Fracture of the radius in a typical location: symptoms, treatment and restoration of the hand in Tashkent

How the radius bone breaks

The lower end of the radius is made of spongy tissue - it is light and elastic, but that is why it is the first to withstand impact. When falling forward, a person reflexively places his palm, and in a split second the entire body weight falls on a small section of the bone at the wrist. In young people, such a fracture requires serious energy: falling from a bicycle, from a height, at speed. After fifty years, especially in postmenopausal women, falling from their own height on a slippery floor or on ice is enough, because bone density decreases by this age.

Therefore, this fracture has two age peaks. The first is young people and adolescents who have received high-energy injuries in sports or on the road. The second, much more numerous, are people over sixty whose bones break from an everyday fall. In children, the situation is even more peculiar: their bone is more elastic and often breaks incompletely, like a green branch, and the fracture line often passes through the growth zone. Such injuries may look deceptively harmless in the picture, but they require the most careful observation, because displacement in the growth zone can affect the further development of the forearm.

• Falling onto an outstretched arm with emphasis on the palm - a classic mechanism
• Falling on the back of a bent hand is a rarer and more unstable option.
• Road and sports injuries, falling from a bicycle or scooter
• Osteoporosis, in which a bone breaks with minimal force
• Taking medications that reduce bone density and long-term inactivity
• Balance problems, dizziness, vision problems - anything that increases the risk of falling

Symptoms and main misconception

Immediately after the injury, a sharp pain appears in the wrist area, which intensifies when trying to turn the hand palm up or lean on the arm. During the first hour, swelling increases, and later a bruise appears, sometimes down to the fingers. With a pronounced displacement, the forearm above the hand looks stepwise curved - this silhouette is called a bayonet-shaped deformity. But with a fracture without displacement, there may be almost nothing externally except swelling, and it is precisely such cases that are most often mistaken for a bruise.

• Pain on the dorsum or palmar surface of the wrist, sharply increasing when leaning on the hand
• Rapidly growing swelling, bruising on the second or third day
• Inability to fully rotate the hand with the palm up and down
• A crunching sensation at the time of injury
• Visible deformity or shortening of the forearm when displaced
• Preserved finger movements - they do not exclude a fracture

The “try to make a fist” test does not prove anything: the flexor and extensor tendons run from the forearm through the wrist to the fingers, and a fracture of the bone itself hardly interferes with their work. In the same way, moderate pain is deceptive - with an impacted fracture, when the fragments fit tightly into each other, the pain can be tolerable. The only reliable way to figure it out is to take a picture.

Survey

1. Осмотр травматолога: оценка деформации, отёка, объёма движений, а также обязательная проверка чувствительности и кровоснабжения пальцев.
2. Рентген лучезапястного сустава в двух проекциях — прямой и боковой. Это main метод: он показывает линию перелома, величину и направление смещения, укорочение лучевой кости и наклон её суставной площадки.
3. КТ — при внутрисуставных, многооскольчатых и неясных переломах. Она нужна, чтобы увидеть ступеньку на суставной поверхности: даже смещение в один-два миллиметра внутри сустава через годы оборачивается артрозом и болью.
4. Рентген локтевого сустава и предплечья — при высокоэнергетичной травме, чтобы не пропустить сопутствующее повреждение локтевой кости.
5. МРТ или ультразвук — по показаниям, когда есть подозрение на разрыв связок запястья или повреждение хрящевого комплекса на стороне мизинца.
6. Женщинам после менопаузы и мужчинам старше 65 лет разумно после сращения обсудить с врачом обследование на остеопороз: перелом лучевой кости от простого падения — часто первый его сигнал.

It is useful to understand what exactly the doctor is measuring in the image. Three parameters are assessed: the length of the radius in relation to the ulna, the angle of inclination of its articular area in the direct projection and the inclination of this area in the lateral projection. Each of them has its own norm, and deviation beyond its limits means that the brush will work at the wrong angle. That is why the conclusion “displaced fracture” does not say anything without numbers: the displacement can be acceptable, but it can also be such that without surgery there will inevitably be a limitation in the rotation of the hand and pain on the side of the little finger.

Treatment without surgery: plaster is not just a fixation

If the fragments are positioned correctly or the displacement can be completely eliminated, treatment is conservative. The key stage here is not the application of plaster, but closed reduction - comparison of fragments with hands under anesthesia. It is done on the day of treatment, and the quality of this comparison determines the entire result. After reposition, a plaster or polymer bandage is applied and a control photograph is taken directly in the bandage.

1. Обезболивание и закрытая репозиция — врач восстанавливает длину и правильный наклон суставной площадки лучевой кости.
2. Иммобилизация повязкой, которая захватывает предплечье и кисть, но оставляет свободными пальцы и обычно локоть.
3. Контрольный рентген сразу после наложения повязки — подтверждение, что отломки стоят правильно.
4. Повторный рентген на 7–10-й день, когда спадает отёк. Это обязательный визит, а не формальность.
5. Средний срок иммобилизации у взрослых — 4–6 недель, у детей заметно меньше, у пожилых с остеопорозом решение принимается индивидуально.
6. После снятия повязки — контрольный снимок и начало разработки движений.

When is surgery needed?

The operation is not an alternative to casting “for those who want it faster.” It is performed when it is impossible to maintain the correct position of the fragments with a bandage or when the fracture passes through the articular surface. The modern standard is osteosynthesis with a plate with angular stability: through a small incision along the palmar surface of the forearm, the fragments are compared and fixed with a plate with screws. This fixation is strong enough to begin moving the brush within the next few days.

• Intra-articular fracture with a step on the articular surface
• Significant displacement that could not be corrected by closed reduction
• Secondary displacement identified on the control image
• Comminuted fracture, in which the fragments are not retained
• Shortening of the radius and change in the inclination of its articular area beyond the permissible limits
• An open fracture, damage to blood vessels or nerves is an emergency indication
• Combination with a fracture of the ulna or rupture of wrist ligaments

In addition to the plate, fixation with knitting needles, external fixation apparatus and combined techniques are used - the choice depends on the type of fracture, the condition of the bone and soft tissues. In most cases, the plate is not removed: it does not interfere and does not require repeated surgery if it does not cause discomfort. Separately, it is worth saying that surgery itself does not guarantee an ideal hand - the result is determined by the accuracy of the anatomy restoration plus discipline in rehabilitation.

Brush restoration and common mistakes

Bone fusion and restoration of function are two different things. The bone usually heals in 6-8 weeks, and the hand returns to full use in 3-6 months, with the last degrees of forearm rotation and the last pounds of grip strength taking the longest to arrive. The main enemy here is not pain, but stiffness: a joint that has not moved for several weeks is surrounded by swollen and stuck together tissues, and it needs to be developed gradually but persistently.

1. С первого дня в повязке — активные движения пальцами, локтем и плечом. Это не разрешение, а обязанность: неподвижные пальцы отекают и теряют подвижность быстрее всего.
2. Возвышенное положение руки в первые дни — кисть выше уровня локтя, локоть выше уровня плеча.
3. После снятия повязки — постепенное восстановление сгибания, разгибания и поворота предплечья, без насильственного преодоления боли.
4. Через несколько недель — упражнения на силу хвата и на мелкую моторику.
5. Возвращение к офисной работе обычно через 4–8 недель, к тяжёлому физическому труду и контактному спорту — не раньше 3–4 месяцев и по решению врача.
6. При остеопорозе — обследование и лечение основного заболевания, иначе следующим станет перелом шейки бедра или позвонка.

There are two situations that you should know about in advance. The first is numbness and night pain in the first three fingers: swelling in the fracture area compresses the median nerve in the narrow carpal tunnel, and post-traumatic tunnel syndrome develops. It usually goes away as the swelling subsides, but if symptoms persist, it requires treatment. The second is a sudden inability to straighten the thumb a few weeks after the injury. This is a sign of a rupture of the long extensor tendon, which rubs against the sharp edge of the fused bone. There may be no pain at all, and the person simply notices that the finger has stopped obeying. Such damage is repaired surgically, so there is no need to delay treatment.