Fracture of arm - Causes, symptoms and treatment. MF.

Hand( upper limb) - this is the organ, the structure of which in many respects distinguishes us from other animals and allows us to work, develop, relax and enjoy life. Therefore, it is very important to properly fuse the fractures of the hand and maximize the restoration of functionality.

Fractures of the hand combine: fractures of the humerus, fractures of the forearm, fractures in the area of ​​the elbow joint, as well as fractures of the hand and fingers. These areas can be damaged both separately and conjugate, with a significant traumatic effect. The most common are a fracture of the radius in a typical place, a fracture of the surgical neck of the shoulder, a fracture of the metacarpal bones of the hand and fractures of the fingers.

Skeleton of the hand

Symptoms of a fracture of the hand

For fractures of the hand, the general symptoms of fractures are characteristic:

• The pain of at the site of the fracture can give to neighboring areas, for example, pain in the fracture in the elbow region rests in the forearm and shoulder. The pain syndrome is of a strong nature, its intensity is sharply increased when moving and creating an axial load on the limb.

• Swelling and bruising .This symptom is also found in any of the fractures of the hand. Edema is usually very pronounced with fractures of the hand, fingers, elbow joint area.
• Deformation and shortening of the of the damaged segment is noted for fractures with displacement, most often visible in fractures of the humerus and fractures of the forearm.
• Restrictions of movements in the joints of near the fracture site. Thus, if the radius of the radial bone is broken in a typical place, the movements in the radiocarpal joint will be limited, and if the humerus fractures, the shoulder and elbow joints will be restricted.
• Bone fragments crack .Symptom is not always, it is characteristic for fracture of the shoulder, the elbow process.
• With nerve damage , at the time of fracture, there may be paralysis of the hand and fingers, a violation of sensitivity. Nerves are most often damaged by fracture of the humerus.

More details about the symptoms that are typical for the damage to each area of ​​the hand can be found in separate articles on our website.

First aid for suspected hand fracture

With a fracture of the arm and suspicion of it, the main task is the to immobilize the damaged segment and the adjacent joints. Immobilization( immobilization) is achieved by imposing tires from improvised materials, boards, strong bars, even sticks will do. The found construction is pribintovyvayem to the damaged segment of the hand and provide his property, as a consequence, reduce pain and prevent the displacement of fragments.

An unprepared person may have difficulty in ensuring immobility of the shoulder and elbow joints. Therefore, in order not to harm and not cause unnecessary suffering, it is better to limit yourself by hanging your hand on a kerchief.

In the case of finger fractures, a comb or nail file can be used to make the tire, and it is also possible to pribintovat the damaged finger to the adjacent finger. You can not try to "level off" the damaged segment of the hand by force, try to set something yourself, etc., if you are not sure of your knowledge, it's enough to hang the injured hand on the kerchief.

Hand immobilization for fracture

Anesthesia. Any anesthetic drug in the home medicine cabinet( ketorolac, analgin, aspirin, nimesulide, etc.) will do. It is important to remember - if you are not sure that this medication is pain medication, or have not met with it before, do not engage in self-treatment, it is better to wait for the arrival of emergency medical care.

Fractures of the hand, especially the fractures of the hand and fingers, are often accompanied by swelling of the fingers. To prevent the build-up of edema and the necrosis of the finger, it is better to get rid of rings and other ornaments on the damaged arm in the first few minutes. But you do not need to try to bite the ring yourself if you fail to remove it. For a couple of hours on a swollen finger, it does not hurt, and a specialist in the hospital department will help you to remove it more competently and painlessly.

Open fractures are accompanied by bleeding. It should be remembered that the application of a tourniquet is necessary only for arterial bleeding from large arteries( bleeding will be abundant and pulsating, with scarlet blood).In other cases, it is enough to apply a tight bandage bandage.

Diagnosis of a hand fracture

Symptoms typical for hand fractures can occur with bruises, ligament injuries and dislocations, so an X-ray examination is used for diagnosis. Very rarely( if the diagnosis is unclear) requires a computerized tomography. If the nerves are damaged, it may be necessary to examine the neurologist.

Hand fracture treatment

Hand fractures without dislocation are treated by applying a gypsum tire or a circular gypsum dressing. In case of fractures of the shoulder, the gypsum is imposed from the "bones" at the base of the fingers to a healthy scapula. Fractures of the forearm and the area of ​​the elbow joint require the imposition of gypsum from the "bones" to the upper or middle third of the shoulder. Fracture of the radius in a typical place - from the "ossicles" to the upper third of the forearm. A similar cast is superimposed on fractures of the hand bones, sometimes with the gripping of the fingers. Currently, with fractures of the fingers instead of gypsum, special immobilizing tires are used.

Terms of wearing gypsum are also different. Fracture of the shoulder - 6-8 weeks, fracture of the forearm 6-8 weeks, fracture of the radius in a typical place - 4 weeks, fractures of metacarpal bones - 3-4 weeks, fractures of fingers - 3-4 weeks.

In fractures with displacement, the fracture is reversed and the gypsum is applied for the same period or 1-2 weeks more.

Fractures with many fragments, irreparable and open fractures operate and install various metal structures: knitting needles, screws, plates, rods. In the future, also impregnated with gypsum. Screws and knitting needles are removed several months or years after the injury. In fractures of the shoulder, skeletal traction can be used to correct and hold the fracture, for a period of 3-4 weeks. After stretching, a plaster bandage is also applied.

From drugs for hand fractures are used: calcium preparations( kaltsemin), painkillers( ketorol, nimesulide), various anti-inflammatory ointments( ultrastin, fastum gel, ketoprofen, etc.).

Rehabilitation after a fracture of the hand

After the first component of the treatment of fractures of the hand - the installation and retention of the fragments in the correct position, proceed to rehabilitation measures. Rehabilitation includes: physiotherapy, physical therapy and gymnastics, massage, occupational therapy.

After 2-3 days from the moment of injury, they begin active movements in a healthy hand, to movements in "not gipsy joints" and fingers.

From the first 3-10 days after the injury,

• Interference currents can be assigned. This type of physiotherapy is aimed at reducing swelling and pain.(course 6-10 sessions)
• Ultraviolet irradiation of a healthy limb in a symmetrical area. Reflex way to improve blood circulation at the site of the fracture( 6-10 sessions).

From the same period, they start isotonic( without making movements) muscle strains in the injured limb.

Two weeks after the injury and after the removal of the gypsum, the following are assigned:
• Magnetotherapy .The action of magnetic fields improves blood supply, removes puffiness, accelerates the healing of the fracture, promotes the fastest development of movements.
• Laser therapy .The therapeutic effect due to the improvement of microcirculation and the removal of inflammation at the site of the fracture.
• UHF .The electric field of high frequency also helps to relieve edema, reduce inflammation and pain syndrome.
• Ultrasound .With the help of ultrasound, it is possible to deliver various therapeutic substances to the site, for example, the hydrocortisone ointment, which has a significant anti-inflammatory and analgesic effect.
• Electrophoresis of novocain solution , has analgesic effect.

All procedures are appointed in a comprehensive manner and selected individually. The number of sessions can vary from 6 to 15 or more procedures.

In the later period, after removal of gypsum and removal of inflammation, mud treatment, paraffin baths, baths with sea salt, coniferous baths are prescribed. The main task of these procedures is to improve the development of joint movements and to strengthen weakened muscles under gypsum. Also, mud treatment and saline baths help to improve blood circulation and the fastest recovery of the injured hand and the body as a whole.

After removal of gypsum, along with physiotherapy, an active therapeutic exercise is carried out. Exercises are made with an emphasis on the most affected joint. With a shoulder fracture, it is necessary to actively develop the shoulder joint, with a fracture of the bones of the forearm and the area of ​​the elbow joint - the ulnar joint. With a fracture of the bones of the hand and radius in a typical place - carpal joint and finger joints. Each exercise should be performed for 10-15 repetitions, 3-4 times a day. With the intensification of pain, it is necessary to take a break or apply anti-inflammatory ointments, the load should be increased gradually, without sudden movements and transitions. For more effective impact on joints and the fastest development of muscles, some exercises need to be performed in water, preferably in the sea.

Complexes of exercises for each of the arm joints are examined in separate articles on our website:
development of the shoulder joint, elbow joint development, wrist joint development, joint and finger joint development.

An important component of restorative treatment is massage. Massage should be performed gently, starting with the intact segment of the arm. Only 6-10 weeks after the injury, a slight massage of the muscles of the broken segment is allowed, and after a good formation of the bone callus( fracture fusion), more active massage movements are allowed.

For the purposes of occupational therapy, the following is used: needlework( knitting, embroidery, drawing), light work in the garden or on the site, as well as small-scale housework. Occupational therapy is the last stage of returning to a full life and complete restoration of the function of the hand.

Forecast and timing of arm fracture treatment

General treatment terms, including rehabilitation, for various areas of the arm fluctuate. With a fracture of the surgical neck of the shoulder, the function of the hand is practically restored after 2-3 months, the humerus bodies - 3-4 months, fractures of the forearm bones( ulnar and radial) - 2-3 months, radius in a typical place - 1-2 months, fracturesThe bones of the hand are 1-3 months old, the scaphoid bone is 3-6 months old, the fractures of the fingers are about 1 month. In the presence of contractures( restriction of movements) of joints and open fractures, the treatment time increases significantly and reaches 6 months or more. And with damage to the nerves or the presence of infection in the bone, treatment can be delayed for years.

Trauma Physician Voronovich NA