Fracture of scaphoid bone: symptoms and treatment
Fractures in humans happen often enough. Usually injured limbs. Such fractures do not pose a threat to life. In most cases, their treatment and the subsequent recovery period are successful.
One of the most common types of injuries is a fracture of the scaphoid bone. The IBC of the 10th revision assigned this code S62.0.Its peculiarity is that it is very difficult to detect such a fracture. Inexperienced doctors often take damage for a banal bruise, so treatment is appointed incorrectly. In today's article, we will describe what symptoms are accompanied by a fracture of the scaphoid bone. Also, your attention will be presented to the main methods of its treatment.
The navicular bone is considered to be one of the most traumatic elements of the wrist. It is located on the side of the thumb. The name of the boat-shaped formation is due to the shape resembling a boat. The wrist is represented by eight small bones, which form two rows. In each of them there are four elements. The scaphoid bone can be independently palpated in the area of the "anatomical snuff-box".This point is localized between the tendons of the thumb and the abduction muscle.
Anatomy of the joints and bones of the wrist is one of the most complex in the whole body. These structures allow you to perform various movements in several planes. On the other hand, the ligaments ensure the strength of the joints. The navicular bone is responsible for the coordination of movements and the location of the remaining nearby structures. Therefore, if it breaks, the work of the entire wrist is disrupted.
Causes and mechanism of development of damage
Fracture of scaphoid bone most often occurs due to a fall on the arm. In this case, there is a re-dissection in the region of the carpal joint. Therefore, the bulk of the load falls on the scaphoid bone. In rare cases, traumatic injury is the result of direct effects on this structure.
The overwhelming majority of the victims are diagnosed with a closed fracture of the scaphoid bone. The presence of ruptures on the skin may be due to trauma features. For example, when falling on a stony surface.
Damage to the scaphoid bone appears in several variants. Among them, the main are the following:
- A transverse split, which entails the formation of two identical fragments of the same size.
- Detachment of bone along the edge.
- Fracture, accompanied by the formation of a large number of fragments and bone displacement. Otherwise it is called multi-lobed.
If we talk about the main causes of such injuries, they most often arise in sports or are a consequence of a car accident.
The fracture of the navicular bone is difficult to diagnose. It is caused by a weak clinical picture. Therefore, it is so important immediately after getting the injury to seek help from a doctor and undergo a comprehensive examination. This will help to avoid the development of complications in the future.
The main manifestations of a fracture of the scaphoid bone include:
- Appearance of puffiness in the affected area. Over time, it can spread to larger areas.
- Presence of a pain syndrome on the back surface of the wrist. Discomfort usually increases when the joint is unbent or pressed down on the affected area.
- Violation of the full functioning of the hand.
- Presence of bruising and bruising due to vascular rupture.
Symptoms that characterize the fracture of the scaphoid bone of the hand are diverse. With proper diagnosis and competent physical examination, it is not difficult to suspect the problem.
After the injury, the victim must urgently provide first aid. First, the hand should try to immobilize. The extension or reflex tension of the muscles will provoke the displacement of the bone fragments. They, in turn, can further injure soft tissues. You need to hang your arm in a loose position on a scarf or a piece of cloth. It is not recommended to fix the brush independently with the help of tires and bandages. Any treatment options without consulting a doctor are strictly contraindicated. Otherwise, you can only harm the victim, provoke the development of quite serious complications.
What can I do to alleviate the pain?
- Apply an ice pack to the affected area. Keep the cooling bandage for no more than 15 minutes to prevent frostbite. As a compress you can use ice cubes, a bottle of cold water or a piece of frozen meat. Between it and the surface of the skin you need to lay a cloth. Do not allow non-sterile condensate to enter the open wound.
- Take a non-narcotic analgesic tablet. Thus it is necessary to follow the attached instruction and not to allow overdoses. Otherwise, the medicine may cause poisoning.
The transportation of the injured person is usually carried out in-house. If necessary, you can call a team of medical workers. In no event should one allow self-movement on the car to a person who suspects a fracture of the scaphoid bone. A strong pain syndrome causes a decrease in concentration of attention.
Diagnostic features of
If one or more of the symptoms of the injury that were described a little above, you should immediately seek qualified help. It is better to consult a traumatologist or a surgeon.
The first step in the diagnosis is the collection of anamnesis. The patient must describe what preceded the damage to the scaphoid bone. This can be a fall, intense sports or a domestic fight. Also, the doctor should be aware of the previous diseases of the motor apparatus, injuries of the wrist joint.
After this, the specialist usually passes to a physical examination. With a fracture, there is a swelling in the affected area, pain discomfort after palpation. Sometimes the patient is asked to bend the wrist joint, paying attention to the peculiarities of movements in this area.
If the doctor suspected a fracture of the navicular bone of the hand, the patient is sent for radiography. The procedure is mandatory in three projections. The absence of obvious pathologies in the image does not mean that they do not really exist. In this case, the patient is impregnated with gypsum, which can not be removed for two weeks.
After this period, repeated radiography is done. Within 14 days the bone will have time to undergo the process of rareification, and the gap between the fragments will increase significantly. Such a fracture can be seen on the roentgenogram. Based on the results of the diagnosis, the doctor will be able to make an accurate diagnosis, give recommendations for treatment.
Conservative methods of therapy
Treatment of a fracture of the scaphoid bone of the hand depends on the severity of the trauma and the level of activity of the victim. Not the least role in this matter is the desire of the patient to recover as soon as possible.
For fractures without bias, conservative methods of action are used. For treatment on the wrist joint and the first finger is impregnated with gypsum. The bandage is worn for about two months, until the fracture fully merges. Sometimes patients insist on carrying out of an operative measure to reduce term of immobilization and faster to restore working capacity of a brush. This method of treatment still causes controversy among surgeons.
Fracture of the lower third of the scaphoid bone fuses in 4-6 weeks. This part of the brush is characterized by good blood supply, so there is practically no problem with recovery.
A fracture in the middle third or in the proximal pole requires a longer treatment. These areas of the scaphoid bone have poor blood supply. The time of adhesion depends largely on the patient's age, metabolism. Periodically it is necessary to visit a doctor for examination. In particularly serious cases, it may be necessary to take radiographs and carry out CT to evaluate the dynamics of recovery.
Regardless of the specific area of trauma, gypsum in the case of a fracture of the scaphoid bone is imposed on all patients. When wearing bandages, doctors recommend:
- to limit wrist mobility;
- to refuse to engage in sports;
- adhere to a balanced diet;
- follow the regime of work and rest.
Subject to these recommendations, the process of recovery will go to faster.
In patients with a marked displacement of fragments or a high risk of aseptic necrosis, surgical treatment is recommended for patients. Its main goal is the stabilization of the affected limb. This approach contributes to the early restoration of blood supply in the affected area, fracture fusion.
Surgical intervention is usually performed on an outpatient basis using regional or local anesthesia. During the operation, the doctor removes the displacement of bone fragments, fixes them with a screw( implant).An X-ray is used to evaluate the result.
The incision is performed on the back or palmar side of the wrist. Its size and specific localization depend on which part of the scaphoid bone has been traumatized. Displacement is eliminated quite easily. A fresh fracture of the scaphoid bone of the wrist is usually fixed with a screw through a cut about 3-5 mm.
If the damage has mismatched incorrectly, a more serious approach is required. The surgeon first makes a large incision allowing an osteotomy. After that, he begins to recreate the correct anatomy, and then fixes the bone with screws.
When multiple lesions are present, a special graft is used during the operation. It is a synthetic variant of bone tissue. It is placed around the lesion. The transplant is used to stimulate the process of tissue healing.
When the diagnosis of "fracture of the scaphoid bone of the hand", the timing of treatment largely depends on a well-organized rehabilitation. Restorative procedures begin with the course of exercise therapy. All exercises are selected by a specialist. Their main goal is to eliminate stiffness and contracture. The rehabilitation period can be divided into 3 conditional stages.
At the initial stage of exercise therapy pursues the following tasks:
- muscle relaxation in the affected area;
- elimination of pain syndrome;
- hemorrhage elimination;
- normalization of circulation of the lymphatic fluid;
- recovery of metabolic processes.
The above goals allow you to select the most effective exercises. As a rule, bending and extension of fingers, circular and pendular movements by a brush are used. This recovery phase lasts about 14 days.
Since the third week, the exercises are slightly modified. Now LFK is aimed at restoring limb functions and the amplitude of joint movements. For this purpose, various complexes with gymnastic ball and on the machine are recommended.
At the third stage of exercise, exercise therapy is reduced to increasing the tone of the whole body, improving the mood of the victim. Patients are allowed to do complicated exercises: push-ups, pull-ups and so on.
After the fracture of the scaphoid bone and the removal of the plaster bandage, physioprocedures( UHF, massage, paraffin applications) are mandatory. Correctly chosen methods of rehabilitation allow to completely restore mobility and working capacity of the damaged limb.
Possible consequences of
The competent diagnosis of an injury is very important, since it helps to prevent the development of negative consequences. In addition, one can not leave a fracture of the scaphoid bone without therapy. Treatment, conducted untimely, threatens the appearance of complications. Among them, the most dangerous are the following:
- Arthrosis of the wrist joint. This pathology is accompanied by painful pains and restriction of mobility in the limb. In particularly serious cases, it leads to disability.
- Incorrect bone fusion. In rare cases, the damaged fragments coalesce at a small angle. The patient experiences severe pain discomfort. Such a problem can only be solved with the help of a new operation. During the surgical intervention, repeated bone scrapping, alignment of all elements is performed. After this, they begin to transplant bone tissue.
- Necrosis. Against the backdrop of poor blood supply, bone tissue begins to gradually die off. As a result, the inflammatory process develops, and gangrene may develop in neglected situations. To eliminate this pathology, a complete amputation of the wrist is often required. Aseptic form of necrosis develops gradually. At the initial stages it can not be considered even on the roentgenogram.2-3 months after the injury, severe symptoms of the disorder appear. It is often not possible to save bone tissue.
According to statistical information, the fracture of the navicular bone of the brush often goes unnoticed. Therefore, this pathology inherent in the emergence of various complications. Timely diagnosis and competent therapy are the key to successful recovery. Moreover, with the help of properly performed rehabilitation, it is possible to fully restore the functionality of the limb.
Doctors warn that the fracture of the scaphoid bone( ICD 10 - S62.0) is a very serious ailment. Leave it without attention and ignore its manifestations should not be. Damage to one small bone often results in a disruption to the entire wrist.