Кость, что образует мизинец, считается одной из самых тонких, и сломать ее достаточно легко. А симптомы и интенсивность боли при закрытом переломе выражены слабо, из-за чего люди могут не обращать внимания на травму долгое время, что всегда ведет к развитию осложнений.
Фото 1. Основной признак перелома — синюшность кожи. Источник: Flickr (d h-j).
Причины и механизм перелома мизинца
В зависимости от того, что стало причиной, переломы мизинца подразделяют на 2 категории:
- травматические, которые появляются при ударах, компрессиях и т.д.;
- патологические — те, что развиваются на фоне болезней, влияющих на прочность кости: остеопороз, например, или злокачественные опухоли.
Обратите внимание! Повышенная ломкость костей возникает не только по причине болезней, но и при неправильном рационе: кальция с пищей в организм поступает мало, и кости становятся хрупкими.
Но чаще всего травма – следствие резкого подворачивания конечности, занятий такими видами спорта, как бег или футбол (там риск перелома высок), удара о мебель, неудачного прыжка или падения на ногу чего-то тяжелого.
Механизм возникновения перелома прост: сила внешнего воздействия на мизинец превышает прочность кости, отчего последняя ломается.
При патологических состояниях участок кости поражен болезнью, его структура нарушена. И прочность снижается настолько, что для перелома достаточно и слабого внешнего механического воздействия для возникновения травмы.
Виды и классификация перелома
Виды перелома мизинца, принятые в медицине, приведены в таблице ниже.
| Название | Признаки |
|---|---|
| Закрытый | Сломанная кость не повредила кожу и мягкие ткани. |
| Открытый | Возникновение открытой раны, в которой могут быть видны обломки кости. |
| Без смещения | После травмы кость не поменяла положения. |
| Со смещением | Кость разошлась (сместилась) частично или полностью. |
Перелом может оказаться локализованным: в области ногтевой фаланги — и это частый случай, или в районе основной фаланги, что считается более сложным вариантом.
Перелом бывает абсолютным или частичным. В первом случае речь идет о полном разрушении кости, во втором – лишь о ее частичном повреждении.
Как отличить ушиб мизинца от перелома
Наверняка различие покажет только рентгеновский снимок. Но есть признаки, по которым можно предположить, что мизинец сломан, а не ушиблен:
- На день, следующий после травмы, улучшений никаких нет.
- После первой помощи, болевые ощущения не стихают — даже усиливаются.
- Отек несмотря на принятые меры продолжает увеличиваться и переходит на другие участки стопы.
- Палец визуально кажется короче.
Обратите внимание! Иногда при отсутствии перелома боль все равно не проходит. Это означает, что мизинец вывихнут, или разорваны сухожилия. Поскольку такие повреждения требуют особой терапии, хирурга нужно посетить как можно скорее.
Признаки перелома
Для перелома именно мизинца характерна следующая симптоматика:
- очень сильная, резкая боль в пальце, которая расходится на всю стопу;
- в течение первых минут после травмы кожа над участком перелома заметно бледнеет;
- потом она начинает синеть, появляется отек;
- температура в месте травмы высокая, прикасаться к этому участку больно;
- если перелом был со смещением – будет слышно похрустывание отломков.
Важно, что именно синюшность кожи является характерным признаком перелома, тогда как при ушибе она не наблюдается. А боль настолько сильная, что пострадавший не позволяет прикоснуться к стопе и отдергивает ногу. Наступить на нее он не может. Палец же, если перелом был со смещением, приобретает патологическую подвижность.
Первая помощь и правила действий при переломе
В первую очередь необходимо вызвать скорую помощь. Травмированному человеку нельзя ходить или иначе двигать стопой, чтобы не вызвать смещение костей. Это значит, что ему нужно обеспечить покой. Если же перелом открытый, то рану как можно скорее следует обработать антисептиком и остановить кровь.
Фото 2. Ногу нужно постараться обездвижить еще до приезда медиков. Источник: Flickr (Aurelie S Cannella).
После этого нужно сделать следующее:
- поместить пострадавшую стопу в такое положение, чтобы сломанный палец ни с чем не контактировал – это предотвратит усиление боли;
- дать травмированному человеку обезболивающее лекарство;
- если перелом со смещением, надо наложить иммобилизирующую повязку, т.е. зафиксировать мизинец вместе с соседним пальцем;
- приложить к пострадавшему участку лед, что уменьшит отек, выраженность гематом и предупредит кровотечение.
Обратите внимание! Категорически не рекомендуется самостоятельное вправление отломков!
Лечение перелома мизинца
В зависимости от вида перелома лечение назначат либо консервативное, либо хирургическое.
Консервативное лечение
Консервативное лечение, которое называют закрытой репозицией, проводят, когда отломки кости не прорвали кожи и мягких тканей. Под местной анестезией доктор устанавливает костные отломки в правильное положение и накладывает гипс, либо его аналог – скотчкаст (повязка из специального материала), ортез или шину. Надрезы кожи и мягких тканей не проводятся.
Хирургическое лечение
Хирургическое лечение, или открытая репозиция, предполагает установку кости в нужное положение при помощи операции и иммобилизацию пальца в двух суставах для полного срастания. Оперативное вмешательство проводят, когда иначе придать правильное положение кости невозможно. Операция проходит под местной анестезией, после чего накладывается гипсовая лангета с подошвенной фиксацией.
Последствия перелома мизинца
Последствия будут, если диагностика перелома была запоздалой, или пациент не обратился за врачебной помощью вообще. В таком случае, можно ждать:
- образования большой костной мозоли;
- формирования ложного сустава, который не имеет хрящевой прослойки, в результате чего трение между концами кости повышено: будут частые боли и воспаления, палец теряет двигательную и опорную функции;
- анкилоза, а при нем суставная щель исчезает, и тоже развиваются бурные воспаления;
- остеомиелита – воспаления костного мозга.
Восстановительный период
Восстановить все функции поврежденного мизинца и его подвижность можно только следуя всем указаниям доктора.
Как долго проходит восстановление
Сроки реабилитации зависят от тяжести перелома, своевременности медицинской помощи, точности, с которой пострадавший соблюдает назначения доктора. Но в среднем требуется от одного до двух месяцев.
Сколько времени нужно носить фиксаторы
Гипс, ортезы, скотчкасты и другого рода фиксаторы придется носить от двух до четырех недель в зависимости от тяжести травмы и скорости образования костной мозоли.
Лекарства и диета
При переломе мизинца также назначается медикаментозная терапия, ее задача – ускорить срастание кости и сделать его более эффективным. Она включает:
- препараты с легкоусвояемым кальцием;
- лекарства, что улучшают трофику мышечного аппарата и хрящевой ткани;
- курс противовоспалительных и обезболивающих препаратов.
Кроме этого, доктор может порекомендовать диету, состоящую из богатых белком и кальцием продуктов, и назначить массаж, физиотерапию, лечебную гимнастику.
Профилактика и общие рекомендации
Чтобы снизить риск перелома мизинца надо, по возможности, избегать мест, где на стопу может упасть тяжелый предмет, соблюдать осторожность при ходьбе или занятии такими видами спорта, как футбол и бег.
Также надо носить удобную обувь, которая имеет устойчивую подошву. Включить в рацион продукты, содержащие кальций (бобовые, картофель, яйца, ржаной хлеб и т.д.). И снизить употребление того, что кальций из организма вымывает, а это кофе, алкоголь, сладкая газировка.
Вовремя проходить обследования и серьезно заниматься лечением болезней, что влияют на плотность костей.
Перелом мизинца на руке происходит чаще всего. Основная причина — месторасположение пальца. Он находится на краю кисти и принимает на себя негативные воздействия.
Травмы получают люди, занимающиеся активным видом спорта, рабочие в строительных, машинных отраслях и, конечно, дети.
Причины переломов мизинцев на руке
Переломы на мизинце происходят по разным причинам:
- падение на руку;
- давление на основную и конечную (дистальную) часть фаланги;
- удар тяжёлым предметом по мизинцу;
- попадание в машинный механизм.
Как правило, механическое повреждение целостности кости возникает в бытовых или производственных условиях.
Виды переломов
Нарушение целостности кости разделяют на два основных вида:
- Травматическое, когда перелом происходит вследствие механического повреждения фаланги.
- Патологическое. Является следствием влияния какого-то заболевания, в результате которого нарушается прочность скелета.
К переломам относят следующие патологические состояния органа опорно-двигательного аппарата:
- Надлом. Плоскость излома в этом случае равна половине и более диаметра костной трубки.
- Трещина. Объём механического повреждения занимает большую половину диаметра кости, но соединительная ткань остаётся целой, без разрывов.
- Растрескивание. Орган опорно-двигательного аппарата повреждается со всех сторон трещинами (поперечными, винтообразными, косыми, продольными, оскольчатыми). Могут возникнуть только при мощнейшем, целенаправленном ударе мизинца.
По характеру повреждения кожного покрова переломы пятого пальца на руке различают:
Отличаются они между собой бактериологической загрязнённостью тканей. При первично открытом (во время травмы) или вторично открытом повреждении кость разрезает кожу и выходит наружу. Патологический процесс сопровождается заражением и требует немедленного хирургического вмешательства.
Проявления и симптоматика
Симптомы перелома мизинца на руке обычно несут явный визуальный характер:
- Локализованная отёчность.
- Проявления скопления крови вследствие разрыва или ранения сосудов.
- Деформация фаланги (при переломе со смещением) и наружного покрова (открытое нарушение целостности кости).
К этому добавляются выраженные физические страдания, усиливающиеся при движении мизинца или небольшом механическом воздействии.
Признаки перелома мизинца на руке с тыльным вывихом или подвывихом проявляются только обездвиживанием пальца.
Независимо от такого, какие симптомы проявляются после механического воздействия, диагностирование и дальнейшее лечение должен производить только врач. В противном случае есть угроза потери всех функций повреждённого мизинца.
Диагностика
Последовательные процессы распознавания типа заболевания заключаются в визуальном осмотре мизинца доктором и рентгенографии — фиксировании анатомической структуры повреждённого участка на плёнке.
Трудность в диагностике представляют нарушения целостности кости без её смещения, внутренних суставных переломов и трещины.
Отличительные черты ушиба от перелома
Как отличить ушиб от перелома мизинца? Для начала разобраться в определении каждого из них.
Ушиб — внутренняя травма, не сопровождающаяся нарушением целостности кожи. Больше повреждаются мягкие ткани и органы, расположенные вблизи неё. На месте ушиба образуются гематома и отёчность, есть ограничения в подвижности. Он может быть результатом перелома.
Перелом — травма, которая влечет за собой более тяжёлые последствия: нарушение целостности хряща или кости с возможными разрывами кожного покрова, сосудов, мышц, нервных окончаний.
Симптоматика ушиба и закрытого перелома практически одинакова, но есть некоторые отличительные черты:
- При переломе боль не проходит и может даже увеличиваться, а при ушибе по истечении некоторого времени она стихает.
- Отёчность также ведёт себя по-разному. При нарушении целостности кости место распухает на 2-3 день, при закрытом повреждении тканей появляется сразу.
- Двигательная активность полностью нарушается после перелома, а вот при ушибе даже через боль можно согнуть мизинец.
Перелом у ребёнка. Что делать?
Диагностика нарушения целостности кости у детей осложнена тем, что существуют незакрытые зоны роста. Как определить перелом, если даже после рентгена врач иногда затрудняется точно сказать, имеется тот или нет.
В этом случае важна внимательность травматолога: точное сравнение с другой рукой, усердный осмотр. Также рекомендуется проверить болевые ощущения, нажав на мизинец вдоль оси пальца. Если физические страдания ребёнка становятся невыносимыми, то в 90% это перелом.
Лечение до приезда врачей может начать любой взрослый. Всё, что нужно сделать, — провести иммобилизацию (обездвижить, создать покой) травмированной части тела. Нужно зафиксировать палец с помощью бинтов и любого прямого и твёрдого предмета. В случае открытой раны необходимы обеззараживающие мероприятия.
Перелом со смещением и без
Травматическое поражение без смещения происходит без покидания костью оболочки надкостницы. Лечение проводят с применением гипсовой повязки, которая фиксируется от средней трети предплечья до кончика повреждённого пальца.
Альтернатива медицинской затвердевающей повязке — шина. Её преимуществом является обездвиживание только травмированного мизинца.
Перелом мизинца на руке со смещением характеризуется перемещением отломков кости относительно друг друга, при этом могут повреждаться окружающие её ткани: сосуды, кожа, связки, мышцы, суставы. Исправление нарушения проводится под местной анестезией, после чего также накладывается шина или гипс на 3 недели.
Краевой перелом
Краевой перелом мизинца на руке характеризуется обламыванием краешка или маленькой части от кости. Иногда сопровождается деформацией ногтевой пластины.
Это самая лёгкая форма травматического поражения, но лечить патологию необходимо, поскольку нарушается процесс кровоснабжения руки, что чревато повреждением целостности сосудов или некрозом тканей.
Опасные изменения после перелома
Последствия зависят от правильности оказания неотложной помощи и способа лечения. Существуют следующие патологии:
- Медленное сращивание костей. Выход один — оставить гипс или шину на длительный период.
- Неправильно сросшийся перелом. Нарушается функциональность кисти, присутствуют ноющие боли. Патологию исправляют повторным вправлением.
- Отсутствие процесса сращивания. Если кости не начали соединяться через несколько недель, проводят оперативное вмешательство.
- Инфекция. Остеомиелит трудноизлечим, но оперативное вмешательство или долгий курс антибиотиками способствует постепенному выздоровлению.
- Тугоподвижность. Возникает вследствие регулярных переломов на одном и том же месте. Даже после долгого лечения палец может так и не срастись. Облегчит ситуацию физиотерапия.
- Болевой синдром. После полного излечения возникает боль в холодное время года и при средней нагрузке на кисть.
В запущенных формах травмы возможна инвалидизация или ампутация пальца.
Нарушена подвижность после перелома. Что делать?
После снятия гипса у многих пациентов наблюдается нарушение подвижности мизинца. Восстановить полную функциональность руки можно простыми действиями: перебирать крупы или массажировать.
Эффективной будет физиотерапия, которую следует посещать несколько недель после снятия твёрдой фиксирующей накладки. Каждая последующая процедура должна приносить облегчение — активное сгибание пальца. Это значит, что процесс реабилитации идёт отлично.
Лечение
Производится в зависимости от осложнения:
- Открытый перелом мизинца на руке — нужно оперативное вмешательство.
- Разрушение подвижных соединенных костей скелета — применяется эндопротезирование (замена части сустава).
- Перелом сустава — осуществляется репозиция различными фиксирующими конструкциями.
- Многооскольчатый перелом — значит, нужен компрессионно-дистракционный метод (фиксация спицами) с использованием аппарата Илизарова.
Болевой синдром и отёчность снимают анальгетиками и нестероидными противовоспалительными препаратами.
Что лучше накладывать — шину или гипс?
Шина или гипс накладывается независимо от разновидности перелома. Что лучше? Всё зависит от предпочтения пациента. И тот и другой фиксатор надёжно обездвиживает травмированный палец.
Единственным различием является локализация накладки. Гипс размещается от средней трети предплечья и до мизинца. Шина же фиксируется только повреждённый палец, но обойдётся этот современный метод дороже.
Оперативное вмешательство
В случае неизбежного хирургического лечения прибегают к открытой репозиции. С её помощью восстанавливают правильное расположение пальцев, собираются костные отломки, устанавливается внутренний фиксатор.
После оперативного вмешательства проводят иммобилизацию руки, затем назначают курс реабилитации с целью восстановления кровотока и функциональности мышц.
Период восстановления
Комплекс медицинских мер разрабатывается врачом с учетом специфики полученной травмы. Обычно он состоит из следующих физиотерапевтических процедур, которые назначаются через неделю после снятия гипса:
- интерференционные токи;
- уф-излучение;
В случае положительной динамики и восстановления функциональности мизинца через 2–4 недели (вот ответ на вопрос о том, сколько носить гипс) могут быть назначены:
- магнитно-лазерная терапия;
- увч-терапия;
- ультразвук с применением гидрокортизона;
- массаж;
- ванны и йодом и бромом.
Сколько заживает перелом, сразу нельзя определить, всё зависит от индивидуальных особенностей организма и способа лечения.
Зачастую можно услышать шуточное мнение, что самый маленький палец на ноге создан для того, чтобы человек им больно ударялся о твердые предметы. Как известно, в каждой шутке есть доля правды. Перелом мизинца на ноге является одной из наиболее распространенных травм костей стопы. Несмотря на скромные размеры самого пальца, при повреждении мизинца боль человек испытывает довольно сильную, что в большинстве случаев заставляет его обратиться за помощью к специалистам.
Причины повреждения мизинца
Практически всегда причиной перелома мизинца является кратковременное воздействие на ступню человека значительной силы. Механизмы ее приложения при этом могут быть разными. Чаще всего трещина на мизинце появляется после удара о тяжелый твердый предмет, спортивной травме, падения груза на стопу.
Фактором, повышающим вероятность возникновения перелома мизинца, является выраженный остеопороз. Это снижение плотности костной ткани вследствие нарушения обмена кальция и фосфора в организме.
Характерные признаки
Симптомы перелома мизинца на ноге достаточно ярко выраженные, что позволяет врачу заподозрить верный диагноз и своевременно начать лечение.
- Боль – может быть как локальной и охватывать только мизинец, так и всю стопу.
- Отек – сразу после получения травмы ступня несколько увеличивается в размерах. Это происходит за счет активации медиаторов воспаления и повышения проницаемости стенки кровеносных сосудов. У данного явления есть и положительные свойства – при оскольчатом переломе отечные ткани препятствуют значительному смещению отломков, удерживая их на месте. Это поможет избавить пациента от операции в дальнейшем.
- Кровоподтек – так на профессиональном медицинском сленге называется синяк. Фаланги мизинца, как и все кости, хорошо кровоснабжаются и имеют собственную сеть кровеносных сосудов. Когда он сломан, целостность стенок сосудов нарушается, и часть крови изливается в ткани, придавая пальцу фиолетовую окраску.
- Деформацию пальца видно невооруженным взглядом. Характерна для перелома фаланги мизинца со смещением.
- Если говорить об открытых переломах с повреждением кожи, то на травму мизинца указывают видимые в ране костные фрагменты.
Диагностические процедуры
Чтобы определить перелом мизинца или исключить его, необходимо выполнить рентгенологическое исследование и провести осмотр. Снимок позволяет не только подтвердить диагноз, но и определить характер травмы.
- Если отломки кости мизинца находятся на своем месте и сопоставлены друг с другом, то говорят о переломе без смещения.
- Перелом мизинца со смещением встречается реже, но сложнее в лечении.
- Оскольчатый перелом – характеризуется наличием сразу нескольких костных отломков.
Способы лечения
Перелом мизинца ноги лечится по тем же принципам, что и другие повреждения костей. В большинстве случаев приходится загипсовать конечность при помощи лонгеты, которая исключает движения в стопе, а поврежденная кость не испытывает никакой нагрузки при ходьбе.
Обязателен контрольный снимок приблизительно через неделю после перелома мизинца, если есть риск вторичного смещения отломков. Происходит это из-за того, что локальный отек проходит и гипс не лежит так плотно, как изначально. Если пациент замечает, что гипс «болтается» на ноге, то можно самостоятельно более плотно зафиксировать его при помощи обычных марлевых бинтов. Носить гипс при переломе мизинца на ноге необходимо в течение нескольких недель. Этого достаточно для того, чтобы перелом успел зарасти, а кость стала прочной.
На сегодняшний день существуют специальные ортопедические изделия, позволяющие удобно фиксировать отдельный палец на стопе, без надобности ношения большой лонгеты.
Если сломан самый маленький элемент мизинца – ногтевая фаланга, то необходимости в ношении гипса нет. Дело в том, что на нее практически не ложится нагрузка при опоре на стопу. Вылечить пациента в таком случае можно при помощи пластырной повязки. Она представляет собой несколько слоев пластыря, обмотанных вокруг пальца. В результате повязка становится довольно прочной, для того чтобы обеспечить иммобилизацию.
Если есть признаки перелома со смещением и диагноз подтверждается, то может потребоваться операция. Существует несколько способов возвратить фрагменты кости на свое место и зафиксировать их в таком положении.
- Это может быть тонкая спица, проведенная через пальцы. Она становится той осью, на которой и держатся отломки. По истечении определенного времени ее вытягивают из пальца – для этого нет необходимости даже дополнительно использовать обезболивающие препараты.
- Достаточно редко применяют специальные пластинки, которые укладываются на кость и становятся остовом, к которому крепятся отломки. Через некоторое время пластинки извлекаются.
Если говорить о лекарствах, то их при переломе мизинца назначается немного. Это обезболивающие средства, которые необходимы в первые дни после травмы, препараты кальция для ускорения формирования костной мозоли. При открытом переломе и наличии обширной раны могут потребоваться антибиотики – для предотвращения инфекционных осложнений.
По окончании лечения всегда назначается контрольное рентгенологическое исследование, которое должно показать, что в мизинце сформировалась прочная костная мозоль и нет риска повторного сдвига отломка.
Восстановление
Непосредственно сам мизинец в разработке и реабилитации после лечения практически не нуждается, поскольку объем движений в норме он совершает небольшой, а опора на него при ходьбе минимальна. Гипс же, который пациент носил на протяжении достаточно длительного времени, иммобилизирует всю стопу. Мышцы при этом становятся менее эластичными и первые дни без лонгеты пациенту может быть несколько непривычно. Быстро восстановиться в таком случае помогают стандартные методы медицинской реабилитации.
- Физиотерапия – электрофорез, магнит, УВЧ и т. д. Есть они в любой поликлинике и позволяют быстрее вернуть мышцы и мелкие суставы стопы в нормальное состояние.
- Массаж – пациент выполняет его самостоятельно, а может обратиться к помощи профессионала. Процедура хорошо воздействует на тонус мышц голени и стопы, ускоряет разработку сустава.
- Лечебная физкультура – инструктор обучает пациента нескольким упражнениям, которые можно выполнять как под контролем профессионала, так и самостоятельно дома.
Возможные осложнения
Позднее обращение за помощью, при переломе мизинца на ноге, может стать причиной целого ряда осложнений:
- Неровное сращение кости мизинца возникает, если отломки значительно сместились, но не были предприняты меры по их сопоставлению обратно.
- Остеомиелит – гнойное поражение костей. Если перелом открытый, и повреждена кожа, то в ранку могут попасть микробы. Инфекционный процесс может настолько сильно поразить кости пальца, что врачам ничего не остается, кроме как ампутировать мизинец. В более тяжелых случаях инфекция распространяется далее на стопу и доставить немало хлопот медикам и самому человеку.
- Формирование ложного сустава между отломками кости мизинца. Если изначально смещения не было, и палец не обездвижен должным образом, то движения будут препятствовать нормальному сращению.
Если с переломом мизинца своевременно обратиться к специалисту и выполнять все его рекомендации, то практически в 100% случаев выздоровление наступает быстро и без последствий.
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