RU2589664C1 - Method of treating consequences of fractures of forearm bones in gerontological patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used in rehabilitation following fractures of forearm bones in gerontological patients. After removing plaster bandage, diadinamophoresis is performed in a patient sitting on a chair. Arranging first electrode (+) with gasket, soaked in 5 % placenta hydrolysate solution, measuring 6×10 cm above a projection of callus in place of fracture of forearm bones from inner side of forearm. Second electrode (-) measuring 8×10 cm is placed on outer surface of forearm. Diadinamophoresis is carried out with DT-50-3 apparatus with direct current of sinusoidal shape with frequency 100 Hz for 15 minutes. Current is gradually increased until onset of marked but non-painful sensations of vibration under electrodes. Then applying magneto-acoustic effect over a projection of callus in place of fracture of forearm bones using Magofon-01. Value of magnetic induction is 30±9 mT, frequency of acoustic range 0.02-20 kHz for 10 minutes. Course of 10 procedures daily.

EFFECT: method provides marked analgesic effect, normalises function of wrist joint of injured extremity, prevents development of wrist joint contractures, provides higher adaptation of reaction to functional load, promotes recovery of disturbed corticovisceral relationships, normalises metabolic processes due to integrated exposure.

1 cl, 2 tbl, 2 ex

Description

The invention relates to medicine, in particular physiotherapy in the rehabilitation system after fractures of the forearm in gerontological patients.

The frequency of skeletal bone fractures is 8-15%. Of these, the share of limb bones accounts for 65-70%. Most often, fractures of the hands and feet are observed (more than 60%); fractures of the forearm and lower leg bones are equally distributed in frequency and together account for 20%, ribs and sternum - 6%; fractures of the scapula (0.3%), vertebrae (0.5%), pelvis (0.6%), and femur (0.9%) are much less common. Fractures of the forearm bones account for about 30% of all possible. [Sharov D.V., Ivanyuk A.S. Rehabilitation after fractures and injuries. - 2014. - fb2].

Radial bone fractures in a typical place are one of the most common injuries of skeleton bones. Fractures of the distal metaepiphysis of the radial bone, according to various authors, occupy from 15% to 70% of all bone fractures. Most of the victims are people of working age. Also important is the fact that their ability to work is reduced for a long time, they are ill for a long time and cannot start working when such complications as neurodystrophic syndrome appear. As you know, this type of injury is characterized by sexual dimorphism with a predominance of up to 82% in the structure of affected women. Most fractures in women occur in the postmonopausal period. This is due to the fact that they develop a dishormonal disorder in which bone density decreases, simultaneously in combination with poor absorption and absorption of calcium with food. In connection with the expansion of human life and the extension of the retirement period, there is an increase in the social activity of women who participate in production. So, the results of the All-Russian population census of 2002 showed that among people over 60 years old women make up 66%, and over 85 years old - 78%. According to the Center for Human Demography and Ecology, people over 60 are the fastest growing group of people, and now in Russia it is 16% of all residents of the country, and by 2015 it will be 20%. Epidemiological studies conducted on samples of the population aged 50 years and older in selected cities of Russia showed that the frequency of osteoporosis (OP) in women was 30.5-33.1%, while the prevalence of OP in them increased to 46.5% at the age of 65 years and older. After the onset of menopause, the rate of bone resorption increases and, as a result, bone mass decreases. An increase in bone porosity increases the risk of fractures in the most typical places. An unsatisfactory treatment outcome and an inadequate approach to the choice of treatment method lead to the development of complications, reduced ability to work and disability. Given that the majority of patients are people of working age, this, in turn, leads to medical and economic damage to both the patient himself and the state.

The process of bone regeneration is affected by both general phenomena at the systemic body level and local changes in tissue metabolism. The entire subsequent course of the reparative process, and ultimately the rate of healing of a bone fracture, depends on the stability of bone fragments, the rate of biosynthesis of proteins and specific enzymes. Conditions can be considered optimal if bone fragments are well correlated and firmly fixed and there are no pronounced pathological changes on the part of the most important body systems that could disrupt bone tissue repair processes [Mikhailov E.E., Benevolenskaya L.I. Epidemiology of osteoporosis and fractures. Guide to osteoporosis / ed. L.I. Benevolenskaya. - M .: BINOM, 2003.S. 10-53].

The goal of physiotherapeutic effects is to complete the process of fracture consolidation with the maximum possible restoration of the function of the injured limb and restoration of the patient's working capacity, elimination of muscular hypotrophy and the development of osteoporosis.

The main symptoms after removing the immobilization dressing from the fracture site are: restriction of motor function, less pain, violation of trophic tissue in the form of swelling and discoloration of the skin. With the residual effects of soft tissue edema in the area of damage after removal of the plaster cast, it is very important to activate the lymphatic drainage and improve the drainage function of the deep vessels. After prolonged immobilization of the limb, contractures often develop in the joints. Physiotherapy in these cases should be aimed at improving blood circulation in the joints and adjacent areas, increasing the elasticity of scarred tissues, reducing pain during joint development [Types of rehabilitation: physiotherapy, physiotherapy, massage: training. allowance / T.Yu. Bykovskaya [et al.]; under the general. ed. B.V. Kabarukhina. - Rostov n / a: Phoenix, 2010. - 557, [1] with: ill. - (The medicine). S. 69-72].

Most patients return to their daily activities after a fracture of the distal forearm bones after 1.5-2 months. Of course, the timing of rehabilitation after a fracture depends on many factors: the nature of the injury, the method of treatment, the body's response to damage. Affected patients with osteoporosis almost all have a restriction of movement in the wrist after immobilization. Sudeck's syndrome is one of the significant complications of injuries to the limbs. This complication has recently been identified more and more often. Sudeck's syndrome is a pathological condition caused by inflammation or damage to soft tissues, nerves, bones, and joints. The most striking manifestation of Sudek syndrome in this group of patients is acute developing pronounced bone atrophy (osteoporosis), local blood flow disorders, with consequences in the form of joint stiffness and limitation of their function. The symptom complex of the disease consists of manifestations of the trophic order. The limb loses its shape. The contours are smoothed out, the skin becomes thinner, it becomes cyanotic, cold to the touch, the shape and color of the nails changes, they become brittle, muscle strength decreases. This disease is characterized by constant pain experienced by the patient.

For patients older than 40 years after fracture of the distal metaepiphysis of the radius, the incidence of Sudeck syndrome is 10–40% of cases. The risk of developing this condition increases the lack of physiotherapy and kinesitherapy.

There is a method of treating complications of fractures of the forearm using ultrasound at the fracture site [Private physiotherapy. // Ed. G.N. Ponomarenko. - S.-P. - 2005. - p. 594-630]. Sound is carried out over the projection of the fracture at an intensity of 0.4 W / cm ² in continuous mode for 5-7 minutes on the field, daily up to 10 procedures. The method has an effect on enhancing blood circulation and the development of collaterals at the fracture site, contributes to faster consolidation of bone callus and its strengthening, prevents the development of adhesions in the surrounding tissues.

However, this method has disadvantages: ultrasound cannot be used in patients (usually women in the postmenopausal period) with osteoporosis, when bone fragility increases due to ultrasound exposure with a decrease in bone mass.

The closest in technical essence is the method of treatment after removing the plaster cast or fixing knitting needles for fractures of the forearm with the aim of restoring the function of the limb and relieving pain and swelling syndrome in the form of a low-intensity magnetic field and pulsed currents. The combination of these factors is used to stop swelling of tissues, relieve manifestations of pain in the development of emerging contracture of the joint, stimulate blood circulation to improve trophism of damaged tissues, restore the working capacity of limb muscles [Belyanin OL // Traumatology and orthopedics of Russia. - No. 1. - 2006. - p. 75-78]. The effect is exerted by the devices of the Polyus series with sinusoidal magnetic fields over the fracture area in a continuous mode, magnetic induction intensity of up to 50 mT, 10 minutes of daily procedures up to 10 times. After a course of magnetotherapy, impulse currents from the diadynamic therapy apparatus from the Tonus-2 apparatus to the forearm muscles are prescribed by the current shape Rhythm Syncope (Single-cycle continuous current) up to 12 min per procedure with current strength until visible muscle contraction up to 10 daily procedures.

This method improves trophism of injured soft tissues at the site of bone callus formation. It helps prevent the development of fibrotic formations that worsen the functionality of a nearby joint (wrist), reduces pain and local meteorolability, and prevents the development of contractures.

However, this method has disadvantages:

- a low-intensity magnetic field has a pronounced effect only when up to 18-20 procedures are prescribed, which makes the treatment process labor intensive on an outpatient basis, especially in winter, when fractures are more likely to occur;

- stimulation by diadynamic currents of injured muscles has an efficiency of only 49% in injured under the age of 40 years;

- the pain syndrome persists in the form of chronic pain, which resumes under provoking circumstances: hypothermia, hard physical labor, intercurrent diseases, the presence of meteorolability;

- the presence of osteoporosis progresses in the late post-traumatic period with the formation of contracture of the nearby joint, limiting the participation of the victim in social life at 78%.

The objective of the invention is to increase the effectiveness of treatment in the recovery period after fractures of the forearm bones by reducing the development of osteoporosis and changes in the fibrous nature in the soft tissues of the fracture site and the restoration of the patient's adaptive reserves.

The task is achieved by a method of treating the consequences of forearm fractures in gerontological patients, including magnetotherapy and diadynamic therapy. Immediately after removal of the plaster cast, diadynamophoresis is performed in the position of the patient sitting on a chair. In this case, the first electrode (+) is placed with a pad soaked in a 5% placenta hydrolyzate solution 6 × 10 cm in size over the projection of bone callus at the site of fracture of the forearm bones from the inside of the forearm. A second electrode (-) measuring 8 × 10 cm is placed on the outer surface of the forearm. Diadynamophoresis is carried out from the DT-50-3 apparatus with a constant electric current of a half-sinusoidal shape with a frequency of 100 Hz for 15 minutes, the current strength is gradually increased until there are pronounced, but not painful sensations of vibration under the electrodes. Immediately after the diadynamophoresis procedure, a magnetoacoustic effect is performed over the projection of bone callus at the site of fracture of the forearm bones from the Magofon-01 apparatus with a magnetic induction value of 30 ± 9 mT, with an acoustic frequency of 0.02-20 kHz for 10 minutes. A course of 10 procedures daily.

The novelty of the method:

- A 5% placenta hydrolyzate solution is administered by the method of diadynamophoresis over the projection of bone callus at the site of fracture of the forearm bones.

- The magnetoacoustic effect is carried out from the Magofon-01 apparatus by the contact method in the position of the patient sitting over the projection of bone callus at the site of fracture of the forearm bones, daily for a course of up to 10 procedures.

The technical result. The method has a pronounced analgesic effect, normalizes the function of the wrist joint of an injured limb, is used in gerontological patients.

The method reduces pain at rest and when performing various types of work, prevents the development of contractures of the wrist joint, and also increases the adaptation reaction to functional loads, helps restore disturbed cortico-visceral interconnections, normalizes metabolic processes.

The introduction of a 5% placental hydrolyzate solution at the fracture site in people of an older age group is justified by compensating for the depleted reserve components of cell telomeres, which are responsible for communicative communications and conducting impulses from the periphery to the center and back. At the same time, diadynamic currents contribute to the expansion of blood flow and increased tissue trophism due to an increase in the number of vasculature in gerontological patients in a collapsed state, characteristic of this age group, which prevents regenerative processes: the number of functioning anastomoses and collaterals increases. At the same time, diadynamic currents can provoke an increase in blood pressure, which requires compensation during the procedure, and this effect is offset by low-frequency magnetic fields, which enhance the formation of release factors in the hypothalamus and tropic pituitary hormones that stimulate the function of the adrenal glands, thyroid gland, genitals and other endocrine glands with deficiency of function due to age-related changes. The use of ultrasound as a prophylactic factor for the prevention of dystrophic changes in the nervous, connective and muscle tissues in the older age group is contraindicated due to the development of osteoporosis, which is why the acoustic effect is relevant, which causes a similar effect on connective tissue elements, acting as a mechanical regeneration factor.

The criterion for selecting the effect on the projection of the fracture of diadynamic currents was the mechanism of the factor: diadynamic currents (DDT) excite myelinated conductors of the somatosensory system (skin and muscle afferents) belonging to Aβ fibers. The resulting excitation pulses along the thick myelinated fibers propagate towards the gelatinous substance of the posterior horns of the spinal cord and further to the central nervous system, activating the endogenous opioid and serotonergic systems of the brain stem and causing the formation of a dominant focus of excitation in its cortex. The latter, according to the law of negative induction, causes the suppression of the pain dominant in the cortex and activates the centers of the parasympathetic nervous system, which leads to a decrease in the patient's pain, up to complete analgesia. The development of an analgesic effect is also facilitated by the increased release of endorphins caused by DDT. A decrease in conductivity and a change in the lability of Aδ and C fibers are also important, due to which the impulse from the pain focus does not enter the central nervous system.

The descending efferent impulse flows formed as a result of activation of the cortical and subcortical centers increase the blood flow velocity in the affected organs and tissues, activate the trophic effects of the sympathetic nervous system and local defense mechanisms.

DDT also directly causes rhythmic contractions of skeletal muscle myofibrils and vascular smooth muscle. This, together with the reflex mechanism, causes an increase in local blood flow and an improvement in microcirculation, and also increases the number of functioning anastomoses and collaterals, which, in turn, activates the metabolism and slightly increases the temperature of tissues. Contraction of vascular smooth muscle causes an increase in venous outflow, redistribution of the content of ions and water in the interstitium, helps to remove products of cell autolysis, tissue dehydration and reduce their edema, which is accompanied by an improvement in their functional properties.

The result of DDT is to achieve the effect of analgesia, myoneurostimulation, vasoactivation and trophostimulation in injured tissues (Ulashchik V.S. Physiotherapy. - Universal Medical Encyclopedia. - Minsk: Book House. - 2008. - p. 469).

The procedures were dispensed from the DAD 50-3 TU4.7506165.1-90 Dyadynamic Apparatus (reg. No. 2249. 1991).

The criterion for choosing a 5% placental hydrolyzate solution was the pathogenetic validity of the method of drug exposure during the development of degenerative-inflammatory changes in injured tissues (especially the older age group) as an anti-inflammatory, stimulating, immunomodulating factor. The placenta hydrolyzate preparation was obtained from the placenta of livestock, developed by a team of creators and scientists on the basis of the production company Yalma LLC, followed by laboratory and clinical testing at the Center for Plastic Surgery and Cosmetology of the Ministry of Health of Russia (certificate No. GSEN. Ru. ЦОА. 158 State Register No. ROSS RU. 0001.510346. Minutes No. 46 dated 09/19/2003. Covering letter dated August 26, 2003. Sanitary Epidemiological order No. 77.99.03.915. Д005721.10.01. Dated 01.10.2001. Conclusion of the Institute of Plastic Surgery and Cosmetology of the Ministry of Health Russia from 09/19/2003). The drug contains highly active peptides, amino acids, mucopolysaccharides, hyaluronic and nucleic acids, trace elements. These components provide a powerful antioxidant effect that stimulates not only the processes of local immunogenesis, regeneration and phagocytosis, but also tones the central nervous system, which improves the functioning of the heart muscle. [Deriglazova N.A., 2006, Kozyreva L.G., 2005]. The ingress of particles of the placenta hydrolyzate into the bloodstream and regional lymph glands has a significant immunomodulating effect not only on the local nonspecific protective barrier, but also on the systemic immunity as a whole.

The criterion for choosing the impact of an alternating low-frequency magnetic field on the projection of a fracture of the forearm bones was the mechanism of action of the factor. It is proved that in low-frequency magnetic fields the speed of carrying out action potentials along nerve conductors increases, their excitability increases, perineural edema decreases. The restoration of the altered functional properties of the neurolemma of afferent conductors of pain sensitivity occurs, which leads to the weakening, and then the termination of impulse from the pain focus. Thus, the magnetic field has a inhibitory effect on the peripheral nervous system. In addition, it normalizes the vegetative functions of the body, reduces the increased vascular tone. Due to the increase in the oscillatory movements of the formed elements and plasma proteins, the local blood flow is activated, the blood supply to various organs and tissues, as well as their trophism is increased. It should be noted that the restoration of impaired local blood flow in many cases forms the basis of the clinical effectiveness of this factor. Low-frequency magnetic fields enhance the formation of release factors in the hypothalamus and pituitary tropic hormones that stimulate the function of the adrenal glands, thyroid gland, genitals, and other endocrine glands. As a result, the general adaptive reactions of the body are formed, aimed at increasing its resistance and tolerance to physical activity, stimulating sexual activity. In addition, the activation of the central links of the neuroendocrine regulation of the activity of internal organs by low-frequency magnetic fields leads to an increase in predominantly catabolic reactions. Due to the relaxation of the smooth muscles of peripheral vessels, such fields have a weak hypotensive effect. The north pole of the magnet by its influence causes an analgesic effect. Nerve cells have internal negative and external positive charges. Under the influence of magnetic fields, the external positive charge becomes very strong. When bioelectric exchange occurs, i.e. the interaction of negative and positive charges causes a weak impulse, which is sent to the brain. Such a physiological process is accompanied by an anesthetic effect. The north pole of the magnet is especially effective for pain.

The vibro-acoustic effect from the built-in source in the device Magofon-01 creates a synergistic amplification of the low-frequency magnetic field. The simultaneous generation of sounds with a frequency of 20 to 20,000 Hz causes mechanical excitation of the receptors and peripheral compression and stretching of the tissues, which prevents the development of sclerotic processes in the connective tissue elements of surrounding tissues. As a result, the effect is not only at the cellular level, but also molecular. This is especially important for the rehabilitation of the peripheral and autonomic nervous system, the neuroendocrine (which is actively involved in the process of bone regeneration).

The procedures were dispensed from the low-frequency magnetotherapy apparatus of magnetic induction 30 ± 9 mT and the frequency of the acoustic range 0.02-20 kHz - Magofon-01 (registration No. 90 / 345-107, Russia, Elatma, Ryazan region).

The use of local exposure to a 5% placenta hydrolyzate solution using diadynamic currents on the projection of bone callus at the site of fracture of the forearm bones, followed by the use of the magnetoacoustic contact method, allowed us to obtain a new result:

- Significantly reduce pain: in all patients of the main group (on a verbal rating scale that takes into account the strength of pain, in the main group corresponded to 1, and in the control - 4-5 P <0.01) by the end of the procedures.

- To increase the range of motion in the wrist joint due to the activity of pronators and arch supports in patients of the main group against control by the end of the course (the range of movements in the main group after 10 days was 117.4 ± 12.7 degrees, versus 67.4 ± 5.8 degrees in control P <0.01).

- Significantly reduce the activity of the inflammatory-degenerative process, as can be judged by the articular, pain and inflammatory Richie index in the wrist joint (in all patients of the main group there was a significant positive dynamics of the Richie index: pain index decreased by an average of 63%, articular - by 78 %, inflammatory - by 75% against 34%, 43% and 54%, respectively, in patients receiving treatment according to the prototype P <, 01).

- Prevent the development of algoneurodystrophy (Sudek syndrome), as can be judged by the absence of the development of the syndrome in the main group, while in the control there was a manifestation in 6% of cases.

The method is as follows.

They influence the physiotherapeutic factor in the patient’s position while sitting on a chair, place the first electrode (+) with a pad soaked in a 5% placenta hydrolyzate solution 6 × 10 cm in size over the projection of bone callus at the site of fracture of the forearm bones from the inside of the forearm, the second electrode (- ) 8 × 10 cm in size are placed on the outer surface of the forearm. Diadynamic therapy is carried out from the device "DT-50-3". Current parameters during tempering: DC half-sine wave with a frequency of 100 Hz for 15 min. The current strength is gradually increased until the appearance of pronounced, but non-painful sensations of vibration under the electrodes. Additionally, immediately after the diadynamophoresis procedure, a magnetoacoustic effect is performed over the projection of bone callus at the site of fracture of the forearm bones from the Magofon-01 apparatus with a magnetic induction value of 30 ± 9 mT, with an acoustic frequency of 0.02-20 kHz for 10 min per procedure. Procedures are carried out daily for a course of up to 10 procedures.

The method is used to prevent the development of complications after fractures of the forearm bones in persons of an older age group.

Under observation were 30 patients with a diagnosis of closed fracture of the radius without displacement in a typical place of 14 people; closed fracture of the forearm with a displacement in a typical place of 14 people; open fracture with displacement of the bones of the forearm in a typical place of 2 people who made up the main group who received treatment by the present method. The control group included 30 patients with a similar diagnosis (22 people with a closed fracture of the radius without displacement in a typical place, fractures of the forearm with a displacement in a typical place of 8 people) who received treatment according to the prototype. All patients were under the supervision of a traumatologist on an outpatient basis after applying a plaster cast. In 24 cases, reposition was used to combine fragments of the bones of the forearm.

All patients underwent x-ray of the forearm bones with the wrist joint in the direct and lateral projection three times. After removing the plaster cast before and after the course of treatment according to the proposed method, pain was assessed on a verbal scale. The verbal rating scale contains a number of words describing the strength of pain: pain is absent (1), mild (2), uncomfortable (3), irritating (4), severe (4), unbearable (5). Assessment of the strength of pain is the serial number of the selected definition (Pavlenko S.S. et al., 2002). The range of motion in the wrist joint was evaluated in degrees. The severity of changes in the wrist joint was determined by the evaluation of Richie's syndrome, taking into account the pain, articular and inflammatory nature of the changes. In order to control the restoration of the adaptive-reserve capabilities of the body against the background of physiotherapy, the reaction of L.G. Garkavi.

The results showed that the proposed method has a pronounced positive effect on the restoration of the functional state of the wrist joint involved in the pathological process as a result of fracture of the forearm bones in a typical place.

Example 1. Patient A. Year of birth 1956. Was admitted under observation with a diagnosis of the main: fracture of the forearm bones in the lower third with the displacement of fragments. Reposition of fragments of the bones of the forearm was carried out in order to combine them. An appropriate gypsum circular dressing was applied. Control radiographs 10, 21, and 30 days after the reposition were carried out, respectively: the radiograph of the wrist joint in two projections - in the anteroposterior and lateral projection. On day 10, the bone fragments were repositioned, as secondary mixing of fragments in a plaster cast occurred. After 8 weeks, the plaster cast was removed. On examination, the surrounding tissues of the wrist joint had swelling, a purplish-blue color, lack of flexion and extension, lack of flexion of the fingers, pain when trying to make movements in the joint. The patient immediately had an effect according to the claimed method: diadynamophoresis while sitting on a chair, placed the first electrode with a moistened pad in a 5% placenta hydrolyzate solution (connect “+”), 6 × 10 cm in size over the projection of bone callus at the site of fracture of the forearm bones with an internal sides of the forearm, the second electrode measuring 8 × 10 cm on the outer surface of the forearm (connect “-”). Diadynamophoresis was performed from a DT-50-3 apparatus. Current parameters during tempering: DC half-sine wave with a frequency of 100 Hz for 15 min. The current strength was gradually increased until the appearance of pronounced, but not painful sensations of vibration under the electrodes. In addition, immediately after the diadynamophoresis procedure, a magnetoacoustic effect was performed on the projection of bone callus at the site of fracture of the forearm bones from the Magofon-01 apparatus, with a magnetic induction value of 30 ± 9 mT, with an acoustic frequency of 0.02-20 kHz for 10 min per procedure. The procedures were carried out daily for a course of up to 10 procedures. After completing the course of treatment after 10 days, local dynamics was expressed in the form of the disappearance of swelling of the joint, normalization of skin color, the absence of pain in the joint both at rest and when performing movements. In this case, the angle of flexion and extension reached 106 degrees. Observations of the patient during the month noted persistent positive dynamics in bone tissue regeneration and restoration of the wrist joint function without osteoporosis. Adaptation reaction according to L.G. Garkavi was within the zone of calm activation, which indicated a pronounced effect of physiotherapy on the resistance of the organism as a whole, although the patient was in the postmenopausal period, which significantly reduces adaptive reactions. Outpatient observations for 2 years with two courses of procedures per year by the present method allowed to fully restore the function of the wrist joint and to avoid complications.

Example 2. Patient B. Year of birth 1952. Was admitted under observation with a diagnosis of the main: a fracture of the radial bone of the right forearm in the lower third with the displacement of fragments. Reposition of fragments of the bones of the forearm was carried out in order to combine them. An appropriate gypsum circular dressing was applied. Control radiographs 10, 21 and 30 days after the reposition were carried out, respectively: the radiograph of the wrist joint in two projections - in the anteroposterior and lateral projection. On day 11, bone fragments were repositioned, as secondary mixing of fragments in a plaster cast occurred. After 5 weeks, the plaster cast was removed. On examination, the surrounding tissues of the wrist joint had swelling, a purplish-blue color, lack of flexion and extension, lack of flexion of the fingers, pain when trying to make movements in the joint. The patient immediately had an effect according to the claimed method: diadynamophoresis in a sitting position on a chair. The first electrode was placed with a moistened pad in a 5% placental hydrolyzate solution (“+” plugged in), 6 × 10 cm in size over the projection of bone callus at the site of fracture of the forearm bones from the inside of the forearm. The second electrode measuring 8 × 10 cm is placed on the outer surface of the forearm (connect “-”). Diadynamophoresis was performed from a DT-50-3 apparatus. Current parameters during tempering: DC electric current of a half-sinusoidal shape with a frequency of 100 Hz 15 min. The current strength was gradually increased until the appearance of pronounced, but not painful sensations of vibration under the electrodes. In addition, immediately after the diadynamophoresis procedure, a magnetoacoustic effect was performed over the projection of bone callus at the site of fracture of the forearm bones from the Magafon-01 apparatus with a magnetic induction value of 30 ± 9 mT, with an acoustic frequency of 0.02-20 kHz for 10 min per procedure. The procedures were carried out daily for a course of up to 10 procedures. After completing the course of treatment after 10 days, local dynamics was expressed in the form of the disappearance of swelling of the joint, normalization of skin color, the absence of pain in the joint both at rest and when performing movements. In this case, the angle of flexion and extension reached 111 degrees. Observations of the patient during the month noted persistent positive dynamics in bone tissue regeneration and restoration of the wrist joint function without osteoporosis. Adaptation reaction according to L.G. Garkavi was within the zone of calm activation, which indicated a pronounced effect of physiotherapy on the resistance of the organism as a whole, although the patient was in the postmenopausal period, which significantly reduces adaptive reactions. Outpatient observations for 2 years with two courses of procedures per year by the present method allowed to fully restore the function of the wrist joint and to avoid complications.

Thus, the effect of the proposed method, which consists in the following:

- the disappearance and a significant decrease in the severity of pain;

- prevention of the development of contracture of the wrist joint after a fracture;

- restoration of limb function;

- prevention of the development of complications in the form of algoneuromyodystrophic syndrome (Sudeck syndrome);

- preservation of adaptive reserves of the body.

Claims (1)

A method for treating the consequences of forearm fractures in gerontological patients, including magnetotherapy and diadynamic therapy, characterized in that immediately after removal of the plaster cast, diadynamophoresis is performed in the patient’s position while sitting on a chair, and the first electrode (+) with a pad moistened in a 5% hydrolyzate solution is placed a placenta measuring 6 × 10 cm above the projection of bone callus at the fracture of the forearm bones on the inside of the forearm, a second electrode (-) of 8 × 10 cm in size is placed on the outer surface of the forearm I, diadynamophoresis is carried out from the DT-50-3 apparatus with a constant electric current of a half-sinusoidal shape with a frequency of 100 Hz for 15 minutes, the current strength is gradually increased until there are pronounced, but not painful sensations of vibration under the electrodes, immediately after the procedure of diadynamophoresis, a magnetoacoustic effect is performed on the projection of bone marrow in place fractures of the forearm bones from the Magofon-01 apparatus with a magnetic induction of 30 ± 9 mT, with an acoustic frequency of 0.02-20 kHz for 10 minutes, a course of 10 procedures daily.