Rehabilitation of the patients with the radius distal epiphysis fractures

A.K. Rushay, V.G. Klymovytskyy, F.V. Klymovytskyy, S.V. Lisunov, L.V. Bogdanova

Abstract


Background. Fractures of the radius distal epiphysis (FRDE) occur quite often, especially in elderly people. Unsatisfactory results of the treatment in the patients older than 70 years are found in 44 % cases. The purpose of the work was to improve the results of treatment of patients with fractures of radius distal epi-
physis based on the proposed early complex individual rehabilitation treatment. Materials and methods. 97 patients with FRDE with displacement were investigated. They were treated conservatively. Women predominated: 67 people (69.1 %), over 50 years — 64 (66 %). Among 28 patients with FRDE treated conservatively, the non-traumatic technique of one-step correction was used, in which traction along the length and bending towards the existing displacement was carried out at a fixed elbow joint. Simultaneously, the doctor eliminated the displacement along the width by pressing the fingers on the distal fragment, after which the correction of the angular displacement by palmar flexion was performed. In 69 patients reposition was carried out in accordance with the proposed method of adhesive plaster traction. After the comparison, the fragments were fixed with a gypsum or plastic dressing in the position of a light stretch and a slight flexion or extension of the hand, within a slight supination. Drug therapy followed the correction, depending on the potential neurostrophic syndrome assessed by temperature difference in fingers. The objectives of the therapeutic physical training in the first immobilization period were: general restorative and psycho-emotional tonic effect on the body; improvement of blood circulation and tissue trophism; prevention of muscle atrophy and joint contracture. The post-immobilization period was characterized by the change in the proportion of resto-rative exercises up to 25 %; special exercises for the injured hand were 75 %. The objectives of therapeutic physical training were: restoration of damaged hands function, joint mobility; elimination of muscle atrophy. After complete recovery X-ray bone therapeutic physical training was carried out during the third recovery period. Massage was initiated in 2–3 days after the injury, after acute inflammatory process relief and continued within the period of illness. From the first period physiotherapy — phonophoresis, Payler therapy by Bioptron device, longitudinal calcium electrophoresis, and magnetic therapy were applied. Results. Functional results of the patients with fractures of the radius distal epiphysis by the DASH scale showed good and satisfactory results in 97.8 % cases, and unsatisfactory ones in 2.2 %. Conclusions. There was demonstrated the high efficiency of the complex rehabilitation (rational low-impact correction and fixation of the fragments, individual drug therapy, the method of predicting the possible post-traumatic neurodystrophic syndrome (temperature difference) and early kinesitherapy, massage and physical therapy depending on the treatment period and individual features).


Keywords


distal radius epiphysis fracture; rehabilitation

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DOI: https://doi.org/10.22141/1608-1706.2.18.2017.102553

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