Try not using your hands for a while. Difficult? Not difficult, but almost impossible! The main function of the hands, especially small, subtle movements, is provided by the fingers. The absence of such a small organ compared to the size of the entire body even imposes restrictions on the performance of certain types of work. Thus, the absence of a thumb or part of it may be a contraindication to driving.

Description

Our limbs end with fingers. A person normally has 5 fingers on his hand: a separate thumb, opposed to the rest, and the index, middle, ring and little fingers arranged in a row.

Man received this separate arrangement of the thumb during evolution. Scientists believe that it was the opposable finger and the associated well-developed grasping reflex that led to a global evolutionary leap. In humans, the thumb is located in this way only on the hands (unlike primates). In addition, only a human can connect the thumb with the ring and little fingers and has the ability to both have a strong grip and small movements.

Functions

Thanks to the variety of movements in which the fingers are involved, we can:

• grasp and hold objects of varying sizes, shapes and weights;
• perform small precise manipulations;
• write;
• gesticulate (the lack of ability to speak led to the intensive development of sign language).

The skin of the fingertips has folds and stripes that form a unique pattern. This ability is actively used to identify a person by law enforcement agencies or the security system of employers.

Structure

1. The basis of the fingers is the bony skeleton. The fingers consist of phalanges: the smallest, nail or distal, middle phalanx and proximal phalanx (all fingers except the thumb). The phalanges of the fingers are small tubular bones - hollow inside. Each phalanx has a head and a base. The middle thinnest part of the bone is called the body of the phalanx. The nail phalanx is the smallest and ends at the distal phalangeal tubercle.
2. The connection of the head and base of adjacent phalangeal bones forms the interphalangeal joints - distal (located further from the body) and proximal (located closer to the body). The thumb has one interphalangeal joint. The interphalangeal joints are typical axial joints. Movements in them occur in the same plane - flexion and extension.
3. The finger joints are secured by palmar and collateral ligaments, running from the heads of the phalangeal bones to the base of other bones or to the palmar surface of an adjacent bone.
4. The muscular system of the fingers is just part of the muscles of the hand. The fingers themselves have practically no muscles. The tendons of the hand muscles, which are responsible for the mobility of the fingers, are attached to the phalanges of the fingers. The lateral group of muscles of the palmar surface of the hand provides movements of the thumb - its flexion, abduction, adduction, opposition. The medial group is responsible for the movements of the little finger. Movements of 2–4 fingers are ensured by contraction of the muscles of the middle group. The flexor tendons attach to the proximal phalanges of the fingers. Extension of the fingers is ensured by the finger extensor muscles located on the back of the hand. Their long tendons are attached to the distal and middle phalanges of the fingers.
5. The tendons of the hand muscles are located in peculiar synovial sheaths that extend from the hand to the fingers and reach the distal phalanges.
6. The fingers are supplied with blood from the radial and ulnar arteries, which form arterial arches and multiple anastomoses on the hand. The arteries that supply the tissues of the finger are located along the lateral surfaces of the phalanges, along with the nerves. The venous network of the hand originates from the fingertips.
7. The space between the internal structures of the finger is filled with fatty tissue. The outside of the fingers, like most of our body, is covered with skin. On the dorsal surface of the distal phalanges of the fingers in the nail bed there is a nail.

Finger injuries

When performing various types of work, injury to the fingers is the most common. This is due to the fact that it is with the help of our fingers that we do the bulk of the work. Conventionally, finger injuries can be divided into several groups:

• soft tissue injury - cut, bruise, compression,
• injury to a bone or joint - fracture, dislocation, sprain,
• thermal injuries - frostbite, burns,
• traumatic amputations,
• damage to nerves and tendons.

Symptoms depend on the type of injury, but all injuries are characterized by common signs - pain of varying intensity, tissue swelling, hemorrhage or bleeding in open injury, impaired movement of the injured finger.

Little finger

The smallest, medially located finger. Carry the most minimal functional load. The meaning of the word little finger in Russian is younger brother, younger son.

Ring finger

Located between the little finger and middle finger - it is practically not used independently, which is explained by the commonality of the tendons of adjacent fingers. Bears independent load when playing keyboard instruments or typing. There was a belief that from this finger a vein went straight to the heart, which explains the tradition of wearing wedding rings on this finger.

Middle finger

Its name speaks for itself - it is located in the middle of the finger row. The longest finger of the hand is more mobile than the ring finger. In sign language, the middle finger is used to make an offensive gesture.

Index finger

One of the most functional fingers on the hand. This finger is able to move independently of the others. This is the finger we point most often.

Thumb

The thickest, free-standing finger. It has only 2 phalanges, opposed to the rest, which ensures perfect grasping ability of the hand. The thumb is actively used in gesture communication. The width of the thumb was formerly used as a measurement unit equal to 1 centimeter, and the inch was originally defined as the length of the nail phalanx of the thumb.

Lower limb

The bones of the lower limb are divided into four main groups: (1) foot, (2) lower leg, (3) thigh (femur), (4) hip joint. This chapter provides a detailed overview of the radioanatomy and setup for three of them: feet, lower legs, middle And distal femur, including ankle And knee joints.

FOOT

The bones of the foot are generally similar to the bones of the hand and wrist studied in Chapter 4. The 26 bones of one foot are divided into four groups

Phalanges (toes) 14

Metatarsal bones (instep) 5

Tarsal bones 7

Phalanges of the toes

The distal part of the foot is represented by phalanges, forming fingers. The five toes of each foot are numbered first through fifth, respectively, if counted from the medial edge or from the big toe. Note that the first, or thumb, finger has only two phalanges, proximal and distal, as well as the thumb. The second to fifth toes of each foot also have medial phalanx. Thus, two phalanges of the thumb and three in each finger from the second to the fifth make up a total 14 phalangeal bones.

The similarity with the hand in this case is obvious, since each hand also has 14 phalanges. However, the phalanges of the foot are shorter than the phalanges of the hand, and their range of motion is significantly less.

When describing any bone or joint, it is necessary to indicate which toe and which foot it belongs to. For example, the description - the distal phalanx of the first toe of the right foot - gives the exact location of the bone.

The distal phalanges of fingers 2-5 are so small that it is quite difficult to see them as separate bones on an x-ray.

Metatarsus bones

Five metatarsal bones form the instep of the foot. They are numbered in the same way as the fingers, from one to five, counting from the medial edge to the lateral.

Each metatarsal bone has three parts. The small rounded distal part is called head. The elongated thin middle part is called body. The slightly expanded proximal end of each metatarsal bone is called basis.

Lateral division base of the fifth metatarsal has a protruding uneven tuberosity, which is the site of attachment of the tendon. The proximal fifth metatarsal and its tuberosity are usually clearly visible on radiographs, which is important because this area of ​​the foot is often injured.

(5-6-7) 1, 2, 3 Cuneiformia

The resemblance of the tarsus to that of the upper limb is not so obvious because the tarsus has seven bones, as opposed to the eight bones of the carpus. At the same time, the tarsal bones are larger than the carpal bones and less mobile, since they form the basis for supporting the body in an upright position.

The seven bones of the tarsus are sometimes classified as bones of the ankle joint, although only one bone, the talus, directly belongs to this joint. Each of the tarsal bones will be further considered separately, along with all the bones with which it has articulations.

Heel bone (Calcaneus)

The heel bone is the largest and strongest bone in the foot. Its posteroinferior section is formed by a well-defined process - tubercle of the calcaneus. Its uneven, rough surface is the site of attachment of muscle tendons. The lower expanded section of the tubercle passes into two small rounded processes: the larger one lateral and the smaller, less frequently mentioned, medial process.

On the lateral surface of the calcaneus there is fibular block, which can have different sizes and shapes and is visualized laterally in the axial projection image. On the medial surface, in its anterior section, there is a large protruding process - support of the talus.

Articulations. The calcaneus articulates with two bones: in the anterior part with the cuboid and in the upper part with the talus. The connection with the talus forms an important subtalar joint. This articulation involves three articular surfaces that provide redistribution of body weight to maintain it in an upright position: this is an extensive posterior articular surface and two smaller ones - anterior and middle articular surfaces.

Note that the medial articular surface is the superior part of the protruding buttress of the talus, which provides medial support for this important supporting joint.

The depression between the posterior and middle articular surfaces is called groove of the calcaneus(Fig. 6-6). In combination With similar to the groove of the talus, it forms an opening for the passage of the corresponding ligaments. This hole, located in the middle of the subtalar joint, is called sinus tarsus(rice. 6-7).

Talus

The talus is the second large bone of the tarsus, it is located between the lower part of the tibia and the heel bone. Together with the ankle and talocalcaneal joints, it participates in the redistribution of body weight.

Articulations. The talus articulates with four bones: top with tibia and tibia, from below with calcaneal and in front with scaphoid.

Arches of the feet

Longitudinal arch of the foot. The bones of the foot form longitudinal and transverse arches, providing powerful spring-type support for the weight of the entire body. The springy longitudinal arch is formed by medial and lateral components and is located mostly at the medial edge and center of the foot.

The transverse arch runs along the plantar surface of the distal tarsus and tarsometatarsal joints. The transverse arch is formed mainly by the sphenoid bones, especially the short second, in combination with the largest sphenoid and cuboid bones (Fig. 6-9).

ANKLE JOINT

Front view

Ankle joint formed by three bones: two long bones of the lower leg, tibial and fibular and one tarsal bone - the talus. The expanded distal part of the thin fibula extending onto the talus is called the external (lateral) ankle.

The distal portion of the larger and more powerful tibia has a widened articular surface for articulation with an equally wide superior articular surface of the talus. The medial elongated process of the tibia, extended along the medial edge of the talus, is called the internal (medial) ankle.

The inner parts of the tibia and fibula form a deep U-shaped cavity, or joint space, covering the block of the talus on three sides. However, it is impossible to examine all three parts of the gap in a direct (posterior) projection, since the distal parts of the tibia and fibula are covered by the talus. This is because the distal fibula is located somewhat posteriorly, as shown in the pictures. Posterior projection with an inward rotation of the foot by 15°, called projection of the joint space 1 and shown in Fig. 6-15, allows a full view of the open articular space above the talus.

Anterior tubercle- a small expanded process located laterally and anteriorly in the lower part of the tibia, articulates with the upper lateral part of the talus, while partially overlapping the fibula in front (Fig. 6-10 and 6-11).

Distal articular surface of the tibia forms the roof of the fork and is called the ceiling of the tibia. In some types of fractures, especially in children and adolescents, damage to the distal epiphysis and ceiling of the tibia occurs.

Side view

In Fig. Figures 6-11 show the ankle joint in a true lateral view, which shows that the distal fibula is located approximately 1 cm posterior to the tibia. This relative position becomes important in determining the true lateral position of the lower leg, ankle joint and foot. The main mistake when placing the ankle joint laterally is slight rotation of the joint, as a result of which the medial and lateral malleoli practically overlap each other. However, this will result in the ankle joint being depicted in an oblique projection, as shown in the figures. Thus, with true lateral projection lateral malleolus located approximately at 1 cm posterior from the medial malleolus. In addition, the lateral malleolus is also longer adjacent - medial approximately on 1 cm (this is better seen in the frontal projection, Fig. 6-10).

Axial (axial) view

An axial view of the inner edge of the distal fibula and tibia is shown in Fig. 6-12. The roof of the lower surface of the tibia (the roof of the tibia) is shown in this figure from the inside, in the end view of the ankle joint. The relationship is also visible lateral and medial malleolus fibula and tibia, respectively. Smaller, fibula located more posteriorly A line drawn through the center of both ankles is at an angle of approximately 15-20° to the frontal plane (parallel to the front surface of the body). Consequently, in order for the intermalleolar line to become parallel to the frontal plane, the shin and ankle

This joint should be rotated 15-20°. This relationship of the distal tibia and fibula is important when positioning the ankle joint or ankle slot in various projections, as described in the positioning sections of this chapter.

Ankle joint

The ankle joint belongs to the group block-type synovial joints, in which only flexion and extension movements are possible (dorsial flexion and plantar flexion). This is facilitated by strong collateral ligaments that pass from the medial and lateral malleolus to the calcaneus and talus. Significant lateral pressure can cause sprain of the ankle joint, accompanied by stretching or rupture of the lateral ligaments and rupture of the muscle tendons, which leads to expansion of the intra-articular space on the side of the injury.

1 Frank ED et al: Radiography of the ankle mortise, Radiol Technol 62-65: 354-359, 1991.

EXERCISES ON RADIOGRAMS

The following radiographs of the foot and ankle in the three most common projections provide an anatomical overview of the bones and joints. To conduct a review test, it is proposed to name (or write out) all the parts marked in the pictures, having previously covered the answers given below.

Left foot, lateral view (Fig. 6-13)

A. Tibia.
B. Heel bone.

B. Tubercle of the calcaneus.
D. Cuboid bone.

D. Tuberosity of the fifth metatarsal bone.

E. Superimposed sphenoid bones. G. Scaphoid bone.

3. Subtalar joint. I. Talus.

Oblique projection of the right foot(rice. 6-14)

A. Interphalangeal joint of the first toe of the right foot.
B. Proximal phalanx of the first toe of the right foot.

B. Metatarsophalangeal joint of the first toe of the right foot.
D. Head of the first metatarsal bone.

D. Body of the first metatarsal bone. E. Base of the first metatarsal bone.

G. Second, or intermediate, sphenoid bone (partially overlapped by the first, or medial, sphenoid bone). 3. Scaphoid bone. I. Talus. K. Tubercle of the calcaneus. L. Third, or lateral, sphenoid bone. M. Cuboid bone.

N. Tuberosity of the base of the fifth metatarsal bone. O. The fifth metatarsophalangeal joint of the right foot. P. Proximal phalanx of the fifth toe of the right foot.

Projection of the joint space of the right ankle joint(Fig. 6-15)

A. Fibula.
B. Lateral malleolus.

B. Open joint space of the ankle joint.
G. Talus.

D. Medial malleolus.

E. The lower articular surface of the tibia (the articulating surface of the epiphysis).

Lateral projection of the ankle joint(rice. 6-16)

A. Fibula.
B. Heel bone.

B. Cuboid bone.

D. Tuberosity of the base of the fifth metatarsal bone. D. Scaphoid bone.

E. Talus. G. Sinus of the tarsus.

3. Anterior tubercle. I. Tibia.

TIBIAL AND FIBAL BONES

The next group of bones of the lower limb, which will be discussed in this chapter, includes two bones of the lower leg: tibia And fibular

Tibia

The tibia is one of the largest bones in the human skeleton and serves as the supporting bone of the lower leg. It can be easily felt through the skin in the anteromedial part of the leg. It has three parts: central body And two ends.

Proximal section. The expanded lateral sections of the upper, or proximal, end of the tibia form two powerful processes - medial And lateral condyle.

On the upper surface of the head of the tibia, between the two condyles, is located intercondylar eminence, in which two small tubercles are distinguished, medial And lateral intercondylar tubercles.

The upper articular surface of the condyles has two concave articular surfaces, often called tibial plateau, which form an articulation with the femur. On the lateral projection of the lower leg it can be seen that The tibial plateau has an inclination of 10° to 20° in relation to a line perpendicular to the long axis of the bone (Fig. 6-18) 1. This important anatomical feature must be taken into account when positioning to obtain a straight posterior projection of the knee joint, the central ray should run parallel to the plateau and perpendicular to the cassette. In this case, the joint space will appear open in the image.

In the proximal part of the bone, on its anterior surface, immediately behind the condyles, there is a rough protrusion - tibial tuberosity. This tuberosity is the attachment site of the patellar ligament, which contains the tendons of the large muscle of the anterior surface of the thigh. Sometimes adolescents experience separation of the tibial tuberosity from the shaft of the bone, a condition known as Osgood-Schlatter disease(see clinical indications, p. 211).

The body of the tibia is the long middle part of the bone located between its two ends. Along the anterior surface of the body, between the tuberosity of the tibia and the medial malleolus, there is a pointed crest, or leading edge tibia, which can be easily felt under the skin.

Diet department. The distal part of the tibia is smaller than the proximal one, it ends in a short process of a pyramidal shape, medial malleolus, which can be easily palpated in the medial area of ​​the ankle joint.

On the lateral surface of the lower end of the tibia there is a flat, triangular shape fibular notch, to which the lower end of the fibula is adjacent.

Fibula

The fibula is smaller and located laterally to the back in relation to the larger tibia. The upper, or proximal, part of the bone forms an expanded head, which articulates with the outer surface of the posteroinferior part of the lateral condyle of the tibia. The upper end of the head is pointed, it is called top head of the fibula.

Body The fibula is the long thin part between its two ends. Expanded distal fibula

1 Manager Bj: Handbooks in radiology, ed. 2, Chicago, 1997, Year Book Medical Publishers, Inc.

FEMUR

The femur, or femur, is the longest and most powerful of all the tubular bones of the human skeleton. It is the only long bone between the hip and knee joints. The proximal femur will be described in Chapter 7 along with the hip joint and pelvic bones.

Middle and distal femur, anterior view(rice. 6-19)

As with all tubular bones, the body of the femur is an elongated and thinner part. On the front surface of the lower thigh bone lies the patella, or kneecap. The patella, the largest sesamoid bone in the skeleton, is located anterior to the distal femur. Note that in the frontal view, with the leg fully extended, the inferior edge of the patella is approximately 1.25 cm above, or proximal to, the knee joint itself. It is important to remember this when positioning the knee joint.

The small, smooth, triangular-shaped depression on the front surface of the lower part of the femur is called the patellar surface (Figure 6-19). This depression is also sometimes called the intercondylar groove. In the literature, the definition of trochlear groove is also found (meaning a block-shaped formation, reminiscent of a spool of thread, which consists of the medial and lateral condyles with a depression between them). It is necessary to know all three terms as they relate to this recess.

With the leg straightened, the patella is located slightly above the patella surface. Lying deep within the muscle tendon, the patella, when the knee is bent, moves downward, or distally, along the patellar surface. This is clearly visible in Fig. 6-21, p. 204, which shows the knee joint in a lateral view.

Middle and distal femur, posterior view (Fig. 6-20)

On the posterior surface of the distal femur are two rounded condyles, separated in the distal posterior portion by a deep intercondylar fossa, or notch, above which the popliteal surface is located (see p. 204).

The distal portions of the medial and lateral condyles contain smooth articular surfaces for articulation with the tibia. When the femur is in a vertical position, the medial condyle is located slightly lower, or distal, to the lateral one (Fig. 6-20). This explains why the CL must be angled 5-7° cranially when performing a lateral view of the knee, which projects the condyles onto each other and the femur parallel to the cassette. An explanation for this is given additionally in Fig. 6-19, which shows that in a vertical anatomical position, when the condyles of the distal femur are parallel to the lower plane of the knee joint, the body of the femur in an adult is deviated from the vertical by approximately 10°. The value of this angle ranges from 5° to 15°". In short people with a wide pelvis, this angle will be larger, and in tall patients with a narrow pelvis, it will be correspondingly smaller. Thus, the value of this angle in women, as a rule, is more than men.

The characteristic difference between the medial and lateral condyles is the presence of the adductor tubercle, a slightly protruding area to which the adductor tendon attaches. This tubercle is located in the posterior

Keats TE et al: Radiology, 87:904, 1966.

Patella

Patella(patella) - a flat, triangular-shaped bone, approximately 5 cm in diameter. The patella appears upside down because its pointed apex forms an inferior edge, and rounded base- upper. External side anterior surface convex and rough, and the inner one is oval in shape back surface, articulating with the femur, smooth. The patella protects the front of the knee joint from injury, in addition, it acts as a lever that increases the lifting force of the quadriceps femoris muscle, the tendon of which is attached to the tibial tuberosity of the leg. The patella in its upper position with a fully straightened limb and a relaxed quadriceps muscle is a mobile and easily dislocated formation. If the leg is bent at the knee joint and the quadriceps muscle is tense, the patella moves down and is fixed in this position. Thus, it can be seen that any displacement of the patella is associated only with the femur and not with the tibia.

KNEE JOINT

The knee joint is a complex joint that includes, first of all, femorotibial the joint between the two condyles of the femur and their corresponding condyles of the tibia. Also involved in the formation of the knee joint femoral-patellofemoral nickname joint, because the patella articulates with the anterior surface of the distal femur.

Menisci (articular discs)

The medial and lateral menisci are flat intra-articular cartilage discs between the superior articular surface of the tibia and the femoral condyles (Figure 6-27). The menisci are crescent-shaped, their thickened peripheral edge gently declines towards the thinned central part. The menisci are a kind of shock absorbers that protect the knee joint from shock and pressure. It is believed that the menisci, together with the synovial membrane, are involved in the production of synovial fluid, which plays the role of lubricating the articular surfaces of the femur and tibia, covered with elastic and smooth hyaline cartilage.

I L A V A O

LOWER LIMB

Straight posterior projection of the lower leg (Fig. 6-29)

A. Medial condyle of the tibia.
B. Body of the tibia.

B. Medial malleolus.
D. Lateral malleolus.

D. Body of the fibula. E. Neck of the fibula. G. Head of the fibula. 3. Apex (styloid process) of the fibular head

I. Lateral condyle of the tibia. K. Intercondylar eminence (tibial crest

Lateral projection of the lower leg (Fig. 6-30)

A. Intercondylar eminence (tibial crest
bones).

B. Tibial tuberosity.

B. Body of the tibia.
D. Body of the fibula.

D. Medial malleolus. E. Lateral malleolus.

Straight posterior view of the knee joint (Fig. 6-31)

A. Medial and lateral intercondylar tubercles; you
stupas of the intercondylar eminence (crest of the tibia
cervical bone).

B. Lateral epicondyle of the femur.

B. Lateral femoral condyle.

D. Lateral condyle of the tibia. D. Upper articular surface of the tibia.

E. Medial condyle of the tibia. G. Medial condyle of the femur.

3. Medial epicondyle of the femur.

I. Patella (visible through the femur).

Lateral view of the knee joint (Fig. 6-32)

A. Base of the patella.
B. Apex of the patella.

B. Tibial tuberosity.
D. Neck of the fibula.

D. Head of the fibula. E. Apex of the head (styloid process) of the fibula

bones. G. Medial and lateral condyles superimposed on each other

3. Patellar surface (intercondylar, or trochlear, groove).

Lateral projection of the knee joint (with slight rotation) (Fig. 6-33)

I. Tubercle of the adductor muscle. K. Lateral condyle. L. Medial condyle.

Tangential view (patellofemoral joint) (Fig. 6-34)

A. Patella.

B. Patellofemoral joint.

B. Lateral condyle.

D. Patellar surface (intercondylar, or trochlear, groove). D. Medial condyle.

The only exception to the group of synovial joints is distal tibiofibular joint, relating to fibrous connections, in which the articulation between the articular surfaces of the tibia and fibula occurs with the help of connective tissue. It refers to syndesmoses and is continuous motionless, or inactive joint (amphiarthrosis). The most distal part of this joint is smoothed and covered by the common synovial membrane of the ankle joint.

SURFACES AND PROJECTIONS OF THE FOOT Surfaces. Determining the surface of the foot can sometimes cause some difficulties, since the foot rear called top part. Dorsum usually refers to the back parts of the body. In this case we mean dorsum of the foot, which is the upper, or opposite to the sole, surface. The sole of the foot is rear, or plantar, surface.

Projections. Posterior projection of the foot is plantar projection. Less commonly used anterior projection may also be called rear projection. Radiologists should be familiar with each of these terms and have a good understanding of the specific projection they are performing.

LAYINGS

General questions

X-rays of the lower extremity are usually performed on an imaging table, as shown in Fig. 6-38. Patients with severe trauma are often examined directly on a stretcher or gurney.

DISTANCE

The X-ray source/receiver distance (XRD) for radiography of the lower extremity is usually 100 cm. If the image is taken on a cassette located on the table deck, it should be taken into account that the distance from the table deck to the cassette holder is usually 8-10 cm, and therefore the emitter should raise further. When taking x-rays on a gurney or stretcher, use the depth gauge, usually located on the depth diaphragm of the machine, to set the RIP = 100 cm.

Radiation protection

When radiography of the lower extremity, gonadal protection is desirable, since the gonads are in close proximity to the radiation zone. The gonad area can be protected with any leaded vinyl cover 1 . And although the requirements for radiation protection of gonads apply only to patients of reproductive age and only when the gonads are directly located in the area of ​​the direct beam, it is recommended to apply it in all cases.

DIAPHRAGM

The rules for aperture are always the same - the boundaries of the aperture area should be visible on all four sides of the image, but the images of the organs being examined should not be cut off. The minimum size cassette should be used to obtain an image of the area of ​​interest. Note that when radiography of the lower limb, small cassettes are most often used.

Several projections can be performed on one cassette for radiography of the lower extremity, so careful attention should be paid to diaphragm setting.

When using digital X-ray imaging receivers (particularly computed radiography systems with memory phosphor plates), cover the unused area of ​​the cassette with a sheet of leaded vinyl. The phosphor is very sensitive to scattered radiation, which can cause severe fog on subsequent radiographs.

If the aperture boundaries are visible from all four sides, then this makes it easier to find the center of the image - at the intersection of the diagonals.

GENERAL PRINCIPLES OF LAYING

For the upper and lower limbs when laying, the same rule applies - the long axis of the limb being examined should

Rice. 6-38. Exemplary placement for the mediolateral projection of the lower limb:

Correct direction of the CL;

Correct aperture;

Correct use of radiation protection;

Diagonal placement of the lower limb allows you to get
X-ray image of both joints

not located along the long axis of the cassette. If you need to perform several projections, then When taking multiple images on one cassette, the orientation of the limb must be maintained.

The exception is the adult shin. It is usually laid diagonally across the cassette so that the knee and ankle joints enter, as shown in Fig. 6-38.

CORRECT CENTERING

Accurate centering and positioning of the body part being examined, as well as the correct direction of the CL, are very important when radiography of the upper and lower extremities. The photographs should show open joint spaces and there should be no geometric distortions of the shape of the bones, that is, the part of the body being removed should be parallel to the plane of the cassette, and the CL should be directed perpendicular to the limb being removed. Follow the directions on the styling pages.

EXPOSURE SETTINGS

Exposure parameters for radiography of the lower limb:

1. Low or medium kV (50-70).

2. Short exposure time.

3. Small focus.

Correctly exposed radiographs of the lower extremity should show both soft tissue contours and clear trabecular bone structure.

RADIOGRAPHY IN PEDIATRICS

Firstly, you should speak to the child in a language he understands. Parents often assist in restraining the child, especially if it is not a case of trauma. At the same time, care should be taken to ensure their radiation protection. Braces are useful in many cases because they help the child keep the limb still and in the desired position. Soft pillows for ease of laying and straps for fixation are common tools. Sand cushions should be used carefully as they are heavy. Measuring body thickness is an important factor in determining optimal exposure parameters.

In general, reduced exposure parameters are used in pediatrics due to the small size and low density of the limbs being examined. Use short exposure times, increasing the current (mA), - this reduces the dynamic blur of the image.

RADIOGRAPHY IN GERIATRICS

Elderly patients should be positioned for imaging with caution, and radiography of the lower extremity is no exception. Pay attention to signs of a hip fracture (the leg is excessively twisted). Routine positioning should be adjusted to suit the patient’s ability to bend limbs and personal pathology. When positioning the limb, pillows and supports should be used to ensure patient comfort.

Exposure parameters should be selected taking into account possible osteoporosis or osteoarthritis. Using short exposure times, increasing the current (mA), this reduces the dynamic blur of the image due to voluntary and involuntary movements.

ARTHROGRAPHY

Arthrography is commonly used to visualize large synovial joints such as the knee. It is performed by introducing contrast agents into the joint cavity under sterile conditions. Arthrography reveals diseases and injuries of the menisci, ligaments and tendons (see Chapter 21).

RADIONUCLIDE DIAGNOSTICS

Radionuclide scanning is intended for the diagnosis of osteomyelitis, metastatic processes in the bones, impacted fractures, as well as inflammatory diseases of the subcutaneous tissue. The organ being examined is assessed within 24 hours from the start of the study. Radionuclide testing is more informative than radiography, since it allows you to assess not only the anatomical, but also the functional state of the organ.

Clinical indications

Radiologists should be familiar with the most common clinical indications for lower extremity radiography, which are (the attached list is not complete):

Bone cysts- benign tumor-like formations, which are a cavity filled with serous fluid. They most often develop in children and are located mainly in the knee joint.

Chondromalacia patella- often called runner's knee. The pathology is based on dystrophic changes (softening) of the cartilage, leading to its wear; accompanied by pain and constant irritation of the affected area. Runners and cyclists are often affected.

Chondrosarcoma- malignant bone tumor. The predominant localization is the pelvis and long tubular bones. It is more common in men over 45 years of age.

Ewing's sarcoma- primary malignant bone tumor is usually observed in childhood, from 5 to 15 years. The tumor is usually localized in the diaphysis of long tubular bones. The clinical picture includes pain, increased body temperature at the onset of the disease, and leukocytosis.

Exostosis, or osteochondroma- a benign tumor-like bone lesion, the essence of which is the hyperproduction of bone substance (the knee joint area is often affected). The tumor grows in parallel with the growth of the bone, moving away from the adjacent joint.

The hand, together with the fingers, ensures the functional and labor activity of a person. Hands, using fine motor skills and finger movements, are involved in understanding the world around us and maintaining a relationship with it. The metacarpophalangeal joint (MCP) connects the phalanges of each finger to the stationary part of the hand. The metatarsophalangeal joints of the legs play a slightly different role. To better understand the structure of the joints, you need to delve into your knowledge of anatomy.

[Hide]

Anatomical features of the PFJ

The anatomical structure of the hand includes small bones connected by joints. The hand itself is divided into three zones: the wrist, the metacarpal part and the phalanges of the fingers.

The wrist consists of 8 bones arranged in two rows. The three ossicles of the first row, which have fixed articulations, and the pisiform ossicle adjacent to them, form a common surface and are connected to the radius ossicle. The second row contains four bones connected to the metacarpus. This part is like a boat, with a hollow in the palm. The interosseous space contains nerves, blood vessels along with connective tissue and articular cartilage. The mobility of the bones relative to each other is limited.

The articular part that connects the radius to the wrist allows for rotation and movement. The metacarpal part is formed with 5 bones of a tubular structure. In the proximal part they are attached to the wrist through immovable joints. The opposite side, called the distal side, is connected to the proximal phalanges by movable joints. Due to the spherical metacarpophalangeal joints, flexion and extension of the fingers and rotation of them occur.

The joint of the thumb is saddle-shaped, which allows it only to bend and extend. In the structure of the fingers of the hand, in addition to the thumb, there are three phalanges: the main (proximal), middle and distal (ungual). They are connected by block-shaped interphalangeal movable joints, allowing flexion and extension movements. The thumb is two-phalanx, the middle phalanx is missing.

All carpal joints have strong articular capsules. One capsule is capable of connecting 2-3 joints. The ligamentous structure serves to support the osteoarticular skeleton.

Role and functions in the body

The MCP joints of the hands serve as a separator between the fingers and the hand. They protrude from the outside when the hand is bent into a fist. The joint is the base of each of the 5 fingers and provides functional mobility.

The four fingers of the hand act mostly synchronously, with the first finger having a separate function. The second or index finger, due to greater dexterity and independence of movements, grasps an object earlier. The middle finger differs from the others in length and massiveness. Necessary for long-term grip retention. The ring finger is endowed with a developed muscular sense and touch, and the little finger completes the grip and provides stability to the hand when moving.

The design of the joint ensures mobility around the frontal and sagittal axis. Flexion and extension, abduction and adduction movements, and circular movements occur around these axes. Flexion and extension are performed at 90-100 degrees, and adduction and abduction are possible at 45-50 only with extended fingers.

Detailed structure

The metacarpophalangeal joints are the articulations of the heads of the metacarpal bones and the sockets of the bases of the proximal phalanges of the fingers. The joints are saddle or condylar. The head of the metacarpal bone is biconvex, and the base itself is biconcave and much smaller in area.

High mobility is explained by the significant difference in size between the articular heads and fossae. They can actively move towards the palm, bend and extend with high amplitude. The function of sweeping lateral movements, that is, abduction and return, is less pronounced. The muscular-tendon apparatus allows them to be converted into rotational movements. The second finger is endowed with the greatest ability for lateral displacement and is called the index finger.

If the articular surfaces were similar, the possibility of displacement would be significantly reduced, which would significantly limit the motor capabilities of the hand.

Ligaments

The interphalangeal joints and MCP joints are characterized by a loose and thin capsule. It is fixed by the solid ligament of the palm and the transverse metacarpal ligaments. On the lateral sides there are collateral ligaments that strengthen the metacarpophalangeal joints and prevent lateral displacement of the finger during flexion. Collateral ligaments originate in the fossae of the ulnar and radial part of the articular surface of the metacarpal bones and the opposite part. Associated with the lateral and palmar portion of the proximal phalanx.

The two ligaments of the flexor and extensor retinaculum on the back of the hand form fibrous sheaths for the muscles. Fibrous sheaths and synovial spaces protect the tendons from injury.
Accessory ligaments are located in the palmar part of the capsule and are called palmar. The fibers of the ligament are woven with the transverse metacarpal ligament between the apices of the II-V bones and keep the apices of the metacarpal bones from moving in different directions.

The intertendinous tissues help retain the extensor muscle. They connect the tendons of pairs of fingers: index and middle, middle and ring, little and ring fingers. Located close to the PFJ. The main tendon near the extensor muscle is divided into superficial, located in the center, and deep, located on the sides.

Muscle structure

The articular membrane is covered by the tendon of the flexor muscle on the back side and the tendons of the lumbrical and interosseous muscles. The fibers of these muscles support the flexor muscle by being located above its tendons. Sagittal bundles are called retinaculum fibers. They are divided into radial or medial, and ulnar or lateral.

The tissues of the bundles are located in a thin layer on the surface and denser in depth. The superficial layer entwines the flexor tendons from above and connects to the sagittal fascicle on the opposite side. Deeper under the tendon, a depression is formed in the form of a channel that stabilizes and supports the tendon in one place.

The muscles that allow you to bend and extend your fingers run along the back of the forearm. Their tendon fibers extend throughout the hand to the tips of the MCP joint. They are attached to the middle and tops of the fingers. The extreme fingers, the little finger and the index finger, have additional extensor muscles. The tendons of these muscles are located at the upper points of the corresponding MCP joint along with the common digital extensor and are balanced by similar structures.

Features of the structure of the thumb

The mobility of the hand joints allows you to grasp and hold various objects. The fulfillment of this task is ensured by the mobility of the thumb, which is opposed to the rest.

The MTP joint of the thumb, although externally similar to the others, has differences in structure. First of all, the trochlear joint is different. It is saddle-shaped and its articular head is much larger, the tubercles on the palmar side are more developed. Articular capsule, on the surface facing the palm, with two sesamoid bones: lateral and medial. The part facing the cavity is covered by hyaline cartilage, and the long flexor tendon passes between the bones.

The shape of the articular surfaces ensures finger mobility in two planes: extension and flexion, abduction and reverse movement. The effectiveness of the palm grip is ensured by the special structure of the ligaments and tendons on the hand, in which the flexion of the index finger and little finger is directed towards the thumb.

The distal part of the lower limb is the foot, which is necessary to hold the body in an upright position. Its structure is a complex combination of groups of small bones that form a strong arch to support the body when moving and in a standing position. This design and the large number of joints create a flexible and durable structure. The lower arch of the foot in contact with the ground is called the sole, the opposite part is called the back.

What does the foot skeleton consist of?

The skeleton of the human foot includes 26 bones, divided into three parts: the tarsus, metatarsus and the phalanges of the toes.

1. There are 7 bones in the tarsal portion. These are the cuboid bone, scaphoid, calcaneus, talus, medial sphenoid and intermediate bones.
2. The structure of the metatarsus includes five short tubular bones. They connect the tarsus with the proximal phalanges of the fingers.
3. Short bones of a tubular structure form the phalanges of the fingers. According to their location, they are called proximal, intermediate and distal.

The interphalangeal joints of the toe joints are called the metatarsophalangeal, proximal and distal joints. The structure of the first toe is similar to the big toe. It has only two phalanges, while the rest of the fingers have three. The mobility of the joints of the foot is similar to the corresponding carpal joints, but with restrictions. The toes are slightly retracted to the sides and back, have developed dorsal flexion and slightly less developed plantar flexion. Their extension is greater than flexion.

Metatarsophalangeal joints

At the site of the ligament of the heads of the metatarsal bones with the lower part of the proximal phalanges there is a metatarsophalangeal ball-and-socket joint. On the back side, the joints of the toes are closed by extensors, and on the sole by tendon channels. On both sides the joints are strengthened by lateral ligaments. From the side of the sole – intercapitate ligaments and tendons.

The joint of the first finger is strengthened on the inside by the tendon of the abductor muscle. On the outer side it is adjacent to the tissue of the interdigital space. In the plantar part, the capsule includes the internal and external sesamoid ossicles.

The metatarsophalangeal joint of the second toe on the plant side is strengthened by the fibers of the fibrous canal of the flexor muscles. The tendon fibers of the intercapitate ligament and adductor muscle are woven into the capsule. On the inside it is supported by a ligament of tendons of the first dorsalis muscle, and under the ligament by the tendons of the lumbrical muscle.

The capsule is strengthened from the outside by the tendons of the dorsal interosseous muscle. On both sides of the capsule there is fiber in the interdigital spaces. The heads of all metatarsal bones are braided by a deep transverse ligament. The flexion angle of the metatarsophalangeal joints is small, which is associated with the high density of the joint capsule.

Video “Joint Deformation”

Why joint deformation occurs and what it looks like, as well as how to carry out treatment, watch the video.

23475 0

Of the phalanges, the nail is most often damaged, then the proximal and middle ones, often without displacement of the fragments. For marginal fractures, immobilization with a plaster splint lasts 1-1 1/2 weeks; for fractures of the nail phalanx, the nail acts as a splint.

Reposition of fragments is carried out by traction along the axis of the finger while simultaneously giving it a functionally advantageous position. Immobilization is carried out with two plaster splints (palmar and dorsal) from the tip of the finger to the upper third of the forearm (Fig. 1). For intra-articular fractures, shorter periods are required (up to 2 weeks), for periarticular fractures - up to 3 weeks, for diaphyseal fractures - up to 4-5 weeks. Fractures of the proximal phalanx heal faster than fractures of the middle phalanx.

Rice. 1. Therapeutic immobilization for fractures of the phalanges of the fingers: a - plaster splint; b - Böhler splint; c - rear modeled tire

Rehabilitation - 1-3 weeks.

Surgical treatment indicated for fractures of the metacarpal bones and phalanges with a tendency to secondary displacement. The fragments are compared and fixed with pins percutaneously (Fig. 2). Immobilization is carried out with a plaster splint on the palmar surface for 4 weeks. The needles are removed after 3-4 weeks. For intra-articular and periarticular fractures of the phalanges with displacement of fragments, a distraction device is used.

Rice. 2. Transosseous fixation with wires of fractures and fracture-dislocations of the phalanges of the fingers: a - with wires (options); b - distraction external device

Damage to the ligaments of the finger joints

Reasons. Damage to the lateral ligaments occurs as a result of a sharp deviation of the finger at the joint level (impact, fall, “breaking off”). More often, the ligaments are partially torn, but a complete rupture leads to instability of the joint. The ligaments of the proximal interphalangeal joints and the first metacarpophalangeal joint are mainly damaged.

Signs: pain and swelling in the joint area, limitation of movements, lateral mobility. The diagnosis is clarified by pinpoint palpation with a button probe or the end of a match. To exclude avulsion of a bone fragment, it is necessary to take radiographs in two projections. When the ulnar collateral ligament of the metacarpophalangeal joint of the first finger is ruptured, the swelling may be insignificant. Characterized by pain when abducting the finger to the radial side and decreased grip strength. The ligament may be damaged along its length, or it may be torn from its attachment to the proximal phalanx.

Treatment. Local cooling, immobilization of the finger in a half-bent position on a cotton-gauze roll. Application of a simulated plaster splint along the palmar surface of the finger to the middle third of the forearm. Flexion at the joint to an angle of 150°. UHF therapy is prescribed as a decongestant.

The period of immobilization is 10-14 days, then light thermal procedures and exercise therapy.

The first finger is immobilized in a position of slight flexion and ulnar adduction for a period of 3-4 weeks. In case of complete rupture of the ligament or its separation, early surgical treatment (suture, plastic surgery) in a specialized medical institution is indicated. After the operation - immobilization with a plaster splint also for 3-4 weeks. Rehabilitation - 2-3 weeks.

Working capacity is restored after 1-1 1/2 months.

Damage to the extensor tendons of the fingers

Features of the anatomy are presented in Fig. 3.

Rice. 3. Scheme of the structure of the dorsal aponeurosis: a - common extensor tendon; b — tendon of the interosseous muscles; c — tendon of the lumbrical muscles; d - spiral fibers; d - retinacular ligaments; e - triangular ligaments; g - central tape; h - side tapes; and - a portion of the aponeurosis to the base of the proximal phalanx; j - medial stripes of the tendons of the interosseous and lumbrical muscles; l - middle portion of aponeurosis; m - lateral stripes of the tendons of the interosseous and lumbrical muscles; n - lateral portions of the aponeurosis; o - the final part of the tendon-aponeurotic stretch; n - transverse intermetacarpal ligaments; p - transverse portion of the reticular ligament

Injuries to the extensor tendons of the fingers and hand account for 0.6-0.8% of all fresh injuries. From 9 to 11.5% of patients are hospitalized. Open injuries account for 80.7%, closed - 19.3%.

Causes of open extensor tendon injuries:

• incised wounds (54.4%);
• bruised wounds (23%);
• lacerations (19.5%);
• gunshot wounds and thermal injuries (5%).

Causes of closed extensor tendon injuries:

• traumatic - as a result of an indirect mechanism of injury;
• spontaneous - arise as a result of degenerative-dystrophic changes in the tendons and unusual load on the fingers.

Subcutaneous rupture of the tendon of the long extensor of the first finger was described in 1891 by Sander under the name “drummers' paralysis.” In army drummers, with prolonged stress on the hand in the dorsiflexion position, chronic tenosynovitis develops, causing degeneration of the tendon and, as a consequence, its spontaneous rupture. Another cause of subcutaneous rupture of the tendon of the long extensor of the first finger is microtrauma after a fracture of the radius in a typical place.

Diagnostics fresh open injuries of the extensor tendons do not present any particular difficulties. The localization of wounds on the dorsum of the fingers and hand should alert the doctor, who will pay special attention to the study of motor function. Damage to the extensor tendons, depending on the area of ​​damage, is accompanied by characteristic dysfunction (Fig. 4).

Rice. 4.

1st zone - zone of the distal interphalangeal joint to the upper third of the middle phalanx - loss of the function of extension of the distal phalanx of the finger.

Treatment surgical - suturing the extensor tendon. If the extensor tendon is damaged at the level of its attachment to the distal phalanx, a transosseous suture is used. After surgery, the distal phalanx is fixed in the extension position with a wire passed through the distal interphalangeal joint for 5 weeks.

2nd zone - the zone of the base of the middle phalanx, the proximal interphalangeal joint and the main phalanx - loss of the function of extension of the middle phalanx of the II-V fingers. If the central extensor fascicle is damaged, its lateral fascicles shift to the palmar side and begin to extend the distal phalanx, the middle phalanx takes a flexion position, and the distal phalanx takes an extension position.

Treatment surgical - suturing the central bundle of the extensor tendon, restoring the connection of the lateral bundles with the central one. If all three bundles of the extensor apparatus are damaged, a primary suture is applied with separate restoration of each bundle.

After surgery - immobilization for 4 weeks. After applying a suture to the tendon and immobilization for the period of fusion, an extension contracture of the joints develops, which requires long-term rehabilitation.

3rd zone - the zone of the metacarpophalangeal joints and metacarpus - loss of the function of extension of the main phalanx (Fig. 5).

Rice. 5.

Treatment surgical - suturing the extensor tendon, immobilization with a plaster splint from the fingertips to the middle third of the forearm for 4-5 weeks.

4th zone - the zone from the wrist joint to the transition of the tendons into the muscles on the forearm - loss of the function of extension of the fingers and hand.

Treatment operational. When revising the wound to mobilize the extensor tendons near the wrist joint, it is necessary to cut the dorsal carpal ligament and the fibrous canals of the tendons that are damaged. Each tendon is sutured separately. The dorsal carpal ligament is reconstructed with lengthening. Fibrous channels are not restored. Immobilization is performed with a plaster splint for 4 weeks.

Diagnosis, clinical picture and treatment of fresh closed injuries of the extensor tendons of the fingers. Subcutaneous (closed) damage to the extensor tendons of the fingers is observed in typical locations - the long extensor of the first finger at the level of the third fibrous canal of the wrist; triphalangeal fingers - at the level of the distal and proximal interphalangeal joints.

With a fresh subcutaneous rupture of the tendon of the long extensor of the first finger at the level of the wrist joint, the function of extension of the distal phalanx is lost, extension in the metacarpophalangeal and metacarpal joints is limited. The function of stabilizing these joints is lost: the finger sag and loses its grip function.

Treatment operational. The most effective method is the transposition of the tendon of the extensor muscle of the second finger onto the extensor muscle of the first finger.

Fresh subcutaneous ruptures of the extensor tendons of the II-V fingers at the level of the distal phalanx with separation of a bone fragment and at the level of the distal interphalangeal joint are accompanied by loss of the function of extension of the nail phalanx. Due to the traction of the deep flexor tendon, the nail phalanx is in a forced flexion position.

Treatment of fresh subcutaneous ruptures of the extensor tendons of the II-V fingers is conservative. For closed tendon fusion, the distal phalanx is fixed in extension or hyperextension using various splints for 5 weeks. or fixation is performed with a Kirschner wire through the distal interphalangeal joint.

For fresh subcutaneous avulsions of the extensor tendons with a bone fragment with significant diastasis, surgical treatment is indicated.

A fresh subcutaneous rupture of the central part of the extensor apparatus at the level of the proximal interphalangeal joint is accompanied by limited extension of the middle phalanx and moderate edema. With correct diagnosis in fresh cases, the finger is fixed in the position of extension of the middle phalanx and moderate flexion of the distal one. In this position of the finger, the lumbrical and interosseous muscles are most relaxed, and the lateral bundles are shifted towards the central bundle of the extensor apparatus. Immobilization continues for 5 weeks. (Fig. 6).

Rice. 6.

Old damage to the extensor tendons of the fingers. A wide variety of secondary deformities of the hand in chronic injuries of the extensor tendons is due to a violation of the complex biomechanics of the flexor-extensor apparatus of the fingers.

Damage in the 1st zone manifests itself in two types of finger deformation.

1. If the extensor tendon is completely damaged at the level of the distal interphalangeal joint, the function of extension of the distal phalanx is lost. Under the influence of tension in the deep flexor tendon, a persistent flexion contracture of the distal phalanx is formed. This deformity is called “hammer finger.” A similar deformity occurs when the extensor tendon is torn off with a fragment of the distal phalanx.

2. If the extensor tendon is damaged at the level of the middle phalanx proximal to the distal interphalangeal joint, the lateral bundles, having lost connection with the middle phalanx, diverge and shift in the palmar direction. In this case, active extension of the distal phalanx is lost and it takes a flexed position. Due to the violation of the point of fixation of the lateral bundles, over time, the function of the central bundle, which extends the middle phalanx, begins to prevail. The latter occupies a hyperextension position. This deformity is called the “swan neck.”

Treatment of chronic damage to the extensor tendons in the 1st zone is surgical. The most important condition is the complete restoration of passive movements in the joint.

The most common operations are the formation of a scar duplication with or without dissection, and fixation of the distal interphalangeal joint with a wire. After removal of the needle after 5 weeks. After the operation, a course of rehabilitation treatment is carried out. In case of old injuries and persistent flexion contracture, arthrodesis of the distal interphalangeal joint in a functionally advantageous position is possible.

Old damage to the tendon-aponeurotic sprain in the 2nd zone at the level of the proximal interphalangeal joint is accompanied by two main types of deformity.

1. If the central bundle of the extensor tendon is damaged, the function of extension of the middle phalanx is lost. The lateral bundles, under the tension of the lumbrical muscles, shift in the proximal and palmar directions, promoting flexion of the middle phalanx and extension of the distal phalanx of the finger. Into the gap formed in the extensor aponeurosis, the head of the proximal phalanx moves like a button passing into a loop.

A typical flexion-hyperextension deformity occurs, which has received several names: loop rupture, button loop phenomenon, triple contracture, double Weinstein contracture.

2. With chronic damage to all three bundles of the extensor tendon apparatus, a flexion position of the middle phalanx occurs. Hyperextension of the distal phalanx does not occur due to damage to the lateral bundles.

Treatment of chronic damage to the extensor tendon apparatus at the level of the proximal interphalangeal joint is surgical. In the preoperative period, a course of restorative treatment is carried out to eliminate contractures and restore the range of passive movements.

Weinstein's operation: after mobilization of the lateral bundles of the tendon-aponeurotic stretch, they are brought together and sutured “side to side” over the proximal interphalangeal joint. In this case, excessive tension of the lateral bundles occurs, which can lead to limited flexion of the finger (Fig. 7).

Rice. 7.

For chronic injuries of the extensor tendons with impaired finger function, surgical treatment is indicated. The choice of surgical treatment method depends on the condition of the skin, the presence of scars, deformities and contractures. One of the common methods is the formation of a scar duplication.

In the postoperative period, immobilization lasts 4-5 weeks, after which a course of restorative treatment is carried out - ozokerite applications, lidase electrophoresis, massage, exercise therapy on the fingers and hand.

Traumatology and orthopedics. N. V. Kornilov

The phalanx of human limbs consists of three parts: the body - the base, the proximal and distal ends, on which the nail tuberosity is located.

Each human finger consists of three phalanges, except (it consists of two). Three phalanges: main, middle and nail. The phalanges on the toes are shorter than those on the fingers. The longest of them is on the middle finger, the thickest is on the thumb.

The structure of the phalanx of the fingers: an elongated bone, in the middle part having the shape of a semi-cylinder. Its flat part is directed towards the side of the palm, the convex part towards the back side. At the end of the phalanx there are articular surfaces.

By modifying the phalanx of the fingers, certain diseases can be diagnosed. The symptom of drumsticks is thickening of the terminal phalanx of the fingers and toes. With this symptom, the fingertips resemble a flask, and the nails resemble watch glasses. The muscle tissue that is located between the nail plate and the bone is spongy in nature. Because of this, when pressing on the base of the nail, the impression of a movable plate is created.

Drum fingers are not an independent disease, but only a consequence of serious internal changes. Such pathologies include diseases of the lungs, liver, heart, gastrointestinal tract, and sometimes diffuse goiter and cystic fibrosis.

A phalanx fracture occurs from a direct blow or injury and is often open. It can also be diaphyseal, periarticular or intraarticular. The fracture is usually comminuted.

The clinical picture of the fracture is characterized by pain, swelling and limited finger function. If there is internal displacement, then deformation is noticeable. If there is no displacement, a bruise or sprain may be diagnosed. In any case, an X-ray examination must be performed for a final diagnosis.

Treatment of a fracture of the phalanx of the fingers without displacement is carried out with a plaster or an aluminum splint, which is applied when the nail phalanx is bent to 150, medium - up to 600, main - up to 500. The bandage or splint is worn for 3 weeks. After removing the material, therapeutic exercises are performed with physiotherapy. After a month, the working capacity of the phalanx is completely restored.

In case of displaced phalangeal fractures, a comparison of the fragments is carried out. After this, a plaster or metal splint is applied for 3-4 weeks. For fractures of the nail phalanges, the finger is immobilized with an adhesive plaster or a circular plaster cast.

The phalanges of the toes often suffer from dislocations in the metatarsophalangeal and interphalangeal joints. Dislocations are directed towards the back of the foot, the sole and to the side.

This problem is diagnosed by a characteristic deformation, shortening of the finger or limitation of its movement.

The largest number of dislocations occurs on the phalanx of the first finger, its distal part. In second place are dislocations of the fourth finger. The middle toes are much less affected due to their location in the center of the foot. In direction, dislocations are usually observed to the rear and to the side. The dislocation is reduced before swelling develops. If swelling has already formed, it is much more difficult to insert the phalanx into the joint.

Closed dislocations are reduced after local anesthesia. If it is difficult to reduce using the usual method, then use the insertion of a pin through the distal phalanx or the use of a pin. The procedure is simple and safe. Then they apply traction along the length of the damaged finger and countertraction (which is carried out by an assistant) at the ankle joint. By pressing on the base of the displaced phalanx, the dislocation is reduced.

For old dislocations, surgical intervention is required.