Fracture of the hand is diagnosed in more than 30% of cases of contacting a traumatologist with a violation of the integrity of the bones. In any traumatic situation, a person tries to defend himself with his palms in front of him, which explains the high prevalence of injury. Severe damage to the hand is manifested by vivid symptoms, which is similar to a severe bruise. Despite the characteristic clinical manifestations, an x-ray study is used to clarify the diagnosis.
A fracture is an open or closed injury, which is based on complete or partial damage to the bone structure. The brush consists of 27 small bones that are easily injured.
In everyday life, hands are involved in performing various manipulations. Therefore, it is not surprising that a fracture of the hand is recorded in every third patient with a similar injury. According to statistics, the fingers and bones of the wrist are most often broken.
Violation of the integrity of one or more bones of the hand leads to the development of a vivid clinical picture, the variety of which depends on the location of the fracture. All manifestations can conditionally be divided into general and specific signs.
- piercing pain – numerous pain receptors are on the palms and in the fingers;
- edema, which is not limited to a damaged brush, but extends to the wrist joint and forearm;
- hematoma – subcutaneous hemorrhage can be localized or occupy a large area;
- bluish skin over a broken bone;
- hand movements are impossible;
- unnatural deformation of part of the brush or finger, as well as protruding bone fragments viewed under the skin;
- open fractures are characterized by the presence of a wound in which damaged muscles and bones are visible;
- on the injured area, the skin is hot to the touch.
A fracture of the hand is easy to suspect if a history of falling or crushing of the upper limb is present.
Given localization, the following specific signs are observed:
- Wrist area – fingers of the victim “do not work”, it is impossible to squeeze a hand into a fist. When trying to move, a piercing pain impulse appears with irradiation into the phalanges of the 3 and 4 fingers, as well as into the scaphoid.
- If the bones at the base of the fingers are destroyed, an attempt to move 2 fingers causes acute pain. In this case, the first finger is in a forced position: pressed to the brush in a bent form.
- Violation of the integrity of the fingers is accompanied by deformation of the phalanges with a deviation from the vertical axis.
With the displacement of bone fragments under the skin, a solid formation is noticeable.
On palpation, it painfully and easily moves with a crisp sound, which indicates crepitus due to the friction of parts of the broken bone against each other.
In practical traumatology, several types of bone damage are distinguished. Given the violation of the integrity of the skin, there are closed and open fractures. In turn, trauma, as a result of which deep skin tissues, muscles, connective tissue communicates with the environment (earth, air, surface of objects) are considered infected.
By the nature of the damage:
- Simple – the bone is destroyed in one place, while fragments do not form.
- Fragmentary – as a result of trauma, 2 fault lines are obtained, as a result of which a fragment of bone tissue is formed between the fragments of the destroyed bone.
- Cellulose – in the area of damage, the bone is fragmented, surrounded by small fragments.
- Crushed – severe trauma leads to disruption of the anatomically correct shape of the parts of the bone formation, which complicates their comparison.
In addition to the direction of the fracture line, the severity is determined by the presence of displacement of bone fragments. Offset damage is more difficult to treat than an uncomplicated injury.
By type of damage:
- full – with a fracture of the bone in one or more places;
- incomplete – cracking;
- as a “green branch” – more common in childhood, integrity is preserved in the periosteum.
In addition, the destruction in the middle of the bone is called diaphyseal, in the region of the heads – epiphyseal. If the bones break inside the joint, an intra-articular injury (Bennett and Rolando fracture) is diagnosed, or extra-articular if the fracture line is outside the joint.
Bennett fracture is characterized by destruction of the bone at the base of the thumb. In this case, a part of the bone in the shape of a triangle, which remains motionless, breaks off. Rolando fracture – fragments appear at the fracture site (metacarpal bone of the thumb), a slit hole in the form of the letter “Y” is visible on the x-ray in the injured area.
If a fracture of the hand occurs as a result of a serious injury, the bone is destroyed under the influence of external force. When in older people, damage is observed for no reason or after mild exposure, we are talking about the pathological etiology of the fracture.
In most cases, injury to the hands occurs as a result of mechanical action of an external force. Squeezing by heavy objects as a result of a load falling or pinching of the distal part of the arm between hard surfaces. A fracture of the hand can provoke a strong blow or fall, with emphasis on the hand.
In older people, a bone fracture appears after an injury, which in a healthy person cannot cause a similar reaction. Increased injuries due to a decrease in the mineral composition of the bone after the development of the following conditions:
- leaching of calcium after uncontrolled intake of diuretics;
- hormonal disorders;
- degenerative processes due to age.
A large percentage of injured patients are children, which is explained by high mobility and enthusiasm for outdoor games.
Initially, the determination of the type of injury is based on external manifestations. A traumatologist examines the damaged area, listens to the complaints of the victim, and clarifies the time and details of the injury. Given that, according to common signs, a fracture of the hand is in many ways similar to a dislocation and a strong bruise, a hardware study is performed using an X-ray.
At the same time, for greater informational content, radiography is prescribed in two projections. In some cases, due to severe edema, fracture symptoms are not visualized. Then the diagnosis is postponed for 8-10 days, and while waiting, the hand is immobilized with a rigid bandage made of gypsum or polymer bandages.
If the fracture is confirmed by repeated radiography, the traumatologist determines the method of further treatment, taking into account the nature of the injury, age and health of the patient.
Injury, as a result of which a fracture of the hand develops, can happen in everyday life and on the street, in the workplace or during rest. Wherever an unpleasant event occurs, the victim needs qualified assistance. Deterioration can develop rapidly, therefore, before meeting with a medical specialist, it is important to conduct pre-medical measures on the spot.
Emergency care involves the following actions:
- A damaged arm must be inspected. If there are jewelry, carefully remove them, if you do not need to make an effort. When the rings are not removed, it is not necessary to do this forcefully, so as not to complicate the fracture.
- If the skin is damaged, the wound is carefully cleaned of foreign objects. The damaged area can be treated with an antiseptic solution (3% hydrogen peroxide) and covered with a sterile cloth to prevent further infection.
- The brush must be immobilized. A tire is not used for immobilization. The hand is fixed to the body, hanging on a scarf or other fabric in the form of a “scarf” at a right angle. Another option is to bandage the hand to the body without affecting the hand, so as not to cause displacement of bone fragments.
- With severe pain, the victim is given an anesthetic (Tempalgin, Ketorol). If a psychoemotional state suffers, valerian extract is suitable as a sedative.
After carrying out the manipulations, the victim is taken to the nearest trauma center.
The main goal of therapeutic measures after a fracture is to restore the functions of the hand in full. This will require a set of measures, which includes a comparison of bone fragments to restore bone integrity with subsequent rehabilitation.
Uncomplicated injuries are successfully treated at home after preliminary immobilization. For this, a fixing bandage of plaster or polymer bandages is applied to the injured brush. If it is possible to do without surgery, the bones are set, after which the hand is immobilized.
With complicated injuries, medical manipulation is performed during the operation. In this case, the edges of the bone are fixed using metal pins or staples. After that, the brush is gypsum, while in order to exclude the possibility of the slightest instability, the bandage begins on the fingers and reaches the elbow joint.
The duration of fixation in time varies from a couple of weeks to several months, depending on the number of broken bones and the complexity of the fracture. At the time of wearing the retaining bandage, the hand is placed in a bandage according to the type of “scarf” in order to prevent tension of the injured upper limb.
For simple fractures of the hand as an immobilization, it is allowed to use a bandage on the wrist joint of rigid fixation. The detachable design is equipped with metal plates, which makes the brush impossible to move. The orthosis is easy to put on, which makes it possible to care for your skin. If a finger is damaged, there are medical devices that separately fix the finger.
Periodically, a pain syndrome may appear. To eliminate the pain, non-steroidal anti-inflammatory drugs are prescribed – Diclofenac, Ketorolac. With the development of severe inflammation or insufficient effectiveness of NSAIDs, the use of glucocorticosteroids – Prednisolone, Hydrocortisone may be required. To enhance regeneration, chondroprotectors – Teraflex, Structum are used.
In the framework of rehabilitation measures, the main directions are used:
The recovery period begins with the removal of the plaster cast. After prolonged physical inactivity, the blood circulation of the hand and fingers worsens, the amplitude of movement decreases, the muscles atrophy, and there is no possibility of complex manipulations.
To improve the functioning of muscle fibers and enhance hemodynamics, a therapeutic massage is performed. In addition, passive physical effects develop the joints, gradually increasing their mobility. At the same time, the doctor selects therapeutic exercises for the hand. The initial sessions of exercise therapy are controlled by the instructor, in the subsequent classes are conducted independently.
To speed up recovery, a course of physiotherapy is performed. The methods can be applied not only for therapeutic purposes during the rehabilitation period, but also to maintain a stable therapeutic effect every six months.
When a fracture of the hand is prescribed:
- magnetic therapy;
- laser exposure;
- ultrasonic wave treatment.
The prognosis after injury depends on the type of fracture, severity, speed of contacting a doctor, age and general functional state of the patient. Most often, with strict adherence to the recommendations, the brush is restored completely.
To avoid severe injury, you must adhere to safety rules when performing various manipulations. To prevent falls, wear comfortable shoes. During sports use protective equipment. Proper nutrition and timely treatment of chronic diseases will prevent bone fragility, which contributes to the development of trauma. If an accident has occurred, a visit to the doctor should not be delayed. A fracture of the hand can lead to its immobility, therefore, the assistance provided should be effective and immediate.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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