American Journal of Medicine and Medical Sciences

p-ISSN: 2165-901X    e-ISSN: 2165-9036

2022;  12(6): 694-698

doi:10.5923/j.ajmms.20221206.17

Received: May 30, 2022; Accepted: Jun. 17, 2022; Published: Jun. 29, 2022

 

Features of the Formation, Course and Outcomes of Fractures of the Wrist Bones in Injuries with Blunt

Indiaminov Sayit Indiaminovich1, Shopulatov Iskandar Bakhtiyorovich2

1Doctor of Medical Sciences, Head of the Department of Forensic Medicine, Samarkand State Medical University, Uzbekistan

2Research Candidate of the Department of Forensic Medicine of the Samarkand State Medical University, Uzbekistan

Correspondence to: Indiaminov Sayit Indiaminovich, Doctor of Medical Sciences, Head of the Department of Forensic Medicine, Samarkand State Medical University, Uzbekistan.

Email:

Copyright © 2022 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract

In order to identify the features of the formation, course and outcomes of fractures of the bones of the wrist, fractures of the bones of the wrist were studied in 24 male individuals aged 15 to 48 years who were injured under various circumstances. It has been established that fractures of the scaphoid bone (83.3%) are most often formed from the impact of blunt objects, fractures of the other bones of the wrist are detected relatively less frequently (16.7%). In the navicular bone, Type A 2 fractures are often formed - an incomplete fracture of the waist, relatively less often - types B 2 - a completed fracture of the waist and B 4 - transnavicular - perilunar fracture-dislocation. The main types of fractures of other bones of the wrist are fractures of the bodies of the lunate and hamate, intra-articular uncomplicated fracture of the pisiform and palmar fracture of the triquetral bones. In patients with scaphoid fractures, especially in cases of late seeking medical care, there may be complications in the form of a false joint and aseptic necrosis, causing a pronounced dysfunction of the wrist joint, up to a functionally unfavorable position for it. The given data should be taken into account in clinical and forensic practice, in the process of providing medical care and qualification of the severity of harm caused to health in injuries of the bones of the wrist, as well as in the development of measures to prevent such injuries and their complications.

Keywords: Wrist bones, Fractures, Types, Outcomes, Complications, Harm to health, Severity

Cite this paper: Indiaminov Sayit Indiaminovich, Shopulatov Iskandar Bakhtiyorovich, Features of the Formation, Course and Outcomes of Fractures of the Wrist Bones in Injuries with Blunt, American Journal of Medicine and Medical Sciences, Vol. 12 No. 6, 2022, pp. 694-698. doi: 10.5923/j.ajmms.20221206.17.

1. Actuality of the Problem

Injuries to the bones of the hands are characterized by polymorphism of injuries and an extreme variety of fractures and deformation of bone structures, which is due to the anatomical and functional features of this part of the body. In this regard, the problem of treatment and rehabilitation of patients with fractures of the bones of the hand continues to be highly relevant for modern traumatology and orthopedics, due to a significant risk of developing post-traumatic contractures [1,7,9,10,11,13].
The bones of the wrist are spongy structures. Fractures in them are observed most often with an indirect mechanism of injury. This is due to their special anatomical structure, the presence of a large number of inactive joints, strengthened by stretched ligaments, as well as the location of the trihedral, pisiform, hook-shaped, capitate, trapezoid bones in the form of a vault with a bulge to the rear [5,14].
In case of injuries with blunt objects, fractures of the scaphoid (60.88%) are most often observed, then those of the lunate and triquetral bones (up to 12%), injuries to other bones of these structures are rare. The mechanism of formation of fractures of each structure has its own characteristics. Fractures of the navicular bone usually occur when falling on an outstretched hand with emphasis on the palm, while hyperextension occurs in the wrist joint and the load of force falls on this bone. The formation of fractures of the navicular bone from the impact of direct traumatic force is a rare phenomenon. The course and outcomes of fractures of these structures depend both on the nature of the fractures and the period of treatment of patients for medical care, as well as the qualifications of the assistance provided [3,4,8]. In forensic medicine, fractures of these structures require the determination of the severity of the harm caused to health and the duration of the injury, as well as the circumstance of the origin of the fractures.
Studying the circumstances of damage to the bones of the wrist and identifying the features of the formation and outcomes of fractures of these structures, aimed at improving the forensic medical examination to establish the mechanism of injury, prescription and severity of fractures, will contribute to the development of methods for early diagnosis and the provision of qualified medical care to patients at various stages of treatment and prevention of hand injury.

2. The Purpose of the Study

Identifying the features of the formation, course and outcomes of fractures of the bones of the wrist, in persons affected by various types of mechanical trauma from the impact of blunt objects.

3. Materials and Methods of Research

Fractures of the bones of the wrist were studied in 24 males aged 15 to 48 years who were injured under various circumstances: falls on a plane (11), impacts with blunt objects in the area of the hands (6), bicycle injury (1), collisions with moving vehicles and sports games (6) - (Table 1).
Table 1. Fractures of the wrist bones in persons affected, depending on the circumstances of the injury
     
In 17 affected persons, there was an isolated hand injury with fractures of the bones of the wrist, in the remaining 5 cases, the injury of the hands was combined with injuries of other parts of the body: with fractures of the bones of the forearm (2), craniocerebral injury (2) and fractures of the bones of the shoulder, thighs and lower legs (1).
All the victims were provided with the necessary medical care, a full clinical examination and treatment in accordance with the standards. In the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Uzbekistan. The circumstances of the injury were identified according to the anamnesis from the registration logs of the admission department and the patient's medical records.
Identification of the nature of bone fractures was based on data from medical records, the results of radiographs in 2 projections, in some cases, and on the basis of computed tomography (CT). Separated outcomes of the injury were established on the basis of examination of the state of the hands after the end of treatment.
In relation to 13 persons with fractures of the bones of the wrist, after the treatment, a forensic medical examination (FME) was appointed to establish the mechanism of injury and the severity of the harm caused to health. In the process of SME, the victims were subjected to additional examination.
The severity of the harm caused to health associated with fractures of the bones of the wrist was established in accordance with the rule - "Forensic medical determination of the severity of bodily injuries" [5].

4. Research Results and Their Discussion

Table 1 shows that fractures of the navicular bone were most often observed from the wrist structures - 20 (83.3%), fractures of other bones were noted in 4 (16.7%) cases. Types and subtypes of fractures of the scaphoid and other bones of the wrist were established on the basis of the classifications of fractures of these structures (Herbert, Russe) - tables 2 and 3.
Table 2. Types and subtypes of scaphoid fractures
     
Table 3. Types and subtypes of fractures of other wrist bones
     
As can be seen Tables 2 and 3, type-A, in the scaphoid, Type A 2 fractures were most often observed - an incomplete fracture of the waist (14), relatively less often - types B 2 - a completed fracture of the waist (4) and types B 4 - transnavicular - perilunar fracture - dislocation of the wrist (2). On the part of other bones, a fracture of the bodies of the lunate and hamate (2), an intra-articular uncomplicated fracture of the pisiform (1) and a palmar fracture of the trihedral (1) bones (p =) were noted.
18 patients with trauma of the bones of the wrist, who applied for medical care in a timely manner, underwent conservative treatment with the imposition of a plaster splint for a period of 8 to 12 weeks. The outcomes of the injury in these patients were favorable, the functions of the hands and wrist joints were restored. In relation to 6 patients with isolated fractures of the bones of the wrist, who sought medical help a few weeks and months after the injury, surgical treatment was performed, subsequently, 2 of them showed restoration of the function of the hands, and 4 had complications in the form of a false joint (3) and aseptic necrosis (1). In a patient with aseptic necrosis, there was a loss of motion in the wrist joint with a loss of hand function for hard work.

5. Discussion

The results of the study showed that fractures of the navicular bone (83.3%) prevailed in the structure of wrist bone injuries. It distinguishes four types of fractures. Our observations were dominated by stable fresh fractures (Type A) in the form of subtype A2 - incomplete fractures of the waist, in which the fracture lines, in relation to the axis of the bone body, had a transverse (horizontal) and oblique-longitudinal directions. The origin of these fractures was mainly due to the impact of blunt objects on the rear of the hands, or the impact of the zone of these bones on such. Of the 20 cases with fractures of the navicular bone, 4 patients in the long-term outcome of the injury had unfavorable outcomes in the form of a false joint (3) and aseptic necrosis (1), which in the outcome caused pronounced dysfunction of the radiocarpal joint, up to a functional disadvantage. The degree of severity of harm caused to health in these complications, according to the criterion of loss of permanent loss of total disability over 1/3 (35-40%), was qualified as severe bodily injury. It should be noted that with fractures of the bones of the wrist, patients usually do not feel pain, or pain and swelling are minor, which patients usually do not pay attention to. This is due to the absence of periosteum in these bones, and therefore, even with timely operations, an unfavorable outcome can be observed, among which the formation of a false joint predominates [2,3] were classified as grievous bodily harm. It should be noted that with fractures of the bones of the wrist, patients usually do not feel pain, or pain and swelling are minor, which patients usually do not pay attention to. This is due to the absence of periosteum in these bones, and therefore, even with timely operations, an unfavorable outcome can be observed, among which the formation of a false joint predominates [12] were classified as grievous bodily harm. It should be noted that with fractures of the bones of the wrist, patients usually do not feel pain, or pain and swelling are minor, which patients usually do not pay attention to. This is due to the absence of periosteum in these bones, and therefore, even with timely operations, an unfavorable outcome can be observed, among which the formation of a false joint predominates [12].
On the side of the lunate and hamate bones, fractures were observed in the area of their body. The pisiform bone is a sesomoid bone located inside the tendon tissue, and therefore its fractures are of an intra-articular nature, which in our observation was noted in a pedestrian injured as a result of a collision of moving vehicles. In a trihedral bone, its palmar fracture was combined with a perilunar dislocation. The outcomes of these fractures were favorable, that is, after the treatment, the function of the hands and fingers was restored in full.
In case of uncomplicated isolated fractures of the navicular bone, as well as fractures of the lunate, triquetrum, hamate and pisiform bones, taking into account the duration of the health disorder for a period of more than 3 weeks, less than 4 months, the severity of the harm caused to health was classified as moderate. The qualification of the severity of fractures of the bones of the wrist with associated injuries (5) was established taking into account the nature and severity of associated injuries of other parts of the body [5].

6. Conclusions

1. It has been established that fractures of the scaphoid bone (83.3%) are most often formed in persons affected by the impact of blunt objects, fractures of the other bones of the wrist are detected relatively less frequently (16.7%).
2. In the navicular bone, Type A 2 fractures are often formed - an incomplete fracture of the waist, relatively less often - types B 2 - a completed fracture of the waist and B 4 - transnavicular - perilunar fracture-dislocation. The main types of fractures of other bones of the wrist are fractures of the bodies of the lunate and hamate, intra-articular uncomplicated fracture of the pisiform and palmar fracture of the triquetral bones.
3. Patients with fractures of the scaphoid, especially in cases of late seeking medical care, may experience complications in the form of a false joint and aseptic necrosis, causing a pronounced dysfunction of the wrist joint.
4. In forensic medical terms, isolated uncomplicated fractures of the bones of the wrist, taking into account the duration of the health disorder for a period of more than 3 weeks, less than 4 months, the severity of the harm caused to health is qualified as moderate.
Isolated fractures of the scaphoid bone, complicated by a false joint and aseptic necrosis, causing a pronounced dysfunction of the wrist joint, up to a functionally disadvantageous position, the severity of the inflicted health, according to the criterion for the loss of a permanent loss of total disability, over 1/3 (35-40%), qualifies as severe injuries.
The forensic medical qualification of the severity of fractures of the bones of the wrist, with associated injuries, is established taking into account the nature and severity of the associated injuries of other parts of the body.
5. The given data should be taken into account in clinical and forensic practice in the process of providing medical care and qualification of the severity of harm caused to health in injuries of the bones of the wrist, as well as in the development of measures to prevent such injuries and their complications.

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