal end has the thinnest cortical layer. There are two types of this type of fracture: extension (Wheel fracture) and flexion (Smith’s fracture).

What other types of radius fractures are there?

Like any other, fractures of this bone can be open or closed. They can also be with or without displacement of bone fragments.

When falling with emphasis on the outstretched hand, the head and neck of the radius usually break. These fractures can be simple or with displacement of the fragments, with fragmentation of the head (comminuted) or when the fragments are displaced inside the head.

Symptoms of a radius fracture

This type of fracture is manifested by the following symptoms:

sharp pain at the fracture site;
swelling;
hemorrhage under the skin (but may not exist);
bayonet-shaped joint deformity;
the hand hardly moves in the joint;
There may be noticeable bone distortions.

Fracture of the head and neck of the radius of the arm

Such an injury can be of three types: a fracture or crack without displacement, marginal fractures with displacement, and a comminuted fracture of the head of the radius. Rarely, an isolated neck fracture occurs.

The symptoms of such fractures are as follows: severe pain in the area of the head of the radial bone, the area is swollen, with a hematoma. Any movement in the elbow causes sharp pain, especially rotational movement (turning in a circular path) is impossible.

Comminuted fractures completely limit the movement of the arm in the joint. If the head is crushed with many fragments, then crepitus may be heard.

An x-ray taken in two projections helps confirm the diagnosis.

How is a radius fracture treated?

Providing first aid boils down to the fact that the victim’s hand must be secured by applying a splint (any available means). All actions must be very careful, since any manipulation causes suffering to the patient.

If the fracture is open, then the situation becomes more complicated. If there is bleeding, apply a tourniquet above the wound.

You can also pinch the bleeding vessel with your finger, but before doing this, be sure to wash your hands with alcohol. Only after the bleeding has stopped, apply an aseptic bandage to the wound and secure the victim’s hand.

After this, immediately send him to the hospital. Further treatment should be carried out only in a hospital.

When diagnosing, special attention is paid to rotational displacement, because it determines how to correctly straighten and fix the hand. To reduce pain, painkillers are administered (narcotics are not used, since the pain is not as severe as with other types of injuries).

After anesthesia, it is necessary to set the fracture and apply a plaster fixing the forearm from the elbow joint to the hand. For adults, the period of use of a plaster splint is up to a month; for children, this period is much shorter, because their bones heal faster (up to 15 days).

A day after the reduction, gymnastics for the fingers of the affected hand can be prescribed. To reduce swelling, magnetic therapy is performed, and UHF is prescribed to accelerate tissue regeneration.

Treatment for fractures of the head and neck of the radius

For a normal fracture, after local anesthesia, the arm is fixed at a right angle in the elbow joint. To do this, a posterior plaster splint is applied in the forearm position midway between flexion and extension.

After two weeks, the splint is removed, and the development of the elbow joint is prescribed - dosed flexion, extension and rotational movements. The patient can return to work in five to six weeks.

If a fracture occurs with a displaced fragment of the head, it must be set. To do this, the arm is extended at the elbow and placed in the desired position.

By influencing the fragment, the head is set in its place. If the reduction could not be done at once, resort to surgical intervention.

During the operation, open reduction of the head is performed. If it is fragmented, then it is simply removed.

Children do not undergo such a resection, since the bone is still growing. Young people undergo endoprosthetics at the same time.

After the operation, the forearm is again fixed for up to ten days, and after prosthetics - for a month. After removing the plaster cast, the elbow joint is vigorously developed in combination with thermal procedures.

An isolated fracture of the radial neck can rarely be reduced simultaneously using closed reduction. Therefore, an operation is performed in which the head of the bone is fixed with a bone pin.

Restoring the radius after a fracture: rehabilitation

During prolonged wearing of a plaster cast, the muscles atrophy and blood circulation is impaired. That is why it is necessary to develop the arm after a fracture of the radius by flexing and extending the elbow joint. Each patient should be prepared for the fact that after the cast is removed, the arm will still hurt for a long time, despite the fact that tissue regeneration has completed.

Therefore, a massage is prescribed using pain-relieving ointments and gels.

A course of physiotherapy and exercise therapy is also required.

Sometimes, to relieve muscle tension, exercises are done in warm water.

Particular attention should be paid to nutrition. During the rehabilitation period, bones need additional resources - calcium and collagen, and the immune system needs to be supported with vitamin complexes. There is no point in following a strict diet, but the diet should be rich in protein (fermented milk products, cottage cheese, poultry) and fiber (soft porridges), more vegetables and fruits.

How will the arm move after a fracture of the radius?

Many victims complain of prolonged pain and not quite full mobility of the arm. But if a person carefully follows all the doctor’s recommendations and works on developing joints after a fracture, then such troubles usually do not happen.

Regularly performing the exercises prescribed by a specialist will quickly restore hand mobility. Take care of yourself and be healthy.

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perelom.su

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.

Titanium plate price

The price of titanium plates for fractures depends on their quality and, most often, on the country of origin. Imported plates, as a rule, are of higher quality, are purchased for dollars and are more expensive than domestic plates.

Previously, osteosynthesis operations could only be performed in large cities such as Moscow and St. Petersburg. Nowadays, surgical treatment of fractures is carried out in every city. The average price of titanium plates varies from 20 to 50 thousand rubles.

If bone integrity is compromised, doctors prescribe osteosynthesis of the radius. The surgical method is used for pseudarthrosis and improperly healed fractures. Treatment is aimed at stable fixation of damaged areas, reducing the likelihood of bone displacement, as well as normalizing the functioning of the problem area.

Indications for use

The operation is used in cases where, as a result of fractures, the bones do not heal without the intervention of a traumatologist. More often this is a comminuted fracture of the radius with displacement, which disrupts the appearance of the wrist. The method is recommended if the closed type of injury turns into an open form. The need arises when bone integrity is violated, and soft tissues located between fragments or nerve endings damaged due to injury to the area occur.

The operation is prescribed when the patient has a short rehabilitation period. These may include professional athletes and military personnel, as well as individuals who have previously been diagnosed with a comminuted fracture. If this type of injury is insufficiently or poorly treated, the person subsequently suffers from pain.

The doctor prescribes surgical intervention when bone fragments re-diverge and their parts grow unevenly and slowly. And also when diagnosing pseudarthrosis.

Contraindications

The presence of an infectious disease is contraindicated for surgery.

Reduction of the radius is not recommended in cases of open injuries covering a large area that has direct access to infection. The operation is prohibited if the patient’s health indicators do not correspond to the norm, he has congenital diseases of the internal organs and skeletal system, and also when there is a spread of infection not only to the damaged area, but throughout the body.

Operating period

Preparation for osteosynthesis of the radius

The purpose of osteosynthesis is to firmly fix bone fragments until they heal. For the operation to be successful, the doctor must examine the patient. Diagnosis is made after a visual examination, CT scan and x-ray to understand the extent of the fracture and how injured the wrist is. If the patient has foci of inflammation due to the spread of infection, the intervention is postponed and, first of all, treatment is carried out against harmful microorganisms.

How is the operation performed?

Methods for connecting bone fragments.

Depending on the stage of the radial bone injury, the following types of osteosynthesis are prescribed:

interior;
outer.

The first method involves the use of implants, with the help of which the broken areas are fixed. This may be fastening with a plate, pins, screws, wire or knitting needles. The second method is characterized by connecting the fragments with distraction-compression external fixation devices. On average, surgery lasts about two hours, after which a rehabilitation period begins.

Osteosynthesis is a surgical method of aligning bones after a fracture so that they can heal properly. This technique is used in particularly difficult cases, using special clamps. After osteosynthesis, a full course of rehabilitation is required to restore lost functions, although movements in the joints are allowed within a week after the operation. Rehabilitation also allows you to quickly get rid of pain after osteosynthesis due to improved blood circulation and nutrition of the damaged area.

Over time, on average after 8-10 months, metal structures are removed from the body. During this time, the bones have time to heal and the joints resume functionality. Sutures after osteosynthesis and removal of structures are removed after about 2 weeks, after which almost all normal physical activity is allowed.

Indications for osteosynthesis

In most cases, bone fractures do not require osteosynthesis and conservative methods are sufficient for their treatment. But sometimes surgery is unavoidable.

Indications for osteosynthesis are:

intra-articular fractures;
fractures accompanied by displacement of fragments that cannot be compared using a closed method;
improper fusion as a result of conservative treatment;
formation of a false joint after a violation of the integrity of the bones;
long-term non-healing fractures;
skeletal deformations that impair quality of life.

Most often, surgery is required for fractures:

femoral neck;
radius;
collarbone;
elbow joint;
patella;
calcaneal joint;
ankle;
tibia and tibia;
feet.

Types of osteosynthesis

There is no uniform classification of surgical treatment of fractures. Depending on the nature of the installation of fixing parts, they are distinguished:

Depending on the type of fixation of bone fragments, the following are distinguished:

external osteosynthesis, which does not require complete exposure of the injury site;
The immersion method involves inserting a fixator directly into the fracture site.

Possible complications

Osteosynthesis usually allows for rapid healing of fractures and restoration of the functioning of the damaged bone. But still, complications occasionally arise. These could be:

It is very rare that a fracture occurs after osteosynthesis in the case of incomplete fusion of bone fragments and early removal of the fixators.

General characteristics of the rehabilitation period and its stages

A recovery program after surgery is developed for each patient individually. It includes several areas at once: physiotherapy, physical therapy, water procedures, social and labor adaptation, massage and other methods. In addition, the patient should maintain rest and a special balanced diet, give up bad habits and spend more time in the fresh air.

Rehabilitation periods:

early postoperative period - lasts approximately 2-3 weeks, begins immediately after surgery and continues until discharge from the hospital;
immediate postoperative period – the first 2-3 months after discharge from the hospital;
late postoperative period - from approximately the 3rd month after surgery to six months;
period of functional recovery – from the 6th month after surgery.

Postoperative rest period

Rehabilitation after osteosynthesis surgery begins with short rest, approximately 2-5 days. During this time, the patient often experiences pain, and the surgical site swells.

The patient is provided with semi-bed rest or bed rest. The injured limb is placed in a functionally advantageous elevated position. Vacuum drainage, which helps prevent the formation of hematomas and the development of complications, is removed 1-2 days after surgery.

During bed rest, patients are required to undergo breathing exercises to prevent pneumonia. It begins to be performed already on the first day after surgery.

Postoperative sutures are removed 8-10 days after osteosynthesis on the arms and 12-14 days on the legs.

Mobilization period

From about the 3rd day, after pain and swelling have decreased, provided the patient is feeling normal, physical activity gradually begins to increase. First, static exercises are performed, moving over time to full-fledged therapeutic exercises.

The choice of exercises for physical therapy is carried out by the attending physician. He also recommends loads and shows the correct execution of movements. The selection of exercises depends on the nature of the injury and location.

Exercises help improve lymph flow and blood flow, normalize the nutrition of bone tissue, which promotes rapid fusion of bone fragments, prevents the formation of contractures and the development of complications due to lack of movement. Therapeutic exercise allows you to speed up the restoration of the functions of the limbs and joints.

If the elbow joint is damaged and surgery is performed on it, the arm after osteosynthesis begins to be developed almost immediately. At first, the doctor performs arm rotation, extension, flexion and extension. As pain is eliminated and limb function is restored, the patient begins to perform exercises independently.

After osteosynthesis on the knee or hip joint, physical therapy is carried out on special simulators with a gradual increase in load. After osteosynthesis of the ankle, physical education is prescribed within a day after the operation, starting with static exercises.

An important condition for carrying out exercise therapy is the absence of severe pain during its implementation, as well as accurate dosing of permitted loads. For example, during osteosynthesis using tibial screws, any load is prohibited until a bone callus of sufficient strength is formed. Therefore, starting any exercises without a doctor’s prescription is prohibited.

Therapeutic massage

There is still debate about the benefits of massage after osteosynthesis. On the one hand, it allows you to speed up the restoration of joint mobility and prevent muscle atrophy, and on the other hand, it increases the risk of developing complications such as the formation and separation of a blood clot.

Therefore, before prescribing a course of massage, the doctor must refer the patient to a phlebologist for duplex scanning of the veins. If there is a suspicion of thrombosis, massages are prohibited.

Physiotherapy

Physiotherapeutic methods are an important component of rehabilitation. They help fight swelling, reduce pain and eliminate other postoperative symptoms. In addition, physiotherapy accelerates wound healing and bone healing, resolves bruises, prevents the development of muscle atrophy and the formation of contractures. Treatment procedures are prescribed 2-3 days after surgery. It is possible to carry out UHF therapy, ultrasound, electrophoresis, UV irradiation, inductothermy, diathermy, mud therapy, paraffin baths, magnetic therapy, and electromyostimulation.

Pool exercises

About a month after surgery, the patient is recommended to start visiting the pool. Doing exercises in water allows you to improve blood flow in the extremities, accelerate recovery processes in tissues, restore the functionality of joints and prevent muscle atrophy.

Pool sessions last from 20 to 30 minutes. The water temperature should be within 32 degrees Celsius. If rehabilitation is carried out after a fracture of the bones or joints of the hands, then the exercises are performed while in water up to the neck. If there was damage to the legs, the exercises are performed while lying on your back or stomach and holding the handrail.

Social and household rehabilitation

After restoring the functionality of the damaged bones, the patient must undergo social rehabilitation. It is designed to teach the patient to independently care for himself in everyday life. This type of rehabilitation is particularly difficult for seriously ill patients. Their return to normal life takes a long time and requires the use of special devices and training in the use of household items in new conditions.

Professional rehabilitation deserves special attention. It consists of restoring ability to work and learning new professional activities in cases of impossibility to engage in previously performed work. This type of rehabilitation allows you to speed up the healing process, because during work the patient is distracted from thoughts about the injury and pays less attention to pain.

Duration of the recovery period

After osteosynthesis, rehabilitation measures begin almost immediately after the operation. The duration of the period is determined in each case individually.

In this case, the doctor takes into account:

complexity of the fracture;
the type of operation performed and the complexity of the structure used to fasten the bones;
localization of damage;
the age and health status of the patient;
speed of recovery after surgery.

For example, after undergoing immersion osteosynthesis of the elbow, femur, tibia and patella, the recovery period will last from 3 to 6 months. Rehabilitation with the transosseous external method of surgery is approximately 1-2 months.

Basically, osteosynthesis of the radius is used for complex comminuted fractures that require professional surgical intervention. The procedure itself involves connecting and fixing fragments of bone structures until they are completely fused. Osteosynthesis can restore normal mobility of the wrist and avoid curvature of the upper limbs, which is observed with improper healing of fractures.

When is it held?

The main indication for osteosynthesis is a comminuted fracture of the radius, in which parts of the bone structure are unable to independently fasten and grow together without disturbing the normal anatomical position of the limbs. A similar surgical intervention is indicated for cases that often occur with an unsuccessful landing on the wrist. Osteosynthesis is carried out when there is a high probability of damage to the skin by fragments, which is noted when a closed fracture turns into an open form. In this case, the operation is performed as an emergency.

A displaced fracture of the radius leads to surgical intervention, which is accompanied by tissue damage or a complication in the form of pinched blood vessels or nerve fibers. Indications for surgery include improperly healed fractures that have been treated, repeated splinter events, and slowly healing bones.

If there is a displacement of bone structures, the operation is performed in the first 2 weeks after the fracture.

Types of osteosynthesis of the radius

The type of surgery depends on the severity and complexity of the fracture itself.

According to the methodology and means used during osteosynthesis, there are 2 main types of the procedure:

Interior. The submersible method involves fastening and fixing fragments of bone structures directly in the human body, through the introduction of special implants. Depending on the degree and complexity of the lesion, plates, screws, wires, knitting needles, and pins are used.
Outer. Various devices or their individual sections are used to fix bone fragments in case of polytrauma. Hardware structures are used to pre-fix bone structures and are often combined with other methods of therapeutic therapy. The Ilizarov apparatus is most often used.

How is it carried out?

Osteosynthesis can restore the functionality of the hand and return it to full functionality. As a rule, fusion of the radial bone takes about 2 months. Although, with the use of special fixators and sets of exercises, the limb can be developed 2 weeks after the intervention. The operation itself depends on what material and technique is used.

Osteosynthesis with a plate

A metal material is used that is made specifically for restoring the wrist area. Significant fragments are compared, after which they are covered with a plate and fixed with screws. In this case, sutures are placed on the skin for at least 14 days, and a special splint is placed for another 2 weeks. After the operation, painkillers and mineral complexes are prescribed. After the expiration date, the plate is not removed.

External fixation device

The method is transosseous, intended for compression or stretching.

Its task is to fix bone particles using pins that are inserted through the skin directly into the bone. They are used for elderly people and for significant tissue swelling. This procedure does not require unnecessary incisions, but it is important to control the needles and treat the site of their entry. For the first 2 weeks you need to wear a splint, along with a hardware design. The device is removed no earlier than after 6 weeks under X-ray control. Next, the hand is bandaged with sterile material. A similar procedure is repeated every other day for about 1 month. At this time, the injured limb is in a fixed position on a scarf.