Reduction of forearm dislocation. How to restore an arm after a forearm dislocation: reduction technique and rehabilitation tips

A dislocation of the forearm is diagnosed in every fifth case of damage to the bones of the arm. In a child, trauma is often accompanied by a fracture. Active children and adults involved in extreme sports most often end up in emergency rooms with dislocations of forearm bones.

The human elbow joint is formed by the connection of three bones: the humerus, radius and ulna. It is also surrounded by a thin articular capsule, which is strengthened by two ligaments. During an injury, muscle tissue, brachial arteries and nerves are damaged. In any case, it is necessary to diagnose the damage as early as possible and provide first aid.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

An elbow bruise accompanied by a dislocation will have a pronounced clinical picture. The affected person complains of the following symptoms:

• severe pain - the patient has to support the injured limb with his healthy hand;
• the appearance of swelling in the area of ​​impact;
• passive position of the limb;
• deformation elbow joint, obvious displacement of bones.

Reduction is carried out only after accurate diagnosis in the traumatologist's office and studying x-rays. During the examination, the type of dislocation is determined, on which further therapy depends.

Diagnosis of dislocation

Examination of the patient begins with palpation. The doctor examines the extent of the damage, assesses muscle strength in upper limb. Active movements of the hand are impossible, and passive movements are characterized by springiness. The full functionality of the hand is studied and the skin is examined.

An x-ray will help rule out a violation of the integrity of one of the bones. The most difficult thing to diagnose is an isolated dislocation accompanied by a fracture.

Classification of forearm dislocations

The bruise is always accompanied severe pain. It is important for the doctor to determine the type of injury in order to offer competent therapy. A person has a complete or incomplete dislocation, primary or repeated, complicated or uncomplicated. Therapy and speed of recovery depend on this.

There is the following classification:

1. Posterior dislocation - occurs due to a fall on an outstretched upper limb with a hyperextended elbow. There is a shift in the lower shoulder area. There is also a rupture of the elbow joint capsule. In adults, dislocation is accompanied by a fracture of the condyles of the humerus; in children, trauma to the epicondyles of the shoulder occurs. The victim experiences severe pain, the upper limb reflexively is bent. Visually, the forearm looks shortened.
2. Lateral dislocation - rarely observed, occurs due to a directed blow to the elbow joint from the outside to the inside. Always accompanied by rupture or partial damage ulnar nerve or middle.
3. Anterior dislocation - occurs when a fall or blow occurs with the elbow bent. Movement functions are practically preserved, but severe pain is felt. The forearm visually looks elongated.

Posterior dislocation is diagnosed most often in children. This is due to the inability to group during a fall.

Treatment of dislocations in the forearm area

Reduction – the only way put the arm bone in place. The procedure is carried out under local anesthesia or general.

Correct manipulations lead to the appearance of free passive movements. Incorrect actions will lead to a fracture of the coronoid process. To fix the limb, a splint is used (a wide strip made of several layers of plaster bandage).

Treatment lasts 1.5-2.5 months. After eight weeks, full working capacity returns. During therapy, control x-rays are taken to prevent improper healing. After removing the splint, 7-10 days later physiotherapy is prescribed - hydrotherapy, exercise therapy and physiotherapy.

Dislocations and subluxations of the radius and ulna in children

The head of the radius in children under six years of age is susceptible to injury. Subluxation occurs due to a forced position, which is typical for babies holding the hand of an adult. The head of the radius consists of soft cartilage; it easily slips out of the ring, damaging the soft fibers and ligamentous tissues. The injury is accompanied by severe pain and swelling.

Subluxation of the radial head is easier to prevent; parents should watch how high the child’s limb rises. Treatment consists of bone adjustment.

Serious complications after forearm injuries occur at older ages. Patients complain about unpleasant pain during weather changes. In rare cases, the hand function is impaired and the elbow joint does not bend fully.

From total number Forearm dislocations account for 18-27% of injuries. More than half of this amount is due to childhood injuries. The main cause of damage is a fall.

The forearm is the middle fragment of the upper limb. Consists of the ulna and radius bones, articulated by an interosseous membrane.Upper fragments form the elbow joint, andlower – .

The forearm consists of an articular shell that combines three joints and two ligaments.

Forearm dislocations are classified into:

• rear;
• front;
• lateral.

Posterior dislocation of the forearm is diagnosed in 90% of cases and is often accompanied by:

• rupture of lateral connective tissues;
• violation of the integrity of the medial ligament and segment of the epicondyle or coronoid process;
• destruction of the growth epiphasor cartilage of the epicondyle (childhood injury);
• under the influence of strong compression, it is possible that the capitate eminence or lateral epicondyle;
• damage to other tissues and systems.

Anterior and lateral dislocations are recorded infrequently. Lateral injuries are considered the most dangerous; there is a risk of injury to the nerve endings of the elbow.

Divergent- most difficult case, in which the ulna and radius diverge into different sides with concomitant damage to adjacent tissues. It is a consequence of rough influence.

Trauma code according to ICD 10

According to the international classification of diseases ICD 10, damage - dislocation of the forearm is included in the class ", sprain and overstrain of the capsular ligamentous apparatus elbow joint S53". The code for the forearm according to ICD10 is T003.

Causes

Forearm dislocations are mainly a consequence of:

• falls with support on the upper limbs,
• mechanical impact, etc.

Joint injuries are divided into complete and incomplete (the surfaces of the joints are partially in contact).

Symptoms

Dislocation of the bones of the forearm is characterized by symptoms:

• movement in the elbow joint causes severe pain;
• visually noticeable deformation anatomical structure joint, swelling, hematomas;
• dysfunction of hand movements is observed.

Often the injury is accompanied by:

• rupture of the annular ligament and/or interosseous membrane;
• abrasion of the tendon (often with the olecranon process) and/or muscle tissue;
• epicondyle fractures;
• damage to soft tissues, etc.

The genesis of the resulting damage complements big picture specific symptoms:

• Rear ones - come with full or partial ruptures ligaments of the capsular-ligamentous apparatus and fractures of bones and their fragments. Injured: blood vessels, muscle tissue, nerve endings.
• Posterior dislocation is characterized by shortening of the forearm and lengthening of the shoulder. Visually noticeable dislocation of the olecranon process posteriorly, the axis of the forearm.
• When displaced anteriorly, the damaged joint lengthens. Accompanied by damage to the side connective tissue joint capsule, triceps brachialis muscle and breaks muscle tissue at the site of articulation with the condyle. (about 5% of cases)
• Diverging is a serious injury that is not often seen. The radius and ulna diverge forward, backward, inward and outward. Damage to the capsular-ligamentous apparatus of the elbow joint is observed.
• diagnosed with, occasionally with damage to nerve endings. Limb movements are limited and painful.

First aid

After receiving injury, the victim is provided with standard first aid. Firstly, they call an ambulance. The limb is fixed without trying to correct the dislocation of the forearm yourself. To relieve pain, apply cold to the elbow area for 15-20 minutes.

If possible, the patient should be transported to medical institution after the provision of primary care.

Diagnostics

Diagnosis is made based on examination and complaints of the patient. The patient is in the “injured limb” position. The damaged area swells, hematomas are possible, and disturbances in the anatomical structure of the elbow are visually noticeable. Characteristic sign– “springy mobility” when trying to make passive movements.

X-rays are taken, if necessary, with contrast, which makes it possible to determine the presence of deformation of the connective and bone tissues of the elbow joint.

After diagnosis, treatment is prescribed, at the discretion of the traumatologist - outpatient or inpatient.

Treatment

Treatment for a forearm dislocation is carried out in the hospital, under complete or local anesthesia, and depends on the symptoms of the forearm dislocation.

Reduction of a dislocated forearm is carried out by a doctor and an assistant. The patient is laid down or seated and the arm is moved to the side.

With a posterior displacement, the head of the bone should be set forward, with anterior displacement - backwards. The surgeon and assistant perform a smooth repair while flexing it at the same time. At the same time, the doctor presses on olecranon for injuries of the posterior type and to the head shoulder joint- at the front. Completion of the manipulation is accompanied by a characteristic click.

A control radiography is performed to clarify the correctness of the manipulation and check the integrity of the capsular-ligamentous apparatus.

Check heartbeat on arteries, mobility and lateral stability of the joint. The treatment is completed by fixing the arm with a plaster splint.

Treatment of forearm dislocation in mild cases is limited to closed reduction followed by fixation of the limb in a cast.

A fixation splint is applied from the shoulder joint to the fingers for 14-21 days. The patient is recommended to exercise his fingers. After a few days, isometric exercises for the elbow muscles are prescribed.

After removal of the plaster splint, restorative therapy is carried out.

Note!

Treatment of trauma in children is carried out without anesthesia.

Surgical treatment

Forearm dislocations with complications are treated surgically. If necessary, osteosynthesis is performed. Special medical devices are used to fix the reduced joints or fragments. During the operation, the damaged ligament is sutured with transosseous Mylar sutures.

Forearm dislocations and fragment displacements are operated on within the next few days after the injury. Resection of the damaged part is carried out, and the elbow apparatus is carefully sutured.

Note!

Old injuries are not amenable to conservative treatment.

At the end of the surgical procedures, a plaster splint is applied.

Rehabilitation

Upon completion of immobilization, the patient undergoes a rehabilitation course.

Procedures to restore normal functionality of the upper limb begin after the cast is removed. The patient is prescribed:

• physiotherapy;
• massage;
• development;
• classes in the pool;
• physical therapy, etc.

Note!

Warming procedures are contraindicated because they can cause salt deposition in the joint.

The recovery period after uncomplicated cases is 1.5-2 months. But if a nerve or artery is damaged, recovery period may last for several years.

Complications and consequences

Forearm dislocations have a considerable number of complications. The most common is contractures, which limit the mobility of the arm.

Depending on the individual characteristics In the body, long-term fusion of bone tissue and joint instability may occur. Relapses of the pathology are possible.

Serious complications from dislocated joints are compression or rupture of the artery. Hemorrhage into the joint cavity can lead to deforming arthrosis. Timely detection of hemarthrosis and removal of blood accumulation from the cavity will prevent the development of this pathology.

The most dangerous complication– damage to nerve endings, which leads to impaired sensitivity and mobility of the joint.

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.

Dislocations in the elbow joint ranked second in frequency. According to various authors, they make up 18-27% of all dislocations, mainly in young people. Most often, forearm dislocations occur during a fall. outstretched arm with hyperextension of the elbow joint.

Observed:

1) dislocations of both bones of the forearm: posterior, anterior, outward, inward, divergent dislocation;

2) dislocation of one radius: anteriorly, posteriorly, outwardly;

3) dislocation of one ulna.

The most common are posterior dislocations of both bones of the forearm (90%) (Fig. 80) and anterior dislocation of one radius. Other types of forearm dislocations are rare.

Rice. 80. Diagram of dislocation of both bones of the forearm. a - rear; b - front.

Posterior dislocation of the forearm. The diagnosis is made based on joint deformity. Its area is enlarged in circumference, painful, the limb is in a forced semi-extended position. Active movements are impossible. When attempting passive movements, springy resistance is felt. When viewed from the front, the forearm is shortened compared to the healthy side. The olecranon process projects posteriorly more than usual, located above and posterior to the line of the epicondyles (Gunther's line; Fig. 81). The epiphysis of the shoulder is palpated in the elbow bend.

Rice. 81. Ponter’s line is a straight line connecting the epicondyles with the arm straightened (a), Ponter’s triangle - when the forearm is bent at a right angle, the epicondyles and olecranon form the vertices of an equilateral triangle (b).

Rice. 82. Reduction of posterior forearm dislocation.

Treatment of posterior dislocation It is preferable to perform under anesthesia. The patient is placed on his back on the table with the arm abducted at the shoulder and bent at the elbow joints so that the forearm is in vertical position. The surgeon places his first fingers on the olecranon process, pressing on the patient's shoulder from front to back and at the same time pushing the olecranon process forward (Fig. 82). At this moment, the assistant performs traction along the length of the forearm and flexion at the elbow joint. After reduction they do X-ray.

Check the pulse at the radial artery. The elbow joint bent at an acute angle is immobilized with a posterior plaster splint for 7 days, after which therapeutic exercises- careful in the first days and more active from the 10th day, combining it with thermal procedures.

Working capacity is restored in 20-30 days.

Anterior forearm dislocation. Its reduction requires flexion of the shoulder and elbow joints.

Rice. 83. Reduction of anterior dislocation of the forearm.

The assistant, applying traction along the length of the hand and forearm, slowly bends it, while the surgeon, placing both of his first fingers on the protruding back side articular end humerus, lifts it anteriorly in the proximal direction, while simultaneously moving the forearm back in the distal direction with the remaining fingers. X-ray control is required before and after reduction of the dislocation. Along with what is described, a modified technique is also used (Fig. 83).

After reduction, the assistant extends the forearm to an obtuse angle. In this position, the limb is fixed with a posterior plaster splint with the forearm supinated for 10-12 days.

If manual reduction fails, reduction can be performed operative method, but only if there is no ossification around the joint; if it is present (ossification occurs very quickly - after 2 weeks), it is better to perform arthrodesis or arthroplasty of the elbow joint.

Traumatology and orthopedics. Yumashev G.S., 1983

Forearm dislocation is a fairly common injury. It accounts for 18–27% of the total number of such injuries. This injury often occurs in children. Its main cause is a fall. The forearm consists of the ulna and radius bones, which are connected by an interosseous membrane. Top part forms the elbow joint, and the lower one forms the wrist joint.

Types and characteristic symptoms of injury

This dislocation can be of the following types:

• rear;
• front;
• side.

Posterior dislocation is diagnosed in 90% of cases. It is often accompanied by:

• rupture of the lateral ligaments;
• gap medial ligament and epicondyle or coronoid process;
• violation of the growth cartilage of the epicondyle (observed in children).

Anterior and lateral dislocations are uncommon. The lateral one is considered more dangerous, and there is a risk of injury to the nerve fibers of the elbow.

The most difficult is a divergent dislocation, in which the radius and ulna bones move apart and damage adjacent tissues.

Dislocation can be complete or incomplete (), when the surfaces of the joints partially touch each other.

The cause of such an injury can be a fall on the hand, an accident, or mechanical damage.

Symptoms of forearm dislocation:

• movements in the elbow cause severe pain;
• a violation of the joint structure is visible;
• swelling and hematomas appear;
• hand movement is impaired.

Often the injury is accompanied by soft tissue damage and epicondyle fractures.

A posterior dislocation can result in ligament rupture and bone fracture. In this case, blood vessels, muscles, nerve fibers. From the side one can see shortening of the forearm and lengthening of the shoulder, as well as backward dislocation of the olecranon.

As you move forward, the joint lengthens. The injury is accompanied by disruption of the connective tissue of the joint capsule, triceps brachii muscle, and rupture of the muscles at the junction with the condyle.

A divergent dislocation is a severe injury in which the radius and ulna bones diverge forward, backward, inward, outward. Accompanied by a violation of the capsular-ligamentous junction of the elbow. Anterior displacement of the head of the radial bone can be combined with a fracture of the ulna and damage to the nerve bundles. Hand movements are limited and cause severe pain.

First aid

After a dislocation, the patient must be given first aid:

1. People around you should call an ambulance.
2. The arm needs to be fixed, but you should not try to straighten the dislocation yourself.
3. To eliminate pain, apply cold to the damaged area for 15–20 minutes.
4. After first aid is provided, the patient is taken to a medical facility.

Therapeutic measures

An examination is being carried out at the hospital. The injured area is swollen, hematomas are observed, and bone abnormalities are visible. The doctor prescribes an x-ray, which makes it possible to diagnose the deformity bone tissue elbow joint. After diagnosis, the doctor prescribes either outpatient or inpatient treatment.

Therapy for this injury is carried out in a hospital under local anesthesia or general anesthesia. The choice of painkiller depends on the clinical picture.

The doctor and assistant adjust the dislocation. The technique is as follows. The patient lies down on the couch and moves his arm to the side. In case of posterior displacement, the head of the bone must be moved forward, and in case of anterior displacement, it must be moved backward. The doctor and assistant restore the displaced bones of the upper limb while simultaneously bending it.

In this case, the doctor should press on the olecranon process while posterior injury and on the head of the shoulder joint - at the front. If the joint has been reduced, a characteristic click is heard. Then an x-ray is prescribed to ensure that the measures taken are correct, as well as to check the integrity of the capsular-ligamentous junction. Check the presence of a pulse in the artery and joint mobility. Then the arm is fixed with a plaster splint.

The doctor applies a fixation splint from the shoulder joint to the fingers for 14–21 days. The patient needs to perform finger movements for prevention. After a few days, the doctor prescribes exercises for the elbow muscles. After removal of the splints, restorative therapy is recommended.

Complicated traumatic dislocations are treated by surgery. Special devices are used to fix the fragments. During the operation, the injured ligament is sutured with a percutaneous lavsan suture. The operation is performed the next day after the injury. Resection of the injured area is carried out, ulnar ligament is sutured. After the operation, a plaster splint is applied.

Rehabilitation and recovery

After removing the splint, the patient is prescribed a course of rehabilitation. Procedures begin to restore the motor ability of the hand. The patient is prescribed physiotherapeutic treatment, massage, joint development, swimming in the pool, and therapeutic exercises.

Warming procedures cannot be used, as this may cause salt deposition.

The rehabilitation period is 1.5–2 months. If nerve processes or blood vessels have been damaged, the recovery period can last several years.

The content of the article

Most common dislocation of both bones forearm posteriorly or in combination with subluxation outward or inward (93%). Anterior and purely lateral dislocations account for only 7%. Dislocations of the forearm bones occur mainly in adolescents.
The mechanism of posterior dislocations is based on indirect exposure to traumatic force. Most often, these dislocations occur when falling on an outstretched arm. A contributing factor in this case is the tendency to hyperextend the limb at the elbow joint.
When the articular end of the humerus leaves the glenoid cavity, the anterior wall of the articular capsule, as well as one or both lateral ligaments of the elbow joint, rupture.

Symptoms of dislocation of the bones of the forearm

Treatment of dislocations of the forearm bones