What are the types of wrist fracture? How to recover quickly after wrist fracture?

Fracture is a very common accident in life, and sometimes it may be broken if you accidentally fall. Wrist fracture is also very common, which occurs on the wrist and is divided into several different types. So, what are the types of wrist fracture? How to recover quickly after wrist fracture? Let's get to know it together!

1, wrist fracture type

(1) Fracture of distal radius

Conventional anteroposterior, lateral and oblique X-ray examination is not easy to miss the diagnosis of most distal radius fractures. However, for fractures without displacement, especially radial styloid process fractures, it is easy to miss the diagnosis. The styloid process fracture of radius is a kind of oblique fracture, which often involves the articular surface and often occurs in axial stress or direct attack.

Figure 157-year-old female, with her palms propped on the ground, suffered from tenderness of styloid process of radius after falling. (a ~ c) Anterior and posterior, oblique and lateral radiographs showed soft tissue swelling (*) and hairline fracture (white arrow); (d ~ f) After 2 weeks, the fracture lines in the anteroposterior, oblique and lateral radiographs were obvious. Due to the deposition of new callus, bright lines and sclerotic lines coexisted. (g ~ I) Another 1 case of radial styloid process fracture was not obvious on the frontal and lateral radiographs, but it was more obvious on the oblique radiographs.

(2) navicular fracture

60% ~ 70% of scaphoid fracture occurred in the waist, 15% in the proximal pole, 10% in the distal pole and 8% in the distal articular surface. In addition to the conventional anteroposterior, lateral and oblique films, special navicular bone films (ulnar wrist joint and wrist joint centered on navicular bone) are needed, especially when the snuff bottle is tender.

Fig. 2 Patients with scaphoid fracture (A, B) 1, intra-articular fracture of distal scaphoid (white arrow), clearly shown in oblique film (B); (c, d) The second patient had a scaphoid waist fracture (dotted arrow), and the oblique film showed clearly (d); (e ~ h) The third patient had a fracture of the proximal navicular bone, but the fracture (dotted circle) was not seen on the conventional X-ray film.

(3) Fracture of metacarpal plate

Palmar plate is a fibrous structure on the palmar side of metacarpophalangeal joint and interphalangeal joint capsule to prevent joint hyperextension. The distal end of metacarpal plate is thickened fibrocartilage, which is attached to the base of metacarpal and phalanx, and its two sides are fused with the fibers of lateral collateral ligament. Palmar fracture mostly occurs in hyperextension injury, which is an avulsion fracture.

Fig. 3 Orthographic, oblique and lateral radiographs of the little finger in metacarpal fracture (A ~ C). Because of the location and characteristics of fractures, it is usually difficult to find fractures on the frontal film. After magnification, a bone fragment (white arrow) can be seen in oblique position (D) and lateral position (E).

(4) Fracture and dislocation of carpometacarpal joint

Fracture and dislocation of carpometacarpal joint is a kind of high-energy injury, often accompanied by nerve injury. Carpometacarpal joint is composed of many bones, and there are many overlapping bites on lateral radiographs, so the fracture is not easy to find and easy to be missed. On the anterograde film, the articular surface is not smooth, the joint space is asymmetric, the articular cortex is destroyed, and the articular surface overlaps, which often indicates the fracture and dislocation of carpometacarpal joint. In particular, the dislocation of the 4th and 5th carpometacarpal joints is not easy to find on the anterograde film. Unstable injury, also known as "mutant boxer injury/fracture".

Fig. 4 Fracture and dislocation of the 4th and 5th carpometacarpal joints. (a) The carpometacarpal joint is normal, and the articular surface is balanced, undulating and parallel; Anterior and posterior position (b), oblique position (c), lateral position (d), swelling of soft tissue near the proximal end of the 5th metacarpal bone (white arrow), overlapping of coronal articular surfaces, hamate fracture (*) caused by dorsal impact shear stress, and double-density shadow can be seen in the frontal and oblique films. Small fracture fragments can be seen at the bottom of the fourth metacarpal bone (D, dotted arrow), and the palmar sides of the fourth and fifth metacarpals are angled. (e ~ g) Variant boxing injury: dislocation of the back of the 4th and 5th metacarpals without fracture (e, dashed box), small fragment fracture in hamate (f, short dashed arrow) and intra-articular fracture at the base of the 4th metacarpal (g, long dashed arrow).

(5) hamate fracture.

Hamate's fracture can occur in the body and hook, while hamate's fracture is more common, which can be combined with dislocation of the fourth and fifth carpometacarpal joints. The mechanism of injury is direct violence or avulsion of transverse carpal ligament. Fracture signs include no hook sign, blurred cortical margin, sclerosis or double-density shadow. Conventional anteroposterior position often cannot make a definite diagnosis, so it is necessary to take additional photos of carpal tunnel position to clearly show its hook.

Figure 5 Severe wrist pain after playing golf. Conventional X-ray film of wrist joint is normal (X-ray). Carpal tunnel X-ray film (B) vaguely showed transverse fracture of hook body (dotted arrow), and CT examination (C, D) further confirmed the diagnosis.

(6) Triangular fracture

Triangular fracture is one of the common wrist fractures except navicular fracture. Its dorsal side is the attachment point of dorsal ligament of radiocarpal joint, so dorsal fracture is more common. Conventional radiographs can basically make a definite diagnosis. A small amount of bone can be seen on the lateral radiograph of dorsal fracture.

Figure 6 Triangular fracture. (1) The fracture of anterior and posterior radiographs is not obvious; (b) Only a small bone mass (short arrow) accompanied by soft tissue swelling (long arrow) was seen on the lateral radiograph.

(7) Weak area of wrist joint

Perilunate dislocation and perilunate fracture dislocation often occur in the palm rest after falling, which are caused by overstretching and axial violence. The so-called "fragile zone" includes styloid process of radius, polygonal bone, navicular bone, proximal skull, proximal hamate, lunate margin of triangular bone and styloid process of ulna.

Fig. 7 Periosseous dislocation (anterior and posterior position, oblique position and lateral position of wrist joint) through scaphoid fracture. (a, b) Anterior and posterior positions and oblique positions indicate lunate waist fracture (black arrow), the 1st 1 and 2nd wrist arcs are interrupted, the proximal pole (*) of scaphoid is still in the original position, and the distal pole (dotted line) is dislocated dorsally.

2. How to exercise after fracture?

(1) Early functional exercise

It is usually performed at 1-2 weeks after injury. The main purpose of exercise during this period is to promote the blood circulation of patients' limbs, thus reducing swelling, stabilizing fractures and promoting recovery.

The starting time of functional exercise is mainly the isometric contraction of the injured muscle after fracture reduction and fixation, that is, when the joint is at rest, the muscle performs static operation and relaxation rhythmically, which is what we usually call muscle "tension" and "relaxation". Isometric contraction of muscles can prevent muscle atrophy or adhesion, and promote fracture healing and functional recovery.

(2) Mid-term of functional exercise

From 2 weeks after the injury to the clinical healing period of the fracture, the swelling of the affected limb gradually disappeared, the pain was relieved, the fiber at the right side of the fracture was connected, callus gradually formed, and the fracture site became more and more stable.

During this period, in addition to continuing to do muscle isometric exercise, with the help of medical staff or healthy limbs, you can gradually restore the unfixed joint activities at the proximal and distal ends of the fracture and the activities of the upper and lower joints at the fracture, from passive movement to active movement, to prevent the decline of adjacent joint activities; When the patient allows, he should get up as soon as possible for full-body activities.

(3) Late stage of functional exercise

For those who have achieved clinical healing or removed external fixation, at this time, the callus has formed and developed on the X-ray film, and the bones have some support, but there are many functional obstacles such as decreased joint activity and muscle atrophy near the joint. Therefore, the purpose of rehabilitation exercise at this time is to restore the activity of the affected joint, enhance muscle strength and restore limb function. The main forms of functional exercise are strengthening the active activities of injured limb joints and weight-bearing exercise.