Contents
Closed facility
The doctor manipulates the bone fragments to bring them back into their correct position (reposition) without making a skin incision or exposing the fracture; different types of anesthesia can help to make this situation bearable for the patient.A splint or cast is attached and manually modeled on the patient’s forearm and hand.
The cast usually reaches above the elbow to increase stability and neutralize the external forces that can arise from the natural movements of the upper and lower arm.
How a fracture is treated after a closed facility varies from case to case and depends on a number of factors affecting the patient and the X-rays.
The patient’s condition and needs play a fundamental role when considering the various treatment options, including general health, age, activity levels and bone quality.
After weighing these factors, the surgeon must decide whether the fracture is sufficiently stable or whether there is a risk of correction loss, and will then recommend one of the following treatment options.
Gypsum for radius fracture
The cast gives the hand and forearm external stability, applying slight pressure to the skin and soft tissues underneath. It forms a rigid shape that holds the established bone in the correct position during healing. If the fracture is stable and has been precisely repositioned, immobilization in the plaster may already be sufficient.
The plaster cast must be applied several times during the healing process.
It can be hselt so that it fits tightly and can give the fracture a secure hold. It can end below or above the elbow and also include the thumb, depending on the type of injury and the doctor’s preferences. The dressing is usually made of a different material at the initial stage of treatment, because the area is still swollen and the pressure exerted must not be too great to avoid nerve and vascular injuries.
After the first week, a harder and lighter material is used for the subsequent healing phases.
Surgery for radius fracture
If the fracture is treated surgically, bone healing begins after two weeks. Patients can obtain a second opinion during this time in order to better assess the different treatment options.
The time that elapses until the operation has no effect on the final result.
Taking into account the severity of the injury and the short- and long-term effects of the injury on daily activities and what aids are necessary, the patient must be fully informed about the treatment options available, the expected results and possible complications.
Internal fixation in case of radius fracture
Internal fixation is carried out in an open procedure; above the fracture, an incision is made and a stainless steel plate with screws is inserted to bring the bone ends into a correct axis position and to prevent a later loss of correction.
The advantages of internal fixation are:
- increased stability;
- strategic positioning of fixatives;
- no external device required
- less bulky gypsum; previous use of the hand.
Percutaneous fixation with screws and plaster
For some types of fractures, the use of one or more screws may be sufficient to create a stable situation.
The screws can be inserted without a skin incision under local anesthesia.
The wrist is then immobilized in a plaster cast until healing.
After the screws have been removed, physiotherapy can begin.
The advantages of percutaneous fixation are:
- adequate stability, for the fact that the treatment was closed;
- no permanent fixation device necessary;
- minimal bone and soft tissue complications;
- less painful than other methods;
- reduced scars and no surgical incision.
External fixation in case of radius fracture
External fixation has been used for many years and provides for the use of a fixator positioned on the outside of the body, which is fixed on both sides of the fracture with the help of screws; to insert the screws into the bone, small skin incisions are made.
Recent random broad-spectrum studies confirm that this method has better clinical and functional outcomes for some forms of fractures than the more invasive surgical procedures.
In the external fixation method, the external fixator is usually used together with (percutaneously attached) screws and bone implant to directly strengthen and support the bone fragments; in this way, less tensile force is required, which must be applied by means of a fixing device.
The wrist can thus take a comfortable position and the fingers can be used almost immediately after the procedure for light everyday activities.
The advantages of an external fixation are:
- proven technology;
- minimal injury to soft tissues;
- the entire retaining frame is removed;
- very small scars remain because the incision is minimal;
- a bone implant can be inserted to support the joint surface;
- equal or better radiological, clinical and functional results.
The disadvantages of external fixation are:
- bulky metal or plastic framework on the wrist;
- screws protruding from the skin and the need for medication;
- physiokinesitherapy of the wrist may not begin until weeks after the procedure.
Complications of surgical intervention
The procedure is not necessarily suitable for everyone.
Possible complications of surgery:
- Correction loss possible;
- detachment of osteosynthetic agents (plates, screws, etc.);
- incorrect positioning of plates or screws;
- Infection;
- re-intervention;
- Injury to a nerve;
- tendon damage;
- Stiffness.
Read more:
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- spoke fracture, rehabilitation
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