Fractures, fracture of the ulna, rehabilitation. Forearm fracture

A joint fracture is a violation of the integrity of bone tissue as a result of injury or other type of impact. A fracture can be combined with a dislocation. A fracture of the ulna often occurs during a fall or impact while the limb is in a flexed or straightened position.

Classification

A fracture of the ulna is accompanied by severe and sharp pain, swelling, hematomas, impaired mobility of the injured arm or, conversely, unnatural joint mobility, numbness and the inability to move the fingers.

Fractures can be open or closed, with or without displacement of the broken fragments. Depending on the location of the traumatic injury, fractures are classified as follows:

• Monteggia damage. This is a fracture of the upper end of the head of the radius, in which the articular ligaments are affected, and it is called parry. Damage occurs due to a fall on an arm bent at the elbow or from a crushing blow. This type of ulna fracture is one of the most serious injuries to the olecranon. If the upper end of the humerus is not treated in a timely manner for a fracture of the olecranon, the limb may remain completely immobile;
• A fracture of the middle section of the articular joint is a rare type of mechanical injury. This type of injury can only be caused by a planned, targeted blow to the wrist joint;
• the fracture is localized in the lower part of the elbow bone, and affects the styloid process of the forearm bones. This type of injury is typical during periods of ice, when, when falling, a person puts his arm forward for support.

In order to maintain joint mobility after a fracture of the radius and ulna, it is necessary to seek medical help in time.

No offset

If the fracture has damaged the ulna and the damage is not aggravated by displacement, then surgical intervention is not required. The main method of treatment will be wearing a plaster splint.

A closed fracture without displacement, like a crack, is the easiest and safest type of injury and can be:

• transverse;
• longitudinal;
• helical;
• oblique;
• compression.

The least common type of fracture of the ulna is an isolated type, which is similar in characteristics to a closed transverse fracture without displacement.

With offset

A displaced fracture of the ulna is a common and serious type of injury. If the fragments are displaced during an injury, then the patient’s usual appearance of the upper limb is disrupted, the soft tissues suffer, and the arm looks unnaturally curved. When the fragments are displaced on more than a third of the surface, very severe swelling develops in the elbow area. The forearm is deformed, the sensitivity of the fingers and hand is impaired.

Damage to the radius and ulna that occurs with displacement occurs:

1. Extensor. With this type of damage, bone tissue shifts to the radial side.
2. Flexible. Fragments of bone tissue are displaced towards the palm. Damage occurs when the bone is in a bent position.

In case of a displaced fracture, hemorrhage may occur into the joint cavity. When you palpate the damaged area, you can detect discrepancy and mobility of the bone tissue.

The listed types of fractures are intra-articular, and are often combined with avulsion of the styloid process of the elbow joint.

Isolated

The most common type of fracture is an isolated injury to the head of the ulna. Isolated injury is often combined with damage to the coronoid process and rupture of the interosseous membrane.

An isolated injury can occur during a directed blow to the forearm. There may be a deviation in length of the shoulder bones, or a fracture may occur without displacement.

The injury is expressed by symptoms such as sharp pain, local swelling, and sometimes deformation is visible. The mobility of the forearm joint is slightly impaired.

First aid

To avoid complications with a fracture of the radius and ulna, you need to know how to provide emergency care.

The following initial assistance is carried out until a medical examination:

1. If the injury is non-displaced or partially displaced, it is necessary to ensure immobility of the injured limb. Any object with a flat surface that is at hand can be used and will perform the functions of a splint. Flat boards or a plastic box will do. You can secure an improvised splint using ropes, a scarf, a scarf, a bandage or any fabric. If a person is conscious and his condition is satisfactory, then drugs from the analgesic group can be given to relieve pain.
2. If the fracture is an open type, it is important not to introduce infection to the ulna and, if possible, stop the bleeding. The wound can be treated with any antiseptic, but only around the edges. A sterile bandage is applied over the wound. To stop bleeding, a tourniquet is applied above the wound, indicating the time of application. When transporting the victim to a medical facility, it is necessary to monitor the tourniquet. After half an hour, the tourniquet must be loosened, otherwise irreversible tissue death will begin.

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Treatment

Treatment for a fracture of the ulna can be conservative or surgical. The type of treatment method depends on the type and severity of the injury.

A closed fracture without displacement of bone tissue, as well as damage with slight displacement, is treated conservatively on an outpatient basis. If the displacement is slight, the damaged bone tissue is repositioned before applying a plaster splint. Reduction is a closed comparison of bony lesions of the radius. If osteosynthesis is successful, surgical intervention is not required.

Surgical intervention is indicated in case of severe fracture of the radius and ulna with displacement, as well as when the damage is combined with a dislocation. The operation is performed in the following cases:

• with an open fracture;
• when conservative treatment has failed;
• for complex displaced fractures;
• if a segmental fracture is diagnosed.

There are several types of surgical treatment for injuries to the elbow joint and forearm, and the methods depend on the diagnosis and severity of the fracture. If necessary, bone fragments are secured with plates, pins or screws, which are inserted into the canal of the damaged bone.

It happens that holes are made in the broken channels for the introduction of a special wire or mylar thread.

At the end of the operation, the elbow joint is fixed with a plaster splint, and the arm is in a sling at an angle of 60 to 90 degrees.

After a week has passed since the operation, a repeat x-ray is prescribed to rule out improper fusion of the bone tissue. If the bones are fused correctly, then wearing a cast is indicated until the bone tissue is completely restored.

In some diseases, bone healing occurs slowly and may take 3 to 4 months. For example, with a pathology such as diabetes, complete healing of a broken bone can take up to six months.

Rehabilitation

The recovery period after an elbow fracture consists of the following activities:

1. Physiotherapy. The recovery time of the hand after a fracture depends on how well and correctly the exercise therapy is performed. If you ignore therapeutic exercises, the limb will not be able to function at full capacity. Therapeutic exercises are indicated already on the 3rd day after applying the plaster. The exercises are aimed at developing fingers.
2. Physiotherapy sessions are necessary. These are electrophoresis and UHF procedures that have a healing and anti-inflammatory effect, strengthening the muscle tissue of the damaged joint. If the styloid process of the elbow bone is damaged during a fracture, then physiotherapeutic treatment should begin as early as possible in order to restore the damaged nerve fibers.
3. Massage helps stabilize blood flow, so damaged tissues will begin to regenerate faster. Massage movements effectively eliminate muscle tissue atrophy.

Physical therapy during the recovery period consists of the following exercises:

• exercises with a ball to develop motor skills of the hand and fingers;
• movements with dumbbells weighing no more than 2 kg;
• close the hand into a lock, and in this position raise the hand up.

The load during physical therapy should increase gradually. Some exercises should be performed despite minor pain. These exercises include the following movements:

• bend and straighten the hand with resistance;
• take a piece of plasticine in your hand and clench your fingers with it into a fist;
• rotational movements of the forearm in and out.

When performing therapeutic exercises, it will take a month to restore arm mobility.

It is necessary to follow all medical prescriptions during rehabilitation in order to fully restore the mobility of the limb.

Possible consequences

After a fracture that occurs in the area of ​​the ulna, the following complications may occur:

1. Incorrect fusion or non-fusion of bone.
2. Slow healing of damaged bone tissue.
3. If the union does not heal properly, the bone may move again, right under the plaster cast.
4. After removing the plaster, limited mobility of the joint occurs. The arm does not move at the elbow or wrist.
5. Implants are rejected: plates, wires, pins.
6. An open fracture becomes infected. Tetanus is one of the most dangerous infections.
7. Loss of sensitivity in the fingers due to damage to the nerve fibers.
8. The vessels of the elbow joint become clogged, and fatty or thrombus embolisms form.

Complete restoration of the arm after a fracture depends on the qualifications of the specialist. How quickly the connective tissue will heal depends on the correct application of the plaster cast and subsequent treatment.

The listed complications can result from non-compliance with medical prescriptions during the rehabilitation period. The arm may remain incapacitated, or the person may only be able to perform limited movements.

If the arms do not heal properly, a second operation may be performed. During surgery, the curvature is completely removed, and a special plate is inserted into the joint to correct the fusion defect. Thanks to fixation with a plate around the fracture site, the damaged bone tissue begins to regenerate.

Prevention of fractures

To exclude articular fractures and other types of mechanical damage, it is necessary to perform the following preventive actions:

1. Perform gymnastic exercises aimed at the ligaments of the elbow joint.
2. At the beginning of spring and at the end of autumn, you need to take vitamin complexes, which your doctor will recommend.
3. During sports activities, you need to wear special protective equipment on your elbow.
4. In winter, when the roads are icy, it is tedious to choose comfortable shoes with flat, grooved soles. You need to learn how to fall correctly. If you do happen to slip, you should not put your outstretched arm forward. This position will not soften the fall, but will lead to injury to the elbow joint.

In case of any, even slight, injury to the elbow, you must immediately seek medical help. A fall, blow or bruise can cause more than just a bone fracture. A crack may develop in the ulna bone. Such damage, like a fracture, can cause limited mobility if not treated in a timely manner.

Articular bone fractures often occur in children. But in childhood, bone tissue grows together faster than in adults. In childhood, bone tissue is not fully formed, so it is more often subject to mechanical damage.

There is a possibility that broken bones will not heal properly in children. Therefore, a week after applying the plaster cast, a control X-ray must be taken.

If a child receives a fracture in the elbow area, parents should ensure that the child does not show excessive activity during the treatment process. Active movements of the affected hand can provoke improper fusion of bone tissue. After removing the cast, you need to do therapeutic exercises with the child to completely restore joint mobility.

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A 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. At-risk groups include athletes involved in contact sports, weightlifting, children and the elderly. Increased bone fragility (osteoporosis) can cause injury.

Types and characteristic symptoms of injury

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

1. Monteggia's fracture. It appears as a result of reflecting a direct blow. In this case, the middle part of the bone breaks completely and is accompanied by a posterior or anterior fracture.
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. Malgenya's injury.

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

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

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

First aid

If such a pathology is present, a person must be provided with first aid, which includes:

1. Immobilization of the hand using improvised means.
2. The splint 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 found itself after the fracture.
3. Before applying the splint, it should be wrapped in 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 put the fragments together yourself. At the medical facility, the patient will undergo x-rays in several projections. Additionally, he may be prescribed an MRI or CT scan.

Therapeutic measures

Treatment of damage to the head of the radial bone or its other parts must be complex and long-term. It provides the following types of therapy:

After the main therapy, a long recovery period is required. This is especially true for the Monteggia fracture, which heals poorly.

Rehabilitation measures

After the main treatment, the patient will have to undergo a recovery course and develop his arm. Rehabilitation involves performing exercise therapy, which begins already on days 3–4 with passive movements. If you have a cast on your hand, you should try to move your fingers. When performing osteosynthesis surgery, the patient has ample opportunities to develop the muscles of the limb. He will have to do the following exercises:

• playing with a ball (to develop the hand);
• closing your fingers behind your back (additionally, you can raise your hands up);
• exercises with dumbbells whose weight does not exceed 2 kg;
• rolling a ball or ball in your 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 improper or untimely treatment, the following complications are possible:

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

Late complications develop due to improper work of doctors or failure to follow the recommendations of a rehabilitation specialist.

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

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

If the upper epiphysis is damaged, prolapse of the head of the condyle with subsequent dislocation cannot be ruled out. When the head of the elbow is fractured, the functions of the joint are impaired. Due to a fracture of the process of the ulna, structures fall out of the cubital fossa. At the same time, the coronoid process of the ulna is injured - all these fractures often accompany each other. Marginal injuries rarely occur without involving articular structures in the pathological process.

Diaphyseal (also known as midline) injuries are classified as follows:

• simple fracture– isolated fracture of the ulnar diaphysis. The area of ​​the ulna fracture has a clear line without displacement;
• splintered– with such an injury, a wedge-shaped fragment is formed between the bones in the fracture zone. Such injuries are characterized by divergence of elements relative to each other. Displaced fractures occur not only due to exposure to a traumatic factor, but also due to reflex muscle contraction;
• difficult– with complicated traumatism, bone tissue is crushed into many fragments. They often take an atypical shape and unpredictable location, which complicates therapy.

Fractures of the styloid process of the ulna are classified as injuries to the distal segments. This is a common type of injury in the case of the ulna. Occurs when struck from the front by the back or side of the palm. When the distal segments are damaged, pathologies of the wrist joint are observed. There are incomplete fractures in the longitudinal direction and transverse ones, in which intra-articular splintered damage is observed.

The classification of injuries also involves 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 except for the transformation of the limb.

Trauma code according to ICD 10

According to the international classification of diseases, everyone receives code S52. The fracture of the upper end, including the montage, is coded S52.0. Statistics show that injuries to both bones of the forearm are more common, the medical code of the disease is S52.4, and the ICD 10 code in the case of isolated damage to the diaphysis of the radius is S52.2. Unspecified elbow injury is coded S52.9.

Causes

Domestic injuries can provoke a fracture of both the radius and ulna of the arm. Most injuries occur from falls. Most often, a fracture occurs when falling on an outstretched arm. In this case, the impact falls on the wrist joint. The nature of the damage varies. Usually joint tissues and bone structures are affected.

Injuries that occur during road accidents are more dangerous. These are multiple damages, ruptures 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 diaphysis. Such injuries are typical for professional sports and work in high-risk environments: industrial production, construction. Often the causes and mechanism of injury are associated with demineralization of bone structures. Such conditions arise for the following reasons:

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

Symptoms

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

There is swelling in the area of ​​the ulna. When a joint is involved in a traumatic process, hemarthrosis occurs. The tumor is intensified in the area of ​​the olecranon. Passive movements in the elbow joint are possible, but painful. Active extension movements are severely limited. Deformation of the elbow joint is observed when the coronoid process of the ulna is fractured with displacement.

Diaphyseal tears have the following symptoms:

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

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

With an extensor Colles injury, a violation of the integrity of the bones of the forearm leads to fragments entering the front or outer side of the arm. In the case of a Smith fracture, the fragments of the ulna on the side of the forearm are displaced posteriorly.

First aid

Medical attention should not be neglected if there is a strong blow to the hand. Outwardly, there may seem to be no cause for concern, but hidden injuries can cause further health problems. In a child, the fracture heals quickly, so it is important to reposition and fix the bone structures in a timely manner.

To begin with, you should exclude accidental impact on the hand to prevent displacement. The following manipulations are carried out at home:

• give a painkiller;
• cool the injured limb;
• immobilize the injured arm.

It is necessary to consult a doctor as soon as possible if there is severe swelling, hematoma and acute pain. A traumatologist will tell you what to do if you have a fracture of the ulna. Until medical care is provided in a hospital setting, the patient’s forearm is fixed. Immobilization for an isolated fracture of the ulnar shaft is a prerequisite for delivery to the emergency room.

Before applying a bandage, the limb can be numbed with topical anesthetics. Immobilization is carried out using a splint. This can be a stick, a board, or any hard and straight object. The dressing is not made tightly, but 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 may detect pathological mobility of bone structures, including parts of the radius. In this case, radiographic studies are necessary to determine the nature and severity of the injury. The traumatologist orders x-rays in two projections - this is an informative diagnostic method that allows you to accurately see the location of the injury.

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

If in case of damage to the middle third of the bone, radiographic 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. A regular plaster cast is sufficient. With such damage, therapy for broken bones is minimal - the injury is treated independently using the method of 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. A fracture takes a long time to heal if multiple bone structures, muscles, nerves, and blood vessels are damaged.

Based on the medical history, the doctor selects the optimal treatment method and sets the period of immobilization. How long to wear a cast for an uncomplicated fracture of the diaphysis? No more than 80 days. Treatment of a displaced arm fracture will be more difficult, and can take up to 112 days. It takes a month for broken bone tissue of the epiphysis to heal without displacement. Patients are interested in how long it takes for a displaced lower epiphysis injury to heal - the bones heal in one and a half to two months.

Surgical treatment

Surgical reduction is used if a person breaks his arm in several places. Surgical intervention is advisable for simultaneous articular pathologies, multiple fragments, and soft tissue rupture. In case of the ulna, in which the fragments are displaced in a chaotic manner, osteosynthesis is indicated. During the manipulation, the fragments are connected using plates or knitting needles. After surgery to reduce a displaced fracture of the ulna, the limb is cast - surgical intervention minimizes the risk of possible deviations.

When there is a soft tissue rupture, surgical treatment is extremely rarely required. The exception is when the fusion occurs 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 arm 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.

Rehabilitation methods after a fracture of the ulna are selected by a rehabilitation specialist. The range of treatment measures is determined by the severity of the injury and the risk of complications. Physiotherapeutic methods, kinesitherapy, and manual manipulation have proven effective in restoring the functions of damaged limbs.

You can do the massage yourself. Gently stroking the damaged area helps to activate blood circulation, improves the condition of small vessels, and prevents tissue hypoxia. Mechanical action ensures an increase in metabolic processes and eliminates congestion. Exercise therapy and massage counteract inflammatory reactions, speed up regeneration, and prevent stiffness. Full recovery will take at least 21 days.

In case of open wounds and inflammatory processes, methods of increasing immune defense are also recommended. At the same time, medications are prescribed to improve blood flow. If there is a tendency to thrombus formation and fat embolism, treatment and rehabilitation are carried out under the supervision of a phlebologist.

Physiotherapy

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

To speed up the recovery of the supinator muscles, medicinal electrophoresis, microwave therapy, and inductothermy are performed. Physiotherapy procedures are recommended that improve healing processes, prevent inflammatory reactions and have a myostimulating effect.

A universal method of physiotherapy is ultra-high-frequency exposure. Electromagnetic fields prevent the appearance of edema, eliminate pain, and stimulate peripheral blood 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 flow. Athermic doses are recommended for the prevention of inflammation. The thermal effect is practically not felt by the patient.

The average recovery period is three weeks. For 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, the fragments of the ulna become overgrown with hard tissue. negatively affects the functioning of the limb. Atypical fusion may require repositioning.

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

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

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

A comminuted fracture is a violation of the integrity of the bone with the formation of three or more fragments. One of the most commonly diagnosed is a comminuted fracture of the ulna. It occurs when a traumatic force is applied along the axis or an impact perpendicular to it - the bone cannot withstand the load and literally breaks up into several fragments at the point of impact.

The symptoms of the pathology are typical - first of all, pain and severe dysfunction of the forearm.

Immobilization with a plaster cast does not ensure correct reposition of the fragments, so surgical intervention is performed.

Total information

A comminuted fracture of the ulna itself is less common than some other fractures. But among traumatic injuries of long tubular bones, it occupies one of the leading positions - along with it, a kind of popular “five” of such fractures are comminuted fractures of the radius, humerus, tibia, etc.

Frequent fractures of the ulna (in particular, comminuted ones) are caused by the following factors:

• there is a large functional load on the forearms;
• the ulna is surrounded by a relatively small array of muscles, which is not able to protect it from traumatic damage;
• When there is a risk of injury (impact, fall, etc.), a person subconsciously puts his hands in front of him, which causes damage to the forearm (namely the ulna).

As in the case of comminuted fractures of other bones, treatment of this traumatic pathology is difficult. The reasons are as follows:

Causes

The described injury occurs:

• when force is applied to the ulna perpendicular to its axis - more often;
• when exposed along the axis - less often.

This mechanism of bone integrity disruption is observed under such circumstances as:

• falling onto an outstretched arm. This often happens because the victim subconsciously puts his hand in front of him to soften the fall;
• a sudden fall, during which the victim does not have time to regroup;
• pronounced pressure on the forearm. This mechanism of injury is observed if the victim finds himself under rubble (for example, during an earthquake);
• a very strong blow to the forearm - this happens during a fight, when the enemy tries to injure as much as possible;
• – usually a bullet (especially at close range).

Such mechanisms of occurrence of a comminuted fracture of the ulna are most often observed:

• in everyday life during fights;
• when doing strength sports;
• as a result of accidents (road accidents, man-made disasters).

The risk of this type of injury increases if a person plays sports such as:

• football;
• volleyball;
• various types of struggle;
• Weightlifting;

and some others.

Non-traumatic factors that contribute to the occurrence of a comminuted fracture of the ulna have also been identified. This:

• previously suffered fractures in the same place - especially those in which the fragments were poorly aligned, or the patient did not heed the doctor’s instructions and began to load the damaged limb ahead of time;
• general weakening of the body - after operations, due to poor nutrition, due to diets, and so on;
• systemic pathology of bone tissue.

In the latter case it is:

• – increased fragility of bone structures due to a decrease in the amount of mineral compounds;
• – disruption of the normal bone structure;
• – an infectious-inflammatory process in bone tissue, in which its individual sections literally rot.

Development of pathology

The ulna is not the most powerful of all the bones in the human body, but it has a certain margin of strength. If a comminuted fracture occurs, this indirectly indicates that the force of the impact on the bone was great.

In most cases, the described injury is accompanied by displacement of the resulting bone fragments, less often by interposition of soft tissues.

According to location, a comminuted fracture of the ulna can be:

• diaphyseal – in this case the actual tubular part of the bone is damaged;
• – fragments form behind the line of attachment of the articular capsule to the bones that form the elbow joint.

The occurrence of an intra-articular fracture complicates treatment, since in order to compare the fragments and fasten them together, it is necessary to penetrate into the cavity of the elbow joint. At the same time, the traumatologist faces the difficult task of restoring the correct shape of the articular surface - otherwise the elbow joint will function with impairments.

Symptoms comminuted fracture of the ulna

The clinical picture of a comminuted fracture of the ulna depends on which part of it was damaged.

When the diaphysis is fractured, the following symptoms appear:

• pain;
• swelling;
• hematoma;
• limb deformity;
• its shortening;
• bone crepitation;
• with an open wound - the presence of bone fragments that are visible through the soft tissue defect;
• dysfunction.

The characteristics of pain are as follows:

• by distribution - with severe pain, the victim thinks that his whole arm hurts;
• by nature - aching;
• in terms of intensity – usually strong;
• by occurrence - they arise at the time of injury, and require injection of painkillers for relief.

Edema occurs as a reaction of the body to damage.

A hematoma usually appears when a large vessel is damaged.

Deformation and shortening of the limb are observed when fragments are displaced.

Bone crepitus is a crunching sound that occurs when bone fragments rub against each other.

In the case of an open fracture, bone fragments are visible in the wound - this is the most reliable sign of a comminuted fracture of the radius.

Due to a violation of the integrity of the bone, the victim cannot perform any work with his hand.

With an intra-articular fracture, the following symptoms occur:

• pain;
• swelling;
• joint deformity;
• unnatural position of the shoulder and forearm in relation to each other;
• dysfunction.

The characteristics of pain with this type of fracture will be as follows:

• by location - in the area of ​​the fracture;
• by distribution - irradiation is usually absent;
• by nature - aching;
• by intensity – pronounced;
• by occurrence - appear at the time of injury, do not disappear without the use of analgesics, intensify when trying to make any movements in the joint.

Swelling of the joint with this type of comminuted fracture of the ulna may be more pronounced than with damage to the diaphysis. The joint may resemble a small ball in shape.

Deformation of the elbow joint manifests itself in the form of “blurred” contours.

The unnatural position of the shoulder and forearm in relation to each other can be aggravated by the fact that, in addition to damage to the articular fragment of the radius, the articular surfaces of the humerus and radius can be damaged.

The dysfunction of the elbow joint with an intra-articular comminuted fracture is quite significant for reasons such as:

• severe pain syndrome;
• the occurrence and increase of swelling of soft tissues;
• violation of congruence (comparison) of the articular surfaces of the bones involved in the formation of the elbow joint.

Diagnostics

It is easiest to diagnose the described injury with an open fracture. Sometimes you can even count the number of fragments formed in a wound. In other cases, the very fact of a fracture of the radius is stated, but fragments can only be identified when additional research methods are carried out.

To understand the mechanism of the fracture and the nature of the damage, it is important to clarify the following details of the anamnesis (history) of the injury:

• under what circumstances the injury occurred;
• how much time has passed since its occurrence;
• whether the victim felt numbness in the limb, “pins and needles”, tingling (this is important for understanding whether large nerve trunks are damaged);
• whether the patient made any movements with the injured limb;
• whether there were previously bone injuries in the same location.

A physical examination reveals the following:

• upon examination, the forearm or elbow joint is deformed and can be literally “twisted,” while the victim supports the injured forearm with his healthy hand. With severe pain and bleeding, the skin and visible mucous membranes are pale. With an open fracture, fragments of the ulna are visible in the wound;
• upon palpation (palpation) - significant pain and swelling of the soft tissues are determined at the fracture site. By gently pressing on the bone fragments, crepitus is determined. Sometimes it is felt more by the examiner's fingers than heard by the ear.

In the diagnosis of a comminuted fracture of the ulna, the following instrumental research methods are used:

• – X-ray photographs are taken in both direct and lateral (sometimes additional oblique) projections. In this case, a fracture is identified, the number of bone fragments is determined and their condition is assessed;
• computed tomography (CT) - computer sections allow not only to study in more detail the characteristics of the bone at the fracture site, but also to identify tissue disorders if the fracture was preceded by some systemic pathology of the bone tissue that provoked its weakness;
• puncture of the elbow joint - it is performed if hemarthrosis is suspected (accumulation of blood in the cavity of the joint that occurs as a result of a fracture).

Laboratory research methods that are used in the diagnosis of comminuted fracture of the ulna are as follows:

• – may be involved when a large vessel is damaged by bone fragments to assess the degree of blood loss. In this case, the number of red blood cells and hemoglobin decreases. With an open fracture, due to the development of the inflammatory process, the number of leukocytes (leukocytosis) and ESR will increase. But this is a nonspecific indicator - it is detected with any other inflammatory lesion;
• microscopic examination - the punctate is examined under a microscope, a large number of red blood cells are detected in it, and if a secondary infection has occurred, then also leukocytes and pathogenic microflora;
• bacteriological examination - it is carried out if a pathogenic infection is suspected. At the same time, the punctate of the elbow joint is inoculated on nutrient media, and the pathogen is determined from the grown colonies. Using this method, the sensitivity of the infectious agent to.

When clinical symptoms appear, which indicate damage to blood vessels and nerve endings when they are compressed, consultations with a neurosurgeon (or neurologist) and a vascular surgeon are prescribed, and they, in turn, will determine the advisability of additional research methods. In particular, the following may be prescribed:

Differential diagnosis

With the intra-articular type of this fracture, differential (distinctive) diagnosis is carried out between a fracture of the ulna and humerus. The diaphyseal type of bone injury, as a rule, does not require differential diagnosis.

Complications

A comminuted fracture of the ulna may be accompanied by the following complications:

• arising directly against the background of a fracture;
• distant.

In the first case it is:

• bleeding;
• hematoma - accumulation of blood in soft tissues;
• hemarthrosis;
• blood loss;
• infection and suppuration of the wound - with open fractures;
• – a limited abscess, which most often occurs due to infection of the hematoma;
• – diffuse purulent lesion with the same mechanism of development;
• – disturbance of blood microcirculation due to severe pain.

Long-term complications of this type of injury are:

• violation of fusion of bone fragments;
• change in forearm length;
• neurological complications;
• impaired motor activity of the elbow joint;
• ankylosis – its complete immobilization;
• muscle hypo- and atrophy – deterioration of nutrition, which entails their weakness and impaired functional activity.

Malunion may manifest as:

• slowing it down;
• complete nonunion of bone fragments. Develops due to interposition of soft tissues or deterioration of the reparative capabilities of bone tissue.

As a result of impaired consolidation, the patient may become disabled.

The following are diagnosed as neurological consequences of a comminuted fracture of the ulna:

• paresthesia (impaired sensitivity). Manifest in the form of “goosebumps”, numbness, tingling sensation in soft tissues;
• deterioration or complete loss of motor activity of the forearm.

Treatment comminuted fracture of the ulna, surgery

Treatment for a comminuted fracture of the ulna consists of providing first aid and restoring the integrity of the bone.

First aid measures for the described damage will be as follows:

If there is a deformity of the limb, then it is prohibited to “align” it yourself. Also, you cannot “reduce” protruding bone fragments into the wound.

The patient must be immediately taken to a trauma hospital.

note

Conventional reposition (displacement of fragments in order to restore the correct structure of the radius) followed by plaster immobilization is little effective, and in the case of an intra-articular comminuted fracture, they are not at all effective.

The treatment of choice for such damage is surgery.. During the operation, osteometallosynthesis is performed - fastening bone fragments using metal nails, screws or plates. Each bone fragment should be carefully examined and a decision made whether it needs to be removed. Fragments to be removed:

• small;
• heavily polluted;
• non-viable;
• those that have lost connection with the periosteum.

The most difficult task is to restore the congruence of the articular surfaces - this means that they must fit together and slide easily, otherwise the function of the elbow joint will be impaired.

In the postoperative period, conservative therapy is prescribed. It is based on the following purposes:

• functional rest;
• dressings;
• painkillers;
• – to prevent infection.

After consolidation (fusion) of bone fragments, rehabilitation measures are carried out - namely:

• massage;
• physiotherapeutic procedures.

In the early postoperative period and during rehabilitation, proper nutrition of the patient is extremely important - especially the intake of milk, cottage cheese, spinach, nuts, sesame and poppy seeds and other foods that contain large amounts of calcium. A course of vitamin therapy is also prescribed at the same time - in the form of both injectable preparations and pharmaceutical complexes for oral administration. The latter are effective due to the inclusion of mineral compounds that increase bone strength.

If the patient's condition is satisfactory and the bone fragments are healing correctly, early activation of the affected limb is practiced. This has a warning value:

• postoperative contractures;
• muscle atrophy.

The terms of rehabilitation are individual and are determined by the operating doctor together with a neurologist if neurological complications of this injury were noticed.

Prevention

Measures to prevent a comminuted fracture of the ulna are:

• avoiding situations fraught with forearm injuries;
• if such situations cannot be avoided, use personal protective equipment;
• proper nutrition, thanks to which a high level of resistance of bone tissue to the action of a traumatic agent is maintained;
• prevention, detection and treatment of diseases that lead to systemic disruption of mineral metabolism and, as a consequence, weakening of bone tissue.

Consequences of a comminuted fracture of the ulna

The prognosis for this type of traumatic injury to the ulna is complex, as with a comminuted fracture of another location. The pathology does not pose a threat to life. But due to technical difficulties in performing reposition (especially in the case of an intra-articular fracture), its results may not be satisfactory.

In a number of cases, reposition and osteometallosynthesis were carried out according to the rules, but due to an inadequate rehabilitation process, complete recovery was not observed.

Comminuted fractures in general and the ulna in particular occur more often against the background of systemic disorders of the bone tissue. Their presence means that the fracture can occur again - in this case, it will be enough to apply less force than the one that resulted in the last fracture.

A non-displaced elbow fracture is a disruption of the structure under the influence of an external traumatic force. Injuries can happen at any age. The most common cause of injury in children is falls. Teenagers and middle-aged people suffer fractures as a result of sports injuries and traffic accidents.

In older people, injuries are caused by age-related problems with coordination of movements and the development of osteoporosis, in which bones become brittle.

Etiology of disorders

The ulna, together with the radius, forms the elbow joint in the upper part, and the wrist joint in the lower part. The limb and joints are equipped with large vessels and nerve fibers, so if a person’s arm breaks, adequate first aid is necessary to help prevent negative consequences and complications.

An open or closed fracture is often a consequence of injury to the upper limb, with the ulna of the left hand being affected much more often than the right. A fracture of the head of the radial bone of the elbow joint is diagnosed more often than other injuries; the violation is accompanied by damage to the medial collateral ligaments and other soft tissues located in the upper carpal joint.

Athletes suffer from this disorder when falling on an extended and extended upper limb. Injuries to the upper third of the ulna are often diagnosed in older people, which is associated with physiological changes and thinning of bone tissue.

In children, damage is also common and is mainly a consequence of excessive mobility, active games, during which one ends up landing unsuccessfully on the hand and getting a fracture. In this case, the styloid process often suffers, and the injury is of a compression or avulsion nature.

Classification

Since the elbow joint consists of 6 anatomical units, in addition to the neurovascular bundles, the types of possible fractures are quite diverse. Mainly they include:

• A fracture of the head of the radial bone is the most common. This happens because it lacks muscle protection and is more susceptible to injury;
• Fracture of the neck of the radius;
• Transcondylar;
• Fracture of the coronoid process of the ulna (usually combined with a dislocation or other injury to the forearm).

In turn, they are divided into different types.

1. Depending on the location of the injury:
   1. intra-articular – characterized by rupture of ligaments, disruption of the integrity of the joint, displacement of bones and their fragments may occur;
   2. periarticular - occur without displacement of bones and their fragments.
2. By the number of bones affected:
3. According to the nature of damage to the skin:
   1. closed;
   2. open.

All these factors are taken into account when assessing the severity of a person’s condition. Particular attention is paid to intra-articular fractures, since they are more unfavorable in treatment and rehabilitation.

Deformation and destruction in the forearm area is considered a consequence of a fracture of the radius or ulna. In severe cases, the victim breaks both bones at the same time. If the damage produces many fragments (3 or more), the damage is classified as fragmentation. If there are 1-2 broken areas, the fracture is classified as a simple fracture. He, in turn, happens:

• transverse;
• oblique;
• helical.

Considering the location of the injury to the forearm area, there are:

• violation of the upper or proximal segments of the bone;
• fracture of the diaphysis of the ulna, when a lesion in the middle third is diagnosed;
• destruction of the lower or distal end.

Depending on the change in the location of the fragments, fractures are distinguished:

• no offset;
• with offset.

The elbow joint has a rather complex structure. The presented part of the upper limbs is formed by the radius and ulna bones, which connect to the humeral tissue. Inside the main elbow joint there are several small ones.

Large nerves and blood vessels, which are responsible for the mobility of the entire limb, pass through this area.

Therefore, fractures of the bones of the elbow joint, in addition to difficulty in motor functions and the development of serious pain, are fraught with a whole host of complications.

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

Causes of injuries

Elbow fracture. Signs, treatment and rehabilitation - Joint disease

The elbow joint is a complex mechanism formed by the radius, ulna and humerus bones, and contains many vessels and nerves in its structure. With the help of this joint, the human hand has greater mobility and allows movements of quite different amplitudes.

Injuries to this joint, including fractures, are a common occurrence that requires serious treatment, including surgical intervention, sometimes even repeated.

An elbow fracture is a fracture of one or more bones or processes that enter the elbow joint.

Types of Elbow Fractures

All elbow fractures can be divided into categories.

• Intra-articular fractures - there is a rupture of the triceps tendon, and bone fragments are displaced upward
• Periarticular fractures - tendon rupture and displacement are not observed and
• Closed fractures - without compromising the integrity of soft tissues and skin.
• Open fractures - the integrity of the skin is compromised.
• Comminuted fractures - separation of one or two fragments from the end of the bone
• Shattered fractures - there are a large number of small fragments.
• Incomplete fracture - a crack forms in the bone.
• Along the fracture line, transverse, longitudinal and oblique fractures can be distinguished.
• Often a fracture is combined with a dislocation and is called a fracture-dislocation.

The most common of the above types of fracture is intra-articular - a fracture of the olecranon process, which does not have muscle protection.

Symptoms and signs

There is pain when palpating the process. If a displaced fracture occurs, you can feel a void between the fragments. When trying to bend the arm in the damaged area, pain is felt, which intensifies at the moment of straightening. With no offset there is a little more freedom of movement.​

The most common locations of fractures

If the fractures of the articular part of the humerus are of a crushing nature, then the surgeon can replace the elbow joint with a prosthesis. This type of fracture of the elbow joint with comminution is more common in elderly patients.

Implants are made of metal and plastic and are attached with special bone cement. A fracture of the elbow joint after surgical treatment may be complicated by damage to the ulnar nerve.

This happens relatively rarely and nerve function is often restored almost completely. ​

​X-ray examination will clarify the exact location and type of fracture. Based on these data, the doctor will determine treatment tactics.​

Symptoms of a fracture

​There are several methods for fixing the bone. The choice of the most suitable one remains with the specialist. The success of treatment of a Monteggia injury depends on strong and maximally stable fixation of the ulna and correct reduction of the radial head. The experience and professionalism of the surgeon plays an important role here.​

The following symptoms are observed with this injury:

​After a week, a repeat X-ray is performed in order to finally exclude possible displacement of the fragments. For a non-displaced fracture, a cast is applied for 6-10 weeks. Next, the patient wears a scarf for some time.

A fracture of the ulna needs timely and proper treatment. The ulna has a complex structure, and its damage can be combined with dislocation or displacement. Therefore, the sooner the victim contacts a specialist, the greater his chances of fully restoring the motor function of his hand.​

Characteristics of fractures

​Titanium plate with screws for fixation (operation);​

• ​ To determine the fracture, an x-ray of the elbow joint is performed in two projections. This research is sufficient in most cases. For a more detailed study of the nature of the fracture, computed tomography (CT) is performed. With its help, you can determine how much the process is destroyed and decide on treatment tactics. Whether to perform the operation and using what metal structure. All these nuances are very important for better fixation and the best treatment outcome.​
• ​Internships:​

​Improperly or poorly healed fractures can cause impaired motor function. If the therapeutic rehabilitation complex does not help restore functions, then surgical treatment is also used. Through a longitudinal incision, all fragments are returned to the correct position and fastened. If the process does not fit well into place, then the tendon is fixed.

Closed fractures

​X-ray examination is carried out to determine the extent of the damage. Moreover, they do it in two projections. The first is the area of ​​the forearm in its upper part, and the second is the place of attachment of the muscles of the humerus. This is done in order to find out whether the annular ligament has ruptured due to a displaced fracture.​

Hand injuries, especially those occurring inside the joint, are dangerous, and approximately 20% of them occur to the elbow.

The elbow joint is one of the most complex in the human skeleton, since it combines three bones at once: the humerus, the ulna and the radius.

In addition, it consists of a large number of small articular joints. All this is united into a single elbow by connective tissues (muscles, ligaments).

The mobility of the limb is carried out due to the dynamics of the joint, as well as the blood vessels and nerve endings passing through the elbow. A fracture of the elbow joint is a serious injury, as it is often complicated by numerous consequences.

In terms of severity, only the injured knee can compete with it, since they are similar in structure. Treatment after a fracture will take a long time, and the recovery period is even longer.

Sometimes it is almost impossible to completely restore hand mobility.

Causes of damage

There are many risk factors for an elbow fracture. Among them are the most common ones, as a result of which damage occurs:

• Bad fall. It is common for a person to protect himself with his hands when falling, placing them in front of him. A fracture of the ulna is no exception. Having fallen on an outstretched or half-bent arm at the elbow, a person receives the main blow precisely to the elbow joint. In other words, by putting your hands forward, a person takes most of the damage on them.
• Chronic diseases. Bone fragility develops as a result of a number of chronic diseases, which makes it almost impossible to prevent a fracture of the elbow joint. Such diseases include osteoporosis, arthritis and many others that purposefully or indirectly destroy the bone structure. Physical stress or force of impact on the affected bone easily destroys it.
• Physical blows. A blow to the elbow can occur in a fight, a traffic accident, or simply by accidentally colliding with a door frame. Depending on how much force was applied and where the blow was directed, the severity of the injury is classified.

Injuries occur much less frequently as a result of playing sports, since athletes pay special attention to equipment, and the elbow is usually protected with an elastic bandage or shield.

Elbow fracture classification

A fracture of the arm in the elbow joint is divided like other fractures. The classification of an elbow fracture is determined as follows:

• closed or open;
• intra-articular or periarticular;
• with displacement and without displacement (usually only one bone breaks);
• multiple, fragmented, etc.

A fracture of the ulna is often accompanied by dislocation of the entire joint or stretching of connective tissues and is complicated by many diseases, for example, arthrosis.

As mentioned, the elbow is made up of three main bones and a large amount of muscle and connective tissue. In addition, the complexity of the elbow joint allows for a special classification based on the location of damage.

The olecranon process is the weak point of the elbow. It is not covered, like the rest of the elbow, by soft and muscle tissue.

A direct fracture of the olecranon is a fairly rare occurrence, but in the event of an unsuccessful fall, bone particles can break off from it.

Such damage is greatly complicated by the displacement of fragments that damage blood vessels and muscle tissue.

Injury to the bone head or neck of the radius occurs as a result of a fall on an outstretched arm. This type of violation is more common.

Violation of the coronoid process often occurs in combination with damage to the forearm and shoulder or is accompanied by a dislocation.

The most common fracture is the radius; it may be accompanied by articular dislocation and damage to the humeral condyle.

Symptoms of a fracture

Diagnosing the main signs is quite simple - they are clearly expressed. A serious reason to seek medical help will be the presence of at least one of the symptoms listed below.

After an injury occurs, the victim experiences the following symptoms:

• the elbow joint swells greatly, the arm increases in size. The swelling is so extensive that it can be seen with the naked eye and without palpation - manual examination of the victim;
• the victim is unable to move his arm, the elbow joint after injury is not able to move at all - the complex structure affects it;
• An extensive hematoma quickly forms at the site of injury. Blood flowing into soft tissues after damage to blood vessels tends to thicken over time and lead to unpleasant consequences. Such blood clots can only be removed through surgery;
• severe pain syndrome - severe, unbearable pain;
• Crunching and visible deformation will be another cause for concern.

Displaced fractures of the ulna are characterized by external signs: irregularities, pronounced arrangement of bones and inaccuracies instead of the usual structure of the arm.

In more detail, the symptoms of injury can be considered in individual cases:

1. An olecranon injury is a very common hand injury, especially in childhood. The symptoms are not much different from the main ones - the pain is felt on the inside of the joint, radiating to the shoulder and forearm. Swelling and bruising spread along the outside of the joint. In addition, an olecranon fracture is assessed by whether it is possible to bend the arm at the elbow. In this case, it is possible to perform rotational movements with the shoulders. There is a characteristic crunch of bone fragments, as well as external deformation of the hand.
2. A fracture of the head and neck of the radius is characterized by widespread pain at the front of the joint, radiating to the forearm. Hematomas and edema are not very pronounced, crunching and deformation are absent. A clear difference between this injury and others is the limitation in rotational movements.
3. Injury to the coronoid process of the elbow joint is described by severe aching pain that intensifies with palpation. Movement of the joint itself to bend and extend the arm is practically impossible. Minor edema is expressed by slight swelling of the tissue over the joint, with no external deformation.

Thus, an external violation of the arm and crunching of bone fragments appears only if a fracture of the entire elbow joint has occurred with displacement.

Urgent Care

Providing first aid is simply necessary. In this case, the tactics of first aid should be selected according to the severity of the injury.

However, it is not possible to reliably establish the complexity of the injury, for example, with a closed fracture.

However, everyone should know the basics of first aid in order to help themselves or others in time.

The basics of pre-medical care fit into the following several measures, which significantly simplify the course of the treatment period:

• Applying a homemade splint to immobilize the arm. It is necessary to firmly fix the hand on a solid object from the middle of the forearm to the fingertips. To do this, it needs to be tied to an improvised splint (for example, a board) or tied to the victim’s body if it is not possible to build a homemade splint.

• To generally reduce pain, local anesthetics and anti-inflammatory drugs are used. Intramuscular administration of the drug will be more effective, but this is not always possible.
• If possible, apply cold to the injury. This will help reduce swelling of the injury so that diagnosis can be made without complications. Ice will slightly reduce overall pain. Even an ordinary bottle of cold water or a frozen semi-finished product can play the role of ice.

Diagnostics and therapeutic therapy

A traumatologist diagnoses an injury based on several x-ray images. The elbow is photographed in several projections - this gives a more complete picture of the injury, making it possible to establish possible consequences.

An elbow fracture is characterized by swelling that increases over time. In the first week, the swelling increases. If the fracture is closed, a tight plaster cast is applied to the arm.

Painkillers and anti-inflammatory complex drugs are used to relieve pain.

The operation is allowed for open displaced fractures. Moreover, such operations must be carried out immediately, since if they are delayed, the functions of the hands will be partially lost. In rare cases, fixation with knitting needles is used.

An internal fracture with fragments and displacement is treated with bone grafting. Additionally, fixing plates are installed. Due to them, complete, but at the same time natural fixation of the hand in one position is achieved. This promotes rapid bone healing.

Rehabilitation

Rehabilitation actions begin during the treatment period - after 14 days it is recommended to strain the arm muscles under a cast. After which physiotherapy, consisting of magnetic therapy, is prescribed. The impact is carried out directly through the plaster cast.

Only a traumatologist can give recommendations on how to develop the elbow joint. After the bandage is removed, additional physiotherapeutic actions are added - electrophoresis, mud and sea salt baths. After a fracture, the hand needs to be massaged.

The elbow joint after a fracture needs serious and targeted development to fully restore all functions. Approaches to the exercises are performed for 10 repetitions, the number of which increases gradually. They must be performed three times a day.

In addition, it is recommended to diversify your daily meals with foods that contain magnesium and calcium. This will contribute to the restoration and fusion of bones. During preventive actions, you need to take vitamins aimed at replenishing missing substances in the body.

It is possible to recover from a fracture of the elbow joint, but it will take quite some time. That is why such injuries can be characterized by both rapid healing and slow development of motor function.

Any injury, including a fracture of the elbow joint, can also provoke a considerable number of chronic diseases in the future. Having a broken arm at the elbow is not a death sentence, so you shouldn’t give up.

Fractures of the elbow joint account for about 1/5 of all intra-articular fractures. Due to the complex anatomical structure of the elbow, there is a high risk of complications.

Its structure consists of the connection of: the bones of the elbow and radius (forearm) and the bones of the shoulder. And the joint itself is divided into 3 small ones:

• superior radioulnar;
• humeroulnar;
• brachioradial.

In addition, the passage of a large number of vascular and nerve bundles is concentrated in the joint. Therefore, it is very important to receive timely and correct treatment.

Diagnostics

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

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

If in case of damage to the middle third of the bone, radiographic 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.

The diagnosis is made by an orthopedist or traumatologist based on clinical and instrumental examinations.

1. Anamnesis collection. The doctor assesses the circumstances of the injury and listens to complaints.
2. Visual inspection. When examining a patient with a fracture without displacement of the fragments, swelling of the arm, hematomas, and limited motor function are detected. On palpation, the patient complains of pain in the area of ​​the fracture.
3. Radiography. The picture is taken in two projections. On an x-ray, the fracture appears as a dark stripe with jagged edges. Using a diagnostic procedure, you can clarify the location of the injury and study the fracture line.
4. CT. A layer-by-layer scan of the affected bone is performed, which makes the picture more detailed than with an x-ray examination. A more accurate, but also more expensive diagnostic method, its price is quite high, and the procedure is not performed in all medical institutions.

Articular fractures may be accompanied by nerve damage, so consultation with a neurologist is necessary.

Before prescribing treatment for a fracture, it is important for the doctor to make an accurate diagnosis and only then decide which treatment regimen is suitable for the individual case. First, the doctor conducts an initial examination, after which a more detailed examination is necessary.

For this, the person is sent for an X-ray examination. If a violation of cartilage, ligaments and tendons is suspected, an MRI or ultrasound is additionally prescribed.

Treatment

The choice of treatment tactics directly depends not only on the type of fracture, but also on the age of the patient. Let's say that if this is a fracture of the radial process without displacement or with displacement, but minimal (no more than 3 mm), then most likely the treatment will be conservative.

The plaster is applied with the arm positioned at an angle, palm up. It is extremely important to completely avoid putting stress on this arm during treatment.

The operation is performed if a displaced fracture, intra-articular fracture, or condyle fracture occurs. It is carried out in stages:

1. Restoration of the location of fragments preceding the injury;
2. Their fastening with any surgical devices;
3. Stitching.

In the case of elbow fractures, when the bone is so crushed that it is not possible to compare it, they resort to implantation of a graft. For these purposes, bone tissue from a donor or the patient itself is used. The arthroplasty method is also widely used.

Bandages are also used to treat fractures and more. It can also be used during the rehabilitation period. Its main qualities are: reliable fixation of the damaged joint, as well as relieving the load from it.

Throughout almost the entire treatment period, anti-inflammatory non-steroidal drugs, painkillers, and antibiotics are prescribed. In cases of open fractures, an anti-tetanus injection is given immediately.

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. A regular plaster cast is sufficient.

With such damage, therapy for broken bones is minimal - the injury is treated independently using the method of 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. A fracture takes a long time to heal if multiple bone structures, muscles, nerves, and blood vessels are damaged.

Based on the medical history, the doctor selects the optimal treatment method and sets the period of immobilization. How long to wear a cast for an uncomplicated fracture of the diaphysis? No more than 80 days.

Treatment of a displaced arm fracture will be more difficult, and the healing time of the bone reaches 112 days. It takes a month for broken bone tissue of the epiphysis to heal without displacement.

Patients are interested in how long it takes for a displaced lower epiphysis injury to heal - the bones heal in one and a half to two months.

Surgical treatment

Surgical reduction is used if a person breaks his arm in several places. Surgical intervention is advisable for simultaneous articular pathologies, multiple fragments, and soft tissue rupture.

For fractures of the radius and ulna, in which the fragments are displaced in a chaotic manner, osteosynthesis is indicated. During the manipulation, the fragments are connected using plates or knitting needles.

After surgery to reduce a displaced fracture of the ulna, the limb is cast - surgical intervention minimizes the risk of possible deviations.

For a subperiosteal fracture with soft tissue rupture, surgical treatment is extremely rarely required. The exception is when the fusion occurs 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.

Fractures of the ulna without displacement of fragments are treated with conservative methods. Under local anesthesia, the affected areas of the bone are aligned and a cast is applied. The patient is prescribed drug therapy.

A week later, a repeat x-ray of the limb is taken to monitor the condition of the bone structures. Next comes a rehabilitation course, including physiotherapy and exercise therapy. You can learn more about the methods of treating a closed fracture from the video in this article.

Urgent measures

If you suspect a fracture of the forearm bone, it is necessary to provide competent and timely assistance to the victim.

The instructions for providing first aid provide the following algorithm of actions:

• fix the limb using special splints or improvised means - flat boards, thick cardboard, rolled newspapers;
• to prevent the development of severe swelling, you can apply cold to the damaged area - ice, frozen foods, a container of cold water;
• in case of severe pain, give the victim an analgesic in an age-appropriate dosage;
• call doctors or take the victim to the emergency room yourself.

It is contraindicated to palpate the injured limb on your own. Inept manipulations can cause undesirable consequences.

Basic treatment

For undisplaced fractures, a plaster cast is sufficient. In case of damage to the elbow, the plaster is applied so that it covers the hand and shoulder joint. The hand is placed on a scarf garter or a special brace in a physiological position. It takes 4-6 weeks for the bone to heal.

The following medications are prescribed at the same time:

• analgesics to relieve pain;
• calcium preparations for bone tissue restoration;
• means to improve blood circulation.

In the fourth week, a control photo is taken.

A rehabilitation course is prescribed immediately after the acute symptoms of injury have been eliminated. It is needed to eliminate symptoms, accelerate bone healing, and restore impaired hand functions.

The course includes:

• physical therapy - carried out by performing active and passive movements with the injured arm;
• massage - performed to improve microcirculation in the fracture area, increase muscle tone, and prevent joint contracture;
• physiotherapy - UHF, magnetic therapy, electrophoresis, inductothermy have an anti-inflammatory, analgesic effect, and accelerate metabolism in tissues.

Rehabilitation is carried out on an outpatient basis and lasts at least a month.

​Scientific and practical interests: foot surgery and hand surgery.​

​Moscow, st. Berzarina 17 bldg. 2, Oktyabrskoye Pole metro station

Treatment occurs in exactly the same way if there is displacement of the fragments, but only slightly. The hand is fixed in the position in which the fragments take their places. Complete restoration of bone tissue requires 3 to 4 weeks.​

​Almost always the fracture occurs inside the joint. If there is no damage to the tendon in the area of ​​the triceps muscle, then the broken parts are displaced nearby and this is hardly noticeable. If a tendon ruptures, the muscle contracts and pulls the fragments with it.​

But more often surgery is necessary. For a simple fracture of the proximal end of the ulna, treatment is reduced to tightening the bone using a wire loop, after repositioning the bone with or without Kirschner wires.​

​displacement of the head of the radius.​

​shortening of the forearm on the injured side;​

​Depending on the mechanism of injury, there are 4 types of Monteggia injury:​

​sharp local pain;​

​1. Exercises begin to be performed in the first days after an injury in the fingers, since the muscles responsible for the functioning of the fingers begin from the area of ​​the elbow joint (from the epicondyles).​

A fracture of the olecranon process, which has a pronounced displacement of fragments, requires mandatory surgical intervention by a trauma surgeon. Otherwise, the forearm will not fully extend; this is a serious violation of the function of the upper limb.

The success of the operation depends on the accurate comparison of bone fragments and their fixation in the correct anatomical position. And further success depends on the correct development of the elbow joint.

​ A fracture of the olecranon process occurs mainly when falling on the elbow from one’s own height. There are cases when this fracture is characterized by a displacement variant.

Most often it occurs at the level of the apex of the process, but sometimes it causes extra-articular damage. It is to this area that the tendon of the triceps brachii muscle (triceps) is attached, which “pulls” the broken elements proximally (towards the shoulder), thereby creating a diastasis between the fragments, which is a serious obstacle to fracture healing.

​Moscow, st. Koktebelskaya 2, bldg. 1, metro station Dmitry Donskoy Boulevard

If the fragments are severely displaced, surgery is required. It is used if there is a distance of 2 mm or more between the fragments or they are displaced to the side.

Surgical intervention is also required for fractures with multiple fragments. After determining the type of injury, the most suitable treatment method is selected, in which it will be possible to begin movement in the injured area as early as possible.

To treat a fracture, osteosynthesis is used, that is, the bones are fastened with two knitting needles and titanium wire. The operation can be performed as soon as the patient is admitted to the department.

​Fractures occur with simultaneous dislocation of the head, called Malgenya injury.​

Anatomy of an olecranon fracture

​If an intra-articular fracture of the elbow joint has occurred and fragments have formed, then it is most difficult to reposition the ulna. In this case, they resort to bone grafting. In case of comminuted fractures, tightening with a wire loop cannot be performed, otherwise the articular surfaces will be shortened, then special dynamic compression plates are used.​

Symptoms of an olecranon fracture

​To prevent serious complications and increase the chance of a successful recovery with restoration of all functions of the hand, it is important to begin treatment of the injury as early as possible.​

​with a posterior dislocation, the displacement of the head of the radial bone is felt;

​I - dislocation of the head of the radial bone forward.​

• ​swelling in the area of ​​injury;​
• ​2. Early development after surgery is performed under the supervision of a doctor.​
• ​When visiting a doctor, the patient complains of pain and dysfunction of the elbow joint.​

Diagnosis of olecranon fractures with and without displacement

​Moscow, Bolshoy Vlasyevsky lane 9, Smolenskaya metro station​

​After anesthesia, an incision is made over the damaged area. All blood clots and very small bone particles are removed through it.

The fragments are adjusted relative to each other in the correct position using a single-tooth hook. Using a drill, two knitting needles are inserted.

At a distance of at least 3 cm from the fracture, holes are drilled for pulling the wire holding the fragments together. The ends of the wire are twisted with pliers.

No more than 2 cm of the length of the needles is left above the olecranon, the rest is bitten off. The ends are bent towards the bone.

Treatment of olecranon fracture

​12 folk methods for home treatment​

If displacement is not diagnosed after an injury, surgery is not performed. The affected areas are aligned under local anesthesia, and then a plaster cast is applied.

After 5-7 days, additional radiography is performed, which will show the condition of the bone structures and how the area that is not yet fused is being restored. For a fracture without displacement, the plaster should be worn for 2.5-3 weeks, after which the bandage is removed.

Resection of the head of the radial bone and removal of damaged soft tissues is prescribed for destructive injuries with displacement, the formation of many fragments and damage to the muscular and ligamentous apparatus. The doctor, under local anesthesia, sets the damaged areas, and to ensure that the fragments heal correctly, a staple, screw or plate is applied.

After all manipulations, the arm is immobilized using a plaster cast, and 5-7 days after surgery the patient is advised to perform light exercises aimed at developing the muscular corset of the affected limb.

Treatment should begin with immobilization. The upper limb is brought into a bent and elevated position. This is important to do as first aid, especially for a displaced injury. Otherwise, the fragments can damage the vessels and nerves near the joint. But if fixing in this position causes pain, you should not force your hand into this position.

In a medical institution, radiography is performed in two projections. If the injury is intra-articular, a computed tomography scan is also performed. The limb is then fixed using a plaster splint. If no displacement is detected, apply a plaster cast for a month.

An injury with displacement and the presence of fragments requires their reposition. Closed injury and displacement of fragments by less than 5 cm allows this to be done percutaneously. In other situations, surgical treatment is performed.

Conservative treatment

It is carried out in the absence of displacements. This is done by wearing a plaster cast. Physiotherapy and exercise therapy may also be prescribed.

The goal of conservative treatment is to ensure limb immobility, prevent swelling and relieve inflammation.

A non-displaced radial neck fracture requires wearing a cast for three weeks. Injury to the coronoid process is treated with a plaster cast for a month. Then rehabilitation is required, which takes about two weeks.

If the epicondyle is fractured and there is no displacement, a posterior plaster splint or circular bandage is applied to the upper limb. The duration of wearing it is three weeks.

Displacement of the fragments requires surgery, after which a cast is also applied for a period of six weeks. Rehabilitation in this case lasts from two weeks to one and a half months.

It is carried out in case of injury to the elbow joint with displacement, as well as in the treatment of an old fracture. The operation is necessary to compare the fragments. If this is not done, there may be serious consequences, in particular, the forearm will not fully extend. An open injury requires intervention within 24 hours.

Surgical treatment consists of comparing the fragments and fixing them with knitting needles or bolts. In some cases, it becomes necessary to eliminate fragments or a damaged head.

In the latter case, an endoprosthesis is installed instead of the head. The operation also involves suturing muscle tissue, torn tendons or ligaments.

In case of violation of the integrity of the ulna, plastic surgery is required, in which fixing plates are used.

Rehabilitation period

In the postoperative period, for rigid fixation, it is recommended to wear fixators - an orthosis or splint. The orthoses contain thin metal plates. The components of splints are plastic or iron plates. The use of fixators is necessary to hold the limb in the same position. This is important to create complete rest for the injured hand.

However, you need to remember that wearing a cast leads to muscle atrophy. For prevention, you need to start doing exercises already on the second day after the injury, when the pain in the arm becomes less pronounced. The consequences of improper rehabilitation are contracture in the articular area of ​​the elbow.

On the second day after injury to the articular area, you should perform gymnastics for the fingers, hand, wrist joint and shoulder. To prevent swelling, the limb should be carefully lifted above the head and placed behind the head.

First aid

Medical attention should not be neglected if there is a strong blow to the hand. Outwardly, there may seem to be no cause for concern, but hidden injuries can cause further health problems. In a child, the fracture heals quickly, so it is important to reposition and fix the bone structures in a timely manner.

How to provide first aid for a fracture? To begin with, you should exclude accidental impact on the hand to prevent displacement. The following manipulations are carried out at home:

• give a painkiller;
• cool the injured limb;
• immobilize the injured arm.

It is necessary to consult a doctor as soon as possible if there is severe swelling, hematoma and acute pain. A traumatologist will tell you what to do if you have a fracture of the ulna. Until medical care is provided in a hospital setting, the patient’s forearm is fixed. Immobilization for an isolated fracture of the ulnar shaft is a prerequisite for delivery to the emergency room.

Before applying a bandage, the limb can be numbed with topical anesthetics. Immobilization is carried out using a splint. This can be a stick, a board, or any hard and straight object. The dressing is not made tightly, but 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.

If there is a suspicion of destruction of the bone tissue of the upper extremities, it is important to provide adequate first aid and immediately transport the victim to the trauma department. If a child or adult has an open fracture, it is important to disinfect the site of the injury using peroxide and brilliant green. After this, it is necessary to stop the bleeding by applying a rubber tourniquet above the injured area.

Next, the limb is immobilized using a special splint or available hard and smooth materials (branches, sticks, knitting needles). If a person has severe pain, it is recommended to give an intramuscular injection of a pain reliever. At this stage, first aid ends. The victim must be taken to the hospital; it is advisable that the person be in a sitting position during transportation.

If fractures or dislocations of the limbs are suspected, it is strictly contraindicated to try to palpate or straighten the affected area on your own. This provokes the development of severe complications.

Complications and consequences

Any violations in the integrity of the structure of bone tissue or even the skin does not pass without a trace. The most harmless thing that can result from a fracture of the elbow joint is a bruise. But usually everything is much worse. Often a persistent contracture can develop, that is, the arm at the elbow does not fully extend or does not bend.

To avoid this, you should strictly follow the sets of exercises prescribed by your doctor. It should be remembered that if during exercise therapy your shoulder hurts and this does not allow you to perform any movements, you need to tell your doctor about it. Very often salt baths help to cope with this; their use helps:

• Warm and numb the injured area;
• Improve its metabolism;
• Remove swelling;
• Accelerate the regeneration of bone and cartilage tissue.

A very scary complication is non-fusion or improper fusion of the bone. This entails surgical intervention, and sometimes even more than one. A broken arm is very dangerous to health and can even result in disability.

To avoid consequences, you must not only follow the prescribed treatment, but also remember that rehabilitation also includes proper nutrition. You should eat foods with plenty of collagen. It is found in meat, fish, seaweed, etc.

The most important way to avoid complications is, of course, to avoid fractures. To do this, you need to be more careful and follow safety rules at work and at home.

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, the fragments of the ulna become overgrown with hard tissue. Callus after a fracture negatively affects the functioning of the limb. Atypical fusion may require repositioning.

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megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...