The symptoms of radius fracture are caused by the wrist fracture of the spoke, also known as distal radius fracture, which is relatively common and means the fracture of one tubular bone of the forearm at the level of the wrist.
The forearm is formed by two adjacent tubular bones: spoke (radius) and ulna (ulna).
The spoke lies on the side of the thumb and forms two joints in this area: one with the ulna, the distal radioulnar joint, and one with various smaller carpal bones, the radiocarpal joint.
In the event of a fall on the stretched wrist, all the tension on the spoke is discharged. With excessive tension, the bone breaks.
Distal radius fracture is common in older people, but can also affect younger people. In the case of a fracture of the spoke, other bones are often involved, such as the ulna or the scaphoid bone.
The frequency of fractures is particularly high in people over 65 years of age because their bones are weakened and more likely to be exposed to fall-related trauma.
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Causes of radius fracture
As a rule, a spoke fracture is caused by a strong force on the wrist, which corresponds approximately to the body weight, as in a fall on the stretched hand.
This can happen with any fall, but it happens especially in sports such as skateboarding or snowboarding (especially on ice), where the surface is extremely hard.
Signs and symptoms of radius fracture
Typical of these injuries is a sudden pain on the wrist or forearm at the moment of the accident.
Then the patient holds the injured arm close to the chest to protect the wrist.
The pain can be felt on the thumb side of the wrist and forearm.
Symptoms may stabilize quickly; back lead
Complaints in the affected area, which become more severe at night or in the morning when getting up.
In addition, swelling may occur and the touch of the fracture site may be perceived as painful.
The pain can increase with certain movements of the wrist, such as closing a fist or during activities that strain the injured wrist, for example, when something is pushed away.
In severe radius fractures (with displacement of the fracture ends), a clear deformity is visible.
Diagnosis of distal radius fractures
A correct diagnosis begins with appropriate diagnostic procedures: X-ray examination, controls and possibly more complex, three-dimensional representations.
Computed tomography (CT) is used to check the axis position and fragmentation of the articular surface.
Magnetic resonance imaging (MRI) is used less frequently; it is used to assess concomitant injuries to ligaments or other bones of the wrist, e.g. the scaphoid bone.
From the age of 50, women with wrist fractures are usually recommended bone density measurement (osteodensitometry) in order to measure and assess the degree of osteoporosis.
A dislocated fracture, i.e. a fracture with displaced fracture ends, must first be set up (repositioned), i.e. the bone fragments are brought back into their exact, anatomically appropriate position.
If the setup is satisfactory, the diagnostic procedure (X-ray or CT) must be repeated to ensure that the position and axis orientation of the fracture ends does not shift in the first healing phase.
If the fracture is unstable due to osteoporosis or severe destruction, i.e. tends to postpone again (secondary correction loss), X-rays may need to be performed once a week.
In the case of stable fractures, fewer X-ray checks are necessary, usually only when the plaster cast is removed.
If the fracture cannot be set up satisfactorily or cannot be set up at all due to the great instability and therefore runs the risk of suffering a loss of correction when immobilization in the plaster, the bone fragments are set up and stabilized during a surgical procedure.
The operation is performed under local anesthesia.
Treatment of radius fracture
The methods for treating spoke fractures near the wrist have changed a lot in recent years.
Possible forms of treatment: no facility, closed facility with plaster, percutaneous surgery or open facility.
Closed facility
Most displaced Salter-Harris fractures are set up closed and immobilized in the plaster cast.
The closed establishment of displaced fractures is carried out under anesthesia; in this way, the pain is relieved and the reposition is non-traumatic.
Most of these injuries cause a displacement of the bone end (epiphysis) dorsally and proximal, with a deformity in palm extension.
The setup is carried out by lightly pulling and bending the distant (distal) epiphysis, the carpal and the hand over the proximal metaphysis.
The intact, dorsal periosteum is used as an elastic band to help set up and stabilize the fracture.
In contrast to similar fractures, in this case, traction of the fingers by weights is often counterproductive.
Nevertheless, the traction of the fingers during reposition can help stabilize the hand, wrist and arm and keep the arm balanced during plastering. If weights are not used, the end of the limb is held by an assistant.
Closed device and percutaneous fixation
The indications for percutaneous fixation of distal radius fractures are controversial.
The most obvious indication is a displaced fracture with median neuropathy and significant swelling of the soft tissues in the palm.
If a supply is carried out by closed device and plaster cast, there is a risk of developing acute carpal tunnel syndrome or compartment syndrome in the forearm.
The internally injured periosteum leads to bleeding of the fracture in the medial section of the forearm and in the carpal tunnel.
If this area is now enclosed by a tight gypsum, the pressure can rise to a dangerous level.
The percutaneous fixation of the nails allows the application of a wide plaster cast, without the risk of a malposition of the fracture.
Nail fixation can be done individually or twice. X-ray fluoroscopy is used to check the location of the hernia and the correct nail positioning.
The anesthesia is done to reduce pain and reduce the risk of further bone injury.
The fracture is brought into anatomically appropriate position and then the nail is inserted from the distal epiphysis of the stylus process of the spoke obliquely into the proximal part of the metaphysis of the spoke.
When inciding the skin to insert the nail, the doctor must take care not to damage the sensitive spoke nerve and extensor tendons.
The stability of the fracture is assessed based on flexion, stretching and rotational movements performed during fluoroscopy.
In children and adolescents, in many cases, the device and a single nail already provide sufficient stability of the fracture.
If one nail alone is not enough, another nail can be positioned.
The second nail is positioned parallel or diagonally to the first at the ulnar corner of the radial piphysis between the fourth and fifth dorsal compartments.
Here, too, care must be taken not to damage the extensor tendons when making the skin incisions.
The nails are curved, protrude from the skin, and are covered with sterile medication. The immobilization in the plaster cast is practiced, but this does not need to fit snugly, because the stability of the fracture is given by the nails.
The nails remain in the bone until the fracture has healed (usually 4 weeks). They can be removed on an outpatient basis without anesthesia.
If nails are used for fixation, there is a risk of causing further bone injury, even if this has not yet been scientifically documented.
As a precaution, nails of small diameter should be used and the insertion should be as untraumatic as possible.
The nails should be removed as soon as bone consolidation is stable enough for a plaster cast to suffice.
Open facility
The main indication for an open facility is an irrepayable fracture.
Often a fracture cannot be set up because the periosteum or the square inward rotation lies in between.
With the open device, access is inside via the distal side of the spoke.
The square inward rotation can also lie between the bone fragments, but this is more often the case with the periosteum.
Immobilization by gypsum is possible, but usually the stabilization of the reposition is done by a percutaneous, smooth nail.
The method of inserting the nail is the same as for the closed device.
Open fractures of the pineal gland are rare and require an open setup.
Here, special attention must be paid to epiphyseal cartilage to avoid the risks of growth blockage.
The rare fracture Salter-Harris III or fracture IV or fracture on three levels usually has to be presented openly.
The joint position can be evaluated with a CT, MRI or arthroscopy of the wrist.
Even a minimal displacement (1 mm) is not acceptable here.
Read more:
- spoke fracture, classification
- spoke fracture, treatment
- spoke fracture, rehabilitation
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