Fracture of the radius, with or without displacement, accounts for 20% of all fractures of the human skeletal system. It differs in location, direction of displacement of fragments, and complications. From the article you will learn features of displaced and non-displaced fractures, how long you will have to walk with a cast, the timing of bone healing and instructions for recovery and rehabilitation.
Types of radius fractures and their signs
Damage to the radial bone of the forearm can be intra-articular, violating the integrity and functionality of the wrist joint, and extra-articular, when the fracture line does not extend to the articular surface.
With a closed injury, there are no visible damage to the skin; with an open fracture, the integrity of the skin is compromised, which is often accompanied by complications such as rupture of blood lines and nerve trunks.
Fracture without displacement of bone fragments
Every second case of fracture radius occursno offset. This is due to the fact that the muscle groups on the forearm are poorly developed and do not have a mechanical effect on the bone at the time of its damage. An x-ray reveals a crack. An incomplete fracture can be localized both in the head and body.
In most cases, non-displaced injury is diagnosed in children and adolescents as a result of active games or sports. The symptomatic picture is blurred. There is no visible deformation of the limb, the swelling is not pronounced, the pain resembles a bruise.
Fracture with displacement of fragments
Displacement of bone fragments occurs under the influence of external force or internal force ─ the pressure of skeletal muscles on the beam. A characteristic sign is a clearly defined deformity of the upper limb.
The fault line is often transverse or oblique. The displacement occurs in the longitudinal or transverse plane; in 50% of cases, the bone simultaneously shifts horizontally and vertically.
In case of automobile or occupational injuries, impacted (compression) fractures are more often recorded. They are accompanied by massive damage to muscle tissue and deep layers of skin. The x-ray shows small fragments (bone fragments).
Typical radius injury
Fractures of the radius in a typical location are the most common forearm injury. When falling on the hand under the influence of body gravity, the radius bone cannot withstand and breaks in the area of the lower third, 3-5 cm above the wrist joint. Depending on the location of the palm during the fall (turned outward or inward), two types of injury are distinguished.
Wheel Fracture or flexion ─ occurs with a direct fall on an open palm, while the bone fragment moves to the back of the forearm. According to statistics, 2/3 of such injuries in a typical location are of this type.
Smith's fracture or extension ─ the fall occurs on the palm turned inward, the fragments are displaced to the inside of the wrist.
Important! At the same time, nearby anatomical formations are damaged, the integrity of the radioulnar and radiocarpal ligaments is disrupted, and a dislocation or fracture of the lunate, scaphoid bones, and styloid process occurs.
Distinctive signs of a radial fracture in a typical location:
bayonet-shaped deformity of the lower arm;
sharp and severe pain;
quickly formed edema and swelling;
extended wrist joint;
any severe restrictions on the movements of the forearm and hand.
The injury is characterized by seasonality. A fracture in a typical location is more often diagnosed in women after 45 years of age in winter (during icy conditions). The strength of bone tissue decreases after menopause; it becomes loose, vulnerable, and sensitive to mechanical stress.
Plaster application for a radius fracture
Before applying a cast, an x-ray of the limb is prescribed in two projections, which allows qualitatively assess the degree of injury. According to indications, closed reposition of bone fragments is carried out, then they are fixed with bandages, and a control photograph is taken.
Purposes of plaster:
immobilization of the hand for proper fusion of bone fragments;
acceleration of recovery;
relief of the patient's general condition.
Standard the bandage is applied from the elbow to the fingertips, provided there are no complications.
Open fractures with several fragments or crushing are accompanied by damage to soft tissues and blood vessels. In this case, surgical treatment ─ open reposition is indicated. A trauma surgeon performs primary treatment of the wound (excises soft tissue with a scalpel, turning a lacerated wound into an incised wound for quick healing). Sews blood vessels and nerves. The wound heals within a few days. Only after this is a plaster cast applied.
Important! Negative sensations under a plaster cast, if they occur, you should immediately contact a traumatologist:
numbness of the hand, fingers;
feeling of fullness under the cast;
pain, fever, chills.
These are signs of bone displacement, internal bleeding, and acute infection.
If there was a compression fracture or the bone was significantly fragmented, the reunited fragments are difficult to hold in an immobilization bandage; fixation is carried out through the skin with two knitting needles (the radius, head and neck of the ulna are captured). Then a cast is applied, cut from the wrist to the middle of the shoulder.
Modern technologies - plastic gypsum
Plastic plaster solves problems such as heaviness, severe limitation of movements, and a constant feeling of itching of the skin.
Polymer immobilization bandage 4-5 times lighter than traditional plaster. It does not allow moisture to pass through, and you can take a shower or bath with it. Hypoallergenic material provides physiological air exchange, the skin under the bandage breathes. Plastic deforms and loses its qualities only under the influence of direct sunlight.
Artificial plaster follows the individual anatomical shape of the hand, it can be modeled for each individual case, and the patient does not experience discomfort when wearing it. The fixator does not disrupt physiological blood circulation and lymphatic drainage, so the hand does not swell. Creates favorable conditions for the restoration of the median nerve.
How long do you wear a plaster cast?
The duration of wearing an immobilization plaster cast depends on the following factors:
severity of the fracture;
patient's age;
the speed of metabolic processes in the body.
It takes at least 21 days to form. During this period, the hand must be securely fixed.
For a non-displaced fracture or crack bone fusion time is no more than 3 weeks. How long to wear a cast is determined individually, on average from 2 to 4 weeks.
For cracks in the neck and head of the bone, the splint is worn for 14-21 days. Damage to the bone body, depending on the number of fragments when the wrist joint is involved, requires immobilization for 1.5-2.5 months.
If 2 whole fragments were repositioned, without crushing the bones, with disruption of the articular surfaces, a cast is applied for a period of 4-5 weeks. If closed manual reduction was difficult, then immobilization can last up to 2 months.
When using knitting needles, the plaster is not removed for 2-2.5 months. If the bone comparison was carried out using the open method or after repeated reposition, the bandage is worn for 6-8 weeks.
The importance of a bandage for a radial fracture
The main purpose of the bandage is prevention of re-displacement bone fragments. The device also relieves skeletal muscle tension, relaxes the hand, and reduces stress on the joints. By immobilizing the limb, pain is reduced.
Modern bandages are made from environmentally friendly, natural materials. When worn, they do not cause irritation, allergies, or itching, and are suitable for all skin types.
Important! An incorrectly selected retainer causes harm and aggravates the healing process. The bandage can compress the joint and blood vessels, disrupting blood circulation, leading to complications ─ bone deformation during fusion, disruption of the innervation of the limb.
The bandage is worn throughout the entire treatment (plaster immobilization), as well as during the rehabilitation period, until the limb is fully functional.
Criteria for error-free use of the fixative:
the arm and joints are completely relaxed;
no painful sensations;
the limb does not swell, the fingers do not turn blue or go numb;
partial mobility of the phalanges is preserved;
a person is comfortable in a sitting position, standing, while walking.
Principles of rehabilitation for a fracture of the radius
After the bone is anatomically restored, it is necessary to resume the functionality of the entire limb. During your stay at rest, muscles and joints lose mobility. To achieve your previous physical shape requires time, diligence, patience and constant physical therapy work.
Important! In most cases, rehabilitation after a fracture takes the same amount of time as the person was wearing a cast. The exceptions are complex injuries with tendon ruptures, joint damage, and multiple fragments of bone tissue.
Comprehensive restoration includes the following activities:
a diet rich in calcium, taking vitamins to regenerate and strengthen bone tissue.
physical therapy, use of special exercise equipment (mechanotherapy);
water procedures ─ warm salt baths, gymnastics in water (hydrokinesitherapy);
paraffin applications;
physiotherapy ─ UHF, magnet, electrophoresis, laser;
Exercise therapy is the main method of restoring hand function
It is necessary to develop the arm while it is in a cast. All finger movements are done with caution. If discomfort or pain occurs, immediately stop gymnastics.
The first exercises are done at the end of the first week after applying the immobilization bandage. Gymnastics begin from the shoulder girdle and gradually move down to the wrist. Fingers should be developed especially carefully.
After the cast is removed, the patient experiences stiffness of movement, mild pain, and a feeling of fear of damaging the bone again. Limited mobility is due to the fact that the ligaments have temporarily lost their elasticity. Despite this, the movements are made more actively, involving all muscle groups of the arm, including the deep ones.
Exercises for the arm while wearing a cast
Before working out your arm for the first week after an injury, you need to assess the person’s well-being. There should be no sharp pain or high body temperature. All exercises are aimed at ensuring that the patient can simply take care of himself independently ─ hold a cup, spoon, toothbrush, change clothes, cut with a knife. When kneading the arm, sharp, circular, forceful loads are contraindicated in order to avoid repeated displacement of bone fragments.
The first set of exercises for a hand in a cast is performed in a sitting position. It is important to develop each phalanx of the fingers to avoid the formation of contractures (limitation of passive movements). At first, you can help with your healthy hand. 
The following types of physical activity are effective:
place your forearm on the table with your palm up, carefully clench and unclench your fingers (6-10 times), repeat the same exercise with your palm down;
if the fracture is without complications and the elbow is free from plaster, make flexion movements in the joint ─ the hand lies on a hard surface and slowly rises to the face with the back and inner side of the palm alternately (5-7 times);
squeezing and unclenching a soft rubber ball or “anti-stress” toy with your fingers (10 times).
Gymnastics lasting 5 minutes is carried out 2-3 times a day. As you improve, this time is increased to 15 minutes. Criteria for successful rehabilitation at week 3: ability to dress independently with a cast on a limb, cut soft foods with a knife, and hold a filled cup.
Forearm restoration after plaster removal
Before starting the main exercises, do a light warm-up. Develop the wrist joint in a circular motion, clench your fingers into a fist, and lightly massage the hand.
Basic exercise therapy after a fracture includes the following groups of exercises:
spreading and closing fingers;
pressing the end phalanges onto a hard surface;
alternately raising fingers from the table with maximum amplitude;
rotational movements of the brush.
Effective use of available tools. It is useful to lift and hold a glass of water, knead plasticine with your fingers, toss and catch a tennis ball. To stretch the tendons and ligaments, gently rest your wrists on the table with your palms and the inside and outside of your hand.
The gymnastic complex must include movements that involve all joints and parts of the hand. At the same time, the shoulders and arms are raised and released, followed by extension to the sides. Rotate the forearm at the elbow joint clockwise and counterclockwise.
In order to restore the primary functionality of the limb, you need to use it more often in everyday life - combing your hair, dressing, preparing food.
Special forearm supination/pronation simulators help you develop your arm safely. During rehabilitation exercises, all movements are carried out anatomically and physiologically correctly (the amplitude is adjusted up to 90°C). Fast clinical results are ensured by optimizing the load in each individual case.
What contraindicated during the rehabilitation period until full restoration of working capacity:
carry a bag or package weighing more than 0.5 kg;
lift dumbbells;
practice with heavy medicine balls (volleyball, basketball);
transfer the center of gravity of the body to your hands (lean);
turn the key, open tight door locks.
With regular performance of the entire set of exercises, the functionality of the limb is restored in 1.5-3 months.
Gymnastics in warm water
Warm salt baths reduce muscle tone, relax the nervous system, relieve pain, dilate blood vessels, ensuring blood flow. For exercises, you need a container that can fit your forearm without restrictions (wide pelvis, baby bath). The optimal water temperature is 36-37°C.
Contraindications:
infection of soft tissue at the fracture site;
skin rashes, ulcers;
increased body temperature;
hypertension during exacerbation.
It is best to work out your hands in warm water in the evening, 2 hours before bedtime. Dissolve 100 g of sea salt and immerse the forearm, wrist, elbow joint, up to half the shoulder.
In the water, make bending movements with your fingers, palm, and rotate your brush in different directions. Raise and lower closed fingers, turn the palm up and down. Each type of exercise is done 6-8 times.
Therapeutic training in water is mandatory for the first 2 weeks after the removal of the cast, after which the procedure is advisory in nature.
Physiotherapeutic measures after a radial fracture
The goals of physiotherapy are rehabilitation of the musculoskeletal system, elimination of the negative consequences of surrounding soft tissues.
Massage
Light massage movements are allowed while wearing a cast. Direct impact on the muscles is carried out in open areas on both sides of the bandage ─ stroking, rubbing, low-intensity pressure. Tapping on the plaster is allowed. Acupressure is performed using a magnetic acupuncture apparatus.
This procedure increases blood flow, oxygen access to tissues, promotes rapid regeneration, and improves metabolic processes. This activates the outflow of lymph, quickly eliminates swelling, and reduces the time required to wear an immobilization bandage.
After removing the cast, the hand is massaged more actively. Classic movements:
transverse and longitudinal stroking over the entire surface of the forearm;
kneading;
percussion (tapping);
circular rotational movements working deep muscles.
Additionally, special hand trainers, rollers, rollers, and needle applicators are used. Full massages are indicated no earlier than a month after the removal of the cast, when muscle mass is restored.
Paraffin therapy
Paraffin treatment is a thermal effect on damaged tissue. Paraffin is a natural substance with high heat capacity. The method is indicated for rehabilitation after complex multiple fractures of the radius.
Deep heating relieves muscle spasms, improves microcirculation and lymphatic drainage. Prevents the formation of contractures and ankylosis (immobility of the joint). The therapeutic course is 15 procedures (every other day).
Electrical stimulation of bone and muscle tissue
Electrical stimulation is based on the use of pulsed currents to restore different types of body tissue.
The procedure accelerates the formation of callus, enhances bone calcification and the process of cartilage formation. The electric field acts at the cellular level, promotes the synthesis of chondrocytes, osteoblasts, and lymphocytes. According to WHO statistics, the technique reduces the rehabilitation period by 30%.
Shock wave therapy
UVT is a technique for restoring the musculoskeletal function of the arm using acoustic waves. Treatment is indicated for poorly healing fractures, complications due to improper reduction or immobilization, pseudarthrosis (formation of a false joint in an unusual location).
Shock wave therapy stimulates the formation of new blood vessels and bone tissue. After only 3 procedures, callus formation can be observed on x-rays. The presence of metal pins or plates is not a contraindication.
Fracture of the distal metaepiphysis of the radius─ a common hand injury; in traumatology it is called typical.
The site is located 2 cm above the wrist joint.
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The ratio of the number of injuries without displacement of bone fragments and with displacement is 1:1. This is explained by the poor development of the muscular system of the lower half of the arm.
When landing on the hand, the muscles do not exert pressure on the beam, so its fragments do not move. Only the crack is visible on the x-ray.
Signs
The clinical picture of a crack is blurred.
Symptoms resemble a bruise:
- Aching but tolerable pain;
- Swelling in the joint area;
- Mild swelling;
- No bone deformation;
- Partial preservation of hand functionality.
Therapy
For incomplete fractures, apply a plaster splint (splint) from the elbow joint, grab the hand, leaving the fingertips exposed. The hand is fixed in the average physiological position.
To reduce pain and inflammation, nonsteroidal drugs are prescribed orally ─ Nimesil, Diclofenac, Ibuprofen.
Displaced fracture
The peculiarity of the injury is a pronounced deformation of the arm, which is determined upon examination. The fault line with subsequent displacement can run in different directions - vertical, horizontal.
Sometimes it is located in several planes at once. Depending on where the palm was bent at the time of the fall, there are 2 types of injury.
Colles' fracture ─ occurs when landing directly on the palmar surface. The bone fragment is displaced to the dorsum of the forearm.
Smith's fracture ─ is diagnosed when a person falls on a palm that is bent inward, and the fragments are directed there.
Symptoms
Signs of injury:
- Deformation of the lower third of the limb in the form of a bayonet;
- The pain is sharp, worsening with movement;
- Instant swelling;
- Crepitation of fragments;
- (in case of nerve damage);
- Limitation of joint mobility of the forearm, hand, fingers.
Treatment
In case of uncomplicated injury with displacement of fragments, a one-step reduction is performed by hand. Then a plaster cast is applied from the elbow to the proximal phalanges of the fingers.
If necessary, Illizarov's compression-distraction apparatus is used. It holds bone fragments together, exerts moderate compression (squeezing) or stretches the limb.
Treatment of complex injuries is carried out using osteosynthesis ─ a surgical operation with fixation of fixing elements ─ knitting needles, pins, screws, staples, nails, screws on the bone.
Closed fracture
A closed injury is distinguished by the absence of a violation of the integrity of the skin. Sometimes extensive hematomas appear, there is a decrease in skin sensitivity, paresis (partial paralysis) due to damage to blood vessels and nerves.
A radial fracture can be extra-articular, the fracture line does not affect the joint, and intra-articular - the fragments disrupt the anatomical structure of the joint capsule.
How long to wear a cast
The duration of wearing plaster for a fracture of the distal metaepiphysis depends on the following circumstances:
- Severity of injury, presence of complications;
- Speed of metabolic processes, features;
- Age.
The minimum period for the formation of bone callus is 21 days.
For an injury without displacement, a plaster cast is worn for 2.5-4 weeks. If a small crack is found, a splint is placed on the arm for 14-20 days. If there are 3 or more fragments, the cast is worn for 1.5-2.5 months.
When repositioning 2 whole fragments, without crushing bone tissue, immobilization lasts a month. If closed manual alignment of the bone was difficult, the plaster is not removed for 2 months.
If knitting needles are used simultaneously with a plaster cast, this design is worn for 2-2.5 months. For open or re-matching, the arm is immobilized for 6-8 weeks.
How long does rehabilitation last?
If the tactics of physiotherapeutic measures are correctly structured and the patient follows all instructions, restoration of full functionality of the hand occurs in 1.5-3 months.
On average, rehabilitation lasts the same amount of time as the person was in a cast. A longer restoration of hand functions is required in case of complex injuries with ruptures of large vessels, tendons, large-scale disruption of the integrity of the joint, and bone crushing.
How long does it take to grow together?
Any injury received takes a long time to heal and brings unpleasant sensations, a fracture is no exception. It is necessary with displacement, which is aimed at developing and restoring motor functions. Development should be carried out after the doctor’s permission.
In order for the limb to regain its mobility, it is necessary to carry out physical therapy:
- Claps both in front of you and behind your back.
- Pour water into a basin and place your hands there, straightening and bending your palm.
- You need to stretch your fingers, but don't overdo it.
- Raising your arms in different directions.
- Raising your shoulders up.
- you need to do it from simple to complex.
- First, move your fingers, bend and straighten them.
- Then move to your wrists.
- At the end, the load should be distributed over the entire arm.
As soon as the cast is removed from your hand, you will feel as if the hand is someone else’s. This is not surprising, because the hand was immobile for a long time and the muscles weakened, the blood supply was insufficient, so swelling appears.
To make swelling disappear, you need to do some exercises:
- To check if there is any strength left in your hand, squeeze your palm. Don't take on everything at once. First, on ordinary plasticine, warm it up in your hand.
- To make the blood move faster, stretch your arms in front of you, clench your palms and turn right and left. After some time, the hand will begin to function. But you shouldn’t rotate the limb too often.
- An ordinary tennis ball will help relieve swelling; you need to throw it at the wall and catch it, but you shouldn’t do this too quickly. You can move the ball into your palm and roll your fingers over it.
Types of damage
Displaced fractures can be either open or closed.
Fractures are dangerous because they cause bone movement that affects tissue. In cases where nerve tissue or blood vessels are damaged, after healing the limb cannot function fully.
More often, an ordinary fracture turns into a fracture of the radius. Doctors call this type of injury “typical,” and often the radius bone is damaged in the lower third (at the site of impact).
If the bone does not heal properly, arm movement will be limited. If the fall lands on a straight arm, a double fracture may occur.
Symptoms
Signs that you have broken your radius depend on the type of injury.
Basically the signs are:
- The upper limb begins to swell.
- Painful sensations when touched.
- The elbow joint is damaged, which means the pain intensifies.
- Increasing pain.
- The bones crunch when you move the radial carpus.
- Bruises appear.
- Joint pain.
Another symptom that a limb is broken will be its coldness, this happens due to the fact that the blood supply is disrupted. When a fracture occurs, there is a large loss of blood, which leads to loss of consciousness.
The essence of a broken diaphysis
This type of damage is rare. But it happens because a blow was made to the radial left or right side of the forearm. The symptoms are different: pain, swelling.
If the fracture is displaced, then reposition is carried out and fixed for 8-12 weeks, carrying out X-ray control.
Surgical and conservative methods
To provide first aid, specialist intervention is not required. The main task of a person, he provides assistance to the victim, is to ensure the rest of the limb and prevent damage to nearby tissues (near the fracture). No “insertion” of the joint by outsiders is performed.
If the fracture is not open, then fix the limb in a position that is more comfortable, stop the bleeding at the fracture and apply a special bandage. Take the victim to a medical facility.
At the hospital, the doctor will give you first aid. If a medical professional is on the scene, even better. Upon arrival, the doctor assesses the patient's condition and determines what measures need to be taken.
After examining the patient, the doctor secures and prevents damage to the limb. If the patient's location is a hospital, then the doctor determines whether hospitalization is necessary or not.
Conservative therapy
This is one of the old but effective techniques. The secret of this method is that the traumatologist restores bone fragments with his hands so that their position coincides with what it was before the injury.
The bones are fixed in this position and they need to remain like this until a bone callus is formed. This is the safest method, but sometimes surgery is better. Sometimes urgent reduction is required.
Surgery
Yes, there are cases when nothing will work without the intervention of doctors. If any complications occur, specialists will come to the rescue, because they will solve your problem better and more accurately.
Treatment with surgery is necessary in cases where:
- Open fracture of the radius.
- Pathological fracture.
- The referral to specialists occurred much later after the injury.
- Displaced fracture.
- Fracture with compression of nerves.
Doctors compare bone fragments and use plates or knitting needles as fixators. The choice of what to fix depends on the fracture.
Open fractures require the intervention of surgeons, because the infection spreads quickly and can spread throughout the body, including tissues in the arm and other parts of the body.
The time it takes for the bone to heal depends on how badly it is damaged. A fracture that has healed incorrectly is still difficult to heal.
Plaster for closed and open fractures of the radius must be worn:
- If the broken head of the radial bone is restored - 2-3 weeks.
- The diaphysis grows together in 8-10 weeks.
- “Typical place” – 10 weeks.
- The ulna heals in 10 weeks.
Wellness massage
One of the most optimal components for treatment is massage.
In order for the blood in the arm to begin to circulate well again, you need to warm up the muscles and saturate the tissue with oxygen.
After removing the plaster, you need to learn how to massage, it’s not difficult:
- First, make (stroking) movements along the entire length of the limb.
- Then move on to rubbing.
- Knead your hand with your fingers, this helps tissue regeneration.
- Vibration, you need to gently press on the limb, alternating with stroking.
Once all the courses are completed, your hand will regain its previous appearance, if everything goes according to plan. But if the bone heals incorrectly, then you cannot avoid situations when the muscles become deformed and the hand becomes ugly.
Diagnostics
Radiation diagnostic methods are the “gold standard” in the diagnosis of fractures. More often in routine practice, radiography of the limb in 2 projections is used.
An x-ray will show the presence of a fracture, its nature, the presence of fragments, the type of displacement, etc. These data play a key role in the choice of treatment tactics.
Sometimes traumatologists use computed tomography to diagnose complex injuries.
An experienced traumatologist will determine the necessary diagnostic methods depending on the general condition of the victim. The prognosis for recovery without consequences depends on the timeliness of contacting a doctor. Displaced bones are restored through repositioning.
Physiotherapy methods
Physiotherapy plays an important role in rehabilitation. With the help of procedures, the rehabilitation period is shortened and it becomes possible to avoid complications.
Procedures used:
- Electrophoresis with calcium preparations. The essence of electrophoresis is the slow directed movement of drug particles deep into the tissue. Calcium increases bone mineral density and accelerates the healing of bone fragments;
- Low frequency magnetic therapy. Has an analgesic and anti-inflammatory effect;
- UHF method. The chosen technique is aimed at warming up the soft tissues. As a result, local metabolism improves, which accelerates regeneration;
- Ultraviolet radiation. Under the influence of ultraviolet radiation, vitamin D is produced, which is necessary for better absorption of calcium.
Causes of injuries
An incomplete fracture in the area of the radius is a consequence of a fall on a straight arm or damage to the hand during an accident. Injuries often occur in healthy young people during active sports and extreme sports.
According to statistics, radial fractures were recorded in 15% of patients who visited a traumatologist. This problem often occurs in children during active outdoor play.
At an early age, bones heal faster, but parents have to constantly monitor the behavior of the child, who often tries to get rid of the fixing bandage.
Signs that, if they appear after a fall or severe injury, are time to go to the doctor:
- Pain in the area of the wrist joint (even with mild discomfort);
- Slight swelling of the dorsum of the forearm;
- It's difficult to move the brush.
The fracture zone depends on the position of the hand at the time of the fall, and other factors in which a force was applied that exceeded the strength of the bone.
Complications
A fracture is accompanied by damage to soft tissues and blood vessels, pinching of nerve fibers, dislocations and subluxations, which subsequently lead to complications if self-medicated:
- Tissue necrosis due to circulatory disorders;
- In the case of an open wound, purulent-necrotic foci may form due to infectious infection of soft tissues, or provoke osteomyelitis if bone tissue is infected;
- Partial or complete loss of movement of the forearm up to disability.
When falling on an outstretched arm, the shoulder joint is dislocated and the collarbone is displaced.
Only a doctor can assess the full picture of all the nuances associated with a fracture.
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Fractures of the distal radius of the arm are the most common fractures of the forearm and account for about 16% of all skeletal fractures. Typically caused by a fall on an outstretched arm. The description and classification of these fractures is based on the presence of fragments, fracture line, displacement of fragments, intra-articular or extra-articular nature, and the presence of a concomitant fracture of the ulna of the forearm.
Incorrect fusion of the distal radius after untreated or secondary displaced fractures reaches 89% and is accompanied by angular and rotational deformation of the wrist joint, shortening of the radius and impaction of the ulna in the wrist. It causes midcarpal and radiocarpal instability, uneven distribution of load on the ligamentous apparatus and articular cartilage of the radiocarpal and distal radioulnar joints. This causes pain in the ulnar part of the wrist during exercise, decreased hand strength, decreased range of motion in the wrist joint and the development of deforming arthrosis.
X-ray anatomy of the wrist joint
The inclination of the articular surface of the radius in the direct projection is normally 15-25º. It is measured in relation to the perpendicular to the axis of the radius and a line along the articular surface. A change in the angle of inclination of the articular surface of the lower third of the radius is a sign of a fracture, both fresh and long-grown.
Palmar inclination is measured in the lateral projection in relation to the tangent line drawn along the palmar and dorsal eminences of the articular surface of the radius to the axial line of the radius. The normal angle is 10-15º. A clear change in angles is a sign of a fracture.
Types of radial fractures (brief classification)
Fracture of the distal radius almost always occurs about 2-3 cm from the wrist joint. 
Colles' fracture
One of the most common fractures of the distal radius is a “Colles fracture,” in which a fragment (broken fragment) of the distal radius is displaced toward the dorsum of the forearm. This fracture was first described in 1814 by the Irish surgeon and anatomist, Abraham Colles.
Smith's fracture
Robert Smith described a similar fracture of the radius in 1847. Impact on the dorsum of the hand is considered to be the cause of such a fracture. The Smith fracture is the opposite of the Colles fracture, therefore, the distal fragment is displaced towards the volar surface.
Classification of fractures of the radial bone of the hand:
Other classification of radius fractures:
. Intra-articular fracture: A radial fracture in which the fracture line extends into the wrist joint.
. Extra-articular fracture: A fracture that does not extend to the articular surface.
. Open fracture: When there is a break in the skin. Damage to the skin can be from the outside to the bone (primarily open fracture), or damage to the bone from the inside (secondary open fracture). These types of fractures require immediate medical attention due to the risk of infection and serious problems with wound healing and fracture healing.
. Comminuted fracture. When a bone is broken into 3 or more fragments. 
It is important to classify fractures of the radius of the hand, since each type of fracture must be treated, adhering to certain standards and tactics. Intra-articular fractures, open fractures, comminuted fractures, displaced fractures of the radius cannot be left without treatment, be it closed reduction (elimination of displacement) of the fracture or surgery. Otherwise, hand function may not be fully restored.
Sometimes, a fracture of the radius is accompanied by a fracture of the adjacent ulna.
Causes of radial fractures
The most common cause of distal radius fractures is a fall on an outstretched arm. 
Osteoporosis (a disease in which bones become brittle and more likely to break under significant stress or impact) can contribute to a fracture from a minor fall on the hand. Therefore, these fractures most often occur in people over 60 years of age.
A fracture of the radius, of course, can also occur in healthy, young people if the force of impact is strong enough. For example, car accidents, falls from a bicycle, work injuries.
Symptoms of fractures of the radius of the hand
A fracture of the distal radius usually causes:
. Immediate pain;
. Hemorrhage;
. Edema;
. Crepitation of fragments (crunching);
. Numbness of fingers (rare);
. In many cases, it is accompanied by displacement of fragments and, as a consequence, deformation in the area of the wrist joint.
Diagnosis of fractures
Most distal radial fractures are diagnosed by conventional radiography in 2 projections. Computed tomography (CT) is necessary for intra-articular fractures. 
Delay in diagnosis of distal radius fractures can result in significant morbidity.
Computed tomography (CT) is used to plan operative repairs, providing increased accuracy in assessing articular alignment in intra-articular fractures. Also in the postoperative period, to determine whether the fracture has healed.
After a wrist injury, it is necessary to exclude a fracture, even if the pain is not very intense and there is no visible deformation, there is simply no emergency in this situation. You need to apply ice through a towel, give your arm an elevated position (bend at the elbow) and contact a traumatologist.
But if the injury is very painful, the wrist is deformed, there is numbness or the fingers are pale, it is necessary to urgently go to the emergency room or call an ambulance.
To confirm the diagnosis, radiographs of the wrist joint are taken in 2 projections. X-rays are the most common and widely available diagnostic bone imaging method.
Treatment of radius fractures
Treatment of fractures of any bones consists of assessing the nature of the fracture and choosing a tactic.
The goal is to return the patient to a level of functioning. The doctor's role is to explain all treatment options to the patient; the patient's role is to choose the option that best suits his needs and wishes.
There are many treatment options for a distal radius fracture. The choice depends on many factors, such as the nature of the fracture, the age and activity level of the patient. This is described in more detail in the treatment.
Conservative treatment of radial fractures
Fractures of the radius in a typical location without displacement are usually fixed with a plaster or polymer bandage to prevent displacement. If the radius fracture is displaced, then the fragments must be returned to their correct anatomical position and fixed until the fracture heals. Otherwise, there is a risk of limited hand movements and rapid development of arthrosis of the damaged joint.
The popular concept of “reduction of a fracture” is incorrect. Elimination of displacement of fragments is correctly called reposition.
After repositioning the bone fragments, the arm is fixed with a plaster splint in a certain position (depending on the type of fracture). A splint is usually used for the first few days as swelling increases. After this, it is possible to change the splint to a plaster circular bandage or a polymer bandage. Immobilization for radial fractures lasts an average of 4-5 weeks.
Depending on the nature of the fracture, follow-up radiographs may be needed 10, 21, and 30 days after reduction. This is necessary in order to timely determine the secondary displacement in the plaster and take appropriate measures: re-elimination of the displacement or surgery.
The bandage is removed 4-5 weeks after the fracture. Physical therapy of the wrist joint is prescribed for the best rehabilitation.
Surgical treatment of radial fractures
Sometimes the misalignment is so severe and unstable that it cannot be corrected or held in the correct position in the cast. In this case, percutaneous fixation with pins or surgery may be required: open reduction, external osteosynthesis with a plate and screws. During this operation, the displacement of the fragments is eliminated and the bone is secured with a metal structure, the choice of which is determined by the nature of the fracture. Operating access: 1. Dorsal; 2. Palmar. A combination of both accesses. Position the patient on his back. Anesthesia: conduction anesthesia. The operation is performed in the shortest possible time using modern techniques and implants. Implants made in Switzerland and Germany. Implant material: titanium or medical steel. All operations are carried out under the control of an image intensifier (electron-optical converter).
Closed reduction and percutaneous pin fixation
It has been popular for many years and continues to be one of the most popular methods internationally.
First, the doctor closes the displacement of the fragments, then wires are drilled through the fragments in certain (taking into account the nature of the fracture) directions. 
Pros: low trauma, speed, lightness, low cost, no incision and, as a consequence, a postoperative scar
Disadvantages: impossibility of starting early development of the wrist joint, resulting in the risk of irreversible contracture (lack of movement in the joint).
Open reduction of radius fracture
Open reposition external osteosynthesis with a plate and screws. The operation involves a surgical incision, access to the broken bone by carefully retracting tendons, vessels and nerves, mobilization of bone fragments, elimination of displacement and fixation in the correct position. Broken bones are fixed with titanium plates, so the patient is allowed early development of movements in the wrist joint.
Before surgery:
After operation:
Before surgery:
After operation
Recovery after a radius fracture
Since the types of fractures of the distal radius are as varied as their treatment methods, rehabilitation is different for each patient.
Eliminating pain
The intensity of pain during a fracture gradually subsides over several days.
Local cold on the first day for 15 minutes every hour, rest, elevated position of the arm (bent at the elbow at the level of the heart) and NSAIDs largely eliminate the pain completely. But everyone’s pain threshold is different and some patients need strong painkillers, which can only be purchased with a prescription.
Possible complications
During conservative treatment with a plaster or polymer bandage, it is necessary to monitor the hand. Observe whether the fingers swell, do not turn pale, and whether the sensitivity of the hand is preserved.
. If the plaster presses, this may be a sign of compression of soft tissues, blood vessels, nerves and lead to irreversible consequences. If such symptoms appear, you should immediately consult a doctor.
. Suppuration in the area of metal structures (extremely rare);
. Damage to blood vessels, nerves, tendons (iatrogenic complication);
Rehabilitation after a fracture of the radius of the arm
Most patients return to their daily activities after a distal radius fracture within 1.5 to 2 months. Of course, the terms of rehabilitation after a fracture of the radius depend on many factors: the nature of the injury, the method of treatment, the body’s reaction to the injury.
Almost all patients have limited wrist movement after immobilization. And a lot depends on the patient, his persistence in restoring the range of motion after a fracture of the radius. If a patient is operated on using a plate, then as a rule the doctor prescribes exercise therapy for the wrist joint from the first week after surgery.
The human hand is a unique tool that ensures successful knowledge of the surrounding world. She is virtually constantly in motion, providing tactile awareness of the surrounding space.
For this reason, trauma that sometimes occurs to the upper extremities significantly impairs the quality of life. Especially such a dangerous injury as a displaced arm fracture.
Constant movement of the arms is ensured by a complex bone structure connected by joints and tendons:
- In total, there are 206 arm bones in the adult human skeleton.
- In an infant, this number is much higher. Babies have 350 bones, some of which grow together as they grow older.
Rehabilitation after a fracture
A set of rehabilitation measures is recommended for patients undergoing treatment for a broken arm. The following procedures are recommended to restore hand mobility. This is facilitated by a special set of exercises. They can only be performed if there is dull pain. If the pain intensifies, you need to stop exercising.
Exercise therapy complex for recovery and development of the arm:
- Take a small ball transfer it from the healthy hand to the hand of the sore hand, squeezing.
- Perform rotational movements in the joint which is located in the fracture zone.
- Raise a gymnastic stick above your head with straight arms, fix the position and slowly lower it.
- Cross your arms in front of the face at eye level.
- Perform torso turns with palm clapping in front of the body and behind the back.
A set of exercises for recovery
Using self-massage
Self-massage helps speed up recovery. To carry it out, take the cream and make soft stroking movements, kneading the area of the arm affected by the fracture until the skin becomes slightly red.
Principles of nutrition for a broken arm
Foods rich in calcium and potassium help speed up recovery processes:
- Cottage cheese and dairy products are included in the diet.
- The restoration of bone tissue, joints and ligaments is helped by the inclusion in the diet of dishes that contain.
- Including jellied meat and jelly. It is also important to include foods rich in vitamins in your diet: vegetables and fruits, herbs.
Calcium rich foods
Comfortable sleeping positions
When an arm is broken, a person independently chooses to sleep the position in which he is comfortable and in which there are no pain reactions:
- When the sore area is located in the area of the wrist or hand, you can sleep in any comfortable position.
- If your forearm or shoulder is injured, you need to lie on the healthy half of your body.
- If necessary, place a cushion under your back to prevent a spontaneous rollover onto your affected arm.
Features of treatment of a broken arm in a child
Children can often underestimate the extent of what is happening. If the baby’s skin on the arm is inflamed, swelling is noted, palpation reveals a painful area and temperature, immediate contact with a specialist is required.
An important condition for successful treatment of a fracture in a child is monitoring the lack of physical activity. It is advisable not to let the child go outside in the first days to protect the affected area from re-damage.
Consequences of a fracture and possible complications
The highest quality treatment does not guarantee the absence of consequences and complications of a broken arm. Significant harm to health can be caused by untimely access to a medical facility.
The most common consequences include:
- Loss or decreased mobility due to improper fusion. In this case, both the bone itself and the joints located next to it may hurt.
- Purulent-septic complications in open form.
- In situations where a fracture has caused the bones to separate from the soft tissues, the section of bone is completely removed. The tendons have to be sutured and the resulting area of skin excised.
- When soft tissue changes, in some cases a contracture is formed. They reduce the level of mobility of the limb. Even after a successful operation, the prospect of fat embolism remains.
Disability due to a broken arm
If you contact the ITU after a broken arm, the possibility of assigning disability is small:
- For upper limb injuries disability is assigned in 25% of cases from the number of applications.
- Most of the ITU decisions on the assignment of disability, about 50% are due to injuries of the hand or metacarpal bones.
- In any case, disability is assigned in the event of recognition of confirmed permanent or temporary disability. A displaced fracture often leads to this result.
Judging by the practice of doctors in the field of surgery and traumatology, a fracture of the radial bone of the arm is the most common type of fracture. This pathology accounts for about 45 percent of the main number of bone integrity disorders. This amount is explained not only by anatomical features, but also by the conditions of injury. In most cases, when a person falls, he involuntarily puts his hand forward.
Anatomically speaking, the radius is supported by a large number of ligaments, but is not strong. The fragility of this joint also increases due to age-related changes, so among the total number of people with this diagnosis there are many pensioners.
The paired radius bone, together with the ulna, forms two joints: the wrist and the ulna. It is located in the bones of the forearm. Most often in the practice of traumatologists, fractures of the radius occur in a typical location. This is what experts call damage to the area closest to the joint.
Causes of fractures
The number of such injuries increases significantly in the winter season. Ice and melted snow cause people to fall. At the moment he puts his hands forward, as a result of which the main blow falls on them.
Active sports, for example, skiing, skating, cycling, rollerblading, etc., can provoke such a fracture.
Ambulance paramedics record a large number of fractures of the radius in car accidents: when hit, people try to find support by stretching their arms forward.
The tissue becomes thinner, as a result of which older people belong to the “risk group” for fractures of this joint.
Types of bone changes after injury
Fractures can be divided into several main categories, which also have their own subgroups.
- Fractures of the radius of the arm without displacement.
- Displaced fractures of the radius.
The second type is divided depending on the direction of the fragment (broken piece of bone).
- Colles fracture (flexion type). In this case, the fragment moves closer to the back of the forearm. Such options are possible after the open palm rests on the ground during landing.
- Smith's fracture (extensor type). In this case, the fragment moves closer to the side of the palm. Such options are possible after influencing the back surface of the wrist.
Depending on the area affected by the injury, the following fractures are distinguished.
- In the area of the head or neck of the bone. This is a traditional type of injury when a fall occurs on your arms outstretched in front of you.
- In the neck, central area of the radius or ulna. This diagnosis is made mainly after a direct blow or fall.
- In the area of the styloid process (located at the junction of the neck and radius). Such injuries occur when falling on an arm extended in front of you. In this situation, the wrist is pushed first outward and then back. As a result, the bone is damaged and requires immobilization in a plaster cast for 5 weeks. When the styloid process is displaced, it is necessary to “reduce” the bone fragments. This procedure is called reposition. The purpose of its implementation is to fix the articular surface without flaws.
Damage classification
Due to the wide variety, injuries of this type are grouped into blocks.
The first block includes:
- open type - a fracture with damage to the skin (in some cases, fragments of broken bone protrude in such places);
- closed type - without damage to the skin (in such cases, the damaged area is determined using x-ray examination and local symptoms: swelling and pain when touched).
The second block includes:
- fractures without displacement of fragments (in such cases, a crack-type damage forms on the bone, and injuries of this type are the most common and do not require additional interventions other than fixation);
- fractures of the radial bone of the arm with displacement (this pathology is a complicated injury and after reposition there is a high probability of repeated displacement).
The third block includes:
- intra-articular fractures (as a result of such damage, the area of the wrist and neck is covered);
- extra-articular fractures.
Signs of pathological trauma
Sometimes a fracture of the radius of the arm has to be diagnosed based on indirect symptoms, since there are no clear signs.
Complaints may occur:
- sharp pain in the wrist area;
- general malaise, nausea, weakness of the patient and even loss of consciousness;
- difficulty or complete loss of movement in the hand and fingers - due to severe pain;
- formation of hematoma, swelling in the bend of the arm and in the hand: such symptoms are the result of hemorrhage inside the muscles;
- the occurrence of a “crunch” when trying to move the wrist.
In difficult cases, it can be determined by visual deformation of the bone. Such signs are accompanied by a fracture of the distal metaepiphysis. The deformation can be bayonet-shaped or fork-shaped.
A fracture should be suspected if several symptoms are present. The main ones are pain and swelling. To identify an accurate diagnosis, a visit to a traumatologist or surgeon is necessary. If the radius bone of the arm is fractured, treatment is prescribed immediately.
First aid for a fracture of the radius
The main action that needs to be performed after receiving an injury is to rest the hand. This is done using a homemade splint, which is applied from the elbow joint to the forearm. To reduce pain, you can also fix the hand. Any flat hard object can be used as a tire: a piece of plywood, boards, cardboard, etc.
Before being examined by a doctor, your hand should be kept at waist level or raised up - this will reduce swelling and pain. It is necessary to put cold on the injured area through the fabric: ice, a bottle of water and other similar things.
Diagnostics
An accurate diagnosis of a fracture of the radius of the arm occurs after an X-ray examination. From the image you can determine the presence of damage, its type and type. Also, after the examination, the doctor suggests the approximate time of wearing plaster immobilization.
In difficult situations, additional MRI or CT diagnostics are required. Such studies are carried out to determine the nature and extent of associated injury.
Treatment of damage
The duration of treatment for a fracture of the radius of the arm depends entirely on the method. Among them are:
- conservative;
- surgical intervention.
Conservative methods
This type of assistance consists of fixing the injured arm using a plaster splint. The conservative method is used for non-displaced joint fractures. Gypsum can be made from standard materials or polymer. The second type of dressing is expensive, but can be exposed to water.
After application, you must visit the clinic several times a week for further examination. The traumatologist will monitor the condition of the bandage and arm. After the swelling subsides (approximately 7-12 days after the injury), a repeat X-ray examination is performed. Such diagnostics prevents accidental displacement of the bone and makes it possible to more accurately determine the time of wearing the fixation.
Surgical methods
Treatment for a displaced fracture of the radius of the arm is performed surgically. Also, multi-fragmented and complex intra-articular injuries require such intervention. Traumatologists, under local or local anesthesia, meticulously restore the bone and reduce fragments.
In medicine, repositions are divided into 2 groups.
- Closed. This method is considered more conservative, because the reduction of fragments does not require surgery and is carried out manually by specialists under local anesthesia. By performing the necessary movements, traumatologists install the bone in the correct position. This manipulation requires high concentration and precision. Returning the radius to its anatomical position is a very important process, the incorrect implementation of which can lead to serious complications.
- Open. This manipulation is performed surgically under general anesthesia. Traumatologists make an incision over the damaged area to gain direct access to the fragments. The goal of the process is to eliminate displacement and fix the fragments in the correct position using a specific structure. This action is called osteosynthesis. After this procedure, swelling and pain in the damaged area are reduced, and the rehabilitation process after a fracture of the radius bone of the arm is accelerated.
Osteosynthesis methods
Depending on the location of the injury, the time that has passed since the injury and the degree of displacement, doctors distinguish several methods of osteosynthesis.
- Using knitting needles.
- By applying a plate. This method is suitable for the wrist joint area.
- Using the Ilizarov apparatus (distraction apparatus). This method is used for multiple small fragments and severe bone fragmentation.
After providing assistance and applying a plaster splint, some patients experience pain at the site of the fracture of the radius bone of the arm. The timing of fusion depends on the correctness of the doctor’s recommendations, the severity of the damage and the individual characteristics of the body. Often the joint swells at first. Doctors recommend holding your arm in an elevated position and using painkillers.
Rehabilitation measures
Treatment of a fracture of the radius of the arm and the timing of healing after removal of the cast depend on the correct implementation of rehabilitation measures. It involves developing the elbow and wrist joints. If rehabilitation is carried out incorrectly, ignoring the advice of the attending physician, you may lose the full functionality of your arm.
Each specific injury requires a specific, individual series of exercises and activities. In most cases, when the radius bone of the arm is fractured, physical therapy, therapeutic exercises and massage on the damaged area are prescribed.
Complications and possible consequences
After a fall with support on your hands, you should pay attention to the symptoms that appear. If there is pain, swelling of the impact site, crepitus of the bones and impaired movement, you should think about a fracture and consult a doctor to make a diagnosis. In the absence of a timely response, complications can occur. Moreover, some of them lead to disability.
Complications of a radius fracture include the following.
- Nerve rupture. These elements in the human body are responsible for sensitivity (heat, cold, sensation of objects) and movement.
- Tendon damage. They carry out flexion and extension movements and a grasping reflex.
- Muscle rupture. After such damage, contractures and shortening of limb length may form.
- With open fractures, the wound may become infected, which subsequently leads to osteomyelitis.
- Change in the appearance of the hand (with improper fusion of bones).
To prevent any of these situations, you should promptly consult a doctor to diagnose the damage.
