Radius fracture, (distal) radius fracture, base radius fracture, Colles fracture, Smith fracture
English: fracture of the wrist
The wrist fracture is the most common fracture to occur in humans.
The reason for this is that, as a rule, many people try to use their hands to catch falls, which affects the joint.
A wrist fracture is colloquially the fracture of the end of the spoke distant from the body and thus near the wrist (one of the forearm bones).
With about 20 to 25% of all fractures The wrist fracture tops the list of common fracture injuries in humans.
In principle, it can occur at any age, but occurs more frequently in young people between 14 and 18 (here mainly due to risky behavior with a fall result) and older people over 60 before (here especially as a result of a Osteoporosis).
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Usually the cause of a radius fracture (broken wrist) is a fall. When you fall, you try to brace yourself and thereby exert a massive force on that wrist from which of these is often not able to cope - so it breaks.
Usually this happens with the wrist extended, the radius fracture in this case is called Colles fracture designated. In the rarer case of a flexed wrist in an accident, one speaks of one Smith fracture. The reasons for the fall can be very diverse.
In younger people, it is often sports injuries, for example in soccer, handball, skateboarding or snowboarding, that lead to unfortunate falls.
In the elderly, however, falls are often caused by unsteadiness and stumbling bone, by osteoporosis are usually already damaged, have an increased risk of significant damage even with minor injuries.
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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
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Broken wrist
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Typically, a broken wrist is directly associated with pain, which increases with pressure and movement.
A swelling of the joint usually develops very quickly after the accident. A misalignment of the wrist is also often found.
This is due to the fact that the fracture moves towards the back of the hand and the spoke, resulting in the classic picture of the bayonet position.
Since mobility is restricted as a result of the pain and swelling, the patient usually carries the hand in a typical relieving position to relieve the joint.
If the hand is moved, bone parts that rub against each other can lead to so-called "Crepitations“Come, a crackling sound.
If this occurs together with a misalignment, a broken wrist can be considered safe. In some cases, there is also a tingling sensation or a similar sensory disorder in the area of the fingers, which suggests that nerves were also irritated or damaged by the break.
Read more on the topic: Pain in the metacarpal boil and Bump on the wrist
The diagnosis of a broken wrist can usually only be made by the anamnese (i.e. the questioning of the patient) and the clinical picture including a physical exam be asked.
If a patient comes after a fall with a swollen, painful wrist, which also has crepitations and the typical misalignment, the diagnosis of a broken wrist is practically confirmed.
The physical examination can also check mobility, blood flow and the feeling in the wrist.
In order to confirm the suspected diagnosis or to obtain more precise information (for example where exactly the fracture is in the bone or whether parts of the bone have loosened and / or displaced), the doctor can also ask X-ray image request. This is usually made in 2 levels, i.e. once from the front and once from the side to cover everything bone to have a good view of the wrist.
This is especially helpful in order to be able to decide on an appropriate therapy afterwards. One comes more rarely Computed Tomography (CT) to diagnose a broken wrist, for example when the information from the X-ray is not accurate enough.
For therapy one Wrist fracture There are several options available, which are preferred depending on the case.
In principle, one decides between conservative (i.e. non-operative) and surgical therapies.
Both forms of therapy aim to completely restore the original shape of the joint, which means that the axes and lengths of the bones should be normal again, so that the wrist is fully functional again.
With a simple one Broken wrist, which is not postponed, the treatment consists simply in the Applying a plaster castthat usually has to be worn for 6 weeks.
By immobilizing the arm, the bone pieces can grow back together correctly. However, it is important to have regular X-ray checks carried out in order to see whether the bones have not subsequently shifted so that they can be recognized at an early stage and then adequately treated.
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On the other hand, if the wrist fracture is displaced (dislocated), then a Set up (Repositioning). To do this, the fracture site is first numbed by a Local anesthetic is injected into the fracture gap. Then the bone brought back into the correct position by simultaneously pulling on the upper arm and fingers. This process should always be carried out under X-ray control.
If the dislocation is more serious, but the break is still stable, a closed reduction respectively. This means the insertion of wires that are supposed to stabilize the break during the healing process. This procedure can be carried out on an outpatient basis, but it must be followed by one plaster be worn for 6 weeks.
In the case of an unstable wrist fracture (a fracture is considered to be unstable if it has at least three of the following criteria: debris fracture, involvement of the articular surface, dislocations, involvement of the wrist, patient older than 60), a open surgery preferred. Here, the stabilization takes place with the help of plates, which are normally used on the flexor side, as they lead to fewer complications here. These plates can remain in the body for the rest of life.Although this type of operation is more invasive and cannot be carried out on an outpatient basis, it has the advantage that patients do not have to wear a cast and can practically fully relieve their wrist.
To an operational Treatment of the broken wrist the attending physician always decides
In the same way, surgical therapy can also be preferred to conservative therapy if prolonged immobilization is limited (z. B. in older, multimorbid patients) or high loads should be possible again as quickly as possible (z. B. in competitive athletes).
The aim of the surgical fracture treatment is to bring the individual fragments into an optimal position so that they can grow together again without consequences. It is important that the original length proportions and angles of the wrist bones are restored.
Depending on the type of spoke fracture, there are different approaches at the surgical treatment of the hernia.
What they all have in common is that the intervention is under general anesthetic or local anesthesia (Regional anesthesia / plexus anesthesia; only the affected arm is anesthetized) is performed and the surgeon first repositions the broken bone pieces into the correct position (manual reduction) before he then fixes it in this position. How the broken spoke is ultimately fixed depends on the type of wrist book.
$config[ads_text2] not foundRegardless of whether the wrist fracture had to be treated surgically or was treated conservatively from the beginning - with or without repositioning the fragments - it usually occurs (except for an operative plate fixation) to a Plaster plant to the forearm for 4-6 weeks (The duration of the immobilization can also be shorter after an operative treatment).
Proper aftercare includes:
Likewise, with all plaster changes, the intactness of the skin or a smooth one must be ensured Wound healing (e.g. at Surgical wounds) to be controlled. Any sutures should be removed after 10-14 days. After the immobilization, outpatient physiotherapeutic treatment is usually indicated in order to restore the affected wrist to full functionality and load capacity as quickly as possible.
With the right therapy, the wrist fracture shows one very good prognosis. The dreaded permanent misalignment of the wrist as a result of a fracture can actually almost always be prevented if, in high-risk cases, a surgery and if any treatment is accompanied by regular x-ray check-ups.
Otherwise, a radius fracture is associated with few complications. As after any fracture, the risk in the affected joint is one arthrosis to train increased. Also, in rare cases, it can lead to a Pain syndrome such as Sudeck's disease come.
A complete fracture of a bone - also known as a bone fracture - usually results in a complete severing of the bone structure into two or more fragments. If the bone is only partially broken, it is called a bone fissure. A broken wrist, like any broken bone, can heal in two different ways. A distinction is made between a direct (primary) from an indirect (secondary) Fracture healing.
During immobilization by means of a splint or a plaster of paris, the bone healing takes place in several phases, which begins with an inflammatory reaction after the fracture phase, in which blood escapes from the beech ends into the fracture gap.
This leads to the activation of inflammatory cells that migrate into the clotted blood in the fracture gap and activate the cells located there for the formation of new bone. In the subsequent granulation phase, the clotted blood is then converted into connective tissue (Granulation tissue, soft callus), into which new blood vessels gradually grow. Bone-degrading cells remove broken and poorly perfused bone parts at the broken ends, bone-building cells replace them with new bone substance.
Until then, however, at least 4-6 weeks have passed, but the broken bone or wrist fracture is now considered resilient again. In the subsequent phase of callus hardening, minerals are incorporated into the newly formed bone over time, so that it regains its original strength.
However, the fracture point is only completely mineralized after 3-4 months. Over time, however, the newly formed bone substance of the hardened callus is further remodeled (Remodeling) until, after 6-24 months, it is completely aligned again in the direction of the main stress in the bone and corresponds to the original bone.
The time it takes to fully heal from a broken wrist depends on the one hand Severity of the break and the healing process from, but also from Age of patient and type of fracture restoration.
As a rule, surgically treated wrist fractures can be loaded again earlier than conservatively treated. This is due to the fact that the surgical insertion of screws and plates brings the fracture ends back into direct contact with one another and thus direct bone healing occurs and the wrist can be exposed to stress again after 3-4 weeks.
On the other hand, wrist fractures treated conservatively - with a plaster of paris - usually require a healing time of 4-6 weeks before the first mobilization exercises and light loads should take place. Ultimately, one speaks of complete healing of the fracture with unrestricted resilience after a period of 8-12 weeks.
A broken wrist can only be prevented to a limited extent.
High-risk sports should be avoided if possible.
In some areas you can learn to fall "properly" without injuring yourself additionally when you fall. Since intercepting the case with the hand however, if it is often a reflex action, this happens completely unconsciously and cannot be prevented.
All in all you can say that the Broken wrist Although it is a very frequent consequence of accidents, which acutely leads to massive functional impairment and pain, it is usually very treatable thanks to modern therapy techniques and does not cause any lasting discomfort.
Both Wrist fractures in children are usually - unlike adults - so-called Greenwood fractures.
This type of fracture is characterized by the fact that there is only an incomplete bone fracture, as only the internal bone structure breaks, the outer periosteum surrounding the bone (Periosteum) but remains intact. This - also called Flexion fracture - type of fracture occurs mainly in the long tubular bones of children who are still growing, as the bone substance in them has not yet hardened and is therefore still elastic and malleable.
The forces acting in the event of a broken wrist then cause the bony cortex to break on one side of the bone, while on the other hand it only yields through deformation and is deformed.
The periosteum, which always remains intact, prevents the broken bone parts from shifting, thus enabling conservative therapy in most cases. It is usually sufficient if the child's forearm is immobilized with a plaster splint and the break can heal without consequences. However, exist within the framework of the greenwood fracture Bone bending over 20 °However, it may also be possible that the radial bone has to be set up again under anesthesia or even surgically straightened.