Radial fractures in a typical location: description, symptoms and treatment features

A fracture is called bone damage, which occurs with a partial and complete violation of its integrity under the influence of a traumatic factor. Radial fractures in a typical place - an ordinary pathology for a trauma hospital. Actually, that's why she was given such a "talking" name. Especially common is the trauma of the distal part, the one that is closer to the hand.

Anatomy

Normally, the forearm is formed by two bones located parallel to each other: radial and ulnar. They can rotate around a long or longitudinal axis, since they are interconnected by two movable joints and a membrane:

1. Elbow joint. Combines bones at the junction with the shoulder.
2. Interosseous membrane. It is located in the space between the radius and ulna, the vessels and nerves that feed the forearm pass through it. In addition, it is a kind of separator for some muscles of the forearm.
3. Wrist joint. It has ligaments that connect the radius and ulna.

As a single structure, the forearm includes not only bones, but also ligaments, joints, muscles, vessels and nerves.

Bones and joints

Since the radius and ulna are tubular, it is necessary to know their structure in order to better understand the details of the fractures. So, each long tubular bone has:

1. Epiphysis - expansion of the bone to form the articular surface. It is formed by a porous spongy substance and contains a red bone marrow.
2. Metaphysis is a small area of ​​bone characterized by rapid cell division. It is thanks to him that we are growing.
3. The diaphysis is the main length of the bone. This is a hollow tube made of dense matter. Inside it is a yellow bone marrow.

From above, each tubular bone is covered with a periosteum, which nourishes the main substance, ensures its thickening and has a large number of nerve endings. Often it is this feature that helps diagnose fractures, because the bone of the pain receptors itself is devoid of.

There are only two joints, but in their structure they are complex, as they are formed by three or more bones:

1. Elbow joint - formed by the radius, ulna and humerus, can perform flexion, extension and rotation limited in amplitude.
2. Wrist joint - contains the lower segment of the radius and the upper row of the carpal bones. The range of motion is quite wide.

Muscle

To provide such a variety of movements, a large number of muscles are needed. And they need to be thin enough, but at the same time strong and elastic. All muscles of the forearm are divided into:

1. Flexors: located on the front surface of the forearm. There are superficial and deep. Their fixation point is the lower end of the humerus, and the point of movement is the bones of the wrist and phalanx of the fingers. Their function is to bend the hand and fingers.

2. Extensors: located on the back surface of the forearm. Responsible for extension of the hand and fingers. The attachment points are the same.

3. The muscles that rotate the forearm: found between the radius and ulna.

All muscle groups are quite elegant and have long thin tendons passing through the hand. Thus, with injuries of the forearm, a slight effort is sufficient so that, due to damage to the muscular skeleton, the motility of movements is impaired.

Vessels and nerves

Large vessels pass through the forearm, damage to which leads to rapid loss of blood and serious consequences for the body. These are branches of the brachial artery, which are divided in the region of the ulnar fossa into the radial and ulnar.

The first provides nutrition to the muscles of the forearm, as well as the hand and fingers of the palm. It is on it that doctors feel the pulse.

The second is parallel to the beam. She gives away many branches that are woven into the muscle fascia and nourish them. Forms a deep arterial arch of the hand.

The veins on the forearm, as well as on the rest of the body, are divided into superficial and deep. According to its name, the first go directly under the skin, and the second accompany the veins of the same name.

The innervation of the forearm is carried out from the brachial nerve plexus. Sensitive and motor branches depart from it. The largest of them are the ulnar nerve (controls the flexors and the medial part of the palm), the radial (responsible for the work of the flexors) and the median (participates in the regulation of the hand).

Types and types of fractures

It is known from the school physics course that a fracture appears in the place where excessive force was applied. But this factor alone is not enough. A decrease in bone strength and a certain point of application of kinetic energy are also necessary. This principle was the basis for the classification of all types of fractures.

1. Pathological. When the force directed to the bone is low, but due to a decrease in strength, it still breaks. This is due to genetic (crystal baby syndrome ), metabolic or endocrine pathologies, as well as the growth processes of malignant neoplasms. Increased fragility can also be a manifestation of the age when calcium-phosphorus metabolism is disrupted in the elderly.
2. Traumatic. When the intensity of the force exceeds the density of the bone tissue. As a rule, this is a consequence of accidents, traffic accidents, sports injuries. During a fall, a person instinctively puts forward his hand, trying to protect his face or chest, and the entire blow falls on the wrist and forearm.

According to statistics, traumatic fractures are more common, they are more dangerous, because as a result, in addition to bone, blood vessels, nerves, and muscles can be damaged. Very high risk of disability.

By the mechanism of formation of fractures are:

1. Transverse - when the force of application is perpendicular to the axis of the bone.
2. Oblique - the direction of the force is at an angle. It can occur both with a direct effect on a part of the body, and indirectly.
3. Helical - if the bone was subjected to strong rotation at a fixed one end. For example, during an accident.
4. Longitudinal - the fracture line is parallel to the bone length. Usually appear with strong compression and impact with a blunt object with an unlimited surface (asphalt, earth).
5. Cellulose - more than two bone fragments are observed, there is no clear fracture line.
6. Driven in - occur when falling from a height. The direction of the force passes along the longitudinal axis of the bone, and after the fracture, the fragments “enter” one into the other.

With any of these lesions, bone fragments can be displaced and additional soft tissue trauma can occur. But fractures of the radius in a typical place usually do without small fragments.

There is another classification indicating the degree of skin damage. She divides all fractures into open and closed. Open, as it would be logical to assume, damage the skin, and bone fragments can be seen with the naked eye. They are dangerous because of the high probability of infection of the wound and significant blood loss. Closed fractures have a more favorable course and do not communicate with the external environment.

Localization

A traumatologist, knowing where fractures most often occur, can accurately diagnose an injury. So:

1. The area of ​​the head and neck of the radius, near the elbow joint. Formed when falling on an outstretched arm.
2. Radial diaphysis - happens with excessive exposure to force. Often combined with a fracture of the ulna.
3. A fracture of the radius in a typical place is three centimeters from the hand. It occurs when falling on a bent brush with an outstretched arm. More common in older women due to postmenopausal osteoporosis.
4. Fracture with dislocation of the head of the ulna.

Symptoms

It is clear that the main complaints of a person who has been diagnosed with a bone fracture in a typical place do not differ from those with a different localization of the damage, but still it is worth focusing on the symptoms.

So, the patient in the emergency room will complain of pain in the area of ​​injury, aggravated by pressure and movement. Pathological mobility of the injured forearm is observed if displacement of fragments or fragmentation of the bone occurs. Swelling of the hand and a symptom of fluctuations will be observed due to edema. Damage to large vessels is often indicated by a hematoma. In addition, after an injury, there may be a visual or instrumental shortening of the limb (due to displacement of bone fragments), as well as a symptom of crepitus (crunching) when trying to feel the site of the injury. A closed fracture of the radial bone in a typical place is characterized by deformation and configuration of the wrist joint with pathological flexion or extension of the wrist, displacement of fragments and violation of the wrist relief.

Diagnostics

Consists of several stages:

1. Survey (complaints, injury mechanism, history of life and health).
2. Inspection (skin color, presence of fluid under it, pulse, degree of damage, and pathological passive and active movements at the fracture site).
3. X-ray (a picture of a damaged limb in two projections).
4. Linear and computed tomography (used in especially difficult cases to exclude an error in diagnosis or to prepare for reconstructing surgery).
5. Angiography (done to exclude damage to the vessels of the forearm).

Urgent Care

Since fractures of the radius in a typical place are quite common, it will not be out of place to talk about first aid to victims.

1. Be sure to call an ambulance.
2. Maximum immobilize the limb to prevent displacement of fragments.
3. Apply cold to the fracture site, but do not forget to wrap a piece of ice in a towel so that there is no frostbite.
4. Drink pain medication.

Most often, there is a fracture of the right radial bone in a typical place, since this hand is working in most people. A man instinctively tries to block it or lean and is injured. However, do not forget that a fracture of the left radial bone in a typical place is also possible (for both right-handed and left-handed people). It all depends on the situation. Therefore, doctors should not lose their vigilance.

Treatment

The basis of therapy, as in other cases, is immobilization of the limb and relief of pain. To do this, use the application of a plaster cast or langety, taking painkillers. But the treatment for a radial fracture in a typical place does not end there. The victim must be vaccinated against tetanus, given antibiotics and immunoglobulins to increase the body's resistance (especially appropriate for open fractures). Plaster wearing lasts up to 2-2.5 months. Surgery may be required if complications occur.

Complications

No one is immune from problems even with such a common occurrence as a radius fracture in a typical place. Complications are usually detected at the stage of diagnosis. These include:

• open fracture;
• additional fracture of the ulna;
• the presence of a dislocation or subluxation;
• significant displacement of fragments;
• compression of nerves or damage to blood vessels;
• pathological fracture;
• multi-fragmented fracture.

Recovery

The next stage after the removal of gypsum is a long process of physiotherapy, which is necessary to restore the function of the forearm and hand. This usually occurs 2–3 months after the diagnosis of “fracture of the radius in a typical location”. Rehabilitation is necessary to strengthen the muscle frame of the limb and the gradual restoration of its mobility after prolonged immobilization. Difficulties can arise in the elderly, patients with diabetes mellitus, impaired liver, kidney and immune system.

Radial bone fractures in a typical place are a rather ordinary and routine diagnosis at the emergency room, but this makes the pathology less important for both the doctor and the patient.