A Case of Complicated Course of Fracture of the Distal Metaepiphysis of the Radius

INTRODUCTION: Zudek syndrome (neuroreflex algodystrophy, accompanied by osteoporosis, limited range of motion in the wrist and interphalangeal joints, impaired blood flow and associated trophic alterations) accounts for up to 62% of complications of fracture of the distal metaepiphysis of the radius. It may be a consequence of primary action of pathological factors (I type), or may result from compression of peripheral nerves (II type). The article describes a clinical case illustrating occurrence of almost all critical errors in the treatment process (non-performance of local anesthesia of the fracture and of reposition of fragments; fixation of the hand in a vicious (for this type of fracture) flexion position for up to 3 weeks; lack of local physiotherapy, anti-inflammatory and kinesitherapeutic treatment; use of “aggressive” mechanotherapy in passive restoration of the volume of movements and of “hard” massage against the background pain syndrome) that contributed to the development of the given II type complication. As a result, a surgical correction was required — corrective osteotomy of the radius to eliminate the cause of compression of the ulnar and median nerves and restore the interrelations between the articular surfaces in the wrist joint. CONCLUSION: Non-observance of the principles of treatment of a fracture of the radius in a “typical place” (emergency care; adequate anesthesia; immediate sparing reposition; subsequent clinical and radiological control, functional management; sufficient period of immobilization; early physiotherapy and kinesitherapy; etc.) may provoke such a threatening complication as Zudek syndrome characterized by a prolonged disability and inflicting physical and moral suffering. Besides, it is associated with a high cost of treatment and restoration of the function of the damaged limb, significantly exceeding the economic standard.