Hand fracture – violation of integrity of one or several bones of the top extremity as a result of a trauma. The injury of a humeral bone, elbow and beam bone (isolated or simultaneous), bones of a wrist, pyastny bones and bones of a brush is possible. Clinical manifestations can significantly differ. The general signs are sharp pain, a swelling, bruises and restriction of movements. In some cases shortening and deformation of an affected segment, a bone crunch and pathological mobility comes to light. For confirmation of the diagnosis use a X-ray analysis, is more rare – KT and MPT. Tactics of treatment and the forecast at a fracture of a hand depend on a look and the nature of a trauma.
Hand fracture – one of the most widespread traumatic damages. Violation of integrity of any segment of the top extremity is possible, however the lower third of a beam bone (a beam change in the typical place), a surgical neck of a shoulder, a phalanx of fingers and pyastny bones most often is surprised. There is a certain interrelation between the level of a change and age of the patient. So, shoulder neck fractures come to light at elderly people, beam changes in the typical place more often – at children and elderly patients, changes of a diaphysis of a shoulder, phalanxes of fingers and pyastny bones – at patients of young and middle age.
The fracture of a hand can be isolated or multiple. Especially often multiple fractures of pyastny bones and phalanxes of fingers meet. In some cases fractures of a hand are complicated by a sdavleniye or injury of nerves, especially often such complications come to light at changes of a diaphysis of a shoulder and intra articulate fractures of an elbow joint. Perhaps also combination to other injuries: clavicle fracture, shovel fracture, fractures of edges, injury of a thorax, basin change, fractures of the lower extremities, ChMT, rupture of a bladder, stupid injury of a stomach and injury of a kidney. Treatment of fractures of hand is performed by traumatologists.
The hand of the person includes three segments: shoulder, forearm and brush. The shoulder is formed by one tubular bone (humeral) which consists of a semi-spherical head, a neck (border between a head and a diaphysis), a diaphysis and the expanded and flattened lower part which is coming to an end with the block and a golovchaty eminence. Over an eminence two hillocks – lateral and medial nadmyshchelka are located. The head of a humeral bone is jointed with an articulate hollow of a shovel, forming a shoulder joint, and its disteel part connects to blokovidny cutting of an elbow bone and a head of a beam bone.
Proximal parts of a beam and elbow bone are jointed among themselves too. Thus, the difficult elbow joint which includes plecheloktevy, plecheluchevy and lokteluchevy the joints concluded in the general capsule is formed. The forearm is formed by two tubular bones: beam and elbow. The beam bone settles down from a thumb, elbow – from a little finger. In the top (proximal) part the elbow bone is thicker beam, in lower – on the contrary. In a middle part of a bone have approximately equal thickness. In the lower department the beam bone extends, and elbow is narrowed. The beam bone is jointed by the disteel end with a proximal number of bones of a wrist, forming a luchezapyastny joint.
The brush consists of 27 bones. In a proximal part of a brush there are 8 small spongy bones of a wrist located in two ranks (up to 4 bones in everyone). To a disteel number of bones of a wrist 5 tubular pyastny bones, and are attached to them – tubular bones of the main phalanxes of fingers. The II-V fingers consist of three phalanxes, the I finger – of two. Unlike other pyastny bones, the I pyastny bone connects to wrist bones by means of a mobile joint that provides full functioning of a brush: assignment and opposition of a thumb, capture of objects etc.
Depending on the cause in traumatology allocate traumatic and pathological (not traumatic) fractures of a hand. Traumatic fractures of a hand are formed at intensive traumatic impact on a bone with normal structure. Pathological changes arise at the congenital and acquired pathological states which are followed by violation of structure and durability of bones including at osteoporosis, osteomyelitis, a bone cyst, a benign tumor of a bone, primary malignant tumor of a bone, metastasis in a bone of tumors of other localizations, giperparatireoidny osteodystrophy, genetically determined imperfect osteogenesis and some other diseases.
All fractures of a hand are subdivided on dug out (with damage of integuments) and closed (without damage of integuments). At violation of integrity of skin at the time of a trauma open fractures of a hand are called pervichnootkryty, at injury of skin otlomky bones after a while after a trauma (for example, in the course of transportation) – vtorichnootkryty. Open changes usually full, closed fractures of a hand can be full or incomplete. At complete fractures integrity of a bone is completely broken. At incomplete damages the bone cracks, but does not break completely (crack), or the small site (a separation of hillocks of bones, a regional change) comes off it.
Taking into account localization distinguish the following fractures of a hand:
- Epifizarnye – the line of a break settles down in the field of an epifiz (end) of a bone. In most cases it is intra articulate damages.
- Metafizarnye – the line of a break is localized in an intermediate zone between the end of a bone and a body of a bone. Such changes are circumarticular.
- Diafizarnye – the line of a break settles down in a bone body. Such damages, in turn divide into changes in the lower, average and top third.
Depending on the direction and character of a break allocate several types of fractures of hand:
- Cross – the line of a break passes perpendicular to a bone.
- Longitudinal – the line of a break is located parallel to a bone.
- Spiral – the line of a break reminds a spiral.
- Slanting – the line of a break passes at an angle to a bone.
- Splintered – three or more otlomk are formed.
- Shattered – a large number of small otlomk is formed.
There are hand fractures with shift and without shift. Taking into account the displacing factor distinguish primary and secondary shift. Primary shift arises under the influence of the injuring force at the time of damage, secondary is formed because of draft of the muscles which are attached to bone otlomka. Shift on width, on length, angular or rotational can be observed (rotation of one otlomk is relative another). All fractures of a hand are subdivided on stable and unstable. At stable changes (usually cross) otlomk well keep in the correct situation. At unstable (slanting, spiral) the expressed tendency to secondary shift because of the accruing reduction of muscles is traced.
Except usual fractures of a hand there are perelomovyvikh – damages at which the combination of a change and dislocation of a bone is at the same time observed. Usually perelomovyvikh arise at intra articulate damages, however also other combinations, for example, a change of a diaphysis of one of forearm bones in combination with dislocation in an elbow or luchezapyastny joint (damage of Galeazzi and Montedzhi) meet. Fractures of a hand can be complicated by damage of vessels and nerves.
Fractures of a shoulder make about 7% of total number of changes. The most widespread – injuries of a surgical neck of a shoulder. More often elderly patients suffer, the trauma arises when falling on a hand. The joint is edematous, painful at the movements and a palpation, the movements are sharply limited. For confirmation of the diagnosis carry out a X-ray analysis of a shoulder joint. Treatment usually conservative – the closed repozition with the subsequent imposing of a bandage of Dezo who is taking away tires or bandages on Turnera. At nereponiruyemy and unstable changes at patients of working-age expeditious treatment – an osteosynthesis of a surgical neck of a neck of a shoulder is shown by a plate or spokes.
Shoulder diaphysis changes usually come to light at persons of middle and young age. The direct stroke, twisting of a hand ("a police change") or falling on a hand becomes the reason. Perhaps accompanying injury of a beam nerve. The trauma is shown by pain, a swelling, deformation, pathological mobility, a krepitation and sharp restriction of movements. At injury of a nerve violations of sensitivity and movements in a zone of an innervation of a beam nerve are observed. The diagnosis is specified by means of a shoulder X-ray analysis, at suspicion appoint consultation of the neurologist or neurosurgeon to injury of a nerve.
Treatment can be conservative or quick. At the choice of conservative tactics impose extension which after formation of primary callosity is replaced with a plaster bandage. The absolute indication to operation is the unsuccessful attempt of comparison of otlomk by means of skeletal extension, interposition of soft fabrics, a chronic injury and threat of injury of a nerve. In some cases surgical intervention is carried out according to relative indications for early activization of the patient and prevention of development of post-traumatic contractures. The osteosynthesis of a humeral bone a plate or an intra bone nail is possible.
At injury of a nerve and good comparison of bone otlomk perhaps conservative treatment: an immobilization, LFK, physical therapy, reception of the medicines promoting regeneration of a nerve. In the absence of signs of regeneration of a nerve within several months surgical intervention – and plasticity of a nervous trunk with use of an autograft from a superficial nerve is shown.
Damages of the lower end of a shoulder can be extra articulate (nadmyshchelkovy) intra articulate (myshchelkovy). Refer ekstenzionny and fleksionny damages to nadmyshchelkovy changes, to chrezmyshchelkovy – head changes, and also V-and T-shaped changes of the block. Usually damage is result of an indirect trauma – falling on an elbow or on the taken-away and outstretched arm. Are shown by hypostasis, pain, deformation of a joint and sharp restriction of movements.
The diagnosis is confirmed by means of a X-ray analysis of an elbow joint. At hand fractures without shift carry out an immobilization. In the presence of shift for restoration of congruence of articulate surfaces perform operation – an osteosynthesis of condyles or nadmyshchelok a plate, screws, spokes and bolts couplers. In the recovery period at changes of the top and average third of a shoulder appoint physiotreatment and LFK. At intra articulate damages the physical therapy is contraindicated.
Fractures of a forearm make 11-30% of total of changes. Arise at the direct mechanism of a trauma more often, the blow in a forearm, falling from height or road accident becomes an immediate cause of a fracture of hand usually. As a rule, both bones break, is more rare – one (beam or elbow). Sharp pain, hypostasis, restriction of movements and deformation in the place of damage is characteristic. At diafizarny fractures of a hand the krepitation and pathological mobility often comes to light. For specification of the diagnosis carry out a X-ray analysis of an affected segment.
At the isolated changes of one of bones of a forearm it is necessary to exclude damages of Galeazzi and Montedzhi. Damage of Galeazzi represents a beam diaphysis change in a combination to the shift of a head of an elbow bone in a luchezapyastny joint. In similar cases carry out a X-ray analysis of a forearm and a X-ray analysis of a luchezapyastny joint. Montedzhi's damage includes a change of a diaphysis of an elbow bone and dislocation or an incomplete dislocation of a head of a beam in an elbow joint. At such injuries the X-ray analysis of a forearm and a X-ray analysis of an elbow joint is necessary.
At hand fractures without shift carry out anesthesia, impose plaster, after the termination of an immobilization appoint physical therapy, massage and LFK. At diafizarny changes with shift surgery – an osteosynthesis is shown by a pin, a plate or Ilizarov's device. At damages of Galeazzi and Montedzhi carry out the closed repozition and an immobilization a plaster bandage, at impossibility of reposition and unstable changes carry out surgeries.
Fractures of bones of a brush
Make more than 30% of total of skeletal injuries. Result from falling or blow to a brush. Injuries of bones of a wrist meet seldom. The complicating moment at injuries of a boatshaped bone is the high quantity of not accrete changes, a rassasyvaniye of otlomk, formation of cysts and false joints. Treatment is conservative, in the absence of an union and development of complications perform operations – an open osteosynthesis, removal of the deprived food of an otlomk or a hand joint. Fractures of other bones of a wrist, as a rule, grow together without complications.
Fractures of pyastny bones are observed often, can be opened or closed, multiple or single. Are shown by hypostasis, cyanosis, pain and difficulty of movements. Sometimes pathological mobility and visible deformation comes to light. For confirmation of the diagnosis appoint a brush X-ray analysis. Treatment conservative – the closed repozition, plaster. At unstable fractures of a hand and unsatisfactory result of a repozition carry out an open osteosynthesis, skeletal extension or the closed fixing by spokes.
Fractures of fingers are also widespread. Can be closed or opened, out of - and intra articulate, splintered, spiral, cross or slanting. The diagnosis is specified by means of a X-ray analysis of fingers of a brush. Treatment is more often conservative. At impossibility of comparison or deduction of otlomk use the closed or open fixing by a spoke, sometimes impose skeletal extension.