Healing with perspective prognosis | Spoke fracture, radius fracture, wrist fracture

Healing with perspective prognosis

The prognosis for healing depends crucially on the fracture shape of the radius fracture, the fracture care and the follow-up treatment (physiotherapy). Good results can only be expected if it is possible to adjust the fracture continuously and to create stable conditions in the fracture area. Otherwise, false joint formation (insufficient stability) and wrist arthrosis (prearthrosis due to joint step) can occur.

The consequences would be pain, restricted movement and loss of wrist function with effects on the whole arm. In principle, there is a worse prognosis for extensive wrist injuries than for uncomplicated distal radius fractures, even with optimal therapy. An uncomplicated spoke fracture usually heals without consequences.

Complication

Complications can occur in both conservative and surgical therapy. Complications in conservative therapy: Complications in surgical therapy:

• Slipping of the fracture (secondary dislocation)
• Pressure damage due to plaster
• False joint formation (pseudarthrosis)
• Sudeck’s diseaseSudeck’s disease, also known as CRPS, is one of the most dreaded complications of wrist fracture.
• Vascular, tendon and nerve injuries
• Infection
• (slipping of the fracture)
• Implant loosening
• False joint formation (pseudarthrosis)
• Sudeck’s diseaseA Mobus Sudeck or CRPS occurs significantly more frequently after surgical treatment than after plaster therapy. Basically, however, it is not possible to distinguish whether the fracture (violent impact) or the operation triggered the CRPS.

Spoke breakage in children

Radius fracture can occur at any age. However, it is more common between the ages of six and ten years. Fractures of the forearm are among the most common fractures in children, at about 25%.

In children, a spoke fracture is usually caused by falls during sports such as playing handball, skateboarding or snowboarding. Since the bone in children is still in development and the bone mantle is relatively soft, a so-called greenwood fracture may be present. Here the bone is broken, but the periosteum surrounding the bone is undamaged.

The name greenwood fracture comes from the observation of a green branch, which may be broken on the inside, but is still surrounded by an undamaged bark on the outside. This type of spoke fracture occurs mainly in children because their bone mantle is flexible, thus reducing the risk of fracture. Children are far more often treated conservatively than adults.

The undamaged periosteum stabilizes the fracture and conservative therapy with a plaster cast for three to four weeks is usually sufficient. After removal of the plaster, a malposition can occur despite the fracture having healed.If this is not too large, a spontaneous self-correction is possible. Prerequisite for a conservative therapy is a contact of the fracture ends and a certain deformity that cannot be exceeded.

If the malposition is too large or completely displaced, spiking wires are also used here. The healing prognosis is very good in this case due to the spontaneous healing tendency in children. There is a controversy about when the necessity of a surgical therapy is given. It should be considered that metal plates are often not necessary in children and that these are increasingly stressed by the additional procedures such as anesthesia and the surgery itself.