The wrist joint is the radius and the bones of the wrist, they are movably connected. The 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. Wrist - 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 located in 2 rows, which have an irregular shape and are in different planes. Therefore, it has such a curly shape. Its other name is the anatomical snuffbox or the 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 extensor and long abducent muscle. This name has been given since ancient times, because this area was used to place and snuff tobacco.
Here the radial artery passes and you can feel the pulse. Two rows of carpal bones (distal and proximal) have 4 bones, between which there is a cartilaginous layer.
According to the number of bones forming, the wrist joint is complex (more than two bones) and complex (there is a cartilaginous disk), and in the form of articular surfaces it is ellipsoidal and has two axes of rotation - sagittal and frontal.
The composition of the first row of the wrist joint is as follows:
- scaphoid, lunate, trihedral (or triangular) and pea-shaped;
- the second row is hook-shaped, capitate, large and small polygonal.
The wrist joint of a person can carry out such movements as abduction and adduction of the hand along the sagittal axis; bending and extension - along the front axis; elliptical joint allows you to make circular rotation of the hand.
The wrist bones are surrounded by ligaments - collateral radial and ulnar. Which are attached to the styloid process of the ulna at one end, and to the pisiform bone at the other. There are 2 smaller ligaments of the wrist - back and palmar.
The joint of the wrist bones can make movements thanks to the muscles around. All muscles of the joint are combined in 4 groups:
- Group 1 - is responsible for flexion of the wrist and little finger.
- Group 2 - extends the wrist and brings the brush.
- Group 3 - removes the hand and participates in the flexion of the wrist.
- Group 4 - involved in the 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 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 person falling onto an outstretched arm with an emphasis on the palm of the hand. Such injuries are possible when falling from a height of their growth, for example, in ice, in case of an accident, riding a bicycle or a motorcycle.
Promotes beam fracture and osteoporosis. In this case, the bones become brittle due to a lack of calcium, and even with a slight impact, they easily break. Pathology is especially characteristic of the elderly after 60 years. Damage and fractures of the wrist should be treated very carefully, otherwise they will lead to contractures.
Fracture classification
The fracture in the victim must not only be established, but classified. It is extremely important for the choice of treatment tactics and care. Therefore, we propose to study how fractures of the radius of the wrist joint are divided:
- Extra-articular and intraarticular; in the latter case, the fracture with its line is in the joint itself.
- Cellulose - the bone breaks into more than three fragments;
- Open and closed fracture, depending on the presence of skin damage.
A fracture may touch the radius or the wrist. In the joint, the radial bone most often breaks, then the scaphoid follows in frequency.
Fractures are also divided into flexion and extension. Kolesa fracture - extensor. With him, the point of impact falls on the palm of his hand, i.e., the person fell on the palm of his hand. The radial bone breaks from the distal end higher, closer to the forearm. Bone fragments usually move proximally upward from the palm, i.e. to the thumb and closer to the back. Such a fracture is characterized by the appearance of a cone called a bayonet. Consolidation is quite fast due to good blood circulation in this area of the beam.
Smith Fracture - Flexion or reverse fracture of the Wheel. It is much less common. Destructive force is directed to the back of the wrist. This is possible if in a disaster 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 to the side of the palm. Often such a fracture is open, with severe bleeding.
Among the wrist bones, the scaphoid breaks more often than others, then - lunate. But any of the eight others can break.
Similar injuries can be shared along the fracture line, the presence of mixing, or depending on the location. The displacement of the wrist bones (their fragments) during a fracture always causes deformation of the carpal region. Unfortunately, sometimes the hand remains modified forever.
In the scaphoid, the fracture line can extend in the proximal part, middle and distal. 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 hand under himself 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. Cross 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 sharp pain in the wrist area, limited mobility, swelling, bruising or bruising, wrist deformation, crepitus or crunching, numbness of the fingers, this indicates a fracture. In this case, consult a doctor immediately.
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 squeeze a hand into a fist or straighten. The pain axis passes along the scaphoid, i.e. on the axis of the thumb and forefinger.
Hematomas and bruises occur when capillaries rupture and fluid escapes into the interstitial space. This is the mechanism of edema. With massive injuries, bleeding or hematomas of an extensive nature can also occur.
All this leads to a forced position of the hand to reduce pain. A man holds her motionless. With open fractures, the wound almost always has ragged edges that can become infected.
On an X-ray, the fracture line is always clearly visible. However, pain can equally indicate not only a fracture in the wrist joint, but also dislocation, arthrosis, inflammation, and osteoporosis. The difference is that the affected arm retains full or partial mobility. Each bone with a fracture has its own characteristics.
Symptoms of fractures of individual bones
So, the nature of the pain and symptoms depend on which joint bone is broken:
- For scaphoid pain in the radial fossa, at the base of the thumb, is characteristic. If you raise it up, the pain occurs with percussion of 1 and 2 fingers. To unbend a brush is painful, as well as to squeeze into a fist. There are 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 arbitrary brush movements are limited.
- A fracture of the lunar bone is manifested by pain at the fracture site and in the region of 3 and 4 fingers; swelling and bruising appear. Extension of the hand causes severe pain.
- Symptoms of a fracture of other wrist bones - pain in the wrist and swelling upon palpation of the site of damage, pain when loading on the finger of the hand whose axis passes through the damaged bone.
Diagnostics
Since the symptoms in the case of bruises, sprains and dislocations are largely similar, radiography in two projections is done for reliable diagnosis. This will help to accurately diagnose.
Complications of Damage
The cause of the complications may be an incorrect plaster cast or fixation, as well as a later visit to a doctor when a person considered his fracture to be a simple bruise.
With a pseudoarthrosis of the scaphoid, a violation of the functionality of the wrist and its increased mobility occurs. This is especially common in the elderly.
With late treatment, a fractured arm with a displacement in the wrist may not grow together correctly, with damage to the neurovascular bundle. Then the pain syndrome becomes chronic, the functions of the hand are disturbed, and it is deformed. Slow fusion and non-healing wrist fracture are also possible.
Treatment process
The process of treating a wrist fracture is divided into several stages:
- first aid;
- examination by a doctor;
- drug relief of pain;
- main treatment;
- rehabilitation.
When the fracture is not complicated and there is no displacement, immobilization with plaster will be sufficient.
With displacements of fragments, their correct anatomical location should be restored, that is, corrected - this is the initial procedure.
Otherwise, arthrosis will develop. Due to the painfulness of the procedure, it is performed with local anesthesia with a solution of novocaine. Fixation of the bone is achieved through the application of gypsum.
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. In the normal process of fusion, after just two weeks, it is removed and replaced with a plaster cast.
Status monitoring is carried out by x-ray. Conservative treatment is used to treat a wrist fracture of the wrist joint. If the radiation fracture is not displaced, then a gypsum 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 gymnastics is appointed, the emphasis of which is on the fingers. At this time, it is possible to apply UHF to the fracture area. Active joint development begins after removal of the cast. Exercise therapy, massage, physiotherapy are prescribed.
If the bone is damaged without fragments, gypsum is applied for a period of 4 to 6 weeks.
In case of fragmented injuries, percutaneous transarticular fixation for up to 6 weeks is used to immobilize the debris and to avoid dislocation. The control x-ray is carried out in a week. The doctor examines the patient daily and required.
In a fracture with a displacement at which the reposition of fragments was performed, control pictures are taken every 10 days for a month. Control allows you to verify the immobility of the bones after fixation. In the first days after the fracture, you must always pay attention to the fingers, the possibility of their movements. Excessive compression with a plaster cast can lead to edema and neuritis of the peripheral nerves. In such cases, the surgeon can cut a soft bandage, and the edges of the spindles slightly bend.
Active finger movements must be done from the second day of applying the longy. And after removing the edema and pain, it is necessary to carry out movements of the wrist joint - pronation and supination.
From drug treatment are 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.
When infection is necessary antibiotic therapy. During the healing period, diet and herbal medicine are important.
Colles fracture fixation
In case of an extensor fracture, the doctor must traction (stretching) along the axis of the forearm by the hand and at the same time reverse traction in the opposite direction over the shoulder. After the stretching is completed, a back gypsum splint is applied, and the hand is placed with the palmar surface down.
Smith fracture fixation
In a flexion fracture, reposition is similar, but the distal fragment is pushed back to the back of the hand. Fracture fixation is also carried out with the palmar back bandage, the hand is laid palm up.
Surgical intervention
The operation is carried out in cases where the displaced fragments are in critical condition, they do not hold after reposition in the correct position.
In this case, the surgeon-traumatologist fasten the joint together with knitting needles, screws or titanium plates.
Surgeons are performed in an open and closed way, which depends on the type of fracture itself. Closed surgery takes less time and is not traumatic. It is performed without skin incisions. The minus of the method is in the protruding ends of the spokes through which the wound can become infected. This also delays the rehabilitation process in such fractures.
An open reposition of the arm is performed with a classic incision and elimination of bias using the above bonds. Joint development occurs in such cases ahead of schedule, and the wearing of plaster is optional.
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 joint development with active and passive movements.
The development program is selected individually by a rehabilitologist and carried out under his supervision. By the nature of the fracture, he develops individual exercises that will help fully restore the functionality of the hand.
In conclusion, we can say that injuries to the wrist are not life threatening, but they bring many unpleasant moments in their treatment and rehabilitation. In order to avoid dangerous consequences, it is important to follow all the doctor’s instructions.