Fracture of the ulna. How long does a fracture of the ulna heal? Displacement of the ulna

bone fracture- this is a pathological condition in which there is a partial or complete violation of the integrity of its anatomical structure under the influence of an external force. Forearm fractures may develop due to mechanical injury ( when falling on the hand, hitting the forearm, when something heavy falls on the hand, etc.) or occur as a result of certain diseases ( osteoporosis, rickets, osteomyelitis, bone tumor, etc.), accompanied by a violation of the incorporation of minerals into bone tissue.

Forearm fractures are a fairly common pathology characterized by a wide variety of clinical symptoms. With such fractures, pain, swelling at the site of injury, external bleeding, bruising, impaired skin sensitivity, deformity of the forearm, dysfunction of the elbow and wrist joints with limitation of active and passive movements can occur. With open fractures in the wound, bone fragments can often be seen.

Some serious complications are possible with forearm fractures, such as osteomyelitis, malunion of bone fragments, fat embolism ( blockage of blood vessels by droplets of fat), bleeding, nerve damage, suppuration in soft tissues, etc.

The ulna and radius form the bone base of the forearm, therefore, if they are damaged, there is a persistent disruption of the work of almost the entire arm ( hand, wrist joint, forearm, elbow joint). This greatly affects the daily activities of patients. However, despite the severity of such fractures, they are fairly easy to diagnose, and their treatment mainly consists of reduction ( reduction) bone fragments and the imposition of a plaster splint ( bandages) on the injured arm. These patients usually return to work within a few weeks or months. It all depends on the type and severity of the fracture, as well as the presence of any complications.

Anatomy of the forearm

The forearm consists of the following anatomical formations:

• forearm bones;
• muscles;
• skin and subcutaneous fat;
• vessels and nerves;
• elbow joint;
• wrist joint.

Forearm bones

From above, the bones are covered with periosteum, and inside they contain yellow bone marrow ( adipose tissue) and red bone marrow ( hematopoietic organ). Yellow bone marrow is localized in the middle part of the bones of the forearm, red - in the epiphyseal ( in the area of ​​the epiphyses). In the metaphyseal zone there are bone growth layers that allow the radius and ulna to grow in length. Spongy bone substance is located between the red bone marrow and the periosteum in the epiphyses ( the cloth). In the diaphysis of the bones between the yellow bone marrow and the periosteum is a compact bone substance ( the cloth). Compact bone is denser and stronger than cancellous bone. Therefore, the bones of the forearm are most resistant to mechanical stress in their middle part ( in the area of ​​the diaphysis).

The ulna is located on the inside of the forearm ( when turning the hand palm to face). The radius is located near it and parallel to it - with the lateral ( outer side) sides of the forearm. They are about the same length. The bones of the forearm have an unequal and uneven shape. The superior epiphysis of the radius is thinner than the superior epiphysis of the ulna. Its lower epiphysis, on the contrary, is thicker in comparison with the lower end of the ulna.

top end ( epiphysis) of the ulna is called the olecranon, next to it, on the opposite side, is the coronoid process of the ulna. bottom end ( epiphysis) of the ulna consists of the head of the ulna and the styloid process. The radius in its upper part is represented by the head of the radius and its neck. In its lower part there is a bone thickening, which plays an important role in the formation of the wrist joint ( connection between hand and forearm), as well as the styloid process of the radius.

muscles

The second group of muscles allows the forearm and hand to rotate around its longitudinal axis. Inward rotation ( inside) help muscles pronators ( pronator round, flexor carpi radialis, pronator quadrate, etc.). Rotation to the outside ( outside) is provided with the help of the muscles of the supinators ( brachioradialis muscle, supinator, etc.). The third group includes the extensor muscles. These muscles allow the hand to extend at the wrist ( short radial extensor of the wrist, long radial extensor of the wrist, etc.), and the forearm - in the elbow ( ulnar extensor of the wrist, extensor of the fingers, etc.) joint.

Skin and subcutaneous fat

Vessels and nerves

The ulnar artery, in turn, is closer to the ulnar artery. It repeats the course of the ulna and is localized closer to the inner surface of the forearm. In the region of the forearm, the ulnar recurrent artery departs from it, which contributes to the formation of the ulnar arterial network, as well as the common interosseous artery. This artery branches off from the ulnar artery in the upper third of the forearm. A little lower, it bifurcates and is divided into an anterior ( located in front of the interosseous membrane) and back ( located behind the interosseous membrane) interosseous arteries that follow distally ( way down), to the hand, being in the gap between the bones of the forearm.

The venous network of the forearm is represented by deep and superficial veins. The deep veins of the forearm include the radial and ulnar veins. These veins are located next to the main arteries ( radial and ulnar) and completely repeat their course. They begin in the area of ​​​​the hand, and in the area of ​​​​the elbow they pass into the brachial veins. The superficial veins of the forearm include the medial ( inner side) and lateral ( outer side) saphenous veins, intermediate vein of the forearm and intermediate vein of the elbow.

The lymphatic system of the forearm consists of deep and superficial lymphatic vessels. The former follow from the hand to the elbow along with deep arterial and venous vessels. The second are located above and repeat the course of the superficial veins of the forearm.

In the region of the forearm, the main nerve trunks pass - the radial, ulnar, median nerves, as well as additional - the lateral and medial cutaneous nerves of the forearm. The radial and ulnar nerves are located closer to the bones of the same name. The median nerve occupies an intermediate position in the forearm. All three nerves run along the anterior surface of the forearm from the elbow to the hand. The lateral cutaneous nerve of the forearm is a continuation of the musculocutaneous nerve ( one of the nerves of the shoulder). The medial cutaneous nerve of the forearm is a direct continuation of the medial ( inner side) bundle of the brachial plexus.

elbow joint

Inside the elbow joint there is a connection between the bones of the forearm, which is called the proximal ( top) radioulnar joint. It is formed by the union of the head of the radius and the radial notch located on the ulna. Movement in this joint is strictly limited and allows the radius to rotate around the longitudinal axis of the ulna.

wrist joint

Just above the wrist joint is the distal ( lower) radioulnar joint, connecting the lower ends of the ulna and radius bones. The radiocarpal and distal radioulnar joints are separated from each other by a cartilaginous articular disc. In the distal radioulnar joint, the head of the ulna and the ulnar notch on the radius interact with each other. The distal radioulnar joint belongs to cylindrical joints, therefore only rotational movements around the longitudinal axis are possible in it. This joint, together with the superior radioulnar joint, allows the radius to rotate around the longitudinal axis of the ulna.

The strengthening of the two bones of the forearm among themselves is provided not only by means of the elbow, wrist, proximal and distal radioulnar joints. These bones are held together by an interosseous membrane ( interosseous membrane) of the forearm, which consists of dense and durable connective tissue fibers that fill almost the entire gap between the bones of the forearm throughout its entire length.

What are forearm fractures?

In comminuted fractures, two fractured sections of the damaged bone are limited to each other by one smaller bone fragment ( wreckage), which is located between them like a wedge. With multi-comminuted fractures, there may be several small fragments. Thus, at comminuted fractures, at least three bone fragments are formed.

Depending on the localization, all fractures of the forearm are divided into the following types:

• proximal fractures ( upper
• distal fractures ( lower) segments of the bones of the forearm;
• diaphyseal fractures ( medium) segments of the bones of the forearm.

Fractures of the proximal segments of the bones of the forearm

Types of fractures of the proximal segments of the bones of the forearm

Fractures of the distal segments of the bones of the forearm

An incomplete fracture differs from a complete one in that with it the fracture occurs not in the transverse direction, but in the longitudinal direction. Thus, in case of an incomplete fracture, the fracture line of the bone passes through the epiphysis without completely disturbing the contact between the articular surfaces of the wrist joint. Pineal area ( where did the fracture occur) does not separate at the same time, but remains connected to the diaphysis. Among intra-articular fractures, so-called metaepiphyseal fractures may appear. These are fractures in which a violation of the integrity of the bone occurs in the area of ​​the metaphysis and epiphysis of the bone.

Types of fractures of the distal segments of the bones of the forearm

Fractures of the diaphyseal segments of the bones of the forearm

Types of fractures of the diaphyseal segments of the bones of the forearm

When the bone fragments are displaced in width, they move away from each other relative to the longitudinal plane that passes through the axis of the bones of the forearm.

The following degrees of displacement of bone fragments in width are distinguished:

• Zero degree. At zero degree, the displacement of bone fragments during a fracture of the bones of the forearm does not occur at all. Such a fracture is called a non-displaced fracture.
• First degree. At the first degree, bone fragments move away from each other at a distance equal to half the diameter of the damaged bone. The contact between the bone fragments is well preserved.
• Second degree. In the second degree, bone fragments are displaced by a distance of more than one second ( half) diameter of the affected bone. The bone fragments in this case are still slightly in contact with each other.
• Third degree. In the third degree, there is a complete separation between the bone fragments. They do not contact each other.

When the bone fragments are displaced at an angle, a certain angle arises between them, the value of which characterizes the degree of displacement and the severity of the fracture. The displacement of fragments in this case occurs mainly in the transverse direction. Some ends of the bone fragments are very distant from each other, others ( the opposite) usually either continue to interact with each other or slightly move away from each other and form the top of the corner.

In medical practice, there are also open and closed fractures of the bones of the forearm. With open fractures, significant tissue damage occurs at the fracture site, and bone fragments are significantly displaced from each other ( third degree of offset in width) and partially contact with the external environment. Open fractures of the bones of the forearm are accompanied by damage to a large number of tissues of the forearm - muscles, blood vessels, nerves, subcutaneous fat, skin. With closed fractures, bone fragments do not come out, although the surface covers over them can sometimes be damaged due to the action of a traumatic factor on them.

Depending on the mechanism of development of fractures of the forearm, traumatic and pathological fractures are distinguished. Traumatic fractures are observed when a force acting on the bone exceeds the resistance ( strength) of its bone tissue. This can often be seen with various mechanical injuries - falls on the arm, direct blows to the arm, damage to the forearm in traffic accidents. Pathological fractures occur when the bones of the forearm for some reason ( osteoporosis, rickets, osteomyelitis, bone tumor, etc.) strength decreases. In these cases, even a slight mechanical impact on the bones of the forearm can provoke their fracture.

The main signs of a fracture of the forearm

Depending on the location, all fractures of the bones of the forearm are divided into the following types:

• fractures of the upper ends of the bones of the forearm;
• fractures of the diaphysis of the bones of the forearm;
• fractures of the lower ends of the bones of the forearm.

Fractures of the upper ends of the bones of the forearm

Puffiness is also observed in the region of the olecranon of the ulna. Here it is more pronounced. Passive movements in the elbow joint are usually feasible, but painful. Active flexion at the elbow is possible, but extension ( active) is often broken ( especially with a displaced fracture) and very painful. On palpation in the region of the olecranon, it is often possible to detect a depression between broken off bone fragments. With a fracture of the olecranon with its displacement, deformity of the elbow joint often occurs.

With a fracture of the coronoid process of the ulna, there is local pain and swelling in the ulnar fossa ( mostly on the inside side). There may also be a bruise in it ( bruise) due to interstitial bleeding. In some cases, hemarthrosis may develop ( accumulation of blood in a joint). Active flexion movements in the elbow joint are often severely limited. With passive flexion at the elbow, the maximum ability to bend the arm at the elbow joint is reduced. Rotational movements are usually not disturbed. Active and passive extensor movements may be limited due to pain.

A fracture of the head or neck of the radius is accompanied by the appearance of local pain and swelling in the elbow bend, localized mainly on its lateral side in the area of ​​the anatomical projection of these bone formations. All active and passive movements in the elbow joint are limited. This is especially true for extensor and rotational ( in particular, rotation of the forearm outward) movements that cause very intense pain in the elbow joint.

Fractures of the diaphysis of the bones of the forearm

Pain at the fracture site is aggravated by palpation, as well as by compression of the forearm at the site of damage from the sides ( i.e. compression). A distinctive feature of such a fracture is a sharp limitation of active and passive supination ( ) and pronation ( rotational movements inside) movements in the forearm.

A fracture of the diaphysis of the ulna is much easier to detect than a fracture of the diaphysis of the radius ( due to the more superficial location of the ulna in the tissues of the forearm). It is accompanied by the appearance of soreness and swelling from the inner side in the middle of the forearm. With such a fracture, subcutaneous bleeding often occurs, displacement of debris, which cause slight deformation of the affected area of ​​the forearm.

Due to the displacement of the debris, often on palpation it is possible to detect pathological mobility and crepitus ( the sound of friction between broken bone fragments). A fracture of the diaphysis of the ulna is also characterized by limited mobility in the elbow joint in all directions - flexion, extension, pronation ( rotational movements inside), supinations ( outward rotational movements).

With a fracture of both bones, severe pain appears in the area of ​​​​the entire forearm ( especially in the fracture zone). Patients with these fractures are often unable to move their injured arm, so they support it with a healthy limb. Active and passive movements ( flexion, extension, rotation) in the elbow joint are severely limited. Sometimes the function of the wrist joint is disturbed. Quite often at these fractures there is a displacement of bone fragments. In such cases, the forearm may be slightly shortened in length. Significant swelling, pathological mobility, crepitus, bruises, deformation of the anatomical structure of the forearm occur at the site of the lesion.

Fractures of the lower ends of the bones of the forearm

In a Colles fracture, the bone fragments are displaced ( which are located closer to the wrist joint) anteriorly and sometimes to the lateral ( to the outer side) side. Such a fracture often occurs when falling on a hand extended at the wrist joint. He often ( in 50 - 70% of cases) is associated with a simultaneous fracture of the styloid process of the ulna. The main symptoms of a Colles fracture are pain and swelling in the area of ​​the wrist joint, localized mainly on the outer side.

On palpation ( palmar or dorsal side) the pain usually gets worse. Also, with the help of palpation, you can identify the distal ( lower) bone fragment on the back of the hand. Proximal ( upper) fragment is localized behind it, on the palmar surface of the hand. The hand, together with the fingers, is often immobilized and displaced in the same direction as the distal ( lower) bone fragment of the radius. Active and passive movements in the hand are sharply limited. Possible crepitus ( the sound of a crunch between broken bone fragments) and pathological mobility ( the presence of mobility of bone fragments), but it is not recommended to check their presence, because of the high risk of damaging nerves and blood vessels.

In Smith's fracture, the distal ( lower) bone fragment ( or debris) moves backwards and outwards ( sometimes inside). Proximal ( upper) the fragment is displaced anteriorly and is in front of the lower bone fragment of the radius. Smith's fracture is observed when patients fall on a hand bent at the wrist joint, which, during a fracture, shifts to the same place where the distal hand has shifted ( lower) bone fragment of the radius ( palm side).

During palpation in patients with a Smith's fracture, one can easily detect the displacement of the distal and proximal fragments in different directions, as well as identify local pain and swelling. In some cases, with such a fracture, bruising may appear on the skin. Along with them, it is possible to detect deformation of the zone of the wrist joint and its edema. With a Smith's fracture, as with a Colles' fracture, there is a significant limitation of mobility in the wrist joint. The hand in these cases is immobilized, the movements of the fingers are difficult.

Smith's fracture may also be associated with a fracture of the styloid process of the ulna. This fracture is characterized by the appearance of additional pain and swelling that occur in the area of ​​its anatomical projection. With such a joint fracture, pain and swelling become even more diffuse ( widespread) and cover the entire wrist joint.

Diagnosis of a fracture of the forearm

The following methods are used to diagnose a fracture in the forearm:

• anamnesis;
• visual inspection;
• radiography and computed tomography.

Anamnesis

The first group of signs is called reliable signs of a fracture of the forearm. It includes crepitus ( crunching sound that occurs when bone fragments rub against each other) bone fragments, pathological mobility ( mobility in the place where it normally should not be) and change in the length of the forearm. If these signs are present, you can immediately suspect a fracture of the bones of the forearm. These signs are most often detected during external examination. The patient may occasionally report the presence of such signs.

The second group of signs include probable signs of a fracture. These include pain and swelling at the site of injury, the presence of hematomas ( bruising), abnormal position of the limb ( forearms, hands), deformity of the forearm, limited mobility of the adjacent joint. Often the patient in his complaints talks about these signs.

Probable signs, first of all, indicate only the possible presence of a fracture, but do not indicate its presence, in contrast to reliable signs of a fracture of the forearm. Therefore, it is not always worth panicking prematurely when likely signs appear. Quite often, a simple bruise of the forearm can be the cause of probable signs.

Secondly, the attending physician usually asks the patient questions that relate to the causes of the fracture. Basically, he asks about the circumstances under which these symptoms appeared ( when hitting the forearm, when falling on the arm, with mechanical compression of the forearm, when something heavy falls on the arm, etc.). Most often, after such circumstances, fractures of the bones of the forearm develop.

In some cases, a fracture of the forearm can be observed with minor injuries, which in ordinary people can rarely provoke it. Therefore, if the patient does not have any serious injuries in the past, the doctor can ask him about the presence of additional pathologies that can cause demineralization ( decrease in mineralization) bones. It reduces the resistance of bone tissue to mechanical stress and can cause pathological fractures.

In most cases, bone demineralization can be caused by the following main causes:

• Rickets. Rickets is a pathology in which a deficiency of vitamin D occurs in the body, which regulates phosphorus-calcium metabolism and the usefulness of bone mineralization.
• Tumors of the bones of the forearm. With tumors of the bones of the forearm, the growth of pathological tissue very often occurs, which violates their normal anatomical structure.
• Lack of calcium in food. Calcium is the main mineral component of bone tissue. With its insufficient intake with food in the body, the processes of mineralization of bone tissue in the bones of the forearm are disrupted.
• Malabsorption syndrome. With this syndrome, there is a decrease in the absorption of nutrients ( proteins, minerals, vitamins) in the intestine due to any pathology of the gastrointestinal tract ( chronic enteritis, intestinal lymphangiectasia, Crohn's disease, etc.).
• Endocrine diseases. With endocrine diseases, a violation of the metabolism of phosphorus and calcium in the body, which are indispensable components of bone tissue, is very often observed. Demineralization of the bones of the forearm can mainly be observed with hypercortisolism ( strengthening the work of the adrenal glands), hyperparathyroidism ( excessive release of parathyroid hormone from the parathyroid glands), diabetes, etc.
• Prolonged use of medications. Demineralization of the bones of the forearm can cause long-term use of cytostatics, antibiotics, glucocorticoids, anticonvulsants, etc.

Visual inspection

In those patients who applied to a medical institution with a fracture of the forearm with displacement of bone fragments, an external examination most often reveals many signs of a fracture. They are both reliable ( crepitus, abnormal mobility, forearm shortening), and some likely signs of forearm fractures. The latter include bruising, swelling of the fracture site, local pain, forced position of the hand ( most often the injured forearm is supported by a healthy hand), deformation of the anatomical structure of the forearm, absence or limitation of active and passive movements in the elbow or wrist joint. Radiation studies ( radiography, computed tomography) in this case are also done, but here they are needed, to a greater extent, to assess the severity of the fracture, identify complications and choose treatment tactics.

Radiography and computed tomography

Bone tissue is an ideal structure for X-rays, which are absorbed by it to a high degree, since it has the highest density compared to other tissues of the body ( pulmonary, hepatic, cardiac, articular, etc.). Therefore, the X-ray method ( like computed tomography) diagnosis is considered the gold standard for diagnosing various fractures.

In case of a fracture of one or both bones of the forearm, X-rays are taken in two mutually perpendicular projections. This allows you to see the fracture site in more detail, identify bone fragments and the direction of their displacement. On radiographs, the bones of the forearm look like white longitudinal formations that connect ( through the elbow joint) in the upper part with the humerus, and below - with the bones of the wrist ( through the wrist joint).

A fracture of the bones of the forearm looks like a gray or black strip with uneven edges, which completely or partially breaks off ( disconnects) their anatomical structure. This strip is called a break line ( or fracture line). It may have different directions transverse, longitudinal, oblique), which depends on the type of fracture. There may be several fracture lines with multiple fractures or with comminuted fractures ( where more than two bone fragments are formed) forearms. In addition to the fracture line in a fracture of the forearm ( with displacement of bone fragments) on the radiograph, you can also see the displacement of bone fragments, deformation of the axis of the limb, small bone fragments.

Computed tomography uses the same x-rays as x-rays. However, the technique of its implementation is completely different from the X-ray examination. With computed tomography, layer-by-layer scanning of the affected area of ​​the forearm is performed, which provides much more useful information. This study is more accurate than plain radiography. It allows you to identify additional fracture lines, bone fragments unnoticed by radiography, the position and angles of deviation of all fragments, which is very important when planning and choosing treatment tactics.

What does a hip fracture look like on x-ray?

With their usual fracture ( bone fragments) two – proximal ( upper) and distal ( lower). With a comminuted fracture - three - proximal ( upper), middle, distal ( lower). Complex fractures are accompanied by the formation of more bone fragments. The displacement of bone fragments can be easily visually recognized by a fairly understandable separation or fragmentation of the radius into several bone fragments and deformation of its anatomical structure.

What does a hip fracture look like on x-ray?

What to do if you hit your forearm hard and there is a suspicion of a fracture?

With strong blows to the forearm, in the first place, it is categorically not recommended to check the bones of the forearm for a fracture. In particular, in such cases it is not necessary to try to identify reliable signs of a fracture ( pathological mobility, crepitus of bone fragments). It is also advisable not to feel the place where the injury occurred. If the patient is still sure that the forearm injury resulted in a fracture of one or both bones of the forearm, then in no case should he be corrected, since, in most cases, this cannot be done without special skills.

Secondly, one should not judge the severity of damage to the forearm area by clinical symptoms. Since even minor injuries of the forearm can lead to fractures of the radius or ulna, although the symptoms will be quite meager. This happens especially often with pathological fractures, when the resistance of bones to mechanical stress decreases due to the presence of a pathology in the body associated with a violation of their mineralization. Conversely, severe injuries of the forearm, in which severe clinical symptoms appear, may not always cause fractures of the radius or ulna. This misjudgment often leads the patient to go for a long time without seeing a doctor and think that the injury to the forearm only led to a bruise.

Thirdly, you should take painkillers. Their use is not necessary in cases of mild and tolerable pain. But usually fractures of the bones of the forearm are accompanied by severe pain. The drugs of choice should be drugs belonging to the group of non-steroidal anti-inflammatory drugs. They can be Flamadex ( adults 12.5 - 25 mg 1 time per day), ibuprofen ( adults up to 1000 - 1200 mg per day in divided doses), ketorolac ( adults 10 mg 1-3 times a day) and etc.

Fourth, for safety, it is worth immobilizing ( immobilize) injured forearm. This requires a rigid, hard and straight object ( board, stick, etc.) of an oblong shape, the length of which can cover the hand, the entire forearm and the elbow joint. Next, you need to put this object to the lower surface of the forearm and tightly ( but not tight, so that after application to the radial artery near the wrist, its pulse can be felt) harden it to it ( subject) using a sterile bandage. The arm where the forearm is injured should be bent at the elbow at an angle of 90 - 100 degrees. The inclination of the forearm should be such that with it the patient feels minimal pain at the site of injury. In the presence of abrasions, scratches, wounds that have arisen along with an injury to the forearm, it is recommended to put sterile wipes soaked in some kind of antiseptic on these places before immobilizing the hand ( iodine, brilliant green, alcohol, etc.).

Immobilization of the forearm will provide minimal mobility of the bones of the forearm ( this will reduce the risk of displacement of bone fragments in forearm fractures without displacement), reduce the risk of pain and prevent unwanted complications ( damage to nerves, blood vessels, soft tissues, which can develop when bone fragments are displaced). After immobilization, it is recommended to apply cold to the injured forearm ( ice bag) and hang it on a hanging scarf, fastened behind the neck. Also, after immobilization, you should try not to move your hand in the elbow and wrist joint and provide complete rest with your forearm.

Fifth, in order to confirm the presence of a fracture ( or deny its presence) you must immediately go for a consultation with a traumatologist at the nearest traumatology department or emergency room. If this is not possible, then you need to call an ambulance, through which the patient will be taken to traumatology. In the Department of Traumatology, traumatologists will identify the cause of pain in the forearm, as well as help you quickly get rid of it.

Treatment of a fracture of the radius

Traumatologists resort to open reposition for comminuted, severe or complicated fractures of the radius, when the number of fragments does not allow to reunite the original bone structure without resorting to surgical methods of treatment. With closed reposition, doctors undertake some surgical procedures that allow direct access to bone fragments. After which doctors produce them ( bone fragments) assembly, restore the structure of the radius and fix the fragments to metal spokes or plates to prevent their re-displacement.

In rare cases, areas of bone tissue are partially resected ( delete). Quite often, this is done with necrosis of the head of the radius, when, after severe trauma, part of its articular surface cannot normally participate in movements in the elbow joint. Therefore, in such cases, it is removed.

With fractures of the radius without displacement of bone fragments ( and after the reduction of fractures with their displacement) the usual immobilization of the injured limb for a short period is necessary. Sometimes patients may be prescribed painkillers ( ibuprofen, ketorolac, etc.), antibiotics ( antibiotics), as well as immunobiological agents ( vaccines, immunoglobulins). The last two groups of drugs are mainly prescribed for the prevention of infectious complications at the fracture site. In particular, with open fractures of the forearm, the use of antitetanus immunoglobulin is indicated. After removing the cast, all patients must perform therapeutic exercises for the gradual development of the damaged area of ​​the forearm and the normal restoration of the elbow and wrist joints.

Terms of treatment for various types of fractures of the radius

Treatment of a fracture of the ulna

Terms of treatment for various types of fractures of the ulna

Treatment of a fracture of the radius in a typical location

With a simple fracture of Colles or Smith with displacement of bone fragments, their traction reposition is performed ( repositioning of bones by hand pull) under local or conduction anesthesia ( anesthesia). The essence of this reduction lies in the fact that one of the doctor's assistants pulls the hand towards himself, and the second doctor's assistant at this time creates a counter-traction at the opposite end of the arm and holds the affected arm by the elbow. Thus, it turns out that both assistants gradually pull out and slightly separate the distal and proximal bone fragments from each other. At this time, the doctor manually correctly connects ( sets) bone fragments, exerting pressure on them opposite to the direction of displacement.

Immediately after repositioning ( reduction) on the injured arm, the doctor must apply a plaster splint ( from the upper third of the forearm to the base of the fingers on the hand). At the same time, the tension of the arm should remain the same, since there is still a risk of re-displacement of bone fragments. This tension is gradually loosened after the plaster has dried.

In the absence of successful reposition, the presence of complex multi-comminuted fractures, the appearance of repeated displacements, or excessive damage to the articular surface of the distal epiphysis of the radius, Colles or Smith fractures are treated surgically by osteosynthesis. Osteosynthesis is a surgical manipulation in which bone fragments are connected to each other by embedding special plates or pins into the radius, which hold these fragments next to each other after their reposition. After surgical reposition, a cast is applied to the forearm.

Timing of plaster immobilization for fractures of the radius in a typical location ( Colles' fracture or Smith's fracture) with displacement of bone fragments range from 30 to 45 days. The duration of rehabilitation ( recovery) articular mobility after such fractures takes 14-30 days.

Treatment of a fracture of the head of the radius

With a simple fracture of the head of the radius with a displacement of bone fragments, their manual is performed ( manual) reposition ( reduction) under anesthesia. With comminuted, complex fractures, accompanied by the appearance of a large number of bone fragments, as well as with unsuccessful reduction, an operation is indicated for their open reposition. During this procedure, the doctor manually restores the structure of the radius and fixes the bone fragments with special needles.

There are cases when the head of the radius cannot be set during surgery. Usually this occurs with multi-comminuted complex fractures. This serves as an indication for its removal. The head of the radius can also be removed in case of severe damage ( caused by a fracture) of its articular surface.

After closed or open reduction of the head of the radius, temporary immobilization is required ( application of a plaster splint from the hand to the elbow joint) forearms for a period of 21 to 35 days. After removing the plaster, therapeutic exercises are performed in the elbow joint. The damaged forearm will be able to fully restore its function within 40-60 days.

Treatment of a fracture of the ulna and radius without displacement

Treatment of fractures of the ulna and radius without displacement of bone fragments is carried out by simply immobilizing the injured limb with a plaster splint ( for a period of 8 - 10 weeks). After removing the cast, patients are advised to carry out therapeutic exercises for several weeks to develop various movements in the forearm. Full working capacity is restored after 10-12 weeks.

Treatment of a fracture of the ulna and radius with displacement

What are the consequences of a broken forearm?

A fracture of the forearm can have the following consequences:

• bleeding;
• nerve damage;
• osteomyelitis;
• pathological union;
• fat embolism.

Nerve damage
In case of fractures of the bones of the forearm, damage to the nerve trunks is not uncommon ( nerves) passing near them. This usually happens with open or closed fractures with displacement of bone fragments. At the time of the fracture, bone fragments mechanically touch nearby nerves and cause a violation of their normal function. This is accompanied by impaired sensitivity ( tactile, temperature, pain, etc.) skin at the fracture site and beyond, impaired mobility of the fingers, hand, numbness of the limb, blocking the function of the elbow or radial joint, etc.

Osteomyelitis
Osteomyelitis is an inflammation of bone tissue that occurs most often when it is infected with various harmful bacteria. Osteomyelitis can develop in the bones of the forearm after their open fracture, in which the bone fragments of these bones are in contact with the external environment for some time ( air, land, etc.), through which the infection enters the damaged bones. In such cases, not only the bone tissue is infected, but also all other tissues surrounding it, after which post-traumatic suppuration of the bones of the forearm develops. Therefore, when open fractures of the forearm appear, in order to prevent infection, it is necessary to treat the damaged areas of the forearm with some kind of antiseptic ( iodine, brilliant green, alcohol, etc.) before the arrival of an ambulance or before contacting a medical facility.

Pathological fusion
In case of fractures of the ulna or radius, pathological fusion of bone fragments may occur if you do not contact a traumatologist in a timely manner for help. Such fusion often causes discomfort in the movements of the forearm, periodic pain in the area of ​​the fracture, and it also limits the functionality of articular movements.

Fat embolism
An embolism is a blockage of blood vessels by various bodies. It can be caused by gas bubbles ( air embolism), fat drops ( fat embolism), blood clots ( thromboembolism). Quite rarely, with fractures of the bones of the forearm, a fat embolism can develop. It occurs due to the release of droplets of fat from the yellow bone marrow into the blood ( collection of fat cells located in the thickness of tubular bones), localized in the diaphysis of these bones. Fat droplets that enter the bloodstream are transported to the lungs and clog their vessels, which leads to respiratory failure or to its complete stop. Fat embolism can develop after severe and serious fractures of the bones of the forearm ( occurring predominantly in their middle part), at which their fragmentation into many bone fragments takes place.

Is surgery necessary for a fractured forearm?

The operation can be applied in the following clinical situations:

• unsuccessful reposition ( reduction) with a closed fracture;
• open fracture of the bones of the forearm;
• closed comminuted fracture of the forearm;
• multiple closed fracture of the forearm ( a fracture in which fractures occur in multiple places in one or both bones of the forearm);
• the presence of damage to large vessels or nerves with a fracture of the forearm;
• re-displacement of bone fragments after successful reposition of a closed fracture;
• pathological fracture of the bones of the forearm;
• simultaneous fracture of the radius and ulna;
• a simple fracture of the bones of the forearm with a displacement in the case of late admission of the patient to the traumatology department ( in these cases, there is an incorrect fusion of bone fragments, and the traumatologist can no longer set them with his hands without the use of operational measures).

How is rehabilitation after a fracture of the forearm?

Rehabilitation of patients with fractures of the forearm usually takes place on an outpatient basis ( at home). After removing the cast from the patient, the traumatologist sends him home, prescribing him a visit to special physiotherapy procedures, trainings, massage, etc. It is worth noting that the choice of one or another rehabilitation method depends entirely on the type, severity of the fracture, and the presence of complications. Therefore, not always the same method can be used for restorative purposes with different fractures of the forearm.

There are the following main groups of restorative measures that may be required for patients with a fracture of the forearm:

• physiotherapy;
• physiotherapy methods;
• massage.

Physiotherapy methods
After fractures of the forearm, physiotherapy procedures are often used. They can be electrophoresis, ultra-high frequency therapy ( UHF therapy), microwave therapy ( microwave therapy), inductothermy, pulse therapy, etc. These procedures have anti-inflammatory, myostimulating ( stimulate muscles), healing, vasodilating, trophic ( increase in tissue metabolism) action on the fracture site.

Massage
Forearm massage is necessary to improve microcirculation at the fracture site, expand small vessels, restore muscle tone, and increase metabolic processes in tissues. All this helps to quickly eliminate congestion at the site of injury, remove inflammatory substances from tissues, accelerate the recovery of muscle movements in the forearm, improve blood circulation and nervous regulation of damaged bones, muscles and other tissues.

How to provide first aid for an open fracture of the forearm?

The successful establishment of the tourniquet should be indicated by the absence of a pulse in the radial artery below the fracture site and a significant decrease in bleeding from the wound. Also, after applying the tourniquet, it is necessary to write on paper the time of its installation. This paper should then be given to the emergency doctor ( or a traumatologist), so that he knows the approximate time of the shortage of blood supply to the injured limb. If the ambulance does not arrive at the place of call within one hour, the place of clamping with a tourniquet should be loosened for 5 to 10 minutes. This is necessary in order not to cause premature necrosis ( necrosis) hand tissues located distally ( below) of the installed harness.

Next, at the site of the fracture, you need to put ( without touching the wound) several sterile swabs ( made from bandage). They can be soaked in antiseptic solutions ( alcohol, iodine, brilliant green, etc.). After applying tampons, you should easily strengthen them to the fracture site with a bandage. It is worth noting that the installation of tampons on the wound is a means of stopping severe venous bleeding ( dark red blood). With such bleeding, it is not necessary to apply a tourniquet to the shoulder.

The next step involves installing a tire ( any oblong object - a stick, a board) under the injured forearm. The tire is installed for immobilization ( immobilization) forearms and for the prevention of unwanted complications. The splint should be longer than the length of the entire forearm. It is also necessary that it covers the elbow joint and the wrist joint together with the hand. Before putting the tire under the arm, it must be wrapped with a bandage to prevent discomfort for the victim, as well as to prevent unwanted injuries in the form of splinters, scratches, etc.

It should be noted that the tire should be placed on the opposite side from the fracture site. To strengthen the splint to the forearm, the same bandage is needed. It is extremely important to attach the splint with a bandage throughout the entire forearm - from the elbow to the wrist joint, while bypassing the site of an open fracture ( i.e. the bandage used to install the splint should not be applied to the site of an open fracture). This is necessary in order not to cause additional pain associated with compression or displacement ( can occur when wrapping a bandage) bone fragments.

After attaching the splint, the forearm must be bent at the elbow and brought to the chest ( the tire at this moment should be below the forearm) together with the shoulder and hand. After that, the injured arm can be hung by a scarf to facilitate transportation of the victim.

The elbow joint has a rather complex structure. The presented part of the upper limbs is formed by the radial and which are connected to the shoulder tissue. Inside the main one there are several small ones. Large nerves and blood vessels pass through the presented area, which are responsible for the mobility of the entire limb. Therefore, fractures of the bones of the elbow joint, in addition to the difficulty of motor functions and the development of a serious pain syndrome, are fraught with a whole host of complications.

What therapy is used for injuries of this plan? How to treat fractures What is required for rehabilitation? We will try to answer the questions presented.

Causes of injury

The elbow joint is extremely vulnerable to damage, since there is no dense muscular frame that can provide reliable support and protection for the presented part of the upper limb. This area is especially often subjected to stress in babies, who are overly active and often find themselves in situations that are fraught with injury.

You can get an elbow fracture both as a result of a fall, and as a result of a significant impact load on this area. Most often, bone tissue damage here is of an internal nature.

Types of fractures

There are the following types of injuries of the bone tissue of the elbow joint:

1. The elbow joint is characterized by damage to the radius, its neck and head. Most often occurs as a result of excessive load when focusing on a straight limb.
2. elbow joint - in addition to the occurrence of cracks in the structure of the bone, soft tissues are damaged by fragments. In severe cases, a rupture of the skin occurs, a gaping wound is formed, which is accompanied by profuse blood loss.
3. A fracture occurs as a result of significant shock loads on the bone tissue. Such injuries are rare. Damage of this plan is characterized by consequences in the form of displacement and dislocation of the forearm.

There is also a fracture of the elbow joint with and without displacement. Often with such injuries, one bone suffers.

Symptoms

The following signs may indicate a fracture of the elbow:

1. The presence of a sharp steady pain that radiates to the hand and wrist.
2. Limited mobility of the limb or its complete paralysis.
3. Unhealthy, unusual for a person, mobility of the arm in the area of ​​​​the elbow joint, for example, in the lateral direction.
4. The occurrence of edema, the formation of a cyanotic hematoma, subcutaneous bruising.
5. Neurological symptoms - numbness of the fingers and hands, tingling of the forearm.
6. Damage to blood vessels, muscle tissue, skin of the elbow joint).

A clear sign of a serious one is severe pain in the back of it. Gradually, swelling and hematoma form on the front surface of the injured area. Subsequently, the ability to bend the arm is lost. The injured limb hangs limply. When performing a movement with the forearm, muscle stiffness is felt.

After a fracture with a displacement of the bone, the ability to extend the arm remains. However, raising the limb and rotating it laterally causes significant discomfort.

First aid

Tactics of providing first aid for a fracture of the elbow joint is selected based on the specifics of the injury and its severity. Be that as it may, the primary task here is the complete immobilization of the limb. To do this, it is recommended to resort to the imposition of a tire. In this case, the arm is bent at a right angle, after which it is securely fixed. If it is necessary to eliminate unbearable pain syndrome, analgesics are used.

Conservative treatment

In the absence of an injury in an open form, conservative therapy is used. During the first 6-7 days after the fracture, volumetric edema usually occurs. Until the pathological manifestation disappears, a splint plaster bandage is applied to the arm. Avoid stress on the injured limb for up to 3 weeks.

As the bone tissue connects, the arm is periodically released from the plaster to develop the joint. Over time, such a bandage is replaced with a rigid fixator, which has a system for adjusting the range of motion.

Operative therapy

Open fractures of the elbow joint, which are characterized by displacement of fragments, require surgery. Otherwise, the ability of the forearm to bend may not be restored.

The success of surgical therapy directly depends on the accuracy of the actions of the trauma surgeon, in particular, the comparison of bone fragments, their verified fixation in an anatomically correct position. The Center for Traumatology and Orthopedics is capable of providing such an operation.

In case of normal damage to the structure of the end of the ulna, therapy is aimed at tightening the tissues with a medical wire loop. Sometimes additional fixation of the bones in a static position with knitting needles is required.

If you have to treat internal fractures of the elbow joint with the formation of splinters, the therapy is based on bone grafting. In such situations, it is difficult to tighten the tissues with a loop, since this can lead to shortening of the articular surfaces. Instead, they resort to the use of compression dynamic plates.

In cases where there are signs of bone crushing, the center of traumatology and orthopedics can offer the patient a replacement of bodily tissue with a special prosthesis. Produce implants from plastic and metal. They are installed using bone cement.

Possible Complications

A disappointing consequence of a fracture of the elbow joint can be a complete or partial loss of limb mobility. A prerequisite for this is the preservation of a feeling of discomfort or impressive pain at the end of the course of therapy. You can avoid such manifestations by following the recommendations of your doctor exactly.

In order to prevent the occurrence of complications in children, in particular the loss of limb functionality, treatment should be carried out under the supervision of adults. First of all, the injured hand must be at rest throughout the entire course of therapy. The child should not load the limb, perform sudden movements. The admission of such negligence can lead to a re-fracture.

Rehabilitation

Actions aimed at restoring healthy limb functionality include:

• massage;
• medical gymnastics;
• physiotherapy procedures.

The development of the joint with the help of physiotherapy exercises is possible already on the first day after fixing the limb with a plaster cast. Naturally, in this case, bending the arm at the elbow is avoided. The main emphasis is on the movement of the fingers and wrist. The victim is recommended in the prone position to wind the injured limb behind the head, straining the shoulders as well. Such solutions contribute to the removal of puffiness as a result of activation of the outflow of lymph from the tissues.

When the ability of the joint to bend is restored, they proceed to its gradual development. To do this, the main part of the plaster cast is removed, after which measured, unsharp movements of the limb are performed. During rehabilitation with the help of therapeutic exercises, it is forbidden to bend and unbend the arm completely, as this can cause a second fracture.

Massage is resorted to only after the complete removal of the plaster cast. Moreover, the impact is exerted on the muscles of the shoulder girdle and back in a sparing mode. Regular performance of such procedures allows you to eliminate pain, strengthen atrophied muscles, stretch the ligaments and, ultimately, fully restore the mobility of the hand.

As for physiotherapeutic procedures, it is recommended to alternate them with therapeutic exercises. Here they resort to UHF methods, magnetic therapy, electrophoresis, treatment with healing mud.

Finally

As a result, it is worth noting that after discharge from the hospital, the victim needs to clarify several questions for himself. It should be clarified with the attending physician how it is better to make movements in the elbow joint, when it is possible to load the limb with weight, how to avoid relapses and complications, which can be expected in the near future.

Fracture of the ulna is a violation of the integrity of hard tissues due to mechanical trauma. The cause of such damage is a direct blow or a fall from a height. The risk group includes athletes involved in contact sports, weightlifting, children and the elderly. Increased bone fragility (osteoporosis) can provoke injury.

Types and characteristic symptoms of injury

The ulna is a trihedral tubular bone located in the forearm. Depending on the location of the damage, the following can be distinguished:

1. Monteggia fracture. It appears due to the reflection of a direct blow. In this case, the middle part of the bone breaks completely and is accompanied by the posterior or anterior.
2. Damage to the styloid or coronoid olecranon.
3. Fracture of the neck or lower third of the ulna.
4. Isolated damage to the diaphysis.
5. Malgen's injury.

Additionally, open and closed fractures can be distinguished, with or without displacement. Trauma may be accompanied by crushing of hard tissues into fragments.

As for the signs, they depend on the type of fracture:

If the fracture is open, then the severity of symptoms increases. If an infection enters the wound, sepsis or other complications may develop.

First aid

In the presence of such a pathology, a person must be provided with first aid, which includes:

1. Immobilization of the hand with the help of improvised means.
2. The tire is applied so that the limb is bent at a right angle. The palm turns towards the person's face. If the victim feels pain during immobilization, then the arm should be fixed in the position in which it was after the fracture.
3. Before applying the splint, it must be wrapped with a bandage or other soft cloth.
4. If there are no means to immobilize the limb, it can simply be hung on a scarf in a free position.
5. If the fracture is open, then the edges of the wound are treated with an antiseptic to prevent infection.
6. Since the injury is accompanied by pain, the victim is allowed to take an analgesic tablet or a non-steroidal anti-inflammatory drug.

Before arriving at the emergency room, you should not try to fold the fragments yourself. In a medical institution, the patient will be given x-rays in several projections. Additionally, he may be assigned an MRI or CT scan.

Therapeutic measures

Treatment of damage to the head of the radius or other parts of it should be complex and lengthy. It includes the following types of therapy:

After the main therapy, a long recovery period is required. This is especially true of the Monteggi fracture, which does not heal well.

Rehabilitation measures

After the main treatment, the patient will have to undergo a rehabilitation course and develop a hand. Rehabilitation involves the implementation of exercise therapy, which begins as early as 3-4 days with passive movements. If a cast is applied to the hand, then you should try to move your fingers. When performing an osteosynthesis operation, the patient has ample opportunities for developing the muscles of the limb. He will have to perform the following exercises:

• ball game (for brush development);
• closing the fingers behind the back (additionally, hands can be raised up);
• exercises with dumbbells, the mass of which does not exceed 2 kg;
• rolling a ball or ball in the fingers.

The intensity of gymnastics depends on the degree of complexity of the fracture and gradually increases. Initially, a set of exercises is selected by a rehabilitation specialist. Additionally, massage will help speed up the healing of the hand: pinching, stroking, shaking the affected area, turning the forearm. The duration of the rehabilitation period is 3-6 months.

Possible consequences

With incorrect or untimely treatment, the following complications are possible:

• bleeding from damaged bone or blood vessels;
• infection of the wound with an open fracture;
• traumatic or painful shock;
• divergence of postoperative sutures;
• fatty blockage of blood vessels;
• the formation of contractures that prevent the normal mobility of the limb;
• secondary displacement of broken bone fragments after the application of gypsum;
• chronic pain at the fracture site;
• rejection of an artificial implant, if part of the ulna was replaced with one.

Late complications develop as a result of improper work of doctors or failure to follow the recommendations of a rehabilitologist.

Fractures of the ulna are less common than articular injuries of the forearm. Anatomically, these two bone structures are similar. The ulna and radius of the upper limb converge at the articular joints. The ulna has a hollow structure and is divided into three elements: the lower and upper are called the distal and proximal, and the middle - the diaphysis. Usually injuries occur in the middle part. In this place, the bone structures are thinner. With a strong blow, simultaneous damage to the radius and ulna is possible.

With a fracture of the proximal section, intra-articular, extra-articular or combined damage occurs. With an extra-articular rupture, only the upper part of the bone below the capsule is injured. With an intra-articular disorder, one speaks of a fracture of one bone or injury to the radius and ulna. Such injuries are accompanied by transcondylar rupture of the humerus.

If the upper epiphysis is damaged, prolapse of the head of the condyle with subsequent dislocation is not excluded. When the head of the elbow is fractured, the functions of the joint are disrupted. Due to a fracture of the process of the ulna, structures prolapse from the ulnar fossa. At the same time, the coronoid process of the ulna is injured - all these fractures often accompany each other. Marginal injuries rarely do without the involvement of articular structures in the pathological process.

Diaphyseal (they are also median) injuries are classified as follows:

• simple fracture- isolated fracture of the diaphysis of the ulna. The area of ​​the fracture of the ulna has a clear line without displacement;
• comminuted- with such an injury, a wedge-shaped fragment is formed between the bones in the fracture zone. For such wounds, the divergence of elements relative to each other is characteristic. Displaced fractures occur not only due to the impact of a traumatic factor, but also due to reflex muscle contraction;
• difficult- in case of complicated traumatism, bone tissues are crushed into many fragments. Often they take an atypical form and an unpredictable location, which complicates therapy.

Fractures of the styloid process of the ulna are injuries of the distal segments. This is a common type of injury in the case of the ulna. Occurs when struck in front with the back or side of the palm. If the distal segments are damaged, pathologies of the wrist joint are observed. Allocate incomplete fractures in the longitudinal direction and transverse, in which intra-articular comminuted damage is observed.

The classification of injuries also implies a division into open and closed fractures. If an open fracture is characterized by a violation of the integrity of the skin, then a closed one has no visual signs, with the exception of the transformation of the limb.

ICD 10 injury code

According to the international classification of diseases, everyone receives the code S52. The kink of the upper end, including the montages, is coded S52.0. Statistical data says that injuries of both bones of the forearm are more common, the medical code of the disease is S52.4, and the ICD 10 code in case of isolated damage to the diaphysis of the radius is S52.2. For an unspecified injury to the elbow, code S52.9 is assigned.

The reasons

Domestic traumatism is capable of provoking a fracture of both the radius and the ulna of the hand. Most of the damage comes from falls. Most often, a fracture occurs when you fall on an outstretched arm. In this case, the blow falls on the wrist joint. The nature of the damage varies. Articular tissues and bone structures are usually affected.

Injuries that occur during an accident are more dangerous. These are multiple damages, breaks with displacement and fragments. The mechanism of injury to the elbow in the lower third of the bone involves a sharp blow to the forearm. Due to the fall of a heavy object on a straightened arm, a fracture occurs at the site of the diaphysis. Such injuries are typical for professional sports and work in conditions of increased danger: industrial production, construction industry. Often, the causes and mechanism of injury are associated with demineralization of bone structures. These conditions occur for the following reasons:

• endocrine diseases- accompanied by a violation of calcium-phosphorus metabolism and prevent the absorption of nutrients from food;
• long-term drug treatment- demineralization leads to the use of cytostatics, glucocorticosteroids, antibiotics;
• oncological diseases- with bone tumors, changes in the bone structure and growth of pathological tissue are observed;
• rickets- an ailment characteristic of childhood due to vitamin D deficiency.

Symptoms

The location of the injury determines the symptoms. When the forearm is damaged in the upper part, pain occurs in the elbow joint. Pain is aggravated by movement. Due to damage to the nerves of the elbow or wrist joint, the pain can be unbearable.

There is swelling in the region of the ulna. When the joint is involved in the traumatic process, hemarthrosis occurs. The tumor is strengthened in the region of the olecranon. Passive movements in the elbow joint are possible, but painful. Active extensor movements are severely limited. Deformation of the elbow joint is observed with a fracture of the coronoid process of the ulna with displacement.

Diaphyseal ruptures have the following symptoms:

• deformity of the forearm in case of injury to both bones;
• swelling, bruising and acute pain;
• limited ability to move a limb;
• crepitus in comminuted wounds;
• pathological mobility of bone fragments;
• functions of the wrist joint are impaired.

A feature of the fracture of the lower ends of the ulna are signs such as diffuse edema - from the site of injury to the wrist joint, and sometimes to the fingertips. A tumor in the wrist area prevents the movements of the hand in the wrist joint.

In case of Kolles' extensor injury, the integrity of the bones of the forearm is broken, which leads to fragments entering the front or outer side of the arm. In the case of Smith's fracture, fragments of the ulna from the side of the forearm are displaced posteriorly.

First aid

Medical attention should not be neglected in case of a strong blow to the arm. Outwardly, it may seem that there is no reason for concern, but hidden injuries cause further health problems. In a child, the fracture heals quickly, so it is important to reposition in time and fix the bone structures.

To begin with, accidental impact on the hand should be excluded in order to prevent displacement. At home, the following manipulations are carried out:

• give an anesthetic drug;
• cool the injured limb;
• immobilize the injured arm.

It is necessary to consult a doctor as soon as possible in the presence of severe swelling, hematoma and acute pain. What to do with a fracture of the ulna, the traumatologist will tell you. Until the moment of providing medical care in a hospital, the patient is fixed forearm. Immobilization with an isolated fracture of the diaphysis of the ulna is a prerequisite for delivery to the emergency room.

Before bandaging, the limb can be anesthetized with topical anesthetics. Immobilization is carried out using a tire. It can be a stick, a board, or any hard and straight object. The dressing is not made tight, and a soft tissue is placed between the splint and the surface of the body. In case of open damage, it is necessary to carry out antiseptic treatment.

Diagnostics

During an external examination, the doctor can detect pathological mobility of bone structures, including parts of the radius. In this case, radiographic studies are needed to determine the nature and severity of the injury. The traumatologist directs to x-rays in two projections - this is an informative diagnostic method that allows you to accurately see the site of the injury.

For more detail, use the method of computed tomography. It reveals not only the presence of a fracture, but also additional cracks, small bone fragments and other important details that determine the tactics of treatment.

If, in case of damage to the middle third of the bone, an X-ray examination is sufficient, then intra-articular injuries require a more careful study. Fractures of the coronoid process of the ulna are often accompanied by dislocations and subluxations, injuries of the humerus and radius. Therefore, additional studies are carried out: MRI, ultrasound, etc.

Treatment

To restore bone structures, a board is appointed. Traumatologists resort to closed reposition of fragments in most cases. The method of reduction is determined by the specifics of the injury. Reposition is carried out after anesthesia. In the absence of displacement, specific treatment is not required. An ordinary plaster bandage is enough. With such damage, the therapy of broken bones is minimal - the injury is treated independently by immobilization.

With the development of the inflammatory process in traumatology and orthopedics, manipulations with medications are carried out - the introduction of antibacterial and anti-inflammatory drugs, the use of painkillers and immunoglobulins. The fracture heals for a long time if multiple bone structures, muscles, nerves, and blood vessels are damaged.

Based on the medical history, the doctor selects the optimal method of treatment and sets the period of immobilization. How much to wear a cast for an uncomplicated fracture of the diaphysis? No more than 80 days. Treatment of a displaced hand fracture will be more difficult, and can take up to 112 days. It takes a month to heal broken bone tissues of the epiphysis without displacement. Patients are interested in what day the damage to the lower epiphysis with displacement heals - the bones grow together in one and a half to two months.

Surgical treatment

Surgical reposition is resorted to if a person has broken his arm in several places. Surgical intervention is advisable in case of simultaneous articular pathologies, multiple fragments, rupture of soft tissues. When and ulnar bones, in which fragments are displaced in a chaotic manner, osteosynthesis is indicated. During the manipulation, the fragments are connected by means of plates or knitting needles. After surgery to reduce a displaced fracture of the ulna, the limb is plastered - surgical intervention minimizes the risk of possible deviations.

With soft tissue rupture, surgical treatment is extremely rarely required. The exceptions are cases where the fusion has occurred incorrectly. If a fracture of the styloid process of the ulna is accompanied by articular disorders and multiple fragments, then surgical treatment is also resorted to.

Rehabilitation

Special rehabilitation to restore the hand is required if the functions of the limb are partially lost. Difficulties occur with fractures of the coronoid process of the ulna. Both the elbow joint and part of the limb up to the fingers suffer.

Recovery methods after a fracture of the ulna are selected by a rehabilitation doctor. The complex of therapeutic measures is determined by the severity of the injury and the risk of complications. Efficiency in restoring the functions of damaged limbs was proved by physiotherapeutic methods, kinesitherapy, manual impact.

Massage can be done independently. Delicate stroking of the damaged area promotes the activation of blood circulation, improves the condition of small vessels, and prevents tissue hypoxia. Mechanical action provides an increase in metabolic processes and eliminates stagnation. Exercise therapy and massage counteract inflammatory reactions, boost regeneration, and prevent stiffness. Full recovery will take at least 21 days.

With an open wound and inflammatory processes, methods of increasing immune protection are also recommended. At the same time, drugs are prescribed to improve blood flow. With a tendency to thrombosis and fat embolism, treatment and rehabilitation are carried out under the supervision of a phlebologist.

Physiotherapy

Physiotherapy speeds up the recovery period. How to develop a hand after a fracture of the radius, a physiologist will tell you. He will select effective physical therapy exercises - you can practice exercise therapy immediately after removing the cast.

To accelerate the recovery of the arch support muscles, drug electrophoresis, microwave therapy, and inductothermy are performed. Physiotherapy is recommended that improves healing processes, prevents inflammatory reactions and has a myostimulating effect.

A universal method of physiotherapy is ultrahigh-frequency exposure. Electromagnetic fields prevent the appearance of edema, eliminate pain, stimulate peripheral circulation. UHF therapy provides tissue heating, dilates blood vessels, and normalizes muscle activity. A thermal dose in the range of 100-150 W improves blood circulation and increases oxygen supply. Athermic doses are recommended to prevent inflammation. The thermal effect is practically not felt by the patient.

The average recovery period is three weeks. With complicated injuries, the rehabilitation period reaches 42 days.

Complications and consequences

An isolated fracture of the diaphysis (middle part) of the ulna is rarely accompanied by complications. A comminuted rupture with displacement is fraught with malunion. In this case, fragments of the ulna are overgrown with hard tissues. adversely affects limb function. Atypical fusion may require repositioning.

The consequences of a fracture of the coronoid process of the ulna include inflammation of bone structures, rupture of nerves, which is accompanied by numbness of the limbs and a decrease in joint function. Fat embolism sometimes occurs. It occurs due to blockage of blood vessels.

It will be possible to avoid the negative consequences of an injury only if you use medical help in a timely manner. Any delay is fraught with complications.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you survived a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

The elbow joint is formed by several bones at once. And the mechanism of its movement is very complicated, despite the fact that this movement is carried out in only two planes. Often there are serious complications in the fracture of the elbow joint. This is due to its complex structure and the fact that large vessels and nerves pass through this joint. In case of damage to the latter, serious and very unpleasant consequences can occur.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

The total work experience is more than 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitology, in 1997 he completed residency in the specialty "Traumatology and Orthopedics" at the Central Research Institute of Traumatology and Orthopedics named after I.I. N.N. Prifova.

The concept of a fracture of the elbow joint includes several types of damage to the bones that make up its composition, because there are 3 of them in the joint: the humerus and 2 bones of the forearm - the ulna and the radius. The joint itself has a complex structure and includes 3 joints connected by ligaments:

• humeroulnar, formed by the metaepiphysis - the lower end of the diaphysis of the shoulder and the ulna;
• brachioradial, formed by the head of the condyle of the shoulder and the head of the radius;
• proximal radioulnar, formed by two bones of the forearm.

On the back surface of the joint is the process of the ulna, or the elbow is the weakest point of the joint, through it pass branches of the brachial artery- ulnar and radial - and the nerves of the same name, the median nerve, vascular and nerve plexuses. These important anatomical objects that provide the function of the hand can be damaged during joint injuries.

In medical practice, joint injuries are quite common. One fifth of all intra-articular fractures are fractures of the elbow joint. You can break one or more of his bones with direct trauma- fall on the elbow, blow. The cause of the fracture may be indirect mechanism impact with a sharp rotation of the arm, excessive extension, this can happen at home, at work, during car accidents and sports.

Classification

Depending on the nature and localization of fractures, their classification includes the following categories:

In relation to the external environment:

1. Closed, without damage to the skin.
2. Open, with a wound, communicating with the external environment.

In relation to the joint cavity:

1. Extra-articular, not communicating with the joint cavity.
2. Intra-articular, when a bone defect communicates with the joint cavity.

By the nature of the damage:

1. Without displacement of fragments, including a crack (incomplete fracture).
2. With displacement of fragments.
3. Fragmentation with the formation of bone fragments.
4. Shattered with bone crushing.
5. With a dislocation in the joint - fracture-dislocation.
6. With torn ligaments.
7. With damage to the synovial membrane.

By localization:

1. The epicondyles of the humerus - medial (internal), lateral (external).
2. Condylar - transcondylar fracture of the distal epiphysis of the shoulder.
3. Coronoid process of the ulna.
4. Heads of the radius.
5. The necks of the radius.
6. Elbow.
7. Combined - 2 or more bones.

Symptoms

Clinical manifestations vary depending on the location of the injury.

With a fracture of the olecranon (elbow) symptoms are typical and expressed locally: pain, swelling, hematoma on the back surface of the joint, inability to fully extend the arm. When the process is torn off, its shift is characteristic, it is located above its normal position due to the contraction of the triceps muscle of the shoulder.

Signs of damage to the coronoid process is pain localized in the region of the cubital fossa, painful palpation, the arm cannot be fully bent, but it can be straightened. In case of a fracture of the head and neck of the radius, external changes are not characteristic, palpation, movements, and rotation in the joint are painful. Pain may not be pronounced, aching in nature, so such fractures may not be detected for a long time and be mistaken for sprains of the joint.

With a fracture of the condyles and epicondyles of the shoulder local edema, hematoma and deformity of the joint are noted, movements are limited due to pain, a symptom of crepitus is often determined - a crunch on palpation of the damaged area. The diagnostic reference point is the deviation from the horizontal level of the line of the conditional triangle of Guther, formed by the lines between the olecranon and the condyles.

Diagnostics

Examination of the joint can not always suggest a fracture if it is intra-articular. The main criterion is x-ray in two projections. In young children and pregnant women are often limited to non-radiation methods - ultrasonography (ultrasound).

When there is a need for a more detailed study of the injury, the study of the capsule, ligaments, vessels and nerves, appoint computer or magnetic- resonance imaging(CT, MRI).

Features of fractures in children

In a child, due to the peculiarity of the structure of the skeletal system, a fracture of the elbow joint differs from its injuries in adults. Until the age of 15-16, the bone structure is not yet fully formed., there are so-called ossification zones - weak places in the bones, where the cartilage tissue has not yet been completely replaced by bone, especially in the area of ​​​​the metaepiphysis of the shoulder, the heads of the bones of the forearm. Therefore, bone damage can easily occur not only with a fall, but also with a bruise.

Another feature is the symptoms: the manifestations of pain, tissue swelling, the appearance of hematomas, bruising are much more pronounced than in adults and develop faster at the time of injury.

In addition, children are very mobile and often knock down their elbows.

First aid

It is very important when providing first aid to fix the hand so as not to cause additional injury to the victim.

It is necessary to carefully examine the joint, in what position the hand is located. If it is straight and does not bend, you should not try to bend it. The patient should be laid on his back, with a straight arm fixed to the body with a bandage, scarf, scarf, and so on. In this condition, he will be transported to the hospital by ambulance.

When bending in the elbow joint is possible, the bent arm should be applied to the body in a position convenient for the patient.

The optimal angle of flexion in the joint is 70-100 °, but you should not try to bend or unbend, but fix it at such an angle when pain is least felt.

For fixing, you can use a special Cramer's stair rail, bending it along the arm, or improvised material - a board, a bar, it is placed along the outer surface of the shoulder. You need to put a soft roller under the armpit, bandage the hand to the body. You can also do fixation with 2 scarves: tie one hand to the body, on the other hang the forearm to the neck. Together with the elbow, you need to immobilize the shoulder and wrist joints.

Treatment

The tactics of treatment depends on the nature of the fracture, the degree of its displacement, the presence of complications, it can be conservative or surgical.

Conservative therapy

Conservative methods include closed reduction and fracture fixation, physical therapy, exercise therapy, and medication.

Reduction and fixation

When it is possible to close the reduction of fragments and secure fixation of the fracture, in which it can normally grow together, after reduction, a plaster splint or a circular bandage is applied.

If manual comparison fails, skeletal traction is applied using pins passed through the condyles of the shoulder, the olecranon - depending on the location of the injury. In this case, the joint should be bent at an angle of 90 °.

The duration of fixation in case of damage to the olecranon is 4-6 weeks, the neck and head of the radius - 2-3 weeks, the coronoid process - 3-4 weeks, the condyles of the shoulder - 1 month.

The quality of the plaster is very important. An unprofessionally applied bandage can squeeze the hand, causing circulatory disorders, swelling of the hand. As a result of compression, the phenomena of neuritis of the ulnar, radial nerves can develop. Weak bandaging leads to its failure and secondary displacement of fragments. It is also possible to damage the skin if the bandage is too stiff and does not have a cotton pad. Compression and circulatory disorders of the skin occur, areas of irritation and detachment of the upper layer appear - epidermal blisters.

Medical treatment

In the first days and weeks after the injury, painkillers and anti-inflammatory drugs from the group of NSAIDs (non-steroidal anti-inflammatory drugs) - indomethacin, ibuprofen, diclofenac, dexketoprofen and other analogues. Mandatory appointment complex of vitamins with minerals, children are given increased doses of calcium and vitamin D, older people with osteoporosis are prescribed bisphosphonates (alendronate, ksidifon and analogues). To accelerate bone recovery and callus formation, mummy works well, it is used in the form of a 10% tincture, 10-15 drops three times a day.

Physiotherapy

Physiotherapeutic procedures are indicated already a few days after the injury, when the danger of hematoma growth has passed. Appoint UHF, magnetotherapy, iontophoresis with calcium by the longitudinal method, without removing the plaster cast.

Patients on traction with the presence of metal needles are not shown electroprocedures.

exercise therapy

Therapeutic exercises are prescribed from the 3rd day after the fixation of the fracture. It is necessary for the normal flow of blood into the muscles of the arm and the prevention of their atrophy. Movements are performed in the free joints of the limb and movements in the full range of the healthy arm, it is proved that they reflexively have a symmetrical effect on the diseased limb.

A set of exercises for quick rehabilitation after a fracture of the elbow joint

Surgical intervention

When it is not possible to perform a closed reduction of fragments, perform open reduction. The intervention is performed under anesthesia or local conduction anesthesia. The following types of fixation are used: connecting fragments with a wire loop, a screw, applying a metal plate, connecting with a knitting needle and other fixators, depending on the nature and location of the fragments.

After the operation, a plaster splint is applied for the same period as with conservative treatment, but the metal structures are removed 1-1.5 months later.

Along with the benefits the surgical method is disadvantage, consisting in the risk of developing complications. The first place is occupied by infection of the bone and the development of osteomyelitis, in which fusion is impossible, repeated interventions are necessary. There is also a high probability of damage to blood vessels and nerves when inserting spokes, passing them through soft tissues.

Stages of rehabilitation

After removing the cast, it is necessary to begin active development of the joint so that contracture does not develop. The sets of exercise therapy exercises for developing the joint will differ: at an early stage, a small load is given, then it gradually increases until the function is fully restored. They can be performed at home, having previously instructed with a specialist in exercise therapy.

Rehabilitation therapy includes gymnastics and limb massage, which is done before doing the exercises, massaging starts from the periphery of the hand - the fingers of the hand, moving up to the shoulder joint. Physical therapy exercises for the joint are best done by immersing your hand in a bath of warm water, dilute the sea salt there well. It is necessary to develop the joint until the range of motion is fully restored.

Rehabilitation therapy with regular training and massage is a condition for complete healing and prevention of contracture (stiffness) of the joint, prevention of disability.

The main condition for the successful treatment of a fracture of the elbow joint is the timely appeal to a specialist, the implementation of all medical recommendations, the active development of the joint until the function is fully restored.

An example of massage manipulations for the development of the elbow joint