Dislocation of the brush

The dislocations of the brush and the individual components of its bones are rare. Most often, a dislocation of the semilunar bone occurs, and also brush dislocations distal to the first row of the wrist bones.

[1]

What causes a dislocation of the brush?

Dislocations of the brush often occur in the back, rarely - in the palm. The cause of the occurrence is excessive extension or flexion in the wrist joint.

Symptoms of a brush dislocation

Anamnesis

In the history - an indication of an appropriate injury.

Examination and physical examination

Characterized by pain, bayonet deformity of the wrist, edema, dysfunction. When palpation, note the soreness and disruption of the wrist joint shape, a positive symptom of springing resistance.

Perilual wrist dislocation

Perilual wrist dislocation - a dislocation of the hand distal to the semilunar bone, which continues to maintain congruence with the radius.

ICD-10 code

S63.0. Dislocation of the wrist.

Symptoms

Symptoms and diagnostics are similar to brush dislocation, fracture of a ray in a typical place and other types of fractures. The monotony of the clinical picture is a consequence of the displacement of the brush in the back.

Diagnostics

X-ray examination solves doubts.

Treatment

General anesthesia. After intensive stretching along the longitudinal axis and dorsiflexion of the hand, the surgeon presses his thumbs on the protruding part of the back surface of the wrist, and with the other fingers performs an anti-support in the distal part of the forearm. After removal of the dislocation, the wrist is bent at an angle of 135 ° and fixed with a plaster bandage for 3 weeks. After this, the brush is removed to a functionally advantageous position and immobilized with a plaster bandage for another 3 weeks.

Estimated period of incapacity for work

To work begin in 10-12 weeks.

[2], [3], [4], [5], [6], [7], [8]

Dislocation of scaphoid bone

ICD-10 code

S63.0. Dislocation of the wrist.

Dislocation of scaphoid bone occurs with excessive flexion and retraction of the hand to the elbow. The scaphoid bone, displacing, tears the capsule of the joint and dislocates to the rear-ray side.

Symptoms

Detect pain, swelling, edema and smoothness of the contours of the wrist joint, impaired function. Sometimes it is possible to feel a painful bulge in the area of the anatomical snuffbox.

Diagnostics

On the roentgenogram, a dislocation of the scaphoid bone is revealed.

Treatment

Anesthesia is preferably general. Traction for the hand along the axis of the forearm with the lead to the elbow. The surgeon presses his thumbs on the dislocated bone, returning it to its previous position. The brushes are given the position of the back bend and the elbow, the limb is fixed with a circular plaster bandage from the elbow joint to the head of the metacarpal bone for 3 weeks, and then the immobilization is replaced by a removable longure for another 3 weeks.

Estimated period of incapacity for work

Workability is restored in 6-8 weeks.

[9], [10], [11], [12]

Dislocation of a semilunar bone

ICD-10 code

563.0. Dislocation of the wrist.

Dislocation of the semilunar bone occurs due to excessive extension of the hand, which causes an overpressure of the head bone on the semilunar bone and a displacement of the latter in the palmar side.

Symptoms

The wrist is thickened from the palmar side, the painful protrusion is determined above the volar fold, the fingers are half-bent. Movements in the wrist joint are limited due to severe pain, fingers squeezed into a fist or completely unbend the patient can not. Perhaps the emergence of neurologic symptoms as a result of damage to the median nerve.

Diagnostics

The radiograph confirms the diagnosis of dislocation of the semilunar bone.

Conservative treatment

Under anesthesia, a strong and prolonged traction is made along the length, and then pressed on the dislocated bone in the rear direction, returning it to its previous position. Apply a plaster bandage for 3 weeks, then turn it into a removable bandage for another 1-2 weeks.

Surgery

With old or irreparable dislocations of the wrist and wrist bones, external fixation devices are used to create sufficient distraction and to eliminate the dislocation, or to resort to surgical treatment-an open reposition of the dislocated segment.

Estimated period of incapacity for work

The patient can start working in 5-6 weeks.

[13], [14], [15], [16],

Diagnosis of brush dislocation

On the roentgenogram reveal a dislocation of the brush.

Treatment of brush dislocation

The complexity of the structure and the importance of the functions of the brush require highly qualified treatment at all stages of the trauma, so patients should be referred to the surgery departments of the hand or to traumatology.

Conservative treatment

After anesthesia (any method is applicable), the forearm is bent at an angle of 90 °, the shoulder is fixed. Produce traction for the brush along the axis of the forearm, and then dislocate the dislocated segment in the back or palmar side (back to the displacement). After adjusting the brush, which is usually almost always possible, a circular gypsum bandage is applied from the head of the metacarpal bones to the elbow joint. X-ray control is mandatory. The term of permanent immobilization is 4 weeks, after which they start rehabilitation treatment, but the removable gypsum longite is kept for 2-3 weeks.

Surgery

Surgical treatment is indicated if attempts of conservative reduction of the dislocation are unsuccessful.

[17], [18], [19]

Estimated period of incapacity for work

The average recovery period is 7-8 weeks.