Fractured ulna symptoms: Broken arm – Symptoms and causes
Hairline Fracture Treatment & More
What is a Forearm Fracture?
A forearm fracture is a break involving the bones of the forearm: the radius and the ulna. Either or both bones may sustain a fracture. The fracture may occur at any point along the length of the radius or ulna. They may occur where the radius joins the wrist, this type of forearm fracture is called a Colles Fracture. Radial head fractures occur at the union of the radius and the elbow. Proximal ulna fractures occur where the ulna joins the elbow.
Forearm fractures that occur in the shaft of the radius and ulna are the focus of this section. Forearm fractures occurring in adults and children have important differences. The bones of an adult are stronger and more mature than the bones of a child. In an adult the shaft of the bones of the forearm must sustain excessive force to break. Because of this, a forearm fracture in an adult will usually involve both the radius and the ulna, instead of just one bone. When only one bone is broken, it is usually a solitary ulna fracture in an adult who has raised the arm in defense from a direct blow. This is called a nightstick fracture.
The bones of growing children are more pliable than those of the adult. Pediatric forearm fractures are also more complicated due to the presence of growth plates in the bone. Growth plates are cartilaginous areas of bone where new bone cells are formed and hardened. They allow extension in the length of a bone as the child grows taller. Injury to the growth plate of a child’s bone can result in stunted growth or deformity. Growth plates also facilitate quicker repair of pediatric forearm fractures when compared to adult fractures.
The flexible bones of children lend themselves to unique types of fracture where the bones actually bend in response to force being applied to them. In a greenstick fracture, the bone bends on one side and a partial crack results on the opposite side. There is no displacement of the bone. A torus fracture occurs when the bone bends, causing a buckle in the outermost layers of the bone without causing an actual fracture line in the bone.
What Causes a Forearm Fracture?
Forearm fractures are caused by a fall on an outstretched hand or a direct blow to the forearm. In older persons, they may be complicated by osteoporosis. Rarely, they are due to pathologic changes in the bone such as a bone cyst or bone tumor.
What are the symptoms of a Forearm Fracture?
Pain is the most obvious symptom of a forearm fracture. Tenderness and swelling will be present over the location of the fracture. If an open fracture is present, there may be edges of bone sticking out through the skin.
How is a Forearm Fracture Diagnosed?
The history of the injury will suggest that a forearm fracture has occurred. The physical exam will check for injuries to the nerves and blood vessels. X rays are the gold standard for diagnosing forearm fractures and must include views not only of the forearm, but the wrist and elbow as well to exclude concomitant injuries. CT or MRI may be employed to assess vascular, neurological or soft tissue injury.
How is a Forearm Fracture Treated?
The method of treatment used for a forearm fracture depends on the age of the patient, the type of fracture sustained, and the degree of severity of the fracture.
In general, greenstick and torus fractures of the pediatric population can be managed by casting for 4-6 weeks. Even though a complete break has not occurred, these are areas of weakened bone. If the child were to fall on it again the bone may break all the way through.
If a child has a complete fracture, it may be reduced and splinted in the emergency department until the patient can be seen by an orthopedist to place a cast.
Adults who sustain a minimally displaced nightstick fracture of the ulna may undergo closed reduction in the emergency department with placement in a long arm splint while awaiting orthopedic follow up.
An open fracture where bones are sticking out of the skin will require emergent surgical repair.
Children rarely need surgery but it is indicated in those cases where the fracture remains unstable after closed reduction or if reduction cannot be performed.
Adults with moderate to severely displaced nightstick fractures will require open reduction and internal fixation.
Adults with a fracture of both the ulna and the radius are usually admitted for emergent surgery due to the highly traumatic nature of the injury and risk for compartment syndrome. In compartment syndrome swelling occurs in a fixed space, putting pressure on the nerves and blood vessels in such a way that normal circulation and sensation cannot occur. This can cause ischemic injury leading to tissue death, paralysis, and contractures.
Open reduction with internal fixation may be performed, but an external fixator may need to be used if many bone fragments are present.
How can Dr. Knight help you with forearm fractures?
Dr. Knight has years of experience in the treatment of catastrophic upper extremity injuries, particularly forearm fractures. Since this condition is painful, urgent treatment is necessary. Dr. Knight will expedite your treatment on the same day it is needed and provide at least temporary support of the fracture until definitive surgery can be performed. If surgery is needed, he will use the latest techniques and equipment to restore the forearm fractures to their original position.
Come visit Dr. Knight, one of the most accomplished hand specialists in Dallas, Texas. See him at the Southlake office or Dallas hand and wrist center.
Forearm Fractures Fact Sheet
|What causes Forearm Fractures?||Forearm fractures are generally the result of trauma to the radius or ulna, the two bones that make up the forearm.|
|Are forearm fractures something I can treat at home? Will a forearm fracture go away on its own?||Fractured bones are complicated to treat and it is unwise to leave them unexamined, so seeking medical intervention is imperitive in order to guarantee proper treatment.|
|What about pills? Is there any kind of medicine I can take to help me with a forearm fracture?||Forearm fractures tend to be the result of trauma, so painkillers are usually necessary to alleviate the pain of whatever injury caused the break in the first place.|
|What is the recovery time for forearm fractures?||If you fracture your forearm, you can expect theaffected limb to be out of commission for a good four to six weeks. More comlex fractures can take longer to heal, and older patients also have a longer recovery time, but that is a standard.|
|What is a compoud fracture?||A compound fracture occurs when the bone is broken so severely that the broken end protrudes from the skin, forming a secondary injury and wound site that can make healing more difficult, as it increases the risk of infection.|
|How long will the damage from a fractured forearm last?||As with all fractures, the broken bones will eventually begin to heal themselves so it is important to have the bones set correctly to avoid uneven healing or lasting damage or loss of function.|
|How does Dr. Knight go about treating a fractured forearm?||Forearm fractures, in most cases, can be set by the doctor and then placed in a cast to ensure that the bones heal together properly. In some cases, if the break is more severe, surgery may be required to make sure that any pieces of bone from a non-clean break are either removed or reattached with pins and plates.|
Frequently Asked Questions:
Will a forearm fracture heal on its own?
In rare cases, fractures to the forearm may heal on their own, but only if the bone has stayed in precisely the correct position for healing, and the patient does not move that arm even one millimeter during the healing process, which can take up to several months depending on the severity of the fracture. Otherwise, for patients who are awake, alert, and move their bodies regularly, a forearm fracture will require medical intervention of some form in order to heal properly.
Do I need surgery for a forearm fracture?
This depends on the severity of the fracture. If the bone is broken cleanly and the ends are close enough to be reset manually by the doctor, then once that is done the arm is put into a cast and the bones are left to heal naturally. If the fracture is more complicated and there are multiple pieces of bone involved that need to be held together using a screw and plate, or if the ends of the bone are too far apart to be reset manually, then surgery may be required to properly reset the arm and ensure clean healing of the bone.
How do I know if I have a forearm fracture?
Forearm fractures are typified by pain, bruising, and deformity of the affected area. There may also be bleeding if there are flesh wounds in addition to the fracture itself. If the fracture is less apparent, then a simple x-ray by the doctor or emergency room will determine if you have suffered a fracture.
Do forearm fractures hurt?
Forearm fractures are almost always the result of some sort of trauma to the bones of the forearms, so yes, they do generally hurt.
Do hairline fractures need a cast?
Often, hairline fractures of the arm and forearm are splinted or put into a cast in order to minimize the possibility is jostling the healing bone, since the forearm is going to be used by the patient and total immobility is hard to guarantee.
What is a compound fracture?
Compound fractures occur when the fractured bone pierces the skin, which greatly increases the risk of infection in the injured arm.
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Dr. John Knight
Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.
Olecranon Fracture (Elbow Fracture) | Johns Hopkins Medicine
What is an olecranon fracture?
The elbow joint is made up of three bones, the humerus (upper arm bone), ulna (first of two forearm bones on pinky side) and radius (second of two forearm bones on thumb side) and is held together by ligaments, muscle and tendons. It bends and straightens like a hinge, but it is also important for rotation of the forearm; that is, the ability to turn our hands up (like accepting change from a cashier) or down (like typing or playing piano).
An olecranon fracture is a break in the “pointy bone” of your elbow that sticks out when you bend your arm, which is actually the end of the ulna. This type of fracture is common and usually occurs in isolation (there are no other injuries) but can also be a part of a more complex elbow injury.
An olecranon fracture can occur through a direct blow (i.e., fall on the elbow or direct impact from an object) or indirect blow. The latter is mostly secondary to landing on an outstretched arm.
What are the symptoms of an elbow fracture?
Sudden intense pain with inability to straighten the elbow
Swelling and bruising around the elbow
Tenderness to touch
Pain with movement of the joint
What is the treatment for olecranon fracture?
There are usually two treatments for elbow fractures depending on the fracture pattern, displacement and joint involvement.
A splint or sling is used to hold the elbow in place during the healing process. The doctor will closely monitor the healing of the fracture and have you frequently return to clinic for X-rays. If the fracture is not displaced (out of place), you may be allowed to start gently moving the elbow with the assistance of a physical therapist after a few weeks. Weight lifting and bearing will not be allowed for several weeks. Because of the prolonged splinting time, the elbow may become very stiff and require a longer period of therapy after the cast is removed to regain motion. For this reason, nonsurgical treatment is rarely recommended.
If the fracture is displaced or the fracture is open (bone is exposed through the skin), surgery is usually necessary. Surgery is often performed through an incision over the back of the elbow that allows full access to the fractures. The pieces are then put together and held in place in different ways: pins/wires, screws only or plates and screws. Early motion begins immediately following surgery and usually is assisted by occupational therapy or physical therapy.
Broken Forearm | Children’s Hospital of Philadelphia
A broken forearm is a fracture of one or both of the bones that connect the elbow and the wrist. There are two bones in the forearm: The radius bone is on the thumb side of the forearm; the ulna bone is on the pinky finger side.
Forearm fractures are among the most common broken bones during childhood. Broken arms often occur while children are playing and fall unexpectedly.
Fractures of the forearm can occur near the joints of the wrist or elbow, or in the middle of the bone. In most cases, both the radius and ulna bones will break together. The way your child’s forearm breaks will determine its severity, recommended treatment, and how long it will take your child to recover.
There are six types of forearm fractures in children:
- Galeazzi fracture: Both bones in the forearm are affected. In most cases, the radius is broken, and the ulna is dislocated at the wrist joint.
- Greenstick fracture: One of the forearm bones bends and cracks, instead of breaking into separate pieces.
- Growth plate fracture: Affects the layer of growing tissue near the ends of bones and requires immediate care. While either forearm bone may be affected, in most cases the fracture occurs in the radius, near the wrist. Injury to the growth plate can affect the future growth of your child’s bone.
- Metaphyseal fracture: One or both forearm bones may be affected, but the fracture does not affect the growth plate.
- Monteggia fracture: Both bones of the forearm are affected and this injury requires immediate care. In most cases, there is a break in the ulna, and the radius is dislocated at the wrist.
- Torus fracture: Commonly called a buckle fracture, this break compresses the top layer of bone and disrupts the growth plate in the forearm.
If your child sustains a forearm fracture that causes severe pain, breaks the skin, or damages growth plates, treatment should be sought immediately.
Forearm fractures are common in active children as they play and participate in sports. Breaks in the radius and ulna bones account for more than a third of all childhood fractures.
In most cases, the forearm fracture is the result of an impact injury such as a child falling onto an outstretched arm, a child falling directly onto the forearm, or a child receiving a direct blow to the forearm.
Symptoms of a broken arm may include:
- Immediate, severe pain
- Swelling and tenderness
- Numbness in the forearm, hand or elbow
- Deformity of the forearm, elbow or wrist
- Difficulty turning or rotating the forearm
Additionally, your child may feel the need to support the injured arm with their other hand.
At Children’s Hospital of Philadelphia (CHOP), diagnosing a forearm fracture typically begins with a physical examination of your child’s arm, wrist and elbow. The physician will look for any deformity of the arm, as well as swelling, tenderness, and an inability to rotate the affected arm.
In most cases, clinicians will recommend X-rays of your child’s forearm to confirm the diagnosis and determine the extent of your child’s injury. X-rays produce images of bones and help doctors identify the type of fracture so they can recommend the best treatment for your child.
In addition to a physical exam and X-rays, your child may also undergo:
- Range of motions tests to determine how the injury is affecting your child’s movement and dexterity
- Nerve assessment tests to determine if the injury has damaged or compressed any nerves in your child’s arm or hand
The more information we have about your child’s condition, the better we can treat their unique injury.
Treatment for your child’s forearm fracture will depend on the type of fracture, as well as the age and development of your child.
If your child’s forearm fracture is not too severe and the bone is positioned correctly, the broken forearm will likely be placed in a cast until the bone heals.
For children with a simple, displaced fracture — where the bone is not lined up properly — a procedure called a “closed reduction” may be needed to reposition the bone. In this procedure, the bone is straightened without having to open the skin. Clinicians will give your child a local anesthesia to numb the area, and gently push the forearm fragments into alignment.
Once complete, a splint or cast will be applied to keep the bone in place as it heals. Depending on the complexity of the fracture and how much the area swells after the bone is repositioned, a splint may be used for a few days to allow the swelling to recede before a cast is applied.
If your child’s forearm fracture is severe, has broken the skin, affected growth plates or cannot be repositioned externally, surgery will be necessary.
A pediatric anesthesiologist will give your child anesthesia to keep them from feeling pain and sensation during surgery. A surgeon will make an incision to access the bones in the forearm and move them into better alignment.
To stabilize the fracture and keep the bones in the correct position as they heal, the surgeon may use a cast, metal pins, plate and screws, an external fixator or a combination of techniques. Your child’s doctor will discuss the best way to immobilize your child’s forearm as it heals.
Though surgery for forearm fractures is highly effective, we understand that any surgery can be a stressful experience for children and families. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.
Follow-up care for forearm fractures will depend on the treatment needed. Children with simple fractures who only need casting will be able to resume regular activities more quickly than those who need surgery.
Children with complex fractures who need surgery will wear a cast or external fixator for six weeks. When the cast or external fixator is removed, X-rays will be taken to insure the bones in your child’s forearm are healing properly.
Once the fracture is stable, your child will be encouraged to begin motion exercises to limit stiffness and regain range of movement. Depending on the complexity of your child’s fracture, physical therapy may also be recommended.
Your child’s doctor will give you specific information about a recovery program for your child and how soon they can return to daily activities.
Forearm fractures are common in childhood. While your child may experience some stiffness in their arm the first year after the injury, there is typically no lasting impact to movement or activity. Long-term follow-up is not necessary.
Fracture Of The Radius And Ulna – Forearm – Conditions – Musculoskeletal – What We Treat
What is a fracture of the radius and ulna?
A fracture of the radius and ulna is a break of the bones in the forearm. Physiotherapy is very important following a fracture of the radius and ulna.
Above: Soft tissue massage of the muscle and tendons in the forearm
How does a fracture of the radius and ulna happen?
It is most commonly caused by a fall where you land on an outstretched hand. Radius and ulna can also be broken by a direct blow to the forearm.
What are the symptoms of a fracture of the radius and ulna?
The first sensation felt when the radius and ulna are fractured is immediate and intense pain in the forearm. When you look at the forearm there may be an obvious bump or deformity caused by the displacement of the bones. Other symptoms may include:
What should I do if I have a fracture of my radius and ulna?
A fracture of the radius and ulna is a serious injury which requires immediate medical attention at an accident and emergency department. To help with your pain and reduce and control any swelling, you should apply ice to the wrist. Ideally, this should be in the form of crushed ice wrapped in a moist towel or cloth applied for up to 20 minutes.
At the accident and emergency department they can diagnose the injury and the extent of the damage. This may require the use of an X-ray to view the bones. From this, they can provide you with a determination of how long the injury is expected to take to heal and determine the appropriate treatment. This will involve applying an arm cast and a sling or surgery to put the bones back in their original position.
Above: Massage and gentle mobalisations can help decrease stiffness following a period of time in a cast.
Physiotherapy for a fractured radius and ulna.
When a cast is applied, the joints within the cast become stiff and the muscles weaken. Although range of movement and strength may gradually return as you use your forearm, the return is very slow and often not complete. This can cause previously menial tasks, such as turning a door knob, to become very difficult. Physiotherapy can facilitate the return of your joint range of movement and muscle strength, and ensure that upon return to exercising you are at minimal risk of further injury. Physiotherapy treatment may include:
What shouldn’t I do if I have a fracture of my radius and ulna?
If you have or suspect you have fractured your radius and ulna, you should not use the injured arm until it has been assessed by a doctor. In addition, you should avoid any activities which may increase the blood flow to the injured area. These include hot showers, heat rubs, massage and the consumption of alcohol. These may increase bleeding and swelling around the broken ends of bone and potentially delay your recovery.
Could there be any long-term effects from a fractured radius and ulna?
Most fractures of the radius and ulna heal without complication in a matter of weeks. However, some fractures can result in longer-term effects, dependent on the severity of the injury. When the radius and ulna are broken, a number of nearby structures can also be injured. These include the cartilage lining the surfaces of the wrist joint, nerves, blood vessels, ligaments and tendons. Injury to these structures may delay your recovery.
To arrange a physiotherapy assessment call Physio.co.uk on 0330 088 7800 or book online.
Ulna Fracture – Miami Hand & Upper Extremity Institute
The ulna is one of two bones in your forearm. When holding your hands out in front of you with palms up, the ulna is the bone on the inside or on the side of your small finger. This bone may break from falling on an outstretched hand or from blunt force trauma. Fractures of the ulna can occur at the wrist, the elbow or in the middle. This article will focus on the middle segment. The ulna plays a role in forearm rotation, so any fracture to this bone will affect your ability to rotate your forearm and bend/straighten your wrist and elbow.
The bone shown on the bottom (ulna) is fractured in the middle segment
As previously mentioned, ulna fractures usually occur when you fall on an outstretched arm or when you receive a direct blow to your forearm. There are different ways the bone can break. The bone can slightly crack or break into many pieces. If the bone breaks into a number of fragments, the pieces can still be aligned in their normal positions or be far out of place (displaced fracture). Sometimes, bone fragments can stick out through the skin (open fracture), which is very serious and requires immediate medical attention.
Symptoms include pain, swelling, bruising, and/or weakness with wrist movement. There may also be noticeable deformity of the forearm. The goal of treatment is to realign the bone to allow for proper bone healing. Non-surgically, your doctor may try to realign the bones back into place in the hospital, which is called a reduction. After reduction, you will be placed in a split or cast and sling to immobilize the arm and allow the bone to heal. However, most injuries that involve displaced fragments require surgery to properly align and stabilize the bones. Surgeons typically perform an open reduction and internal fixation procedure using plates and screws. First, the surgeon will reposition the bone fragments into their normal alignment. Next plates and screws are used to hold the fragments in place to help the bone to heal in its proper position. Other procedures include open reduction and internal fixation with rods and external fixation. Your surgeon will decide the best course of treatment based on your injury and your needs.
Pediatric Forearm Fracture Treatment Manhattan, Brooklyn NY
The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.
The healing of fractures in children is quicker than that in adults. Thus, if a fracture is suspected in a child, it is necessary to seek immediate medical attention for proper alignment of the bones.
Types of Forearm Fractures
Forearm bones may break in many ways. Fractures may be “open” where the bone protrudes through the skin, or “closed” where the broken bone does not pierce the skin. The common types of fractures in children include:
- A stable fracture that compresses the bone on one side, forming a buckle on the opposite side of the bone, without breaking the bone (Buckle or torus fracture)
- One side of the bone breaks and bends the bone on the other side (Greenstick fracture)
- Displacement of the radius, and dislocation of the ulna at the wrist where both bones meet (Galeazzi fracture)
- Fracture affecting the upper or lower portion of the bone shaft (Metaphyseal fracture)
- Fractured ulna and dislocated head of the radius (Monteggia fracture)
- Fracture occurring at or across the growth plate (Growth plate fracture)
Forearm fractures in children are caused due to a fall on an outstretched arm or direct hit on the forearm, which may result in breakage of one or both bones (radius and ulna).
A fractured forearm causes severe pain and numbness. Other signs and symptoms include:
- Inability to turn or rotate the forearm
- Deformed forearm, wrist or elbow
- Bruising or discoloration of the skin
- Popping or snapping sound during the injury
Forearm fractures in children can be diagnosed by analyzing X-ray images of the wrist, elbow or the forearm.
The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity.
Your child’s doctor will advise you to apply an ice pack over a thin towel on the affected area for 15-20 minutes 3-4 times a day, to relieve pain and swelling. For severe angled fractures, in which the bones have not broken through the skin, your doctor will align the bones properly without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks for a stable buckle fracture. Immobilization for 6 to 10 weeks is recommended for more serious fractures.
Surgery may be necessary for severe fractures such as fractures of the growth plate or the joint. Other conditions, such as broken skin, bone displacement, unstable fractures, misaligned bones, and bones healing in an improper position may also require surgical repair. Your surgeon will first align the bones through an incision and use fixation devices like pins or metal implants to hold the bones in place while the wound heals. A cast or a splint may be placed to hold the bones in place.
In the long run, the forearm of your child may have a slightly different or crooked look than before the fracture, which is normal. It may take around 1-2 years for the bones of the forearm to straighten while the bones undergo the process of remodeling (reshaping). For growth plate fractures, your child’s doctor will carefully monitor the hand for many years to ensure that growth occurs normally.
What to Expect with an Elbow Fracture
Elbow fractures happen quite frequently, and they can be extremely painful. They’re especially common in children. In fact, according to the American Academy of Orthopaedic Surgeons, 10% of the fractures kids get are elbow fractures.
There are a few different kinds of fractures involving the elbow. We’re going to look at what these are, what symptoms you’ll see from the various types, and what the treatments are for each. We’ll also discuss what things usually cause fractures to the elbow, so you’ll know how to try to avoid and prevent them.
The Anatomy of the Elbow
Let’s first go over the anatomy of the elbow so when we discuss the types of fractures it will be easier to understand what happens with the injury.
The elbow is a joint in the center of each arm. There are three bones included in the joint. Here’s a quick look at each of them:
- Ulna – This is a bone in the lower part of the arm called the forearm. It’s located toward the outside of the arm on the side the pinky finger is on. It connects the elbow to the wrist. The olecranon is a part of the ulna. It’s the part of the elbow you can easily feel and see under the skin. It scoops around the end of the humerus and creates the hinge so the arm can move at the joint.
- Radius – This is another bone in the forearm. It’s on the inside of the arm towards where the thumb is. It also runs all the way from the elbow to the wrist. The radial head is the end of this bone where it comes together with the elbow. It moves back and forth and rotates when you move your arm in various ways.
- Humerus – The humerus is in the upper arm. This bone connects the shoulder to the elbow. The end of it is called the distal humerus. It makes the top portion of your elbow and provides the rod for your forearm to pivot around when you bend it or straighten it.
There are ligaments and muscles that hold everything together. There are also three large nerves that cross over the elbow.
Causes of Elbow Fractures
There are endless possibilities for scenarios of things that could potentially break your elbow. Generally though, a fracture in this part of the arm is caused by one of three things. Either:
- You fall straight down on or bang something directly with your elbow.
- Something hits your elbow head on. This could be a football helmet, a wall, a car door in an accident, or any number of other things that are made of hard materials.
- Falling when your arm is completely extended. Usually, when you have your arm in this position, everything is flexed and being held tightly. This sometimes causes a piece of the bone to get pulled off of another bone, usually the ulna.
As we mentioned above, there are a lot of these fractures seen in children. Kids typically do a lot of physical things like riding bikes, scooters, skateboards, running and jumping outside, playing on playground equipment, and more. These activities just open the door more frequently for elbow fractures in children who also tend to have less awareness about how to look out for potential injury-inducing situations.
Types of Elbow Fractures
Not all elbow fractures are the same. The kind of fracture you end up with will depend on what causes it. You could end up with fracturing on the top, the bottom, the front, or the back. You might have a break that’s spiral, straight, slight, or severe. All aspects of the fracture are considered to determine what type of break you have.
This is a fracture that is located in the humerus, so above the elbow. Of all of the kinds of breaks that can happen involving the elbow, this is the one you see the most. It also happens most often to kids who are pretty young, usually under eight years old.
These are fairly common for young kids, but they’re something you should try to avoid. They can cause some serious damage for children because of the major nerves that run over the location. There may also be problems with circulation resulting from this kind of break.
This kind is a break on the inside part of the elbow tip. There is a knob of bone called the epicondyle that pokes out from the joint. When a fracture occurs to the inside of the knob, this is called an epicondylar fracture. It’s seen most often in children that are 9 to 14 years old.
The bottom of the humerus has knobs known as condyles. When the bone breaks right there, it’s called a condylar fracture. There are multiple knobs, but most of the time the lateral or outer knob is the one that breaks. Treatment for these can be a little more complicated due to the presence of the physis (growth plate) and because this is where the surface of the joint is.
You can have a fracture that causes the head of the radius bone to get pushed out of place. These are quite painful and not as common as some of the others.
If you fracture your ulna and it causes the head of the radius to become dislocated, it is known as a Monteggia fracture. When this happens, it’s highly important that the dislocation is discovered. Sometimes it gets missed, which results in a decrease in the functionality of the elbow joint overall.
This is a very severe fracture where one or more bones break through the skin. It can cause many other issues to arise, such as muscle problems, tendon and ligament damage, and longer healing processes.
How to Recognize an Elbow Fracture
The good news is elbow fractures are fairly easy to recognize. Regardless of what type of fracture it is, they usually present the same symptoms. Here’s what you need to look for:
- Extreme pain in the elbow, the forearm, or both
- Swelling at the elbow
- Lack of feeling in the hand
- Loss of functionality of the elbow, cannot straighten out the arm
This kind of injury should not be dealt with on your own. It’s critical that anyone who has potentially fractured an elbow see a doctor as soon as possible. There is a risk of permanent damage if the injury is not properly tended to.
Treating an Elbow Fracture
For the majority of these breaks, there won’t be a need for surgery. However, in some cases it will be necessary. What’s important is that a doctor make that call so the injury will heal the way it should. Below are the possible treatments that may be needed to care for an elbow fracture.
The doctor will start by physically examining the injured area. He or she will look at it and feel for things like tenderness, numbness, or bumps. If the doctor diagnoses an elbow fracture or a determination can’t be made, the next step will be to get an X-Ray done.
The doctor needs to know what the extent of the break is. Also, he or she needs to see if there is a displacement of the bones or if the ends have angulated in relation to one another.
If the patient is a child, there may be X-rays done on both arms because there needs to be something to compare the injured one against. The reason for this is that the bones are not fully developed.
Treatments without Surgery
There are a few different methods for treating elbow fractures without surgery.
- Splints – These don’t provide the amount of strength and support that casts do but they leave room for any swelling that may occur or have occurred. Then, they can be adjusted very easily to accommodate the different levels of swelling you may have. Often, a splint will be used before the casting process because it allows for the swelling to go down before putting on the cast.
- Casts – These are used when it’s important that the bone pieces not move around so they can heal. They immobilize the arm so that the bone can heal itself without any further damage being done.
- Closed reduction – This is a process that usually happens before a splint or cast is put on. It’s what is done to reposition the bone pieces so that they will be able to heal properly. Many times there will be some sort of anesthetic given before the doctor makes any movement on the bone.
- X-rays – After the patient has had any of the above treatments, there may be times when the doctor will want more X-rays performed. It’s important that the healing process is monitored in this way, so the bone doesn’t mend improperly.
Treatments with Surgery
When an elbow fracture is a full displacement of the bone, there can be cause for surgery to put the pieces back into alignment, so they heal correctly. Sometimes there will be hardware used to hold everything in place.
One option is the closed reduction and percutaneous pinning. The procedure starts with a closed reduction like what we discussed above. The doctor moves the bone back into place first. Then, a series of metal pins are used to hold the bone in the realigned position by going through the skin and into the bone. They will bridge the gap between the fragments of bone pulling it together.
Once everything is in place, the arm will be put into a splint for about a week or so to allow for any swelling. After that, a cast will be applied. Usually the cast is only needed for a few weeks. When the bone starts to heal itself, a determination will be made to take the cast off and the pins out. The doctor just needs to see that the healing process is started so the bone pieces won’t be moving back out of place for the rest of the time that is needed to fully heal.
Another option is an open reduction with internal fixation. These are typically performed for open fractures. The bone fragments have to be put back into place through an open reduction. The other reason this procedure would be used is when there is nerve damage involved or some type of vascular injury that needs repairing.
What Does Recovery Look Like with Elbow Fractures?
Different levels of severity will result in differing timelines for recovery. However, you can count on that a splint or cast will probably be on the arm for anywhere between three and six weeks. And that’s with or without surgery.
Once the healing process has finished, some patients will be done and just move on. For others, the treating doctor may request them to move forward with some exercises or physical therapy. This will ensure a better chance at normal functionality and range of motion. Most of the time things will get back to normal eventually.
Stiffness can develop. You might not have the same level of functioning in the elbow joint anymore. You could have trouble with extending it all the way or turning it in certain directions. In some cases, specific exercises can help with this.
Arthritis could become an issue in the joint as well. It can be a lot like stiffness but with pain also. The elbow joint will be inflamed causing the pain and less mobility. It happens more when the injury is to an adult.
Nonunion or malunion could cause a problem. Nonunion means the bone fragments don’t fuse back together. Malunion means they do but not in the right way. There may be a bump or dent that’s visible on the outside. Surgery could be needed to fix either of these.
Elbow fractures should not be taken lightly. A doctor’s expertise is needed to ensure proper healing. Most of these injuries will heal though with the right treatment. So, if you experience an unfortunate accident resulting in one of these, don’t worry, it can be fixed.
Check out more about elbow pain and elbow exercises you can perform at home here.
90,000 fracture, dislocation, sprain, inflammation, arthritis / arthrosis, hygroma – Treatment and recovery
The elbow joint is a unique combination of three bones: the humerus, radius and ulna. This is a complex combined joint, which includes three simple joints: brachioradial, brachioradial, proximal radioulnar. All of them are united by one common capsule and joint capsule (cavity). Inside the joint capsule, synovial fluid is constantly produced, which serves as a lubricant for rubbing joint surfaces and food for anatomical parts.The ends of the bones are covered with a layer of the periosteum, which helps to protect and renew bone tissue, and also aids in the flow of nutrients from the synovial fluid. All articular surfaces are covered with articular cartilage. The elbow joint is reliably strengthened by ligaments and protected by a good muscle frame. These features allow you to perform four types of movements: extension and flexion, supination (rotation of the forearm in the elbow joint, in which it is possible to turn the hand with the palm up) and pronation (rotation of the forearm in the elbow joint, in which it is possible to turn the hand with the palm down).It is worth noting that the end of the ulna on top has an olecranon, resembling a hook in shape. The triceps muscle of the shoulder is attached to it. A fracture of this appendix is a fairly common injury.
Types of damage
The following categories of diseases are characteristic of the elbow joint:
- Bruises. Most often there are bruises of the olecranon, periarticular tissues, shoulder condyles and ulnar nerve
- Stretching of the ligamentous apparatus
- Dislocations.Distinguish between: isolated dislocation and pronation subluxation of the radial head; dislocations of the forearm backward, forward, inward, outward; divergent dislocations with rupture of the proximal articulation and divergence of the forearm bones to the sides
- Fractures of the bones of the elbow joint by the nature of the damage can be divided into:
- no offset;
- with displacement of fragments (displacement of bone fragments most often occurs with fractures of the olecranon)
- Epicondylitis (tennis elbow) is an inflammatory-degenerative disease that affects the tendons in the elbow joint area due to chronic overload of the forearm muscles.
- Styloiditis is a dystrophic-inflammatory process in the place where the tendon is attached to the process of the ulna.
- Bursitis – inflammation of the joint capsule, which is located on the back of the elbow
- Neuritis – ailments resulting from pinching of nerve endings
- Elbow tendonitis – inflammation in the tendon area of the ulnar end of the triceps muscle
- Arthritis – an acute inflammatory process in the articular cartilage and capsule without gross structural changes in the joint
- Osteoarthritis is a dystrophic-degenerative disease of the cartilage and bone tissue of the joint.
Symptoms of pain
The main symptom of elbow disease is pain.
The following signs are characteristic of the traumatic group of injuries:
- Stabbing pain at the time of injury
- Swelling and hematoma in the elbow joint
- Elbow deformity
- Limitations in arm movements, partial or complete loss of limb function
- Or pathological mobility and the possibility of movements atypical for the elbow
- Numbness or tingling in the forearm, wrist, hand
- Squeak or click when moving with elbow
- Any discoloration of the skin in the area of damage
- Perceptible protrusion of bone fragments under the surface of the skin
For any of the above symptoms, you should immediately seek help from the trauma department.
Which doctor should I contact
To make an accurate diagnosis and prescribe the correct treatment, you need to seek help from the following specialists:
Highly qualified specialists are ready to receive you at the clinic of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow. You can make an appointment by calling +7 (495) 104-86-19
Diagnostic measures include:
Treatment depends largely on the type and nature of the elbow fracture.For fractures without displacement (for example, olecranon), conservative treatment can be dispensed with by applying a fixing plaster cast for several weeks. If there is a displacement of the joint, then the question of surgical intervention is decided. For this, the fragments are repositioned (closed or open). With open comparisons, surgical fixation of the fragments is required, this operation is called osteosynthesis. Osteosynthesis is the connection of bone fragments using special fixing devices (bone grafts or metal structures).If the fractures of the articular part of the humerus are fragmented, then it is possible to replace the elbow joint with a prosthesis. To restore the function of the elbow joint in deforming arthrosis, as well as in congenital and acquired deformities and contractures of other etiology, osteotomy is currently being performed. Osteotomy is a surgical operation that helps to eliminate deformity of the elbow joint or improve the function of the musculoskeletal system by artificially fracturing and then fixing it to give a functionally advantageous position.After any surgical intervention, the patient is assigned rehabilitation measures, compiled by the attending physician individually for each.
90,000 Ulna fracture – causes, symptoms, diagnosis and treatment
Fracture of the ulna is a violation of the integrity of the ulna as a result of traumatic impact. It can be combined with a dislocation of the radius or be isolated. Pathology is manifested by sharp pain, swelling, and movement disorders.With fracture dislocations, shortening and deformation of the forearm occurs, as well as a pronounced restriction of movement in the elbow joint. X-rays are performed to confirm the diagnosis, less often CT. Treatment can be conservative (reduction, immobilization with a plaster cast) or operative (fixation with a wire, suture or plastic of the annular ligament).
Ulna fracture is diagnosed relatively rarely in clinical traumatology, fractures of both bones of the forearm are more common.Isolated injuries, as a rule, are not accompanied by pronounced displacement and proceed quite favorably. When a fracture of the ulna is combined with other injuries of the forearm and elbow joint, the course is more severe, there may be significant displacement and damage to the nerves, more often surgical treatment is required.
Fracture of the ulna
Usually injuries occur in domestic conditions and during sports activities. In anamnesis, some patients have criminal incidents involving the use of sticks, batons, iron bars, etc.
- Isolated fractures of the ulna can occur in people of all ages and genders, usually caused by a direct blow to the forearm.
- Montagi’s injuries (fractures of the upper third of the ulna in combination with dislocation of the head of the beam) are more often observed in young and middle-aged men who are actively involved in sports, are formed when a fall on the arm or during a defensive movement when a person tries to repel a blow with a bent arm.
- In children, a Monteji fracture is often formed as a result of a direct blow to the inner surface of the elbow joint.
An isolated fracture, as a rule, is located in the lower third, is transverse, so the fragments are well retained and rarely displaced. Axial and longitudinal displacement is uncharacteristic, since the correct position of the fragments is maintained thanks to the intact radius. In some cases, angular displacement is observed, which necessarily requires elimination, since in the future it can negatively affect the function of the forearm.
Damage to Monteggi is a high-energy injury.With such fractures, the fragments of the ulna are displaced, and the forearm is shortened, as a result of which the head of the beam is dislocated in the proximal radioulnar joint. Such injuries require compulsory reduction, otherwise in the long-term period a deformity of the forearm is formed, and a dysfunction of the elbow joint is noted.
Distinguish between isolated fractures of the ulna without displacement and with displacement of fragments. Fractures of Monteggi are always accompanied by displacement, depending on the nature of the injury, orthopedic traumatologists distinguish four types of injuries:
- 1 – the head of the beam is dislocated anteriorly, bone fragments form an angle open anteriorly.
- 2 – the head of the radius is dislocated posteriorly, the fragments form an angle open posteriorly.
- 3 – the head is dislocated laterally, the ulna is damaged in the proximal region.
- 4 – the head is dislocated anteriorly, a fracture occurs in the proximal parts of both bones of the forearm.
CT (3D reconstruction) of the elbow joint. Fracture of the coronoid process of the ulna.
Isolated fracture of the ulna
In isolated trauma, the patient complains of sharp local pain. The area of damage is edematous, sometimes deformed. Hemorrhage is possible. Movement is limited due to pain, the function of the forearm is usually moderately impaired, active extension and flexion of the elbow joint, supination and pronation of the hand are carried out in a small volume, rotation disorders are most pronounced.
Palpation of the damaged area is sharply painful, when palpating the rib of the bone in the case of a fracture with displacement, a “ledge” is determined.Pathological mobility during careful examination is not always detected; intensive manipulations to detect this sign are not recommended in order to avoid secondary displacement. The axial load is painful.
Fracture of Monteggi
Elbow joint and forearm swollen, deformed, possible bruising. The swelling builds up rapidly. A comparative examination reveals some shortening of the forearm on the side of the injury. With posterior dislocations, it is sometimes possible to palpate the displacement of the ray head.In the area of the fracture of the ulna, a “step” or “ledge” is felt, which have arisen due to the displacement of the fragments.
There are no active movements; when trying to passive movements, spring resistance is detected. The points of greatest pain are determined in the projection of the beam head and in the zone of violation of the integrity of the bone. With pressure along the axis of the limb, pain occurs in the projection of the fracture. Crepitation is possible.
Complications are not typical for isolated injuries.Rarely, in the presence of unrepaired displacement, there is a mild deformation of the forearm, a slight limitation of the functions of the limb. With Montegi fractures, concomitant vascular and neurological disorders are often observed, especially damage to the radial nerve, accompanied by a disorder of movement and sensitivity in the innervation zone.
Sometimes, with Monteggi’s injuries, compartment syndrome develops, due to an increase in subfascial pressure as a result of pronounced edema of the limb.Signs of this syndrome are increasing persistent pain, pain when pulling the fingers and increased tension in the forearm. After bone fusion, in the presence of the listed complications, disorders of the forearm functions are possible, which become the cause of disability.
Diagnosis of fractures of the ulna is carried out by a traumatologist. In the process of diagnostic search, anamnesis data, examination results and instrumental studies are used.The examination program includes the following procedures:
- Objective examination . Edema is detected, hematomas, limb deformity are possible. The pathognomonic signs of a fracture are bone crunch, the presence of a “step” in the damaged area. The dislocation of the beam head is evidenced by the characteristic deformation, spring resistance during passive movements.
- Radiography . It is the main instrumental method. To clarify the diagnosis with isolated fractures, X-ray of the forearm is prescribed in two projections.For Montegi fractures, X-rays of the forearm are performed, involving the elbow and wrist joints, using two standard and oblique projections.
- Other imaging techniques . They are of secondary importance in case of damage to the ulna. Sometimes bone CT is prescribed to detail the damaged structures, and MRI is used to study the state of soft tissues.
If a Monteggi fracture is suspected, attention is paid to the presence of neurovascular disorders, the pulse on the radial and ulnar arteries is assessed.If signs of damage to a nerve or vessel are detected, consultations of a neurologist or neurosurgeon and vascular surgeon are prescribed.
CT scan of the elbow joint. Fracture of the coronoid process of the ulna.
Treatment of an ulna fracture
Treatment of an isolated fracture
In the absence of displacement, treatment on an outpatient basis is possible. With the displacement of bone fragments, hospitalization in the trauma department is indicated.
- Conservative treatment .In case of injuries without displacement, ordinary or polymer plaster is applied for 6-10 weeks. If there is a displacement, reposition is performed, after 10 days a control image is taken, the gypsum is retained for 10-12 weeks.
- Surgical interventions. Operations are carried out in case of unsuccessful reduction and the impossibility of holding the fragments in the correct position. Osteosynthesis of the diaphysis of the ulna is carried out with a plate or a pin. Immobilization also lasts 10-12 weeks.
In the postoperative period, antibiotic therapy is prescribed, UHF, analgesics, antibiotics, exercise therapy and massage are used.The stitches are removed after 8-10 days, then the patient is discharged for outpatient treatment.
Treatment of the Monteggi fracture
The patient is admitted to a trauma hospital, closed reduction is performed.
- For extensor injuries, transarticular fixation is sometimes performed using a thin wire to prevent re-dislocation.
- For flexion fractures, fixation of the head with a wire is usually not required.
Plaster of Paris is applied, a control X-ray is taken, the limb is elevated to reduce edema (the hand is placed on a pillow or suspended from a special stand), physiotherapy procedures are prescribed.The needles are removed after 2-3 weeks. After 4 weeks, the plaster is replaced by changing the position of the limb. Immobilization is stopped after 8-12 weeks.
Surgical treatment is often required for extensor type of fracture. Osteosynthesis of the diaphysis of the ulna is performed with a pin and a suture of the annular ligament. If the ligament cannot be sutured, plastic is performed using an autograft cut from the patient’s fascia. The head of the beam is set and fixed with a spoke.
In case of cervical fractures, the ray head is resected; in such cases, a suture of the annular ligament is not required.To accelerate the fusion, in some cases autografts or homografts (small cancellous bone plates) are applied to the fragments of the ulna. The wound is sewn up. After the operation, physiotherapy, massage, physiotherapy exercises are prescribed. Immobilization is carried out within 3 months.
In children, the surgical tactics are the same as in adults, the only difference is that head resection is tried to be avoided for any type of injury, since this can negatively affect the growth of the radius and the function of the forearm.
With isolated fractures, the prognosis is usually good. Monteggi injury belongs to the category of complex fractures that are difficult to treat and are often complicated by dysfunction of the limb. In the early period in adults, non-union or delayed union of the ulna is often observed, due to a lack of soft tissue on the ulnar side of the forearm.
Angular curvature or displacement of the radial head may be the outcome. Sometimes synostoses (adhesions) are formed between the radius and ulna, the result of which is the limitation of rotational movements.Subluxations and dislocations of the head of the ulna in the region of the distal radioulnar articulation are also possible.
Prevention involves taking measures to reduce the level of injuries. It is necessary to observe safety precautions when performing various work in everyday life and at work, playing sports, equip playgrounds using non-traumatic materials. Measures to reduce the number of criminal incidents (fights) play a certain role.
90,000 Symptoms and treatment of an ulna fracture. MedMarket Articles
The elbow joint is a complex joint that unites the humerus, radius and ulna.
The elbow joint is a complex articulation that unites the humerus, radius and ulna. These bones form three joints, which give the joint the ability to make movements in the vertical plane and rotate along the axis of the shoulder. Due to mechanical factors, fractures of a different nature occur, which differ in localization, mechanism of damage, a combination of several factors at once, etc.Ulna fractures are rare.
The elbow joint is characterized by increased strength and stability due to its special structure, muscle tendons and strong ligaments, but even this mechanism cannot protect the joint and adjacent bones from injury.
The causes of traumatic situations are associated with unexpected falls or receiving a direct blow. The first is most typical for children and the elderly. Children often fall due to their mobility, and old people have weakened bones, so even a slight loss of balance leads to damage to the integrity of the bone.
Fractures of the joint, head and neck of the radius are typical for athletes and people who lead an active lifestyle. In particular, Monteggi’s injuries are very difficult and long in rehabilitation, most often in young men when they fall on their arm or when they try to resist a blow with a bent arm. In addition, some diseases, such as osteoporosis, increase the fragility of bones, and with it the risk of injury.
In accordance with the International Classification of Disease ICD-10, this type of injury has a code S52.2.
Types of fractures:
- open and closed;
- with and without offset;
- transverse, comminuted, oblique, compression;
- Injury complicated by dislocation.
Depending on the location, there are:
- fracture of the elbow process;
- fracture of the coronoid process of the ulna;
- fracture of the radial head;
- fracture of the neck of the radius;
- shoulder epicondyle fracture;
- fracture of the styloid process of the radius.
The clinical picture includes both general symptoms and typical signs indicating damage to specific bone structures. Common symptoms common to all types of fractures of the elbow bones include:
- Pain in the arm that spreads to the fingers and chest;
- swelling of the tissues surrounding the injury site;
- Deformity of the limb in the upper, middle or lower third;
- limitation of mobility;
- the appearance of hematomas, bruises;
- decreased sensitivity, numbness of the skin, weakness in the area of the hand and forearm.
Treatment of elbow bone injury
a) the mechanism of the “parrying” fracture; b) flexion; c) extensor
Often, such an injury is combined with a dislocation or displacement, so it is necessary to seek medical help as soon as possible. I must say that a fracture of the ulna can be isolated, and Monteggi’s damage is also distinguished. In the first case, provided that there is no displacement, surgery is not performed, and the treatment consists in wearing a plaster cast.The plaster is supported by a scarf bandage. The time of wearing the plaster is 6-10 weeks, and after removing it, the patient is recommended to perform special exercises, go for massage, mechanotherapy.
Such therapeutic procedures as ozokerite, paraffin therapy, thermal baths are also shown. In general, the duration of rehabilitation varies from 2 weeks to 1.5 months. In case of a fracture with displacement, a closed reduction of bone fragments is performed and a plaster cast is applied. In this case, treatment can last up to 1 year.In severe cases, surgery is indicated using pins and plates. The patient is recommended to take antibiotics and analgesics, and the rehabilitation course takes up to 3 months.
Damage to Monteggi is often combined with dislocation of the radial head. A flexion fracture is diagnosed in about a third of cases, in which the head of the radius is displaced or broken off. But most often there is an extensor fracture, in which the head of the radial bone is dislocated forward or laterally with damage to the integrity of the annular ligament of the ray.
For an accurate diagnosis, X-rays are taken in two projections and the bone is examined in more detail on CT . MRI allows you to assess the condition of the subcutaneous tissues. The conservative method of treatment involves the implementation of a one-stage reduction followed by the imposition of a plaster cast.
However, most often, surgical treatment is performed by comparing bone fragments and fixing them with plates. Further treatment consists in monitoring the correct reposition, taking analgesics and anti-inflammatory drugs.After 8–12 months, the plates are removed from the ulna. If Monteggi is injured, it is very important to start trauma therapy as early as possible, as this type of fracture is fraught with serious complications. We are talking about displacement of the radial head, delayed fusion or non-fusion of bone tissue, etc.
Treatment of radial head injury
Fracture of the radial head of the elbow accounts for one third of all fractures in the joint and is most often diagnosed in women. The vast majority of such fractures are isolated in nature, but sometimes they go “hand in hand” with a fracture of the coronoid process, rupture of the interosseous membrane, fracture dislocation Galeazzi, etc.
When treating this injury, the doctor aims to restore the possibility of rotational movement, including the entire range of movements of the forearms and elbows. In addition, the prevention of early formation of arthrosis of the elbow joints is carried out.
The degree of displacement, the size of the fragments and the presence of an intra-articular component in fractures of this nature are of great importance. Conservative treatment is indicated only for non-displaced fractures. For this, plaster is applied, a plastic polymer bandage and a rigid orthosis are used.After 3 weeks, the plaster is removed and it is recommended to start developing movements in the elbow joint. Surgical operation is indicated when conservative treatment fails or the fracture is open and complex.
Then a decision is made about endoprosthetics, resection of the radial head, insertion of Kirschner wires or the use of extra-bone osteosynthesis. As soon as pain in the area of the fracture subsides, doctors recommend that the patient begin to move the elbow joint moderately.From the foregoing, we can conclude that the earlier a patient with an injury is assisted, the more chances he has to fully restore the function of the injured arm.
Fracture of the forearm – Official site of the Federal State Budgetary Healthcare Institution KB No. 85 FMBA of Russia
Forearm (Latin – ossa Antebrachii) – a segment of the free upper limb, consisting of two paired bones – radius and ulnar . The forearm is an extension of the shoulder, and is connected to it through the elbow joint.The continuation of the forearm is the hand, which connects to the forearm with the help of the wrist joint.
The forearm plays an important role in the implementation of the function of the upper limb, has a complex structure. The bones of the forearm form 6 joints , thanks to which a person can perform the most complex hand movements in his life.
The bones of the forearm serve as an attachment point for many flexor and extensor muscles of the fingers and hand, etc. The complex structure and function of the forearm is of great importance in the treatment of injuries to the bones that form this segment.
Forearm fractures are quite common among all skeletal fractures . Damage to the bones of the forearm usually occurs as a result of direct exposure to high energy forces. This damage is common among both young and elderly patients, but most often occurs in athletes, in people who have been in road traffic accidents, during hostilities and disasters.
Fractures of the forearm bones can be isolated, and can be combined with other injuries. Fractures of the forearm bones are more common with displacement of fragments, less often without displacement . Depending on the level of the fracture, they are distinguished – damage to the proximal section, damage to the diaphysis, damage to the distal forearm. Fractures of the forearm bones can be closed – they are more common, and open – more rarely.
Damage to the bones of the forearm is also quite common in which a fracture of one of the bones and dislocation of the head of the other occurs – these are the so-called fracture-dislocations of the bones of the forearm.The most common fracture of Monteggia (Monteggia 1814) – a fracture of the ulna in combination with dislocation of the radial head, and Galeazzi’s fracture (Galeazzi) – a fracture of the radius and dislocation of the head of the ulna.
The most common type of forearm fracture is the radius fracture at typical site , which is common in older women.
Diagnosis of forearm fractures
Diagnosis of fractures of the forearm bones , as well as fracture-dislocations, in most cases is not difficult, provided it is performed correctly.Often it is enough for a traumatologist to conduct a clinical (examination, comparative assessment, measurement, palpation, etc.) and X-ray examination of the patient.
The patient’s appearance is often characteristic – he supports the arm, which is adducted and bent at the elbow. Visually, depending on the level of damage, fractures of the forearm bones are inherent in almost all symptoms characteristic of bone fractures – deformity in the projection of the fracture, soft tissue edema, subcutaneous hemorrhage, dysfunction, etc.A more detailed description of the fracture is possible after an X-ray examination.
Complications with fractures of the bones of the forearm
Complications with fractures of the forearm bones – occur in 12-22% of cases, and are quite diverse . Of great importance is the type of fracture, localization, method of treatment, as well as the time elapsed since the moment of injury and subsequent treatment. In the treatment of fractures of the forearm bones, complications occur with both conservative and surgical methods of treatment.
Treatment of forearm fractures
The trauma and orthopedic department of our clinic treats fractures of the forearm bones, hip fractures, lower leg fractures, treatment of meniscus injuries, taking into account the most modern and generally accepted worldwide views on this type of damage.
The priority goals in treatment are: the highest possible functional result of the damaged segment, early rehabilitation, cosmetic result, reasonably acceptable comfort during treatment, the patient’s wishes, etc.
Osteosynthesis in case of fracture of the condylar zone of the shoulder in Krasnoyarsk
Danilov Alexey Vitalievich
Trained at the Krasnoyarsk State Medical Academy from 1999 to 2005. He is proficient in all modern surgical and conservative methods of fracture treatment.
He studied at the Krasnoyarsk State Medical Academy from 1999 to 2005.He is proficient in all modern surgical and conservative methods of fracture treatment. Surgical methods: intramedullary osteosynthesis, bone osteosynthesis, compression-distraction osteosynthesis according to Ilizarov. conservative methods: closed reduction, immobilization with plaster casts,
conservative treatment of fractures in plaster cast or immobilization using modern materials (polyurethane bandages, “plastic plaster”).
Danilov Alexey Vitalievich:
I have experience in the treatment of the following fractures:
– fractures of the clavicle
– fractures of the shoulder
– fractures of the olecranon
– fractures of the forearm
– fractures of the metacarpal bones,
phalanges of fingers
– fractures of the patella (kneecap)
– fractures of the ankles
– fractures of the calcaneus, tarsal bones, metatarsal bones of the foot.Performs operations to restore the integrity of injured tendons, including in the event of rupture of the Achilles tendon, operations to restore the integrity of muscles after their traumatic separation
Fluent in written and spoken English, including in highly specialized topics (medicine, scientific articles, etc.).
There are fractures that are characteristic of certain types of activities (for example, sports injuries), and there are those that are characteristic of certain age groups.For example, from the general statistics of fractures of the condylar zone of the shoulder, the vast majority are in pediatric patients. This is due to the fragility of the bone in the condylar zone in children. The condyles are thickenings of the humerus that extend into the elbow joint. In a simple way, this is the part of the humerus that enters the elbow joint and participates in its work. A bone fracture in this area usually occurs with excessive extension or flexion of the arm at the elbow – for example, when falling on a bent or unbent arm.
It is very important to diagnose a condyle fracture in time, since unevenly fused bones in this area can affect the work of the elbow joint, and this will entail other complications in the work of the entire arm. The “insidiousness” of this fracture lies in the fact that its symptoms are similar to those of a dislocated elbow joint. Fractures of the condyles are also dangerous because in most cases they occur with displacement of fragments. In this case, however, it is easier to diagnose a fracture, because not only does the length of the diseased arm change in comparison with the healthy one, but the mobility of the limb in the elbow joint also changes: when trying to bend or straighten the arm, the forearm can move away from the usual trajectory.However, in addition to a visual examination, the doctor may send the patient for an X-ray examination, and in some cases, to clarify the diagnosis and structural features of the patient’s hand, he may recommend taking an X-ray of the healthy hand – to compare the images of the healthy hand and the patient. Depending on the severity of the fracture, the doctor determines the method of its treatment. If the fracture is not complicated by displacement, or if it is incomplete (what is commonly called a “crack”), simple fixation is required: a plaster cast is applied to the arm bent at the elbow at an angle of 90 to , fixing the limb in this position.They also do with a simple fracture with a displacement – with the only difference that the displaced fragments are compared, after which plaster fixation is also applied. In more complex cases, osteosynthesis is used – extraosseous or intraosseous. Exposed osteosynthesis is used in cases when it is impossible to manually match the fragments or they are displaced again. Intraosseous osteosynthesis is recommended for complex fractures – in this case, the fragments are fixed in the desired position using pins inserted into the bone.There are currently a large number of methods for installing intraosseous pins and applying extra-bone structures. However, they are all united by the need for surgical intervention. It is very important to find a qualified specialist who will immediately determine both the degree of complexity of the fracture and the general condition of the patient, choosing the optimal method of treatment.
As a rule, fractures of the lesion zone heal well, and if the fragments were matched exactly, the mobility and full functioning of the limb do not suffer in the future.However, to fully restore the functions of the hand after removing the fixation, rehabilitation procedures are required – massage and therapeutic exercises.
Clinic “Medistar” has modern diagnostic equipment; we employ only highly qualified specialists who will select the optimal treatment for each individual patient, as well as carry out all the necessary treatment measures.
causes, symptoms, conservative and surgical treatment – Ladisten
How to quickly heal a fracture of the radius? A similar question is often faced by patients and doctors at Ladisten Clinic.After all, a fracture of the wrist bone is a common injury. Statistics say that its occurrence reaches 16% of all fractures, and it is the leader among forearm injuries (90%).
Diagnosis of a fracture of the radial bone
The first diagnosis takes place on the spot – upon injury. Usually, it is hard not to notice it. The characteristic crunch and terrible pain arise immediately, the person himself realizes that he has broken his arm.
But for an accurate diagnosis, you need a doctor’s consultation.After all, wrist injuries are very different, and their treatment is also different.
Symptoms of beam fracture:
- crunch at the moment of falling or injury;
- Immediately after the fracture of the radius, the hand does not bend, it is impossible to clench a fist and take an object;
- swelling after 30-120 minutes;
- If the joints are affected, a hemorrhage occurs, a hematoma is visible.
In some situations, the arm may hurt only during physical exertion and not show any other signs.This is dangerous because the bones may not heal properly. Then patients turn to Ladisten with a complaint: after a fracture of the radius, the arm is crooked.
Confirms the diagnosis by X-ray. He also determines the severity of the injury, the presence of displacements, fragments, exact localization. MRI and CT scans show if joints and muscles are affected.
Types of fractures of the radius
Doctors distinguish two main types:
- Kolles . Dominates in all cases.When falling, a person rests on the palm reflexively. If a fracture occurs, then the bone fragments are displaced to the dorsum.
- Smith’s . It occurs to a lesser extent. The exact opposite of a Kolles injury is a fall onto a wrist that is curved inward. Therefore, the shard is shifted to the palm.
Both types are equally dangerous and risk complications if not treated promptly and correctly. Even if you do not visually see a fracture, the hand hurts slightly, you still see a doctor after falling on your wrist.
Classification of fractures
How much a hand hurts after a fracture of the radius largely depends on the type of fracture. They are complicated and simple. Pain of a different nature arises, joints and soft tissues may be affected, or you may not feel a problem at all.
There are 5 main types of ray fracture:
- Open. Skin is touched and damaged and bleeding occurs. There is a high risk of infection and urgent surgery is required to restore the limb.Additionally, they check whether the patient has a tetanus vaccine; if it is not, they are vaccinated;
- Splined. Difficult species that takes a long time to heal and is difficult to recover. The name means that the bone is crushed into several fragments – from 3 or more. It is impossible to “assemble the puzzle” without surgical intervention;
- Offset. Complicating the situation is the displacement of debris inside a broken limb. They can grow together in the wrong position and prolong the treatment period.The limb is deformed and may remain so forever without treatment. If there is a displaced radial fracture, rehabilitation is also more difficult. The patient has to get used to the new position and shape of the bones;
- Intra-articular. The injury affects the wrist joint; it also needs to be repaired;
- Extra-articular. Considered the simplest, does not extend to the joint, can be easily corrected if there are no fragments or displacements.
Most wrist ray fractures require surgery.
Causes of fractures
The main reason is a fall on an outstretched arm. This is an innate reflex that a person uses when he loses balance. Falling, people stretch out their hand as support and protection of internal organs, face, head. But the defense mechanism does not always work, the radius bone cannot withstand the force of the impact, body weight and breaks.
Trauma can happen to anyone at any age.
Risk group : athletes, people over 50, patients with diseases of the bones and joints.
There are two treatment options:
Conservative. It is used for minor fractures, without fragments and displacements. A plaster cast is applied to the patient, and the hand grows together under it on its own. Sometimes conservative treatment is used to restore debris and displacement. The procedure can fail and the limb becomes deformed over time. The entire treatment takes 4 to 6 weeks plus a rehabilitation period.
Operational. Carried out under anesthesia, cutting the arm and restoring the anatomical structure of the bone.The fragments are fixed with special titanium plates and screws. Also, transosseous osteosynthesis according to Ilizarov is performed¹, a special fixation device is used to restore the hand. In Laditsen Medical Center, the operation is performed using an improved design by Dr. Veklich, without the use of traumatic needles. After the operation, you do not need to wear a cast, only an elbow bandage. Recovery is faster and the patient returns to their normal lifestyle.
How long the radius fracture heals without displacement also depends on the patient.After surgery or casting, it is necessary to perform exercise therapy procedures. Simple gymnastics includes a set of exercises for the fingers, which are performed while sitting at the table. Also used creams, ointments, electrophoresis.
Among the main pathologies after trauma, there are:
- improper adhesion. It mainly occurs if the problem is not noticed and treated;
- chronic pain at the site of the fracture;
- Deformation of the limb and a decrease in its functions: it is impossible to plant a fist normally, bend fingers or a hand;
- the joint loses its stability, arthrosis may develop;
- Inability to perform circular movements with the hand in the wrist area.
In the most neglected situations, one arm becomes shorter than the other.
To avoid complications, you need to see a doctor in time for diagnosis and surgery. In Ladisten, both procedures have been carried out for more than 30 years with the help of modern equipment of its own design and highly qualified specialists.
¹V. V. Veklich. “Treatment of bone defects with guided transosseous osteosynthesis techniques in the light of understanding fractures and their consequences as an angio-traumatological problem” Genius of Orthopedics, no.2, 1999, pp. 98-104.
Fracture of the forearm in miniature dog breeds
Fractures of the front paw, namely the fracture of the radius and ulna in small dogs, is a common traumatic problem in veterinary practice. Fractures of the forearm bones are common in dog breeds such as Toy Terrier, Yorkshire Terrier, Prague Ratman, Chihuahua or Miniature Poodle and requires immediate assistance from a veterinarian in this field.
This type of fracture is characteristic of dwarf dog breeds, as they have factors that predispose to this problem: the absence of a bone canal in the distal part of the forearm, unbalanced feeding with natural food, the very small size of the dog, and much more.
In most cases, dwarf dogs of the above breeds have a simple transverse fracture of the distal third of the radius and ulna in the metaphysis or the beginning of the diaphysis. That is, the lower fragment, as a rule, does not exceed the size of 2.5-3 cm, which somewhat complicates the choice of a solution for the correct fixation of such a fracture.
According to the statistics of our center, the weight of dogs with a fracture of the forearm (radius and ulna) varies from 700 g to 2.5 kg at the age from 4 months to 2 years; more often they are females who eat natural food.For such miniature dogs, any jump from a height, in the presence of concomitant factors to a fracture, can be regarded as a traumatic factor. On average, dogs with a forearm fracture jumped from a small height – about 30 cm to the floor – and even this led to such consequences. Also, in most cases, dogs break both bones of the forearm at once – the radius and ulna.
Clinical signs of fracture
Signs of forearm fracture in small dogs are typical of all breeds.First of all, such fractures are accompanied by severe pain syndrome. Subsequently, edema forms at the site of the fracture, which can go down to the wrist and fingers of the diseased limb. With a fracture of both bones of the forearm, the sore paw can be bent in the fracture zone, which is noticeable with the naked eye. Sometimes, when palpating the fracture zone, you can feel crepitus of the bones.
Displaced forearm fracture in Toy Terrier
First aid for fracture in a dog
First aid for a forearm fracture is to immobilize the fracture, that is, the owner can try to fix the sick paw: tie it to some kind of support.If the dog behaves aggressively, which is often observed in pain syndrome, and it is impossible to fix the paw, then it is necessary to place the dog in a carrier or box and take it to the veterinary center. When fixing a forearm fracture, in no case try to return the paw to the anatomically correct position, as this will provoke an even greater pain syndrome. It is impossible to give any drugs for pain relief on your own, since they do not have an immediate analgesic effect, and can also make it difficult to introduce a dog into general anesthesia during surgery, for example, due to side effects or incompatibility with anesthesia drugs.
It is extremely rare that fractures of the forearm in dwarf dogs can be open, and then it is necessary to close the wound with a bandage with an antiseptic solution (chlorhexidine or dioxidine), try to fix the paw and immediately go to the veterinary center.
In our veterinary center
In our veterinary center, upon admission to an animal with a fracture, veterinary specialists carry out all the necessary diagnostics, make a diagnosis, and carry out the necessary treatment.
First of all, the doctor assesses the general condition of the dog, measures body temperature, blood pressure, performs auscultation of the chest, takes blood for analysis, performs X-ray diagnostics, and so on. The dog will definitely be given painkillers, and, if necessary, also drugs to stabilize the general condition of the body in the form of intravenous infusion. If the owners wish, the dog can be placed in an inpatient unit for diagnostics and subsequent treatment.After stabilization of the general condition, the veterinarian will proceed with the accurate diagnosis of the fracture and plan the type of treatment, which will require an X-ray examination of the diseased limb in two projections.
If the animal needs surgical treatment, the dog will undergo a preoperative examination, which includes biochemical and clinical blood tests, ECHO (ultrasound) of the heart and ECG. In our veterinary center, preoperative examination is mandatory, as it reduces the risk of postoperative complications.
Methods of treating a forearm fracture in dwarf dogs, as a rule, are reduced to surgical treatment, but in any case, the tactics of the operation are chosen by an orthopedic veterinarian. It is important for the dog owner to understand that there is no perfect treatment for a forearm fracture !!! Complications of a fracture are always possible regardless of the choice of fixation. The most important thing is that when choosing a method for stabilizing a fracture, its type is taken into account and all the requirements of functional osteosynthesis are met.
Types of stabilization in case of forearm fracture in dwarf dogs
1. Stabilization with plaster or splint
This type of stabilization is used for “green line” fractures of the forearm or fracture of only the radius without displacement. It is not suitable for fractures of the forearm with displacement, since the fragments overlap, especially in the distal part of the limb due to the inability to stabilize it well and reduce the load on the bone in the area of the fracture, which can lead to nonunion.
Langeta in case of a “green line” fracture
2. Stabilization of the fracture with intramedullary fixation and braces
This type of stabilization can be used as a method of fixation in case of fracture of the forearm of both bones with displacement in combination with the use of a splint. As a rule, an open reduction of the fracture is used, which can lead to iatrogenic damage to bones and soft tissues. The big disadvantage of the method is the placement of the wire inside the bone canal of the radial bone, which contributes to impaired blood circulation and can provoke non-union of the fracture.
3. Fracture stabilization with dynamic compression, LCP or mini-plates
In many literary sources, the use of various plates for fractures of the forearm in dwarf dog breeds gives good results, especially in conditions of non-union of the fracture. The use of plates allows you to perform accurate fracture reduction, create compression in this place, which promotes rapid tissue fusion and provides early support for the diseased limb. The method does not require subsequent removal of the implant.
Application of the mini-plate for forearm fractures
4. Stabilization of the fracture with external fixation – bilateral single-plane external fixator, Ilizarov apparatus
This type of fixation of the fracture provides minimal trauma to the soft tissues during the operation, since the reduction of the fracture is carried out most often in a closed way, sometimes in a limited open way. Can be used for open and infected fractures. This technique is most often used in our clinic; it provides early support for the diseased limb, and the dog begins to use the paw on the 2nd day after the operation.
Bilateral single-plane external fixation device is most often used in our clinic for the treatment of forearm fractures in dwarf dog breeds.
Fracture of the radius in Toy Terrier
Fracture stabilized with external fixation device
Dog with external fixation device in hospital after surgery
Clinical case 1
In the veterinary center “Pride” there are frequent cases of trauma.Forearm fractures are common in small breed dogs. In the modern world, there are many ways to solve this problem.
Yorkshire Terrier Julie was admitted to the center with a fractured forearm (fracture of the radius and ulna) on the left thoracic limb. The patient’s history already had a fracture of this limb, so the veterinarian-traumatologist at the examination made a decision to stabilize the fracture by surgical intervention with the installation of an extra-bone blocking LSP plate.
This design allows a good fixation of the fracture in order to achieve the best union. Removal of this platinum is necessary only in rare cases, as a rule, animals are left with it for life. For fragile bones and increased activity, Julie is a great way to forget about fractures.
Veterinary surgeon, specialist in traumatology, orthopedics and neurology Maslova E.S.
Veterinary anesthesiologist Litvinovskaya K.V.
Clinical case 2
A 1-year-old Toy Terrier dog named Sharp entered the GVOTS Pride.The dog had severe pain in the left forearm, edema, and a change in the shape of the limb. After X-ray examination, the dog was diagnosed with a diaphyseal fracture of the forearm with displacement. After the necessary preoperative examinations (biochemical blood test, echo-heart), the dog was operated on. The fracture was correlated using a double-sided, single-plane external fixation device. With this design, the dog can immediately use the paw in full.The device is removed after complete healing of the fracture under light sedation.
Veterinarian, orthopedic surgeon: Maslova E.S.
Anesthesiologist: Smirnova O.V.
Clinical case 3
A dog of the Prague rat breed named Itessa, age 1.5 years, was admitted to the GVOTS Pride. The dog had severe pain in the left forearm, swelling, the dog could not use the limb normally, and the support ability was completely absent. After X-ray examination, the dog was diagnosed with a distal displaced forearm fracture.