What to do if the fracture healed incorrectly. Wrist fracture treatment and rehabilitation period What to do if the bone has grown together incorrectly

Once a person has a bone fracture, most commonly in the lower or upper extremities, fusion may not be correct. In this case, the bone changes its correct anatomical position. Quite often, the reason that the fracture has grown together incorrectly is insufficient fixation of fragments in plaster. But this is not the only reason.

How does bone regrowth occur?

Wrong can in any part of the body. More often this occurs with fractures of the jaw, hands and fingers. An improperly healed leg fracture is much less common.

Immediately after a misfortune has occurred, the restoration of damage begins in the human body. This process consists of two stages. At the first stage, there is a resorption of those tissues that died during the injury, and during the second stage, the bone itself is restored directly.

It takes a certain amount of time for the bone to heal. During the first week, a special tissue is formed, which is called granulation tissue. This tissue attracts minerals to itself, which leads to the loss of excess fibrin strands. Later, collagen fibers appear, thanks to which the bone is formed in the form in which it should be. Every day, an increasing amount of mineral salts accumulate at the fracture site, which helps the formation of new bone tissue.

If you take an x-ray after three weeks, then you can see the callus at the site of fusion. The fact that the fracture grows together incorrectly can be detected using an x-ray at this stage. What to do with an incorrectly fused fracture is decided in each individual case differently.

Causes of improper healing of fractures

Fractures can be of two types - closed and open. Closed is not as dangerous as open. It grows together quickly, and the reason that the fracture has grown together incorrectly can only be the wrong treatment. It is bad when there are cases when osteomyelitis develops. Or the wound becomes infected.

What went wrong with a broken arm? Why did it happen? The reasons may be as follows:

• Mistakes were made in treatment.
• There was a displacement of the bones in the plaster.
• The hinges that set the bone were not installed.
• During the surgical intervention, fixators were installed not according to morphology.

Most often, the fact that the fracture healed incorrectly occurs due to any mistakes made during the treatment period. If something is bothering the person in the area where the injury occurred, and he suspects that the bones are fused incorrectly, you should contact a traumatologist to confirm or refute this fact.

The most common problem is an improperly healed fracture of the radius of the arm. Therefore, with such an injury during bone restoration, one must be especially careful so that there are no problems later.

If it happened that during a fracture, the radial one did not grow together correctly, then this pathology is treated in the same way as fractures in other places.

Surgical treatments

If abnormal bone fusion occurs, it is usually treated with surgery. There are three types of orthopedic surgeries:

• corrective osteotomy,
• osteosynthesis,
• marginal resection of bones.

This operation is performed under general anesthesia. Its ultimate goal is to eliminate bone deformity. To achieve this, you have to break the bone again, which has grown together incorrectly. It is broken with the help of surgical instruments, dissected by radio waves or a laser.

Fragments of bones are again connected to each other in the correct position and fixed using special screws, knitting needles, plates and more. During such an operation, the principle of traction can be used. A load is suspended from the needle, which is in the bone, which pulls the bone, and it takes the position that is necessary for normal fusion.

Types of osteotomy

Osteotomy according to the type of conduction can be open and closed. In the process of open intervention, a skin incision of 10-12 centimeters is made, which opens the bone. The surgeon then separates the bone from the periosteum and dissects it. Sometimes this is done through specially drilled holes.

With the closed method of this operation, at the site of injury, the skin is cut by only 2-3 centimeters. After that, the surgeon cuts the bone with a surgical instrument only ¾, and the rest is broken. During such an intervention, large vessels and nerves are sometimes seriously damaged, therefore, open-type osteotomy is still more often performed.

A corrective osteotomy is most commonly used to correct an malunion fracture in the lower or upper extremities. Thanks to this operation, the patient's legs move, and the arms perform all the movements that are inherent in them.

Contraindications for osteotomy

This type of operation is prohibited if the patient has the following diseases:

• Severe diseases of the kidneys, liver, and other internal organs.
• Pathology of the heart and blood vessels.
• If at the time of surgery the patient has an acute or exacerbation of a chronic disease.
• Purulent infection of organs or tissues.

Complications after surgery

As after any other surgical intervention, there may be complications after osteotomy, namely:

• Infection in the wound, which can cause suppuration.
• Appearance
• Fracture healing slowdown.
• Displacement of bone fragments.

This is a very popular treatment for fractures that have not healed properly. The essence of this operation is that fragments of a broken bone are attached to each other using various fixators. They can be in the form of special screws, screws, knitting needles, etc. Fixators are made of a strong non-oxidizing material, it can be bone tissue, special plastic, stainless steel, titanium and other materials.

Implants are used for a long time, which allows the bone at the fracture site to fully recover.

Osteosynthesis can be of two types:

• External, it is also called transosseous. During such an operation, bone fragments are connected. Outside, everything is fixed using the Ilizarov apparatus or other similar devices.
• Internal (submersible). This method differs from the previous one in that the implants fix the bones inside the body, and not outside. After this operation, additional fixation is often performed with a plaster cast.

Osteosynthesis is usually used in cases where it is necessary to connect the long tubular bones of the legs (thigh, lower leg) and arms (shoulder, forearm), as well as fractures of the joints and small bones of the hand and foot.

Fixation during osteosynthesis keeps broken bones in a fixed state, and therefore they grow together correctly.

Contraindications for this operation

Such a surgical intervention as osteosynthesis, despite many positive aspects, also has some contraindications. For example:

• The patient is in critical condition.
• The wound has become infected or contaminated.
• A large area of ​​damage if the fracture is open.
• The patient has an ailment that is accompanied by convulsions.
• The presence of osteoporosis, in which the bones become very fragile.

Possible Complications

To fix the bone, the surgeon has to expose a large area of ​​the bone. At the same time, it loses the tissues surrounding it, in which the blood vessels are located, and this leads to a violation of its blood supply.

During the operation, nearby tissues and bones are damaged. Also, a large number of holes, which are necessary for screws and screws, weaken the bone.

If antiseptic precautions are not followed, an infection can enter the wound.

Partial bone resection

During this operation, the damaged area of ​​the bone is removed. Resection can be performed as a separate operation, or it can be only a certain stage of another surgical intervention.

Partial resection can be of two types:

• Subperiosteal. With this method, the surgeon, using a scalpel, cuts the periosteum in two places - above and below the lesion. Moreover, this should be done in the place where healthy and damaged tissues meet. After that, the periosteum is separated from the bone and sawn from below and above.
• Transperiosteal. The operation is done in the same way as the previous one, the only difference is that the periosteum exfoliates towards the affected area, not the healthy one.

Resection is performed under general or conduction anesthesia.

Improper fusion of bones after a fracture is characterized by pain in the bones and adjacent joints, displacement of the anatomically correct axis of the limb and deformation of the bone itself. As a result of the curvature of the bones, their physiological functions are violated. It is possible to correct abnormally fused bones after a fracture only by surgery.

There are three types of basic orthopedic surgeries:

1. Corrective osteotomy.
2. Osteosynthesis.
3. Marginal resection of bones.

osteotomy

Improper bone fusion after a fracture is corrected with a corrective osteotomy. This operation is carried out under the general one, as an independent surgical intervention, or as one of the stages of another major operation.

Its purpose is to eliminate the resulting bone deformity.

To do this, during the operation an improperly fused bone is broken or dissected again laser, radio wave energy or traditional surgical instruments.

The resulting bone fragments are interconnected in a new, correct position. spokes, screws, plates or special devices.

Also used during the operation principle of skeletal traction when a load is suspended from the needle placed in the bone, due to which the bone is pulled out and takes the position necessary for normal fusion.

The type of osteotomy is:

• open, during which the surgeon makes a 10-12 cm skin incision that exposes the bone, separates the periosteum from the bone and cuts the bone. In some cases, the bone is dissected through pre-drilled holes.
• Closed, when the skin at the site of injury is cut only 2-3 centimeters, then with the help of a surgical instrument the bone is incised by about ¾ of its thickness, then the remaining uncut portion of the bone is broken.

During a closed osteotomy, nerves and large vessels can be seriously damaged, therefore, as a rule, an open type osteotomy is used to align the bones in case of their improper fusion!

Operate, most often, the bones of the upper or lower extremities in order to return to them the normal functionality lost during a fracture and improper fusion.

Thanks to the osteotomy, the patient's legs return to the position necessary for movement, and the arms to perform their anatomical movements.

Osteotomy should not be done if:

1. Cardiovascular pathologies.
2. Severe diseases of the liver, kidneys and other internal organs.
3. Exacerbation of chronic or acute diseases.
4. Purulent infection of tissues or organs.

Like any surgical intervention, osteotomy is dangerous with the following possible complications:

• displacement of bone fragments.
• The occurrence of a false joint.
• Infection of the postoperative wound, up to suppuration.
• Slowing down the process of bone fusion.

Osteosynthesis

This method of treatment of improperly fused fractures is very popular today and is used quite widely.

Its essence lies in the fact that during the operation, bone fragments are compared with each other. with various fasteners . As a rule, these are special screws, pins, screws, wires, knitting needles or nails made of non-oxidizing materials resistant to constant mechanical stress.

For such implants, bone tissue, inert plastic fixators and substances such as titanium, stainless steel, cobalt alloy vitalium.

Long-term bonding of bones with implants allows them to fully recover after a fracture!

There are two types of osteosynthesis:

• External or transosseous, in which the Ilizarov apparatus and other similar devices are used to connect bone fragments from the outside.
• Internal or submersible when the bones are fixed with implants inside the patient's body. During surgery, one type of anesthesia is used. After external internal osteosynthesis, the bones are often additionally fixed by applying a plaster cast.

Osteosynthesis is used to compare fragments of long tubular bones of the lower leg, thigh, shoulder and forearm, as well as for intra-articular fractures and for fusion of damaged small bones of the foot and hand.

Thanks to the fixation produced during osteosynthesis, the immobility of broken bones is achieved, which allows them to grow together physiologically correctly.

The connection of bones made by surgeons during the operation, by its nature, can be:

1. Relative allowing minimal movement of the bones among themselves.
2. Absolute. At the same time, there are not even microscopic movements between the bone fragments.

After complete fusion of the bones, metal implants are removed from the patient's body!

There are a number of contraindications for this surgical operation:

1. Contamination and infection of the wound at the fracture site.
2. The general serious condition of the victim.
3. Extensive area of ​​damage in open fractures.
4. The presence in patients of diseases accompanied by convulsions.
5. A severe form of osteoporosis, in which the bones crumble.

During osteosynthesis surgery, the following complications may occur:

• The blood supply to the bone may be disturbed, since during fixation the surgeon exposes a sufficiently large area of ​​it, depriving the bone of part of the surrounding tissues, penetrated by blood vessels and nerve fibers.
• Weakening of the bones by multiple holes drilled for the insertion of screws or screws.
• Damage during the operation of the soft tissues surrounding the bone.
• Introducing an infection into the surgical wound due to a lack of antiseptic and aseptic precautions.

Partial bone resection

Bone resection surgery excision of its damaged area.

Resection can be performed as an independent surgical intervention, or may be a stage of another operation.

Partial or marginal resection is of two types:

1. Subperiosteal, in which the surgeon cuts the top layer of bone tissue (periosteum) with a scalpel in two places - below and above the affected area. And this is done at the junction of healthy and damaged tissues. Then, using a special tool, the periosteum is separated from the bone. After that, the released bone is sawn from above and below, in places of detachment of the periosteum.
2. transperiosteal. The operation is performed similarly to the previous one, with the only difference that the detachment of the periosteum is performed towards the affected, and not the healthy part of the bone.

Fracture of the distal metaepiphysis of the radius ("beam in a typical place")

The distal metaepiphysis is the lower end of the radius, located next to the hand.

A fracture of the “beam in a typical place” usually occurs with a direct fall on an outstretched arm. In addition to a sharp pain in the arm, a bayonet deformity and a change in the position of the hand may appear. The nerves and vessels of the wrist are involved in the fracture process, which can be compressed by fragments, which is manifested by numbness in the fingers, coldness of the hand.

To clarify the nature of the fracture and the choice of further treatment tactics, radiography is used, in some cases, computed tomography. Sometimes an ultrasound of the wrist joint is required.

Since the radius adjoins the hand, it is very important to restore the anatomy and range of motion in the joint in order to avoid problems with it in the future. Previously, such fractures were treated conservatively, i.e. in a plaster cast, but often the fragments were displaced, the bone healed incorrectly, which later affected the function of the limb - the arm did not bend and / or did not unbend to the end - stiffness of the joint formed (contracture), remained pain syndrome. In addition, a long stay in plaster had a negative effect on the skin.

The duration of the sick leave for a fracture of the distal metaepiphysis of the radius depends on the type of activity of the patient. For example, for office workers, the average period of disability is 1.5 months. For professions related to physical activity, the period of incapacity for work may be extended.

Conservative treatment of a fracture of the radius in a typical location (plaster cast)

For fractures without displacement, conservative treatment can be offered - in a plaster cast. The average stay in plaster is 6-8 weeks. This rarely passes without a trace for the limb - after conservative treatment, the joint requires the development of movements, rehabilitation. In the treatment of a fracture, even with a slight displacement in the cast, secondary displacement of the fragments can occur.

Surgical treatment of a fracture of the radius in a typical location (osteosynthesis)

Almost all fractures of the radius with displacement require surgical treatment - comparison and fixation of bone fragments - osteosynthesis. It is this method that allows you to restore the function of the hand most fully and achieve good functional results.

The radius is completely fused in about 6-8 weeks. After this period, the patient can begin to fully use the hand. But it is possible to develop a hand with the help of certain exercises recommended by a doctor, thanks to the use of fixators, already 1-2 weeks after the intervention. Light sports physical activity can be started approximately 3 months after the operation.

Depending on the type of fracture (comminuted, multi-comminuted, with significant or slight displacement), there are several possible fixation options - plate fixed with screws; external fixation device; screws; knitting needles.

In some cases, with severe edema, an external fixation device is applied, and after the edema subsides, it is replaced with a plate (or other fixator, depending on the type of fracture).

Osteosynthesis of the radius with a plate

With a significant displacement of fragments, osteosynthesis of the radius is used with a metal plate specially made for this segment. After comparing the fragments, the plate is fixed with screws to the damaged bone. After installation, the plates are superimposed on the skin, sutures are applied for 2 weeks, as well as a plaster cast for about the same period. After the operation, drug therapy is prescribed: painkillers, calcium preparations for faster bone fusion, if necessary, topical preparations to reduce swelling. The average length of stay in the hospital is 7 days. Stitches are removed on an outpatient basis after 2 weeks. The hand is worn in an elevated position on a kerchief bandage. There is no need to remove the plate.

External fixation device

In some cases, in the elderly, with severe swelling of the hand and wrist joint, it is undesirable to make access to install the plate due to various factors (edema, skin condition). In such cases, an external fixation device is installed - it fixes the fragments with the help of spokes that pass through the skin into the bone. The device protrudes above the skin in a small block (about 12 cm long and 3 cm high). The advantage of this type of osteosynthesis is that there is no need to make large incisions, but the apparatus needs to be monitored - dressings should be done so that the pins do not become inflamed.

After the operation, the arm is in the splint for 2 weeks, then the patient begins to develop the wrist joint in the apparatus, which does not interfere with this.

The external fixation device is removed after about 6 weeks, after X-ray control, in a hospital setting. The operation of removing the external fixation device does not take much time and is quite easily tolerated by the patient. The average hospital stay is 5-7 days, the duration of the sick leave is about 1.5 months. Dressings should be done every other day, on an outpatient basis. The hand is worn in an elevated position on a kerchief bandage.

Fixation with knitting needles or screws

With a slight displacement of fragments, the radius is fixed with knitting needles or screws through small skin punctures. A plaster splint is applied for about 2 weeks, then the person begins to develop the arm. After 6-8 weeks, the needles are removed.

In some cases, it is possible to use self-absorbable implants, which do not need to be removed.

Chronic, malunion fractures of the radius

In case of chronic incorrectly fused fractures, pain may be disturbed, there may be movement restrictions - stiffness of the joint, and other unpleasant consequences (numbness and swelling of the fingers). In such cases, surgical treatment is recommended, most often with fixation with a plate. The bone is disengaged, placed in the correct position and fixed. If there is a zone of bone defect - for example, if the bone has grown together with shortening, this defect is filled either with the person's own bone (the graft is usually taken from the iliac crest), or with artificial bone, which is rebuilt in 2 years into its own bone tissue.

Further postoperative and restorative treatment for chronic and improperly fused fractures of the distal metaepiphysis of the radius are similar to those described above. However, given the chronic nature of the damage, a longer rehabilitation may be required.

Anesthesia in the surgical treatment of a fracture of the distal metaepiphysis of the radius

For all the above operations, as a rule, conduction anesthesia is used - an anesthetic solution is injected into the brachial plexus area, where the nerves that innervate the entire upper limb (responsible for its sensitivity and movement) pass, and the arm becomes completely numb. Such anesthesia is quite easily tolerated, lasts 4-6 hours. In fact, this is a kind of local anesthesia. In addition, premedication is done - a soothing injection, and during the operation the person sleeps with his sleep. General anesthesia may be used. The final choice of anesthesia method is determined by the anesthesiologist on the eve of the operation.

Mis-union and non-union fractures of the radius in a typical location

Old, improperly fused and non-union fractures of the radius in a typical location with displacements, subluxations and deformities of the lower end of the forearm impair the function of the hand in the wrist joint and, to some extent, the pronation of the forearm. Deformity in the area of ​​the wrist joint causes a cosmetic defect and is a source of moral rather than physical suffering for women of young, middle, and sometimes old age.

In chronic cases, in terms of up to 2-4 weeks, and sometimes later, it is possible to reduce by the usual methods - manually with some violence. In more severe cases, reduction may be prevented by the displaced lower end of the ulna, located (against the norm) at the same level (and more often below the articular surface) with the shortened radius. In these cases, resection of the lower end of the ulna for 2-3 cm greatly facilitates reduction. If it fails, a small operation - resection of the lower end of the ulna - not only gives a cosmetic improvement and smoothes the deformity, but also improves function in the wrist joint, reduces pain.

Malunion of fractures of the radius in a typical location is often observed. Depending on the nature of the displacement of the distal end of the radius, there is a greater or lesser deformity and limitation of the function of the wrist joint.

The main causes of malunion and deformities are: 1) poor and insufficient reposition; 2) repeated displacement of fragments in a plaster cast after a decrease in edema; 3) severe fragmentation of the epiphysis; even after a good reduction, the fragments in such cases are often displaced again and, if the articular surface of the radius is damaged, the congruence of the joint is disturbed; 4) a large compression of the epimetaphysis of the radius, which is usually observed in fractures in the elderly; due to kneading of the spongy bone, fusion occurs with a shortening of the radius and, thus, the protruding head of the ulna is located distal to the articular surface of the radius; the wrist joint is expanded; 5) complete rupture of the ligaments of the lower radioulnar joint and, as a result, displacement of the distal end of the ulna; 6) too early removal of the plaster splint and the use of therapeutic exercises (before the union of the fracture); this can lead to repeated displacement of fragments and deformation.

There is a large gradation of deformities, dysfunctions and cosmetic disorders. In this regard, it is necessary to distinguish between cases in which it is necessary to apply surgical methods. If the deformation is not pronounced and does not cause any significant

dysfunctions, operation is not indicated. Even with significant deformities under the influence of therapeutic exercises, massage and physiotherapy, a completely satisfactory function of the hand is often restored.

Surgical intervention is indicated for significant deformity, impaired congruence and function of the wrist joint, and for post-traumatic deforming arthrosis, which often cause pain in the wrist joint.

In young people, especially women, with deformity, even without significant functional impairment, there is often a need for prompt correction of a cosmetic defect. If the deformities are accompanied by Zudeck's osteoporosis, surgery should not be attempted as long as the signs of this syndrome increase, remain stable, or continue to decrease. In other words, surgery for deformity is possible only after the complete elimination of the syndrome of acute painful post-traumatic osteoporosis.

In most cases, surgery improves both the appearance and function of the wrist joint. The choice of surgical intervention depends on the nature of the deformity and the degree of dysfunction of the joint.

Often, with malunion fractures of the forearm in a typical location with significant deformity, protrusion of the lower end of the ulna, which is located distal to the articular surface of the radius, the function of the wrist joint can be significantly limited. In these cases, a small operation - oblique resection for 2-3 cm of the distal end of the ulna, which to a certain extent blocks movement in the wrist joint, not only reduces the deformity and smoothes the cosmetic disorder, but also improves the function of the joint and reduces pain. After subperiosteal removal of the end of the ulna, it is necessary to sew the edges of the periosteum and thus connect the end of the resected ulna to the lig. collateral carpi ulnare (Fig. 81). After the operation, a plaster splint is applied from the elbow to the heads of the metacarpal bones for 10-12 days. Then prescribe therapeutic exercises and thermal procedures.

A simple corrective osteotomy is indicated for angular curvature of the axis of the radius, if the length of this bone and the articulating surface are preserved. After osteotomy, the fragments are connected using a 2-3 mm thick wire, which is passed through both fragments and fixes them in the correct position. One end of the needle is brought out above the skin surface. If a gap has formed between the fragments, it is filled with spongy bone taken from the iliac wing, or with gomosity. After the operation, a plaster bandage is applied from the elbow joint to the heads of the metacarpal bones. The needle is removed after 4-6 weeks, and the plaster cast - 8 weeks after the operation.

If the radius is shortened, a simple corrective osteotomy of the radius with resection of the distal end of the ulna is indicated. Fragments of the radius are fixed in the same way as mentioned above, and the resected part of the ulna is used as an autograft. In some cases, it is possible to lengthen the radius after osteotomy by transplanting a bone autograft taken from the outer part of the distal end of the ulna according to Campbell.

In some cases, with severe deformities with destruction of the radioulnar articular surface, deforming arthrosis, dysfunction and pain, the question arises of arthrodesis of the wrist joint; at the same time, in some cases, resection of the distal end of the ulna is also performed.

Comminuted fractures of the epiphyseal region with damage to the growth zone in children can cause premature cessation of the growth of the radius; the degree of dysplasia and resulting deformity is difficult to predict. Radial fractures with suspected growth plate injury should be monitored every 6–12 months to determine the fate of the growth plate. At

In young children, discrepancy in the growth of the radius may require resection of the distal ulnar cartilage. This should not be done in children at an age at which the ossification phase of the epiphysis of the radius is approaching. In such cases, it is more expedient to perform a subperiosteal resection of the ulna 2-3 cm above the growth cartilage of the distal end of the ulna and then connect the distal and proximal fragments with a suture or screw.




Rice. 81. Resection of the distal end of the ulna with an improperly fused fracture in a typical location.




Nonunion of the distal end of the radius is a rare complication. In these cases, as a rule, there is a shortening of the radius. The distal end of the ulna is resected for 2-3 cm, the fragments of the radius are compared, they are fixed by means of a pin, one end of which is brought out above the skin, and bone transplantation is carried out with cancellous bone plates. The needle is removed after 6 weeks, and the plaster cast after 8-10 weeks.




Spotted post-traumatic osteoporosis and other complications




Spotted post-traumatic osteoporosis, or the so-called acute trophoneurotic bone atrophy of Zudek, or acute painful osteoporosis, is a common complication after fractures of the forearm in a typical place. The pathogenesis of this complication has not been fully elucidated; most likely, it is based on vascular and neurotrophic disorders. The disease is characterized by the development of significant swelling and tension in the soft tissues of the hand and fingers. Circulatory disturbances in soft tissues and bones are noted. The skin acquires a purple color with a glassy sheen, it is cold to the touch. The fingers are swollen, straightened, movements in the finger joints are almost completely absent, in the metacarpophalangeal joints they are very limited, and in the wrist joint they are also limited. Any attempt at active or especially passive movements

causes severe, sometimes excruciating pain. Often, due to the forced fixed position of the arm, patients also experience pain in the elbow and shoulder joints. The process is lengthy, lasting several months.

On radiographs, patchy osteoporosis is noted, capturing the lower part of the radius and ulna, carpal and metacarpal bones, and phalanges of the fingers.

Although traumatic osteoporosis occurs in young people, however, in older people this complication is observed more often and is more severe and prolonged. Finger movements are restored more slowly and more difficult than in young people. Along with severe forms of post-traumatic osteoporosis, less pronounced forms are noted, in which recovery is easier and faster. Usually, in severe forms, the pain begins to subside 2-3 months after the almost frozen state, it seemed; for many months the condition of the hand continues to improve, the swelling decreases and the function of the fingers is restored, although in some cases its limitation still remains.

Treatment consists of a case blockade above the lesion site with 80 ml of 0.25% novocaine solution, the appointment of analgesics, massage, warm baths and, most importantly, inducing active and passive movements for a long time until recovery occurs.

Neuritis of the median nerve, described by G. I. Turner (1926), may result from a bruise of the nerve at the time of injury or compression by scar tissue or bone in the place where the nerve passes on the palmar surface in the carpal tunnel under the palmar and transverse carpal ligaments. The clinical picture is characterized by constant pain with atrophy of the thenar muscles and intercarpal spaces. This complication may sometimes require relatively minor surgery to free the median nerve. Median nerve compression syndrome should not be confused with traumatic osteoporosis syndrome.

Rupture of the tendon of the long extensor of the first finger is a complication that occurs in a later period after injury. The rupture of this tendon occurs under the influence of constant friction over the bone protrusion, formed as a result of the displacement of the distal fragment of the radius to the dorsal and radial sides. Treatment consists of suturing the tendon and moving it beyond the damaged groove of the radius, or flattening the groove.

Every person with a broken bone dreams of restoring the anatomical integrity of the bone tissue in a short time and without complications. And what to do if nonunion of bones is found or bone fragments grow together incorrectly and a false joint is formed? We will try to answer this and other questions in our article.

Physiological processes during bone fusion

In a fracture, two main biological processes take place: the resorption of tissues that have died as a result of injury and the restoration of the bone.

In the first week after the injury, granulation tissue forms at the site of bone injury, the influx of minerals gradually increases to it, and a certain amount of fibrin threads fall out. A little later, collagen fibers are formed, from which the main stroma of the bone is formed. A large amount of mineral salts is deposited in it every day and as a result a small piece of new bone tissue appears.

3 weeks after the fracture, on the radiograph of the victim, the first signs of fusion of bone fragments are clearly visible, they look like a small callus. It is still very fragile and thin, although the callus restores the continuity of the damaged bone, the mobility of the bone fragments is still preserved. Over time, more and more calcium salts are deposited in the formed "young" callus and it becomes harder and stronger, like the bone itself. With the process of gradual compaction of the callus, the mobility of all bone fragments significantly decreases, and then completely disappears.

The true (or secondary) callus itself in a patient is formed only after 2 months. The excess and unnecessary part of the callus by this time is gradually absorbed and the bone marrow canal is restored.

Modern methods of treating this pathology is compression osteosynthesis with the help of special compression-distraction devices.

In modern traumatology, surgical correction of improperly fused intra-articular fractures, as well as fractures located in close proximity to the joint, is used. In case of bone fractures inside the joint, the main goal of surgery is to correct the axis of the damaged limb. In children, this operation is a prerequisite, since in all people with age the deformation of bones and joints increases, their physiological function is disturbed.

Quite frequent cases of surgical intervention are incorrectly fused fractures of the clavicle. They are usually accompanied by significant deformity, pain and compression of blood vessels and nerves.

During the surgical intervention, the doctor separates the bone fragments and then compares them again; in this case, a metal rod or a special Kirschner wire is used for reliable fixation.

In case of improperly fused fractures of the bones of the lower limb in the femur or lower leg, bone fragments after separation can be fixed using bolts, screws, spokes and rods. After the operation, the patient must be covered with a plaster cast. After surgical treatment, a rehabilitation course is prescribed, which includes exercise therapy, physiotherapy and massage.

Magnetic therapy for fractures

One of the most effective and common methods of treating bone fractures is magnetotherapy.

Let us consider the mechanism of physical and biological effects of magnetic therapy on the human body: when exposed to a small area of ​​the body, a non-uniform magnetic field penetrates, which has a variable frequency and a given induction.

The cells of the human body are the ultimate receivers of electromagnetic signals, they activate metabolism, conduct impulses, and thus start the recovery mechanism.

There are several reasons why magnetotherapy is used for bone fractures:

1. Anti-inflammatory effect;
2. Anti-pain effect;
3. Affects the main pathophysiological links of the disease;
4. Enhances local blood flow;
5. Accelerates the excretion of decay products;
6. Stimulates the ganglia of the autonomic nervous system;
7. Improves microcirculation;
8. Enhances the regeneration of damaged tissues;
9. Accelerates the process of wound healing.

Like any method of treatment, magnetotherapy has contraindications, which can be described in detail by a physiotherapist or a rehabilitation specialist. Magnetotherapy is used in cosmetology, urology, traumatology. It is under the influence of a magnetic field that a rapid fusion of bones occurs.

Ununited fracture

An ununited fracture is a pathology based on slowing down or stopping the healing process of a fracture. In this case, scarring of the opposing fragments of the broken bone is observed, they are covered with fibrous tissue on top, which over time can turn into fibrous cartilage in some patients.

If the patient has elements of mobility in the fibrocartilage, then fibroid necrosis develops and a false joint may form. The process of delayed fracture healing is characterized by prolongation of the period of callus formation. The maturation and remodeling of the callus does not fit into the usual time frame.